Etiological Classification Research Articles

Development and Validation of the Length, Segment, and Etiology (LSE) Anterior Urethral Stricture Disease Staging System Using Longitudinal Urethroplasty Outcomes Data from the Trauma and Urologic Reconstruction Network of Surgeons.

To create and validate an anterior urethral stricture disease (aUSD) staging system based on the previously validated Length (L), Urethral Segment (S), and Etiology (E, LSE) classification system. The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) prospective database was used to create and validate the staging system. A novel Urethroplasty Triad Score (UTS) was created to aid in ranking the stagings into stricture severity based on 1) functional outcomes, 2) location of urethral meatus (e.g. orthotopic, perineal) and 3) number of surgeries required for repair. Staging was secondarily validated in a non-TURNS dataset and then compared to two previously described aUSD severity scores - the U-score and the LSE score. Five aUSD stages, with ten total substages, were ultimately created: Stage I - Short bulbar; Stage II - Long bulbar; Stage III - Penile/Fossa of favorable etiology; Stage IV - Penile/Fossa of adverse pathology; Stage V - Pan-urethral (three-segment). Mean UTS decreased (increasing severity) with each substage, with the linear trend being validated in both the separate validation cohort and within the individual TURNS surgeons. LSE staging was superior to the LSE score and U-score in predicting the need for multiple stages or a non-orthotopic meatus and was similar in predicting surgical outcomes. Each stage and substage of this novel LSE Staging System was shown to provide unique information on stricture characteristics, repairs, and surgical outcomes. The LSE staging system will improve communication of stricture complexity/severity with our patients and organize aUSD for multi-institutional outcomes studies and clinical trial recruitment purposes.

Thrombo-CARE-cardioembolic stroke etiology in cryptogenic stroke suggested by fibrin-/platelet-rich clot histology : Thrombo-CARE (configuration analysis to refine etiology).

Despite extensive diagnostic efforts, the etiology of stroke remains unclear in up to 30% of patients. Mechanical thrombectomy (MT) potentially enhances etiological determination by (immuno)histological analysis of retrieved thrombotic material. In this monocentric exploratory study, clots from 200 patients undergoing MT were investigated by hematoxylin and eosin, CD3, and CD45 staining. Semiquantitative and computer-based image analysis defined the histological composition and relative fractions of immunohistochemically stained areas. First, we correlated these results with strokes of known etiology. Subsequently, clots of unknown source were characterized with regard to their (immuno)histological profile to attempt etiological classification. Samples from 198 patients were accessible for analysis. Fibrin-/platelet-rich histology appeared in 45(23%), erythrocyte-rich in 18(9%), and mixed histology in 123 (62%) patients. Etiology was classified as cardioembolic in 87(44%), arterioembolic in 37(19%), and as cryptogenic stroke (CS) in 26(13%) cases. 20(23%) patients with cardioembolic stroke and 5(14%) patients with arterioembolic stroke had fibrin-/platelet-rich clots. 8(22%) patients with arterioembolic stroke and 1(1%) patient with cardioembolic stroke had erythrocyte-rich clots. In CS, cardioembolic clot features appeared more than twice as often as arterioembolic clot features. Whereas the association between histology and etiology was significant (p = 0.0057), CD3/CD45 staining did not correlate. Asignificant association between histology and etiology was observed, with the proportion of erythrocyte-rich thrombi being largest among arterioembolic strokes and the proportion of fibrin-/platelet-rich thrombi highest among cardioembolic strokes. Ahigh number of clots from CS presented histological features of cardioembolic clots. Thus, patients with CS and fibrin-/platelet-rich clots particularly require long-term cardiac rhythm monitoring and may benefit from oral anticoagulation.

Investigating High-risk Factors, Precise Diagnosis, and Treatment of Castration- Resistant Prostate Cancer (CRPC).

The treatment of metastatic castration-resistant prostate cancer (mCRPC) in the actual world currently presents difficulties. In light of this, it is crucial to investigate high-risk factors for the progression of advanced prostate cancer and to identify methods for delaying the onset of CRPC. This study aimed to explore the high-risk factors that impact the progression of prostate cancer and emphasize the significance of precise diagnosis and treatment based on etiological classification in the clinical management of castration-resistant prostate cancer. A retrospective analysis was conducted on 277 newly diagnosed cases of PCa treated with endocrine therapy. A follow-up was done on prostate-specific antigen (PSA) levels and testosterone. Additionally, a prospective analysis was performed on the clinical data of 60 patients with CRPC. Following the principle of "4W1H", 30 patients were included in the precision treatment group for a second biopsy and related tests, while another 30 patients were included in the conventional treatment group. The therapeutic effect and prognosis of the two groups were observed. Distant metastasis (HR = 1.879, 95% CI: 1.311 ~ 2.694, P = 0.001), PSA nadir > 0.2 ng/mL (HR = 1.843, 95% CI: 1.338 ~ 2.540, P = 0.001), testosterone nadir > 20 ng/dL (HR = 1.403, 95% CI: 1.035 ~ 1.904, P = 0.029), and time to testosterone nadir > 6 months (HR = 1.919, 95% CI: 1.364 ~ 2.701, P = 0.001) were risk factors for the progression to CRPC. Patients in the CRPC group were treated with precision therapy and conventional therapy based on their molecular subtyping. The precision treatment group showed a significantly prolonged median PSA progression-free survival compared to the conventional treatment group (16.0 months vs. 13.0 months, P=0.025). The median radiographic progression-free survival was also significantly extended in the precision treatment group compared to the conventional treatment group (21.0 months vs. 16.0 months, P=0.042). Patients with prostate cancer diagnosed with distant metastasis at initial presentation require early intervention. Close monitoring of PSA and serum testosterone changes is necessary during the process of endocrine therapy. After entering the CRPC stage, the etiological classification precision treatment can improve the therapeutic effect and improve the prognosis of patients.

Hemorrhagic encephalopathies and myelopathies in dogs and cats: a focus on classification.

The prevalence of hemorrhagic diseases of the central nervous system of dogs and cats is low compared to other diseases such as neoplasia and inflammation. However, the clinical consequences can be devastating. Several etiological and localization-based classification systems have been reported for intracerebral and spinal cord hemorrhage or hematomyelia in humans but similar systems do not exist in veterinary medicine. The authors propose an etiologic classification system for both intraparenchymal hemorrhagic encephalopathy and myelopathy following a review of the literature detailing the presentation, diagnosis, therapy, and prognosis of these diseases. A summary of the investigative and therapeutic approach to these cases is also provided.

Ringlike late gadolinium enhancement: prevalence, association with cardiac phenotype, and patient outcome in an unselected cohort referred for cardiovascular magnetic resonance imaging

Abstract Background The identification of a non-ischemic ringlike enhancement in the left ventricular (LV) myocardium by cardiac magnetic resonance imaging (CMR) has emerged as a significant biomarker associated with arrhythmogenic cardiomyopathy (CMP) and adverse patient outcomes. Recently, the term "scarring CMP" has been also proposed to encompass various conditions characterized by a high burden of non-ischemic, often ring-like, myocardial scarring, including both genetic and acquired etiologies. Purpose To systematically evaluate CMR phenotypic traits and etiologic backgrounds in patients with ringlike enhancement and to assess the burden of adverse outcomes during follow-up (FU). Methods This is a single-center, retrospective analysis of prospectively enrolled patients undergoing CMR (from 2002 to 2024). Ringlike late gadolinium enhancement (LGE) was defined as continuous enhancement in three or more adjacent segments based on the AHA 17 segment model. Patients records were reviewed for etiologic classification and FU assessment. Results Among 23.472 patients, 19.696 (84%) underwent LGE assessment. In 152 patients (0.77%; 73% male; mean age 48.5 ± 17 years) a ringlike LGE was identified. The mean number of LV segments with LGE was 10 ± 3. Right ventricular (RV) LGE was present in 23% of subjects. LV fatty metaplasia was detected in 22%. Infero-lateral segments were most frequently affected. CMR showed the following morpho-functional features: LV dilatation (53%), LV hypokinesia (69%), LV hypertrophy (10.5%), LV non-compaction (11%), RV dilation (26%), and RV ejection fraction < 40% (21%). Phenotypic classification according to 2023 ESC guidelines identified dilated CMP phenotype (43%), non-dilated LV CMP phenotype (39%), predominant arrhythmogenic right ventricular phenotype (6%), hypertrophic phenotype (7%). 5% of cases remained unclassified, all of them showing LV dilated non-hypokinetic phenotype. Genetic analysis was performed in 101 patients (66%). Etiologic classification revealed non-desmosomal gene related CMP (24%), desmosomal gene related CMP (8%), inflammatory CMP (16%), genetic neuromuscular diseases (5%), congenital metabolic errors (3%), familiar gene elusive CMP (2%) and unknown etiology (45%). Notably, only 17% of patients classified as having inflammatory CMP and 66% of those with unknown etiology underwent genetic testing, with negative results. The median follow-up duration was 3 (IQR: 1-7) years. All-cause mortality occurred in 10.5% of patients, while 17% experienced sustained ventricular tachycardia, appropriate implantable cardioverter-defibrillator therapies, or sudden cardiac death. Heart transplantation or left ventricular assist device implantation was required in 8% of cases. Conclusion Ringlike LGE is a rare, non-disease-specific feature that can be found in different morpho-functional CMP phenotypes. It is associated with frequent genetic-determined etiology and high burden of arrhythmic and non-arrhythmic outcomes.

Urinary Microalbumin predicts early neurological deterioration in acute ischemic stroke: A study based on etiological classification

IntroductionTo investigate the correlation between urinary microalbumin (U-Alb) levels and early neurological deterioration (END), as well as its predictive ability, in patients with acute ischemic stroke (AIS) under different etiological subtypes. Materials and methodsWe consecutively enrolled AIS patients within 72 h of onset, collecting relevant clinical characteristics and baseline laboratory data including U-Alb. END was defined as an increase of ≥4 points in NIHSS score within 72 h of onset, and TOAST criteria were used for stroke etiologic typing. Binary logistic regression analysis was employed to clarify the association between baseline U-Alb and the occurrence of END under different stroke etiological subtypes. ROC analysis was conducted to evaluate its predictive ability under different etiological subtypes. ResultsFinally, 615 patients were included, with 104 (16.9 %) developed END. Binary logistic regression analysis revealed that baseline U-Alb was independently associated with END occurrence (OR = 1.009, 95 % CI 1.002-1.016, p = 0.009). ROC analysis revealed that U-Alb had the best predictive ability for patients with small artery occlusion (AUC=0.707, p < 0.001), followed by large artery atherosclerosis (AUC = 0.632, p = 0.006), with corresponding optimal diagnostic cutoff points of 31.11 and 25.71 mg/L, respectively. However, U-Alb was not an independent risk factor for END in cardioembolic stroke patients (OR = 1.011, 95 % CI 0.980-1.043, p = 0.478). MAU was associated with stroke progression(p = 0.023), and U-Alb was positively correlated with increased infarct volume (r = 0.516, p < 0.01). ConclusionU-Alb is closely associated with END in AIS patients, serving as a potential indicator for predicting END, especially among those with small artery occlusion mechanisms.

Clinical features of chronic tibial osteomyelitis: a single-center retrospective study of 282 cases in Xinjiang, China.

Chronic osteomyelitis is a highly prevalent and severe orthopaedic complication, representing a critical unresolved issue. The clinical symptoms of osteomyelitis are influenced by various factors, including geography, lifestyle, and pre-existing medical conditions.This study aims to provide theoretical basis for treatment and prevention of osteomyelitis by investigating and analyzing clinical features and pathogen distribution among 282 patients with chronic tibial osteomyelitis in xinjiang. A total of 282 patients with chronic tibial osteomyelitis from January 1, 2012 to January 1, 2022 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. All data were collected from electronic medical record (EMR) system including demographics, etiology, risk factors, osteomyelitis location and clinical classification. Farmers, students, unemployed and retirees accounted for a relatively large proportion of the 282 patients. There were 233 males and 49 females with a gender ratio of 4.75:1. The average age was 40.21 ± 15.68 years and was mainly concentrated in 41-50 years, specifically, the mean age of females was slightly older than that of males. Education level was mostly primary and secondary school education, and illiteracy. Risk factors of chronic tibial osteomyelitis included history of smoking and drinking, history of multiple repeated surgeries, and impaired immunity. Frequent clinical symptoms were in the order of pain, local swelling, pus discharge and skin ulceration. Among all inflammatory markers, proportion of positive results were 30.85%, 59.93% and 53.90% for white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), respectively. Positive rate of pathogenic microorganism culture was low and the three most common bacteria were Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli). The most frequent site of infection was middle tibia. According to Cierny-Mader osteomyelitis classification, the most common types were type IIIA, IVA and IIA. Number of visits due to chronic osteomyelitis increased year by year, with young and middle-aged male farmers and low education level as the main groups. Smoking and drinking were two considerable risk factors that should be attached to a great importance. No significant increase was found in inflammatory markers and lower positive rate of pathogenic microorganism culture was observed. Multi-drug resistant bacteria were common and S. aureus remained the most frequent pathogen. Elevated ESR had certain diagnostic value for osteomyelitis. Type III and type IV osteomyelitis accounted for a large proportion which posed great challenges for clinical diagnosis and treatment.

Clinical and epidemiological characterization of infections in pediatric hemato-oncology patients with febrile neutropenia in the North of Mexico

Abstract Background Neutropenic fever is the most common complication in patients undergoing chemotherapy, where the choice of empirical antibiotic treatment should be based on the probable focus of infection, the predominant causative microorganisms, and the sensitivity of those organisms to antibiotics, which varies between each hospital and region. Over time, the spectrum of isolated microorganisms in different clinical syndromes of patients presenting during their infectious episode has changed. Our objective is to describe the prevalence of infectious etiology in pediatric patients with neutropenic fever, as well as the clinical characteristics of patients with documented infection. Methods The study design is ambispective, observational, and descriptive of a cohort type. Patients between 0 and 18 years old from the pediatric department of the “Dr. José E. González” University Hospital will be included from May 2019 to June 2023, with hematological-oncological disease during their febrile neutropenia infectious process with a complete medical record. Results A total of 326 episodes of febrile neutropenia were included, of which 15% had microbiological isolation (49 patients). The etiological classification during the events was as follows: bacteria 81%, viruses 14%, and fungi 4%. Five different infection sites were identified. Among these, bacteremia were the most frequent site of infection (10%), followed by gastrointestinal infections (2.4%), respiratory infections (1.5%), skin and soft tissue infections (1.2%), and lastly, urinary tract infections (1%). A total of 45 microorganisms were isolated from different infection sites. Among these, gram-negative bacteria (28 isolates, 62%) were more common and outnumbered gram-positive bacteria (14 isolates, 31%). Among gram-negatives, Escherichia coli (42%) was the most common isolate, followed by Pseudomonas aeruginosa (17%), and Klebsiella pneumoniae (14%). Among gram-positives, Streptococcus mitis (28%), Coagulase-negative Staphylococcus (21%), and Rothia mucilaginosa (14%) were identified. Conclusion Febrile neutropenia at the Hospital Universitario primarily affects 6-year-old males with ALL. The microbiological characterization suggests the intentional search for gram-negative bacteremia, allowing us to direct timely and targeted antibiotic therapy to influence clinical prognosis. It is worthwhile to continue the research line that allows us to identify susceptibility and resistance profiles to address these patients more effectively.

Technique and early results of endovenous laser ablation in morphologically complex varicose vein recurrence after small saphenous vein surgery.

Recurrences after varicose vein treatment occur frequently and represent a significant health and economic problem. In contrast to primary treatments of superficial truncal venous insufficiency, their management is often more difficult. Here we assessed the technical feasibility and early results of endovenous laser ablation (EVLA) for recurrences with stumps or subfascial meandering varices after small saphenous vein (SSV) surgery. This single-center retrospective study included 45 consecutive EVLA procedures from July 2019 to December 2021 in 40 patients (19 male, 21 female, mean age 62.8 ± 12.7 years). Patients had clinically relevant recurrent varicose veins after SSV surgery, with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification stage of C2S or higher. We categorized the recurrences morphologically according to duplex sonographic criteria. Ablations were done with a 1470 nanometers laser and dual ring radial fibers and aimed at thermal closure as proximal as possible to the upper inflow. Analyses were performed by descriptive statistics and the Kaplan-Meier method. The primary outcome analyzed was the technical success, defined by thermal occlusion not requiring re-intervention during the observation period. The secondary outcome was the occurrence of postoperative complications. A complex morphology with residual stumps or tortuous venous connections to the popliteal vein was present in 35 cases (77.8%). Immediate technical success at the first postoperative visit after a median of 11 days (interquartile range 8-13 days) was 97.8%. During the follow-up period (median 77 days, interquartile range 13-256 days), 6 limbs (13.3%) required redo EVLA due to symptomatic persistent or newly presenting reflux. The median freedom from re-recurrence was 791 days. Otherwise, no medical or surgical complications requiring specific treatment were observed, particularly no endothermal heat-induced thrombosis (EHIT) or other thrombotic complications, and no nerve damage. According to our pilot data, EVLA is technically feasible for complex popliteal variceal recurrence, although the success rate appears substantially lower than for primary treatment of truncal venous insufficiency.

White Matter Lesions, Risk Factors, and Etiological Classification in Young versus Old Cerebral Infarction Patients: A Retrospective Study.

To compare the differences in risk factors and etiological classification between cerebral infarction in young patients and elderly patients, and explore the correlation between cerebral infarction in young patients and white matter lesions (WMLs). Sixty young patients with cerebral infarction and 142 elderly patients with cerebral infarction were included. The distributions of risk factors such as hypertension, diabetes, heart disease, smoking status, alcohol consumption status, migraine status, and WMLs in the two groups were carefully investigated and statistically analyzed. According to the univariate analysis, the proportions of males, obese patients, patients with migraine, and patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) in the young group were significantly greater than those in the elderly group. Hypertension, heart disease, and hyperhomocysteinemia were significantly more common in the elderly group than in the young group. According to the TOAST classification, the incidence of stroke of undetermined etiology in the young group was greater than that in the elderly group, whereas the incidence of large-artery atherosclerosis (LAA) in the elderly group was greater than that in the young group. Binary logistic regression analysis revealed that male sex, migraine status, and obstructive sleep apnea-hypopnea syndrome were independently associated with cerebral infarction in young adults, whereas hypertension, heart disease, and hyperhomocysteinemia were independently related to cerebral infarction in elderly individuals. In addition, the incidence of WMLs in the migraine group of young cerebral infarction patients was significantly greater than that in the nonmigraine group. Compared with those in elderly patients with cerebral infarction, the risk factors for cerebral infarction in young patients are relatively controllable. Furthermore, more methods are needed to determine the etiology of unexplained cerebral infarction in young patients. WMLs are thought to have a relatively high incidence in young patients with cerebral infarction and are significantly associated with migraine.

Evaluation of e-NIHSS scale combined with HINTS for posterior circulation ischemic stroke with vestibular symptoms

Objective:To explore the predictive value of HINTS bedside examination and e-NIHSS scale for posterior circulation ischemia with vestibular symptoms. Methods:136 cases in total patients with acute vestibular syndrome（AVS） hospitalized in our hospital from April 2021 to April 2023 were selected as the study subjects, According to the classification of AVS etiology, patients with central AVS, namely posterior circulation ischemia（PCI）, were divided into case group（68 cases） and peripheral AVS patients were control group（68 cases）, Collect data and perform head impulse test-nystagmus-test of skew deviation test beside the bed, two doctors evaluated the NIHSS and e-NIHSS scales for PCI patients with vestibular symptoms respecb tively, and recorded the results after they were consistent, and improved the head MRI examination. Results:The positive rate of head pulse test in PCI patients with vestibular symptoms was 3 cases（4.41%）, and 60 cases（88.24%） with peripheral symptoms; The positive rate of nystagmus test in PCI group was 64 cases（94.12%） and peripheral 21 cases（30.88%）; The positive rate of eye deviation test in PCI group was 55 cases（80.88%） and peripheral 8 cases（11.76%）. Comparing the data with the consistency of the final diagnosis, the sensitivity was 97.0%, the specificity was 95.7%, and the accuracy was 0.963. It passed the Kappa consistency test Kappa=0.926（P<0.01）. The patients in PCI group were scored, in which the NIHSS score of brainstem group was 1.51±0.59, and the e-NIHSS score was 4.05±1.71（P<0.05）; The NIHSS score of cerebellar group was 1.42±0.62, and the e-NIHSS score was 3.86±1.59（P<0.05）; NIHSS score of thalamus group was 1.31±0.73, e-NIHSS score was 3.56±1.27 （P<0.05）; NIHSS score of non-focus group was 1.11±0.43, e-NIHSS score was 3.06±1.20 （P<0.01）. The difference between e-NIHSS score and NIHSS score in each group was statistically significant. Conclusion:HINTS examination is highly consistent with the final diagnosis of the gold standard. The e-NIHSS scoring scale has a higher detection rate than the NIHSS scoring scale for patients with posterior circulation ischemia mainly characterize〓by vestibular symptoms.

The Causal Effect of Urate Level on Female Infertility: A Mendelian Randomization Study.

This study aimed to investigate the causal relationship between urate level and female infertility using Mendelian randomization (MR) analysis. To identify instrumental variables, we selected independent genetic loci associated with serum urate levels in individuals of European ancestry, utilizing data from large-scale genome-wide association studies (GWAS). The GWAS dataset included information on serum urate levels from 288,649 CKDGen participants. Female infertility data, including different etiologic classifications, consisted of 13,142 female infertility patients and 107,564 controls. We employed four MR methods, namely inverse variance weighted (IVW), MR-Egger, weighted median, and weighted model, to investigate the causal relationship between urate levels and female infertility. The Cochran Q-test was used to assess heterogeneity among single nucleotide polymorphisms (SNPs), and the MR-Egger intercept test was employed to evaluate the presence of horizontal pleiotropy. Additionally, a "leave-one-out" sensitivity analysis was conducted to examine the influence of individual SNPs on the MR study. The IVW analysis demonstrated that elevated serum urate levels increased the risk of female infertility (odds ratio [OR] = 1.18, 95% confidence interval [CI]: 1.07-1.33). Furthermore, serum urate levels were found to be associated with infertility due to cervical, vaginal, or other unknown causes (OR = 1.16, 95% CI: 1.06-1.26), also confirmed by other methods. Heterogeneity among instrumental variables was assessed using Cochran's Q-test (p < 0.05), so a random-effects IVW approach was employed in the effects model. The MR-Egger intercept test indicated no presence of horizontal pleiotropy. A "leave-one-out" sensitivity analysis was conducted, demonstrating that no individual SNP had a substantial impact on the overall findings. In the European population, the urate level is significantly and causally associated with an increased risk of female infertility.

Classification of musical hallucinations and the characters along with neural-molecular mechanisms of musical hallucinations associated with psychiatric disorders.

Musical hallucinations (MH) involve the false perception of music in the absence of external stimuli which links with different etiologies. The pathomechanisms of MH encompass various conditions. The etiological classification of MH is of particular importance and offers valuable insights to understand MH, and further to develop the effective treatment of MH. Over the recent decades, more MH cases have been reported, revealing newly identified medical and psychiatric causes of MH. Functional imaging studies reveal that MH activates a wide array of brain regions. An up-to-date analysis on MH, especially on MH comorbid psychiatric conditions is warranted. To propose a new classification of MH; to study the age and gender differences of MH in mental disorders; and neuropathology of MH. Literatures searches were conducted using keywords such as "music hallucination," "music hallucination and mental illness," "music hallucination and gender difference," and "music hallucination and psychiatric disease" in the databases of PubMed, Google Scholar, and Web of Science. MH cases were collected and categorized based on their etiologies. The t-test and ANOVA were employed (P < 0.05) to compare the age differences of MH different etiological groups. Function neuroimaging studies of neural networks regulating MH and their possible molecular mechanisms were discussed. Among the 357 yielded publications, 294 MH cases were collected. The average age of MH cases was 67.9 years, with a predominance of females (66.8% females vs 33.2% males). MH was classified into eight groups based on their etiological mechanisms. Statistical analysis of MH cases indicates varying associations with psychiatric diagnoses. We carried out a more comprehensive review of MH studies. For the first time according to our knowledge, we demonstrated the psychiatric conditions linked and/or associated with MH from statistical, biological and molecular point of view.

Short Bowel Syndrome: A Case Series and Review of Literature

Short Bowel Syndrome, defined as remaining small bowel in continuity of less than 200 cm, is a disorder with varied presentations and frequent and often difficult-to-manage complications. The most commonly encountered complications are mainly nutritional, gastrointestinal and nephrological. Anticoagulation and bone disorders due to micronutrient and drug malabsorption, among other causes, are also encountered. The clinical follow-ups and considerations necessary vary between patients. Functional, pathophysiological, etiological, clinical and anatomical classifications exist to help physicians predict the required interventions. Herein, we summarise our experience with three cases with differing presentations and prognoses. We discuss the problems encountered during their management in light of the existing literature and guidelines. Specialised units and a multi-departmental approach remain vital in managing intestinal failure and short bowel syndrome; better tools and further research are yet to be required.

Histological synovitis score in juvenile idiopathic arthritis and other pediatric synovial inflammatory conditions

ObjectiveThe Krenn’s scoring is a system for histopathological grading of synovial inflammation, and in adults, useful in etiological grouping. The score has only rarely been used in pediatric samples. We aimed to assess the performance of the score in juvenile idiopathic arthritis and other pediatric synovial inflammatory processes in categorization of the disease and in finding characteristic pathological features. DesignWe collected an unselected series of pediatric (age < 16 years) routine synovial biopsy samples to represent normal synovium and inflammatory conditions. The final diagnosis based on clinical follow-up was determined and classified as normal synovium, and different groups according to etiology. Total of 142 patients were analyzed. According to the score, case was classified to normal, low- or high-grade synovitis. ResultsThe synovitis scores in clinically normal synovium were low with 48 % of cases with scores of low-grade synovitis. In structural joint disorders scores varied from normal to low grade synovitis with occasional cases of high grade synovitis. In transient/reactive arthritis scores showed increase, majority clustering to low grade synovitis. In JIA and in bacterial synovitis the scores were higher than in the other groups high grade synovitis being the dominant grade. Extended oligoarthritis showed higher score than persistent oligoarthritis. ROC analysis indicated that JIA could be differentiated from other conditions. ConclusionsThe Krenn’s synovitis score is useful in the etiological classification of pediatric synovial samples, high Krenn’s score suggesting JIA. Observed differences between the subcategories of oligoarthritis may be useful in subclassifying these types of JIA.

Predictive etiological classification of acute ischemic stroke through interpretable machine learning algorithms: a multicenter, prospective cohort study

BackgroundThe prognosis, recurrence rates, and secondary prevention strategies varied significantly among different subtypes of acute ischemic stroke (AIS). Machine learning (ML) techniques can uncover intricate, non-linear relationships within medical data, enabling the identification of factors associated with etiological classification. However, there is currently a lack of research utilizing ML algorithms for predicting AIS etiology.ObjectiveWe aimed to use interpretable ML algorithms to develop AIS etiology prediction models, identify critical factors in etiology classification, and enhance existing clinical categorization.MethodsThis study involved patients with the Third China National Stroke Registry (CNSR-III). Nine models, which included Natural Gradient Boosting (NGBoost), Categorical Boosting (CatBoost), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Light Gradient Boosting Machine (LGBM), Gradient Boosting Decision Tree (GBDT), Adaptive Boosting (AdaBoost), Support Vector Machine (SVM), and logistic regression (LR), were employed to predict large artery atherosclerosis (LAA), small vessel occlusion (SVO), and cardioembolism (CE) using an 80:20 randomly split training and test set. We designed an SFS-XGB with 10-fold cross-validation for feature selection. The primary evaluation metrics for the models included the area under the receiver operating characteristic curve (AUC) for discrimination and the Brier score (or calibration plots) for calibration.ResultsA total of 5,213 patients were included, comprising 2,471 (47.4%) with LAA, 2,153 (41.3%) with SVO, and 589 (11.3%) with CE. In both LAA and SVO models, the AUC values of the ML models were significantly higher than that of the LR model (P < 0.001). The optimal model for predicting SVO (AUC [RF model] = 0.932) outperformed the optimal LAA model (AUC [NGB model] = 0.917) and the optimal CE model (AUC [LGBM model] = 0.846). Each model displayed relatively satisfactory calibration. Further analysis showed that the optimal CE model could identify potential CE patients in the undetermined etiology (SUE) group, accounting for 1,900 out of 4,156 (45.7%).ConclusionsThe ML algorithm effectively classified patients with LAA, SVO, and CE, demonstrating superior classification performance compared to the LR model. The optimal ML model can identify potential CE patients among SUE patients. These newly identified predictive factors may complement the existing etiological classification system, enabling clinicians to promptly categorize stroke patients’ etiology and initiate optimal strategies for secondary prevention.

Ischemic Stroke in Young Adults in India: Predictors of Recurrence and Functional Outcome.

Ischemic stroke (IS) in young is increasingly recognized as an important health problem in low- and middle-income countries (LMICs). Limited data is available from LMICs about the predictors of outcome and recurrence of IS in young. The study aims to assess the predictors of short-term and long-term functional outcome and the recurrence of the first-ever IS and transient ischemic attack in young. The clinical, radiological data, functional outcome, and recurrence of 569 IS patients aged 18-50 years were recorded. The etiological classification was done. The functional outcome was assessed using the modified Rankin scale (mRS), with a good outcome being mRS 0-2. Logistic regression was used to analyze the predictors of recurrence and outcome. The most common risk factors were hypertension (40.3%) and diabetes mellitus (34.3%). Stroke of undetermined etiology (33.6%) was the most common etiological subtype. Among the cardioembolic subtypes, rheumatic heart disease constituted 47.4%. A good functional outcome at 1 year was seen in 76.3%. While baseline stroke severity predicted both the 3-month and 1-year functional outcome, age ≥40 years and male gender predicted poor outcome at 1 year. The risk of recurrent strokes at 1 year was 2.5%. On multiple logistic regression analysis, diabetes mellitus independently predicted recurrent vascular events at 1 year (odds ratio = 2.43, 95% confidence interval 1.07-5.50). We found a good functional outcome with a relatively low recurrence at 1 year among young IS patients. Baseline stroke severity, age, and male gender predicted a poor 1-year functional outcome.

Association of baseline blood pressure and outcomes in etiology subtypes of large vessel occlusion stroke: Data from ANGEL-ACT registry

BackgroundBlood pressure (BP) management at the initial stage of stroke caused by large-vessel occlusion (LVO) remains challenging. We assessed the association between baseline BP and clinical and safety outcomes of endovascular treatment (EVT) in different stroke etiologies. MethodsPatients with acute ischemic stroke and anterior circulation LVO were screened from a prospective, multicenter registry of EVT from November 2017 to March 2019. The primary outcome was poor 90-day outcome (modified Rankin Scale score 3–6). The safety outcome was 24 h post-procedure parenchymal hematoma (PH). The Trial of Org 101072 in Acute Stroke Treatment criteria were used for etiologic stroke classification. Restricted cubic spline and binary logistic regression analysis were performed to examine the association between study outcomes and natural log-transformed BP. ResultsIn subgroup analyses, a U-shaped correlation existed between baseline mean arterial pressure (MAP) and poor outcome in large-artery atherosclerosis stroke only. Higher MAP was an independent risk factor compared with a central reference value (≥ 133 mm Hg vs 96–115 mm Hg; adjusted OR [aOR], 2.50; 95 % CI, 1.09 to 5.71, P = 0.030). Whereas elevated MAP was associated with PH (aOR, 1.58; 95 % CI 1.04 to 2.39, P = 0.030 for a ln10-unit increase in natural log-transformed MAP) in the range <110 mm Hg exclusively for cardioembolic stroke. ConclusionWhether it is cause or epiphenomenon, baseline BP was associated with 90-day outcome in large-artery atherosclerosis stroke, whereas in cardioembolic stroke baseline BP was correlated with post-procedure PH within a certain range. Identifying these features based on etiological subtypes may offer a reference for BP management in acute LVO stroke.

MRI Evaluation of Traumatic and Non-traumatic Pathologies of the Ankle Joint and Hindfoot: A Single-Center Observational Study.

Background Pathologies affecting the ankle joint and hindfoot can present with a variety of clinical symptoms and etiologies, necessitating accurate diagnostic tools for effective management. Magnetic resonance imaging (MRI) is a valuable imaging modality for assessing these pathologies, providing detailed visualization of bone, joint, tendon, and other soft tissue abnormalities. Objectives To evaluate MRI findings in a diverse cohort of 105 participants with pathologies affecting the ankle joint and hindfoot, focusing on the prevalence and types of bone, joint, tendon, and soft tissue abnormalities. Materials and methods A single-center observational descriptive study was conducted at Dr. D. Y. Patil Medical College and Hospital and Research Centre, Pune, India, over a period from August 2022 to July 2024, involving 105 participants (54.3% male, 45.7% female) with a mean age of 39.04 years. MRI scans were analyzed to assess the prevalence of bone, joint, tendon, and soft tissue pathologies. Clinical profiles, symptom duration, and etiological classifications were documented. Results Analysis of the results obtained from 105 (N = 105) study participants revealed that pain (94.3%, or 99 cases) was the most common symptom, followed by restricted movement (86.7%, or 91 cases), trauma history (75.2%, or 79 cases), and swelling (73.3%, or 77 cases). Traumatic causes (76.2%, or 80 cases) predominated, while inflammatory (48.3%, or 14 cases) and infective (34.5%, or 10 cases) causes were also significant. MRI findings showed marrow edema in 41.9%, or 44 cases, subchondral cysts in 22.9% (24 cases), fractures in 17.1% (18 cases), and erosions in 10.5% of participants (11 cases). Joint involvement was most frequent in the tibiotalar (76.2%, or 80 cases) and subtalar joints (58.1%, or 61 cases). Tendon pathologies included peritendonitis (55.2%, or 58 cases) and tendinosis (23.8%, or 25 cases), with the Achilles tendon being the most frequently affected (39%, or 41 cases). Ligament injuries were predominantly sprains (46.7%, or 49 cases), with less frequent partial (18.1%, or 19 cases) and complete tears (7.6%, or eight cases). Soft tissue findings included subcutaneous edema (76.2%, or 80 cases) and bursitis (24.8%, or 26 cases). Among the study participants who presented with non-traumatic pathologies, inflammatory pathologies (48.3%, or 14 cases) were the most common, followed by infective (34.5%, or 10 cases) and neoplastic (17.2%, or five cases) pathologies. Conclusion MRI effectively identifies a wide range of pathologies in the ankle and hindfoot, with marrow edema, joint effusion, and tendon pathologies being prevalent. The study underscores the utility of MRI in diagnosing and assessing various conditions in the ankle joint complex and highlights the need for accurate imaging to guide treatment decisions. Future research should focus on correlating MRI findings with clinical outcomes to enhance diagnostic accuracy and management strategies.

Risk Factors and Etiological Classification of Ischemic Stroke Subtypes in Southwest Iran

Precise categorization of the causes of ischemic stroke (IS) is crucial for optimizing stroke treatment and assessing the prognosis of patients. This cross-sectional study aimed to determine the risk factors and various subcategories of IS in Iranian patients. The study included all patients with IS referred to Golestan Hospital (Ahvaz, Iran) for one year. Their demographics and clinical data were collected. The etiology of IS was classified based on the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. A total of 1100 patients with IS were evaluated, 658 were male and 442 were female. They had an average age of 66 years (ranging between 20 and 99 years). The majority of them were in the 61-80 age group. The prevalence of risk factors for IS included hypertension (HTN) (71.4%), diabetes (50.4%), smoking (42.4%), history of previous stroke (28%), dyslipidemia (15.4%), and cardiovascular disease (22.5%). Three months after admission, the mortality rate was 10.7% and the majority of patients exhibited a lower level of disability based on the modified Rankin Score (mRS) compared to the time of admission. The frequency of all risk factors, except for HTN, differed significantly between genders (P&lt;0.05). Furthermore, the prevalence of risk factors varied significantly among different stroke etiologic subgroups (P&lt;0.05). The most common etiological factors identified by TOAST classification were associated with large artery atherosclerosis (LAA) and small artery occlusion (SAO). Significant variations were observed in the prevalence of different etiologic subtypes of stroke among genders and across different age groups.