Follow-up Of Young Patients Research Articles

Stress Echocardiography in the Follow-Up of Young Patients with Repaired Aortic Coarctation.

Background: Aortic coarctation (CoA) is a congenital heart disease affecting 5-8% of patients, with long-term complications persisting despite successful correction. Stress echocardiography (SE) is increasingly used for evaluating cardiac function under stress, yet its role in repaired CoA remains under-explored. Objective: This study aimed to assess the predictive value of SE and myocardial strain in repaired CoA patients with a history of hypertension without significant gradients or with borderline gradients at rest. Methods: Between June 2020 and March 2024, we enrolled 35 consecutive CoA patients with successful repairs and either a history of hypertension or borderline Doppler gradients. Baseline and peak exercise echocardiographic measurements, including left ventricular mass index (LVMi) and global longitudinal strain (LVGLS), were recorded. Patients were followed for up to 4 years. Results: At baseline, the positive SE group had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the negative SE group. The positive SE group also exhibited significantly higher basal and peak trans-isthmic gradients. Positive SE was found in 45.7% of patients, with 68.7% of these requiring re-intervention during follow-up. A peak trans-isthmic gradient > 61 mmHg during exercise predicted recoarctation with 100% sensitivity and 71% specificity (AUC = 0.836, p < 0.004). Conclusions: SE identifies at-risk patients post-CoA repair, aiding in early intervention. A peak trans-isthmic gradient > 61 mmHg during exercise is a strong predictor of recoarctation. These findings support incorporating SE into routine follow-up protocols for CoA patients, particularly those with a history of hypertension and borderline gradients, to improve long-term outcomes and quality of life.

Post-traumatic and OA-related lesions in the knee at baseline and 2 years after traumatic meniscal injury: Secondary analysis of a randomized controlled trial

ObjectiveTo assess the presence of early degenerative changes on Magnetic Resonance Imaging (MRI) 24 months after a traumatic meniscal tear and to compare these changes in patients treated with arthroscopic partial meniscectomy or physical therapy plus optional delayed arthroscopic partial meniscectomy. DesignWe included patients aged 18-45 years with a recent onset, traumatic, MRI verified, isolated meniscal tear without radiographic osteoarthritis. Patients were randomized to arthroscopic partial meniscectomy or standardized physical therapy with optional delayed arthroscopic partial meniscectomy. MRIs at baseline and 24 months were scored using the MRI Osteoarthritis Knee Score (MOAKS). We compared baseline MRIs to healthy controls aged 18-40 years. The outcome was the progression of bone marrow lesions (BMLs), cartilage defects and osteophytes after 24 months in patients. ResultsWe included 99 patients and 50 controls. At baseline, grade 2 and 3 BMLs were present in 26% of the patients (n=26), compared to 2% of the controls (n=1) (between group difference 24% (95% CI 15% to 34%)). In patients, 35% (n=35) had one or more cartilage defects grade 1 or higher, compared to 2% of controls (n=1) (between group difference 33% (95% CI 23% to 44%)). At 24 months MRI was available for 40 patients randomized to arthroscopic partial meniscectomy and 41 patients randomized to physical therapy. At 24 months 30% (n=12) of the patients randomized to arthroscopic partial meniscectomy showed BML worsening, compared to 22% (n=9) of the patients randomized to physical therapy (between group difference 8% (95% CI -11% to 27%)). Worsening of cartilage defects was present in 40% (n=16) of the arthroscopic partial meniscectomy group, compared to 22% (n=9) of the physical therapy group (between group difference 18% (95% CI -2% to 38%)). Of the patients who had no cartilage defect at baseline, 33% of the arthroscopic partial meniscectomy group had a new cartilage defect at follow-up compared to 14% of the physical therapy group. Osteophyte worsening was present in 18% (n=7) of the arthroscopic partial meniscectomy group and 15% (n=6) of the physical therapy group (between group difference 3% (95% CI -13% to 19%)). ConclusionsOur results might suggest more worsening of BMLs and cartilage defects with arthroscopic partial meniscectomy compared to physical therapy with optional delayed arthroscopic partial meniscectomy at 24-month follow-up in young patients with isolated traumatic meniscal tears without radiographic OA.

Factors associated with progression of arterial stiffness in ischemic stroke survivors: the Norwegian Stroke in the Young Study

Background Progressive arterial stiffening may increase the risk of recurrent cardiovascular events in ischemic stroke survivors. Information about factors associated with progressive arterial stiffening during the follow-up of young patients with ischemic stroke is lacking. Methods Arterial stiffness by carotid-femoral pulse wave velocity (cf-PWV) and ambulatory 24-hour blood pressure (24hBP) were assessed in 81 women and 190 men ≤60 years of age included in the Norwegian Stroke in the Young (NOR-SYS) study 3 months and 5.5 years after the incident ischemic stroke, representing baseline and follow-up. Covariables of change in cf-PWV were identified using linear regression analysis. Results At baseline, women had less prevalent hypertension (53% vs. 69%, p < 0.05), and lower clinic and 24hBP than men, whereas age, obesity, and prevalence of smoking and antihypertensive drug treatment did not differ. During follow-up, systolic 24hBP remained unchanged, while diastolic 24hBP fell significantly (p < 0.01). Cf-PWV was lower in women both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p < 0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, an increase in cf-PWV at the 5-year follow-up was associated with the presence of hypertension and lower cf-PWV at baseline, and higher systolic 24hBP and lack of use of antihypertensive treatment at follow-up (all p < 0.05). Conclusion In ischemic stroke survivors participating in the NOR-SYS study, the 5-year increase in cf-PWV did not differ between genders and was associated with higher systolic 24hBP and lack of antihypertensive treatment.

Low skull bone density is associated with poor motor prognosis in women with Parkinson's disease.

Parkinson's disease (PD) and osteoporosis are degenerative diseases that have shared pathomechanisms. To investigate the associations of skull bone density with nigrostriatal dopaminergic degeneration and longitudinal motor prognosis in female patients with PD. We analyzed the data of 260 drug-naïve female PD patients aged ≥50 years old who were followed-up for ≥3 years after their first visit to the clinic with baseline dopamine transporter (DAT) imaging. We measured skull bone density as a surrogate marker for systemic bone loss by calculating the Hounsfield unit (HU) in computed tomography scans. A Cox proportional hazard model was built to compare the rates of levodopa-induced dyskinesia (LID) or wearing-off according to skull HU. Longitudinal changes in levodopa-equivalent dose (LED) during a 3-year follow-up were assessed using a linear mixed model. A lower skull HU was associated with lower baseline DAT availability in striatal subregions; however, this relationship was not significant after adjusting for age, disease duration, body mass index, and white matter hyperintensities. After adjusting for confounding factors, a lower skull HU was significantly associated with an increased risk of LID development (hazard ratio = 1.660 per 1 standard deviation decrease, p = 0.007) and wearing-off (hazard ratio = 1.613, p = 0.016) in younger (<67 years) but not in older patients. Furthermore, a lower skull HU was associated with a steeper increase in LED during follow-up in younger patients only (β = -21.99, p < 0.001). This study suggests that baseline skull bone density would be closely linked to motor prognosis in drug naïve women with PD.

New Insights into Renal Failure in a Cohort of 317 Patients with Autosomal Dominant Forms of Alport Syndrome: Report of Two Novel Heterozygous Mutations in COL4A3.

Alport syndrome (AS) is a clinically and genetically heterogeneous disorder with a wide phenotypic spectrum, onset, and progression. X-linked AS (XLAS) and autosomal recessive AS (ARAS) are severe conditions, whereas the severity of autosomal dominant AS (ADAS) may vary from benign familial hematuria to progressive renal disease with extra-renal manifestations. In this study, we collated information from the literature and analyzed a cohort of 317 patients with ADAS carrying heterozygous disease-causing mutations in COL4A3/4 including four patients from two unrelated families who carried two novel variants in COL4A3. Regarding the age of onset of the disease, 80% of patients presented urinalysis alterations (microhematuria, hematuria, and/or proteinuria) before the age of 40 years. The cumulative probability of suffering adverse renal events was mainly observed between 30 and 70 years, without statistical differences between COL4A3 and COL4A4. We observed statistically significant differences between the sexes in the age of developing ESKD in cases affected by mutations in COL4A3/4 (p value = 0.0097), suggesting that males begin experiencing earlier deterioration of renal function than women. This study supports the importance of follow-up in young patients who harbor pathogenic mutations in COL4A3/4. We update the knowledge of ADAS, highlighting differences in the progression of the disease between males and females.

Patient Reported Outcome Measures (PROMIS) of Primary Total Ankle Arthroplasty in Patients Under 50 Years of Age

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. With advancements in 4th generation primary and revision componentry, total ankle arthroplasty (TAA) is considered an option for end-stage ankle arthritis in younger patients aligning with paradigm shifts in knee arthroplasty. Recently published data demonstrates excellent survivorship and complication rates in short/mid-term follow-up of younger patients who received a primary TAA. Additionally, older TAA patients display comparable PROMIS relative to hip/knee arthroplasty. However, there remains a paucity of literature surrounding the PROMIS of younger patients undergoing TAA. Thus, our aim was to assess PROMIS of individuals less than 50 years of age receiving a primary total ankle arthroplastyMethods:A retrospective cohort analysis of adult patients < 50 years who received a primary total ankle replacement at a single academic institution between 2003 and 2019 was conducted. Patient demographics, diagnosis, treatment, and outcome characteristics were recorded from a chart review of 41 patients with at least one year of post-surgical follow-up (Table 1). Post- operative PROMIS scores were obtained via telephone interviews. Primary outcomes that were measured included emotional and physical health, activity limitation, ambulation, and global health. SF-36, PROMIS Global Health, and Sickness Impact Profile Ambulation were used. Functional outcomes in our study sample were compared with age and gender-matched norms from a general US population, and 95% confidence intervals were calculated for each functional outcome mean. Student t-test was used for continuous variables, and chi-square analysis was used for categorical variables.Results:Thirty-one of 41 eligible patients were interviewed. The average age at surgery was 40 years old. Clinical and radiographic follow-up was a mean of 59.7 months and 31.2 months following TAA, respectively. General health as measured with the SF-36 was not significantly different from age/gender-matched norms. Eighty-seven percent of patients would choose to have a TAR again. While 58% reported being limited in vigorous activities, 61% were able to ambulate frequently for long periods of time. On average the patients did not report ongoing pain, and only 16% reported fatigue that hindered activities. Eighty-one percent reported returning to full employment and performing their duties without difficulty, and 84% reported they resumed all normal social activities. Primary implant survivorship was 88%.Conclusion:Despite a younger age and potentially increased demands, patients younger than 50 years of age undergoing primary total ankle arthroplasty are generally very satisfied with their index procedure at a mean follow-up of nearly 5 years. Our findings of positive outcomes on their health and well-being may improve surgeon insight for TAA as a preferred treatment for younger individuals with end-stage ankle arthritis.

Clinicopathological importance of survivin immunoexpression in reproductive age patients with serous borderline ovarian tumors

Purpose: The aim of the present study was to evaluate survivin immunoexpression and the clinicopathologic correlations in serous borderline ovarian tumors (BOT) patients ≤ 40 years old.&#x0D; Materials and Methods: A total of 36 BOT cases were evaluated. After excluding the mucinous type and patients over 40 years of age, 20 serous BOT cases meeting the criteria were included. A similar number of benign ovarian cysts and 20 serous malign ovarian tumors were randomly included as the control group. The patients were then staged based on their surgical findings and 2014 FIGO criteria, and their histological tumor types obtained from pathological specimens were determined using WHO criteria. The survivin levels in the specimens were analyzed using immunohistochemical assays.&#x0D; Results: Positive survivin expression was detected in 10% of benign tumors, 100% of serous BOTs, and 100% of serous malign ovarian tumors. Mean survivin immunoreactivity was statistically similar between groups and it was found to be significantly higher in both groups compared to the control group. Survivin expression was positively correlated with FIGO stage, tumor grade, microinvasion, and micropapillary pattern.&#x0D; Conclusion: Survivin immunoexpression is correlated with the malignancy potential of serous BOTs, and that survivin immune expression may be a histopathological marker that will help in making a decision on fertility-sparing surgery and follow upin young patients.

Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up

Objectives:Glenohumeral osteoarthritis (GHOA) remains a common cause of shoulder pain, loss of shoulder range of motion, and upper extremity dysfunction. Few long-term outcome studies exist evaluating glenohumeral osteoarthritis (GHOA) treatment with arthroscopic management.The purpose of this study was to determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up. It was hypothesized that while some patients would progress to total shoulder arthroplasty (TSA), the majority of patients would demonstrate sustained improvement in patient-reported outcomes and satisfaction without conversion to TSA at long term follow-up.Methods:The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery that otherwise met criteria for total shoulder arthroplasty (TSA). At minimum 10-year follow-up, pre- and post-operative outcome measures collected included the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form–12 (SF-12) Physical Component Summary (PCS), visual analog scale for pain, and satisfaction scores. Kaplan-Meier survivorship analysis was performed with failure defined as progression to arthroplasty.Results:Thirty-eight CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean age of 53 years (range, 27-68) at time of surgery. Kaplan Meier survivorship curve showing 75.3% CAM survivorship (Comprehensive Arthroscopic Management) for glenohumeral arthritis at 5 years and 63.2% at 10 years in Figure 1. Those who progressed to arthroplasty did so at a mean of 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, ASES scores significantly improved post-operatively at both 5 and 10 years (63.3-89.6, p<0.001; 63.3-80.6, p=.007) (Table 1). CAM failure was associated with severe pre-operative humeral head incongruity in 93.8% of failures compared to 50.0.% of patients who did not go onto arthroplasty (p= 0.008). Median satisfaction was 7.5 out of 10.Conclusions:Significant improvement in patient reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. Survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint preserving treatment for GHOA in appropriately selected patients with sustained positive outcomes at 10 years.

Differences in life expectancy between men and women after aortic valve replacement.

Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%-86.4%] and 72.3% (95% CI 69.7%-74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%-86.9%) and 73% (95% CI 69.1%-76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02-1.48; P = 0.03). After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated.

Second ACL Injury Rates in Younger Athletes Who Were Advised to Delay Return to Sport Until 12 Months After ACL Reconstruction

Background:Younger patients are at increased risk for anterior cruciate ligament (ACL) graft rupture and contralateral injury after ACL reconstruction (ACLR). Increasing the amount of time between surgery and the resumption of competitive sport may reduce this risk.Purpose:To determine the rates of graft rupture and injury to the contralateral native ACL at 3- to 5-year follow-up in younger patients who were advised to delay a return to competitive sport until 12 months after surgery and compare this with a nondelayed cohort.Study Design:Cohort study; Level of evidence, 3.Methods:The primary study cohort consisted of 142 eligible patients aged <20 years when they underwent their first primary ACLR. All were informed about the risk of further injury and advised not to return to competitive sport before 12 months postoperatively. Return-to-sport status and the number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) were determined at 3- to 5-year follow-up and compared with a historic cohort of 299 patients with ACLR who were not advised to delay their return to sport for a set period. The cohorts were then combined, and injury rates were compared between those who returned to sport before and after 12 months postoperatively.Results:The follow-up rate was 91% (129/142). In the delayed cohort, 63% returned to competitive sport after 12 months (mean, 14 months). Few patients (n = 10) returned before 9 months. In the delayed group, 33% had a subsequent ACL injury; this was not significantly different when compared with the nondelayed group (31% rate), in which a majority (58%) returned to competitive sport before 12 months. Subsequent ACL injury rates were also similar when compared between patients who returned before and after 12 months postoperatively (33% vs 32%, respectively).Conclusion:At midterm follow-up, the overall rates of subsequent ACL injury were high, even for patients who delayed their return until 12 months after surgery. More research is required to identify strategies to reduce the high reinjury rate in younger athletes.

Факторы риска и особенности течения инсульта у лиц молодого возраста в городской и сельской местности Тамбовской области

Since 2011 according to the national project “Health” the Regional Vascular Center has been operating on the basis of the Tambov Regional Clinical Hospital. This is a ward for patients with acute cerebral circulation disorder. Since 2017 there has been an increase in patients due to an increase in the number of attached population to Tambov Regional Clinical Hospital and, accordingly, unfortunately, the mortality rate from acute cerebral circulation disorder has been increasing. Between 2016 and 2020, a study was conducted based on the follow-up of young patients with hemorrhagic and ischemic stroke. In the study we emphasized the research of regional features of the structure, causes, and risk factors of stroke in persons in the city of Tambov and the districts of the Tambov Region. We verified pathogenetic subtypes of stroke among young patients. We identified and considered main and concomitant factors determining stroke outcome, degree of neurological deficiency, and disabled patients. We identified the leading causes of stroke in persons, the main of which were: arterial hypertension, cardiac pathology, atherosclerosis.

Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up

Background: Few long-term outcome studies exist evaluating glenohumeral osteoarthritis (GHOA) treatment with arthroscopic management. Purpose: To determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up. Study Design: Case series; Level of evidence, 3. Methods: The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery and otherwise met criteria for total shoulder arthroplasty. At minimum 10-year follow-up, postoperative outcome measures included change in the American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, 12-Item Short Form Health Survey (SF-12) Physical Component Summary, and visual analog scale for pain, along with the QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) and satisfaction score. Kaplan-Meier survivorship analysis was performed, with failure defined as progression to arthroplasty. Results: In total, 38 CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean patient age of 53 years (range, 27-68 years) at the time of surgery. Survivorship was 75.3% at 5 years and 63.2% at minimum 10 years. Those who progressed to arthroplasty did so at a mean 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, American Shoulder and Elbow Surgeons scores significantly improved postoperatively at 5 years (63.3 to 89.6; P < .001) and 10 years (63.3 to 80.6; P = .007). CAM failure was associated with severe preoperative humeral head incongruity in 93.8% of failures as compared with 50.0% of patients who did not go on to arthroplasty (P = .008). Median satisfaction was 7.5 out of 10. Conclusion: Significant improvements in patient-reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. The survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint-preserving treatment for GHOA in appropriately selected patients, with sustained positive outcomes at 10 years.

Thinking about the future – data on adolescent patients with a subcutaneous ICD

Abstract Background Implantable cardioverter-defibrillator (ICD) systems are established for the prevention of sudden cardiac death. Long-term data on ICD function in children and adolescents is rare and has suggested higher rates of lead failure as well as oversensing, both leading to inappropriate therapy. The present study displays a long-term single-center follow-up of young patients having received an S-ICD. Methods and results The present study represents a single-center experience of patients younger than 25 years who received an S-ICD (n=49). Follow-up data included regular in-house follow-up as well as unscheduled hospitalisations in our center. Mean age at implantation was 19.2±4.1 years and 33 patients (67.4%) were male. In 21 patients (42.9%) electrical heart disease or idiopathic ventricular fibrillation represented the underlying condition of ICD implantation. 15 patients suffered from HCM (30.6%). Median follow-up duration was 2 years. No patient died during the observation period. Appropriate shocks occurred in 7 patients (14.3%). Inappropriate shock delivery was recorded in 6 patients (12.3%). T-wave oversensing was the main cause for inappropriate shock delivery (5/6 patients), in the other patient myopotentials were the reason for inappropriate therapy. In one patient, operative refixation of the subcutaneous lead was necessary due to hypermobility leading to oversensing. After modification of the sensing vector as well as activation of the SMART pass filter no further oversensing episodes occurred in any patient. Conclusion ICD therapy in children and adolescents is effective for prevention of sudden cardiac death. Every episode was terminated by the first therapy. The rate of appropriate shock as well as inappropriate therapies was quite high compared to typical ICD cohorts. In particular T-wave oversensing seems to be challenging for the S-ICD detection algorithms also in this cohort. Funding Acknowledgement Type of funding source: None

линико-патологические особенности уротелиальной карциномы в педиатрической практике

Introduction. This review of the literature presents the results of the analysis of studies on the etiology, pathogenesis, methods of diagnosis and treatment of urothelial carcinoma in persons under 20 years of age. Worldwide, the number of such patients is small, and special programs of treatment and diagnostic measures, as well as molecular genetic panels for these patients have not yet been developed. Materials. Relevant publications indexed in PubMed, Web of Sciences Core Collection, and Journal Citation Reports were searched. Data on risk factors and molecular-genetic changes that contribute to malignancy of the urinary epithelium, early clinical manifestations, as well as features of radiation, endoscopic, morphological diagnostics and treatment of this class of tumors are analyzed. Results. Risk factors for urothelial carcinoma in patients younger than 20 years and older age groups are similar, however, there is a smaller role of occupational factors in young patients. Differences in the molecular subtype of tumors were found in these age groups with a predominance of urothelium-like subtype A among young patients, which leads to a more favorable prognosis of the disease and a lower rate of recurrence in individuals under 20 years of age. The main method of treatment of these neoplasms in both age groups remains transurethral resection of the bladder (TURMP), which allows radical removal of the tumor. Adjuvant treatment involving intra – bubble or systemic chemo-or immunotherapy in the postoperative period is indicated when detecting tumors with a high malignant potential, due to the risk of its metastasis and the high probability of the need for organ-carrying surgery. In clinical practice, recommendations developed for the treatment of cancer patients in the older age group are used, since there are no special guidelines for the diagnosis, treatment, and follow-up of younger patients. Conclusions. The development of methods for the timely diagnosis, treatment and Rehabilitation of children's patients with verified bladder tumors by representatives of the medical community (oncologists, oncologists, pediatricians) remains an urgent task in the near future.

Prognostic value of serum uric acid levels in patients with non-STEMI undergoing percutaneous coronary intervention.

Because myocardial infarction in young adults is rare, there has been limited research on the condition in this patient group. Very few data are available regarding the long-term outcomes of patients under 40years of age with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing invasive treatments. The prognostic value of uric acid (UA) in young patients with NSTEMI who undergo percutaneous coronary intervention (PCI) has also not been studied. The purpose of this study was to evaluate the long-term clinical outcomes of this specific subset of young patients. In addition, we aimed to identify the role of serum UA in predicting the long-term prognosis of young patients with NSTEMI who have undergone PCI. We performed aretrospective analysis of 213 young adult patients (≤40years old) with NSTEMI who underwent PCI during their hospitalization at our tertiary referral center. The mean age of the 213 patients was 36.8 ± 3.3years (range, 21-40years). The median follow-up was 930days. Our patients were predominantly male (88.3%) and the most frequent traditional cardiovascular risk factors were smoking and dyslipidemia. Baseline TIMI flow 0-1, estimated glomerular filtration rate (eGFR), and UA were found to be independently correlated with long-term major adverse cardiovascular events (MACEs) in multivariate Cox regression analysis. In the present study, baseline TIMI flow 0-1, admission eGFR, and UA levels were correlated with MACEs during long-term follow-up in young patients with NSTEMI.

Significant improvement of clinical course and reverse myocardial remodeling in young patients with chronic heart failure using cardiac contractility modulation

Three clinical cases of 2-year follow-up of young patients with chronic heart failure with a low left ventricular ejection fraction of non-coronarogenic genesis after implantation of the cardiac contractility modulation system are presented. Significant positive dynamics of clinical course and reverse myocardial remodeling according to two-dimensional echocardiography and 2D speckle tracking echocardiography (STE) is shown. The 2D STE technique allowed us to demonstrate the improvement in local contractility of the interventricular septum in the area of implanted electrodes and the remote effect of global contractility improving during 1 year of observation with cardiac contractility modulation.

Mean Platelet Volume Predicts Short-term Prognosis in Young Patients with St-segment Elevation Myocardial Infarction

Abstract Background: Acute ST-elevation myocardial infarction (STEMI) is an uncommon diagnosis in patients less than 40 years of age. Over the last two decades, there is an increase in the frequency of cardiovascular events among young adults. However, at present there is only limited clinical data on the clinical characteristics and outcomes of STEMI in young patients who were treated with primary percutaneous coronary intervention (pPCI). Plaque erosion is the underlying pathological mechanism leading to STEMI in the vast majority of young adults. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. Mean platelet volume (MPV) is recognized as a marker of the platelet activation process and may be a better indicator of short-term prognosis than the inflammatory markers in young patients with STEMI. Therefore, we aimed to investigate clinical and angiographic characteristics, risk factors and the independent value of MPV on predicting short-term major adverse cardiovascular events (MACEs) in young adults with STEMI. Methods: A total of 349 patients aged 40 years or younger who underwent pPCI at our center between 2010–2015 with the diagnosis of STEMI were retrospectively analyzed. Results: The mean age of the patients was 36.4 ± 3.6 years and 90% of them were men. Smoking was by far the most frequent cardiovascular risk factor. MACEs were observed in 23 patients (6.6%), and according to the multivariate regression analysis, Killip IIIIV (OR 7.52, 95% CI 1.25–45.24, p = 0.03), lower admission SBP (OR 0.94, 95% CI 0.90–0.98, p &lt;0.01) and increased MPV (OR 1.67, 95% CI 1.05–2.67, p = 0.03) were found to be independently correlated with MACE in the study population. Conclusion: Our results indicate that MPV is an independent predictor of MACEs at the short-term follow-up in young patients with STEMI undergoing pPCI. Accordingly, we suggested that MPV, a marker of platelet activation, could play a significant role in predicting clinical evolution in young patients with STEMI.

Clinical Characteristics and Outcomes in Young Patients With ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

BackgroundThere are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these “younger” and “older” individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients. MethodsThe study population was a cohort of 2,419 consecutive STEMI patients who were treated with primary percutaneous coronary intervention. The median follow-up time of this retrospective study was 2.2 years. ResultsThe all-cause mortality rates in patients ≤45 years of age at 30 days, 1 and 2 years were 1.7%, 2.0% and 2.2%, respectively. These rates were lower compared with their older matched counterparts whose all-cause mortality rates were 3.3%, 4.2% and 5.5%, respectively (P = 0.010). The incidence of recurrent MI was 4.0% for all age groups combined, 5.4% for younger patients and 3.8% for older patients. The number of stents showed association with recurrent MI in older patients with a first infarction, whereas only composition factor 1 with significantly higher non–high-density lipoprotein and low-density lipoprotein values was significantly associated with recurrent MI in the younger patients. ConclusionsSTEMI patients ≤45 years of age more often had lower rates of all-cause mortality, but the risk of recurrent MI was similar to that of older patients. Regardless of triglyceride level, neither non–high-density lipoprotein nor low-density lipoprotein were independent predictors for recurrent MI during the long-term follow-up in younger patients.

Sex-dependent effects of diabetes mellitus on the revascularization rate in mid-term follow up of young patients with coronary artery disease

AimsWe investigated the association between Type-2 diabetes mellitus (DM) and the need for revascularization at a 5-year follow-up of young coronary artery disease patients and the role of sex in this regard. MethodsAmong 1121 young (males≤45, and females≤55years) patients (female: 49.7%) from Tehran Heart Center's Premature Coronary Atherosclerosis Cohort, 371(33.1%) had diabetes prior to angiography. Revascularization was considered as either percutaneous coronary intervention or coronary artery bypass graft surgery. ResultsThe mean follow-up duration was 57.67±22.43months. In the univariable analysis, diabetics were at a significantly higher risk of revascularization than nondiabetics (Sub-distributional Hazard Ratio [SHR]=1.843, P value<0.001). There was no association between DM and revascularization among men (SHR=1.232, P value=0.508). In contrast, women with DM had threefold more revascularization risk than women without DM (SHR=3.519, P value<0.001). After adjustment for confounding factors, the risk of revascularization in diabetics compared to nondiabetics increased to 2.139 fold (95% CI=1.473, 3.108) among the whole subjects, remained nonsignificant among men, and increased significantly to 3.725 fold (95% CI=2.067, 6.725) in women. ConclusionsOur data showed that in women with premature CAD, but not in men, DM may have a significant role in emerging revascularization during a mean follow-up of 5years.

Quantification of topographic changes in the surface of back of young patients monitored for idiopathic scoliosis: correlation with radiographic variables.

Idiopathic scoliosis requires a close follow-up while the patient is skeletally immature to detect early progression. Patients who are monitored by radiographs are exposed to high doses of ionizing radiation. The purpose of this study is to evaluate if an optic noninvasive method of back surface topography based on structured light would be clinically useful in the follow-up of young patients with idiopathic scoliosis. This could reduce the number of radiographs made on these children. Thirty-one patients with idiopathic scoliosis were submitted twice to radiograph and our topographic method at intervals of 6 months to 1 year. Three topographical variables were applied horizontal plane deformity index (DHOPI), posterior trunk symmetry index (POTSI), and columnar profile (PC). A statistically significant correlation was found between variations of Cobb angle with DHOPI (r=0.720, p<0.01) and POTSI (r=0.753, p<0.01) during the monitoring period. Hence, this topographic method could be useful in clinical practice as an objective adjuvant tool in routine follow-up of scoliosis.