Recurrent Group Research Articles

The association between the recurrence of atrial fibrillation and the shape of left atrial lateral ridge

To investigate the role of the geometry of the left atrial lateral ridge (LLR) in the atrial fibrillation (AF) recurrence after radiofrequency ablation (RFA). A total of 225 patients with AF who underwent RFA for the first time were retrospectively enrolled and divided into the recurrence (n = 53) and non-recurrence (n = 172) groups. The clinical data and the volume of left atrium (LAV) and the LLR geometry were analyzed. The LAV in the recurrence group was greater than that in the non-recurrence group (P < 0.001). There were more rectangular LLR in the recurrence group than the non-recurrence group (43% vs. 77%, P < 0.001). The anteroposterior diameter of the LLR orifice in the recurrence group was smaller than that in the non-recurrence group (P = 0.001), while the length of the LLR in the recurrence group was longer (P = 0.012). Multivariate analysis revealed the shape of the LLR was significant independent predictor of recurrence AF. The shape of the LLR is an independent predictor of recurrence after RFA.

Hyperglycemia and type 2 diabetes mellitus associate with postoperative recurrence in chronic rhinosinusitis patients.

To investigate the associations between fasting blood glucose (FBG) and type 2 diabetes mellitus (T2DM) and the risk of postoperative CRS recurrence. A retrospective cohort study was conducted on clinical data of CRS patients who underwent surgery at our center between February 2019 and March 2022 and were followed up until June 2023. All CRS patients were categorized into two subgroups based on the presence of T2DM and postoperative recurrence. The Kaplan-Meier survival curves and binary logistic regression analyses were performed to examine the associations between FBG, T2DM, and the risk of postoperative CRS recurrence. 1163 CRS patients were enrolled, including 134 in the T2DM group and 276 in the recurrent group. The recurrence rate in the T2DM group was significantly higher than that in the non-T2DM group (P < 0.05). T2DM prevalence and FBG levels were higher in the recurrent CRS group than in the non-recurrent CRS group (P < 0.05). The Kaplan-Meier survival curves and unadjusted and adjusted logistic regression models showed that T2DM was an independent risk factor for postoperative CRS recurrence (P < 0.05). Moreover, multivariate logistic regression analysis suggested that FBG, CRS duration, and allergic rhinitis were associated with the risk of postoperative CRS recurrence (P < 0.05). Elevated FBG levels and accompanying T2DM were associated with an increased risk of postoperative CRS recurrence, which was independent of traditional risk factors. CRS duration and accompanying allergic rhinitis were also proven to be potential risk factors for postoperative CRS recurrence.

Natural History of Chronic Subdural Hematoma following Middle Meningeal Artery Embolization: A Retrospective Analysis

The efficacy of middle meningeal artery (MMA) embolization in the management of chronic subdural hematoma (cSDH) has been increasingly supported by recent randomized controlled trials. However, long-term data on the natural history of cSDH post-treatment remain limited. This study aims to evaluate the natural history and outcomes of cSDH over a 12-month period following MMA embolization. We conducted a retrospective analysis of 61 MMA embolization for the treatment of cSDH in 49 consecutive patients at a single institution between October 2019 and December 2022. Patients underwent MMA embolization as the primary treatment of cSDH, concurrently with surgical evacuation, or after initial surgical evacuation and subsequent recurrence. Clinical data, including patient demographics, hematoma maximal thickness, midline shift size, procedural details, and outcomes, were collected and analyzed. The primary outcomes assessed were time to resolution of hematoma maximal thickness, midline shift reduction and clinical improvement. Secondary outcomes included occurrence of complications, recurrence rate and the characteristics of the group of patients who needed surgical rescue. Tables and Kaplan-Meier curves were created, broken down by the percentage of reduction in current hematoma maximal thickness. Results for the primary, concurrent and recurrent groups were compared. The mean age of included patients was 73 ± 10.8 years. Among them, 33 patients (67.3%) reported a history of previous trauma, with falls being the main mechanism of injury (65.3%). The majority of patients (77.5%) were male. The most frequent neurological symptom was headache (61.2%). The mean hematoma thickness and midline shift were 15.9±7.1 and 5.6±2.6 mm, respectively. There was a significant improvement in clinical symptoms within 1 month following middle meningeal artery embolization. Kaplan-Meier curves were generated for resolution of hematoma size and midline shift. At one month post procedure, only 25% of patients had at least a 25% reduction in hematoma size. However, by three months, 75% had a decrease in hematoma size by 50%. 85% of patients had complete resolution of hematoma by 7 months and all patients had resolution of hematoma by 12 months. Four patients underwent surgical rescue hematoma evacuation and the mean timeframe between the embolization and the surgical rescue was 2 weeks. Hematoma size and midline shift resolved faster for patients who underwent concurrent or rescue surgical evacuation of the hematoma in addition to embolization. No difference in results between the liquid embolics n-BCA and Onyx-18 was found. This study demonstrated a favorable resolution of subdural hematoma within 7 months in 85% of patients and in all patients by 12 months. By 3 months, 50% of patients had a decrease in hematoma size by 50% or more. A complete resolution of midline shift within 7 months, and a significant improvement in clinical symptoms within 1 month following middle meningeal artery embolization. Hematoma size and midline shift resolved faster for patients who underwent embolization for recurrent hematoma or concurrent surgical evacuation of the hematoma in addition to embolization.

URINARY TRACT INFECTIONS IN CHILDREN: A REVIEW OF CURRENT INTERNATIONAL GUIDELINES

Urinary tract infections (UTIs) are the most common bacterial infections in children, which can lead to renal dysfunction, especially in young children in case of complicated and recurrent course. The aim of this review was to analyze all the latest clinical guidelines on UTIs in children in the world, starting from 2018 to 2024. We analyzed current data on the incidence of UTIs in children depending on age and gender. A classification is presented, the main problems of diagnosis, the most modern approaches to treatment and prevention are discussed. Analysis of these guidelines indicates that UTIs should be diagnosed in all young children with fever over 38 ° C without a focus of infection. Empirical antibacterial therapy should be started within the first 24-48 hours, oral antibiotics have an advantage, third-generation cephalosporins are more often used today, but it is necessary to take into account the data on antibacterial resistance in your region. All modern clinical guidelines emphasize the growth of resistant pathogens and their decreasing sensitivity to protected penicillins. All guidelines recommend identifying a "high-risk recurrence group" that includes children with vesicoureteral reflux (VUR), neurogenic bladder dysfunction, constipation, and "uncircumcised" boys under 1 year of age, and timely conducting imaging diagnostics for such children. According to almost all international guidelines for the diagnosis and treatment of UTIs in children, long-term antibacterial prophylaxis should be carried out only according to strict indications, mainly in children with high VUR and low VUR, taking into account the "risk" factors. In recent years, a large number of modern international clinical guidelines on UTIs in children have appeared. This review, which includes all the latest guidelines on UTIs in children in the world over the past seven years, will allow the use of accumulated modern knowledge in the practical work of pediatricians, pediatric nephrologists, and pediatric urologists in the Russian Federation.

Difference in efficacy of osimertinib between patients with EGFR-positive NSCLC with postoperative recurrence and those with de novo unresectable disease: A prospective, observational study

BackgroundAlthough clinical trials of systemic chemotherapy for advanced non-small-cell lung cancer (NSCLC) have included both postoperative recurrence and de novo unresectable cases, postoperative recurrence is reported to have a better efficacy and prognosis. However, there are no efficacy data of first-line osimertinib for postoperative recurrence. MethodsWe conducted a post hoc analysis of a multicenter, prospective, observational study that evaluated the efficacy of first-line osimertinib in patients with epidermal growth factor receptor (EGFR)-positive NSCLC. The patients were divided into two groups: those with postoperative recurrence (recurrence group, n = 167) and those with de novo unresectable disease (de novo group, n = 385). ResultsThe recurrence group had a significantly better Eastern Cooperative Oncology Group performance status (ECOG-PS, p < 0.001) and fewer bone metastases (p < 0.001), brain metastases (p < 0.001), cancer pleurisy (p = 0.006), pleural dissemination (p = 0.003), liver metastases (p = 0.017), and adrenal metastases (p = 0.009) at the start of osimertinib than the de novo group. The recurrence group had a significantly better progression-free survival (PFS) and overall survival (OS) than the de novo group (hazard ratio [HR] = 0.62, 95 % confidence interval [CI], 0.49–0.81, p < 0.001; and HR = 0.58, 95 % CI, 0.43–0.79, p < 0.001, respectively). In a 1:1 propensity score-matching analysis, the matched recurrence group had significantly better PFS and OS than the matched de novo group (HR = 0.72, 95 % CI, 0.52–0.99, p = 0.034; and HR = 0.65, 95 % CI, 0.44–0.95, p < 0.001, respectively). ConclusionPatients with EGFR-positive NSCLC and postoperative recurrence have a better ECOG-PS and fewer distant metastases at the start of first-line osimertinib, and better PFS and OS than those with de novo unresectable disease. Postoperative recurrence should be considered as a stratification factor in future clinical trials for advanced EGFR-positive NSCLC.

The predictive value of pan-immune inflammatory index for early recurrence of atrial fibrillation after cryoablation

ObjectiveThe pan-immune inflammatory (PIV) index holds prognostic value for cardiovascular diseases. This study aimed to investigate the predictive value of the PIV index regarding recurrence of atrial fibrillation (AF) after cryoballoon ablation (CBA).MethodsThe study included 307 patients with AF. Four inflammatory markers, namely, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation (SII) index, and PIV index, were used as indicators. COX regression analysis was conducted to evaluate the predictive value of AF recurrence after CBA. A receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to evaluate the discriminative power of the indicators.ResultThe PIV index [94.9 (168.9,504.9) vs. 143.2 (98.2,210.6), P < 0.01] and SII index [366.3 (256.6,491.9) vs. 569.9 (658.1,438.4), P < 0.01] were significantly higher in the recurrence group. Univariable COX regression analysis showed that these four indices, persistent AF, and left atrial diameter (LAD) were all associated with AF recurrence. In multivariable regression analysis, the PIV index, persistent AF, and LAD (all P < 0.05) were independent predictors of postoperative AF recurrence. The ROC curve analysis showed that the PIV index had a higher predictive value for AF recurrence (AUC = 0.768, P < 0.01, 95% CI: 0.696–0.840) than the SII index and NLR. Kaplan–Meier analysis showed that patients with a PIV index > 260.7 had a higher recurrence rate at 1-year follow-up (P < 0.01). Subgroup analysis indicated that PIV had a predictive value in patients with different types of AF.ConclusionPIV index may be a potential biomarker for predicting relapse in patients with AF after CBA.

Strategies for Recurrent Colorectal Liver Metastases Based on Prognostic Factors and Resectability: Potential Benefit of Multidisciplinary Treatment.

Colorectal liver metastasis (CLM) is classified into technical and oncologic categories, with recommended treatments for each resectability category. However, the classification of recurrent CLM has not been established to date. This study evaluated patients with CLM who underwent initial liver resection between 2006 and 2020 and subsequently experienced liver recurrence. Long-term outcomes and prognostic factors associated with recurrent CLM were investigated. From 949 patients who underwent an initial liver resection, the analysis included 392 patients with liver recurrence. Repeat liver resection was associated with a significantly longer prognosis than non-resection (5-year overall survival [OS] from initial liver resection: 66.3 % vs 27.2 %, p < 0.0001). Multivariable analysis indicated the following independent prognostic factors: four or more recurrent tumors (p = 0.015), tumor 5 cm or larger in size (p = 0.004), and presence of extrahepatic diseases (p = 0.003). The patients were stratified into resectable, borderline resectable, and unresectable recurrent CLM groups based on these criteria. The prognosis varied significantly across the groups, with 5-year OS rates of 67.3 % for resectable recurrent CLM, 30.8 % for borderline resectable recurrent CLM, and 2.6 % for unresectable recurrent CLM (p < 0.0001). Patients with borderline resectable recurrent CLM who did not receive adjuvant chemotherapy after initial liver resection had a positive prognostic impact of preoperative chemotherapy (p = 0.049). The significant independent predictors of recurrent CLM prognosis were four or more tumors, tumor size of 5 cm or larger, and the presence of extrahepatic diseases at recurrence. It is critical to onsider the current condition and tumor resectability at the time of recurrence, and tailored treatments could further improve recurrent CLM outcomes.

Assessing stroke recurrence in sICAS: a study on mCSVD score and culprit plaque magnetic resonance characteristics.

Recurrent ischemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (sICAS) can be attributed to two main causes: intracranial atherosclerotic stenosis (ICAS) and cerebral small vessel disease (CSVD). This study investigates the potential associations between stroke recurrence and the modified cerebral small vessel disease (mCSVD) burden score, as well as the characteristics of culprit plaques related to intracranial artery high-resolution vessel wall imaging (HR-VWI). A total of 145 patients presenting sICAS underwent intracranial artery HR-VWI and routine cranial MRI at two large Chinese hospitals from December 2019-2022 were participants of this retrospective analysis. Standard MRI scans were used to calculate the mCSVD score. Following a 12-month observation period, the patients were categorized into two distinct groups depending on whether or not they experienced a subsequent stroke. Within 12 months, 32 patients experienced stroke recurrence. The recurrence group's mCSVD score was higher compared to the non-recurrence group (p < 0.001). Their luminal stenosis and culprit plaque thickness and burden were also higher (p < 0.05). Additionally, higher rates of diabetes, T1WI hyperintensity of culprit plaques, and significant plaque enhancement were observed in the recurrence group (p < 0.05). The adjusted Cox regression model indicated that the mCSVD score (HR = 1.730, 95% CI 1.021-2.933, p = 0.042) and T1WI hyperintensity of the culprit plaque (HR = 6.568, 95% CI 1.104-39.059, p = 0.039) remained significantly independent risk variables. The combination of the mCSVD score and T1WI hyperintensity of the culprit plaque demonstrated the highest efficacy in predicting stroke recurrence (z = 2.678, p < 0.05). The mCSVD score, associated with T1WI hyperintensity of culprit plaque, effectively predicts stroke recurrence and can be easily obtained, offering high clinical value.

Value of high frame rate contrast-enhanced ultrasound in predicting microvascular invasion of hepatocellular carcinoma

ObjectivesTo investigate the value of vascular morphology on high frame rate contrast-enhanced ultrasound (H-CEUS) and CEUS Li-RADS in predicting microvascular invasion (MVI), Ki-67 expression and recurrence of hepatocellular carcinoma (HCC).MethodsThis retrospective study enrolled 78 patients with single HCC diagnosed by postoperative pathology between January 1, 2021, and June 30, 2022. All patients underwent ultrasound and H-CEUS examination before operation. H-CEUS image features and CEUS Li-RADS were compared in different MVI status and Ki-67 level. Multiple logistic regression analysis was performed to select independent variables for MVI. Differences in recurrence among different H-CEUS image features, MVI status and Ki-67 level were further analyzed.ResultsTumor shape, vascular morphology, LR-M category, necrosis and AFP level were different between the MVI-positive group and MVI-negative group (p < 0.05). Vascular morphology and LR-M category were independent risk factors related to MVI (p < 0.05). Vascular morphology was also different between the high Ki-67 expression group and low Ki-67 expression group (p < 0.05). Vascular morphology, MVI status and Ki-67 expression were different between the recurrence group and no recurrence group (p < 0.05).ConclusionThe vascular morphology of HCC on H-CEUS can indicate the risk of MVI status, Ki-67 expression and recurrence, which provides a feasible imaging technique for predicting the prognosis before operation.Critical relevance statementH-CEUS shows the different vascular morphology of HCC in arterial phase and indicates the risk of MVI, Ki-67 expression and recurrence, which provides a feasible imaging technique for clinician to judge the risk of MVI pre-operation and adopt appropriate treatment.Key PointsH-CEUS can clearly show different vascular morphology of HCC in arterial phase.Vascular morphology on H-CEUS is associated with MVI status, Ki-67 expression and HCC recurrence.Preoperative MVI and Ki-67 expression prediction could help surgeons choose a more appropriate treatment plan.Graphical

The Impact of Systemic Inflammation on Recurrence in Patients with Congenital Nasolacrimal Duct Obstruction.

Background/Objective: Congenital nasolacrimal duct obstruction (CNLDO) is commonly treated by probing, but recurrence remains a clinical issue. This study investigates the potential role of inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), in predicting recurrence after probing in children with CNLDO. Methods: This retrospective cohort study included 172 patients who underwent initial probing for unilateral CNLDO. The patients were then categorized into two groups: those who experienced the complete resolution of symptoms after primary probing, and those who required Ritleng tube intubation due to recurrence following primary probing. Blood samples for calculating inflammatory biomarkers in all subjects were collected during general anesthesia preparation prior to initial probing. NLR, MLR, and PLR values were compared between the groups using the independent samples t-test. The predictive performance of the inflammatory biomarkers for recurrence was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 110 patients were included in the probing group, while 62 patients were in the recurrence group. The mean age at the time of the initial probing procedure was 15 ± 4.06 months in the probing group and 15.83 ± 4.02 months in the recurrence group. There was no difference in the duration of the probing procedure between the groups. The mean age at the time of Ritleng tube intubation in the recurrence group was 37.80 ± 13.34 months. The recurrence group exhibited significantly higher values in all analyzed inflammatory markers compared to the probing group, including the NLR (1.12 ± 0.56 vs. 0.86 ± 0.39, p = 0.002), MLR (0.16 ± 0.06 vs. 0.14 ± 0.06, p = 0.005), and PLR (95.13 ± 24.34 vs. 82.23 ± 22.77, p < 0.001). ROC curve analysis indicated that these inflammatory biomarkers demonstrated moderate performance in predicting recurrence. Conclusions: Recurrence following probing in children with CNLDO was associated with complete blood cell count-derived inflammatory biomarkers. The preoperative assessment of these biomarkers may aid in the individualization of disease management and inform the development of new therapeutic strategies.

Recurrence-Free Survival Prediction for Anal Squamous Cell Carcinoma After Chemoradiotherapy using Planning CT-based Radiomics Model.

Approximately 30% of non-metastatic anal squamous cell carcinoma (ASCC) patients will experience recurrence after chemoradiotherapy (CRT), and currently available clinical variables are poor predictors of treatment response. We aimed to develop a model leveraging information extracted from radiation pretreatment planning CT to predict recurrence-free survival (RFS) in ASCC patients after CRT. Radiomics features were extracted from planning CT images of 96 ASCC patients. Following pre-feature selection, the optimal feature set was selected via step-forward feature selection with a multivariate Cox proportional hazard model. The RFS prediction was generated from a radiomics-clinical combined model based on an optimal feature set with five repeats of nested five-fold cross validation. The risk stratification ability of the proposed model was evaluated with Kaplan-Meier analysis. Shape- and texture-based radiomics features significantly predicted RFS. Compared to a clinical-only model, radiomics-clinical combined model achieves better performance in the testing cohort with higher C-index (0.80 vs 0.73) and AUC (0.84 vs 0.78 for 1-year RFS, 0.84 vs 0.79 for 2-year RFS, and 0.85 vs 0.81 for 3-year RFS), leading to distinctive high- and low-risk of recurrence groups (p < 0.001). A treatment planning CT based radiomics and clinical combined model had improved prognostic performance in predicting RFS for ASCC patients treated with CRT as compared to a model using clinical features only. The use of radiomics from planning CT is promising in assisting in personalized management in ASCC. The study outcomes support the role of planning CT-based radiomics as potential imaging biomarker.

Abstract 4136869: Time Course and Predictors of PVC Recurrence After Acutely Successful Catheter Ablation

Introduction: In prior studies, predictors of long-term success following acutely successful radiofrequency (RF) ablation have included female-sex, single-PVC morphology and EGM-QRS &gt; 24ms. Time course and predictors of PVC recurrence following acutely successful ablation has been less well documented. Use of extended ambulatory monitoring in the immediate post-procedural period can help to identify those with early recurrence. Goals: To define time to recurrence and predictors of recurrence of PVCs after RF ablation following acutely successful ablation. Methods: Consecutive patients from January 1 st , 2016 through December 31 st , 2023 undergoing PVC ablation with available post-ablation extended ambulatory monitoring (Zio, iRhythm, San Francisco, CA) were retrospectively analyzed. Recurrence was defined as an increase in PVC burden to &gt;5% during monitoring after acute success or failure to have sustained reduction in PVC burden of &gt;80%. Acute success was defined as elimination of the targeted PVC after the last ablation lesion. Long-term succes was defined as absence of targeted PVC's during all follow-up visits and PVC-burden &lt; 5% on follow-up monitoring. Results: Among 121 patients who underwent successful PVC ablation, 101 (83.4%) had long-term success and 20 (17%) had recurrence. Patients with recurrence were older (62.4 ± 12 vs 55 ± 13., p = 0.019), had a higher incidence of CAD (13 (13%) vs 9 (45%), p = 0.001) and CHF (40 (40%) vs 15 (75%), p = 0.004). At time of ablation, the recurrence group was also more likely to have &gt;1 PVC morphology (6 (6%) vs 8 (40%), p = &lt;0.001). Location and earliest activation time of the predominant PVC were not assocated with likelihood of recurrence. Within the recurrence group, 13 (65%) had recurrence in the immediate 2 week post-procedural period with an average time to recurrence of 3.9 days. Conclusion: Recurrence occured in slightly less than 20% of cases with a relatively high proportion of those occuring within the immediate 2 week post-procedural period during extended ambulatory monitoring. The presence of greater than 1 PVC morphology at time of ablation is a risk factor for recurrence suggesting a higher likelihood of acute suppression without durable resolution in those instances.

Preoperative total parathyroid volume is an independent marker to predict recurrence for secondary hyperparathyroidism

Purpose This study aimed to explore the value of preoperative total parathyroid volume (TPV) as a marker for predict recurrence of renal secondary hyperparathyroidism (SHPT). Methods We identified 28 patients with recurrence and 128 without recurrence who underwent total parathyroidectomy with autotransplantation (tPTX + AT) at our institution between 2015 and 2022. The TPV and postoperative recurrence information of the patients were recorded. Within the intergroup comparison, data obtained from the recurrence and non-recurrence groups were evaluated using the t-test. Univariate and multivariate analyses were performed according to the regression model to determine factors that were significant in predicting postoperative recurrence. The cutoff value of TPV was determined using a receiver operating characteristic (ROC) curve. Results The mean TPV of recurrence and no-recurrence groups were 2.99 ± 1.52 cm3 and 1.73 ± 1.19 cm3, respectively (p = 0.007). In univariate analysis, female sex, total parathyroid volume > 1.99 cm3, serum PTH > 928.37 pg/mL and p > 1.59 mmol/L were independent factors for SHPT recurrence. In multivariable analysis, TPV > 1.99 cm3, serum parathyroid hormone (PTH) > 928.37 pg/mL and p > 1.59 mmol/L were independent factors for SHPT recurrence. The ability of TPV to distinguish between recurrence and non-recurrence was evaluated using the ROC curve. The cutoff value of TPV was estimated as 2.65 cm3. With this value, sensitivity was found as 60.70%, specificity was 89.80%, and AUC was 0.80 (p < 0.001, confidence interval =0.719–0.882). Conclusion According to the data in this study, it can be said that TPV can be used to distinguish recurrence from no-recurrence. Most importantly, TPV can be used to identify SHPT recurrence.

Association Between Postoperative Medial-Middle Intercuneiform Joint Widening and Recurrence Rates in Hallux Valgus Treated With Modified Lapidus Procedure.

Although an association between intercuneiform (C1-C2) joint instability and the recurrence of hallux valgus (HV) deformity after the modified Lapidus procedure has been suggested, there is currently no radiographic evidence to support it. This study aims to investigate radiographic changes in the C1-C2 joint after the modified Lapidus procedure for HV correction, using weightbearing computed tomography (WBCT). This retrospective cohort study included 52 feet (50 patients) with HV who underwent modified Lapidus procedure and had preoperative and postoperative WBCT. Patients who had an additional transfixation screw between the first and second ray were excluded. The preoperative and average 6.5 months postoperative C1-C2 distance, C1-C2 angle, and C1-ground angle were measured on coronal multiplanar reconstructed WBCT images. Radiographic parameters between the recurrence group (n = 9) and nonrecurrence group (n = 43) were compared. Recurrence of HV deformity was characterized by a postoperative hallux valgus angle (HVA) greater than 20 degrees. Nine of 52 patients (17.3%) had recurrence of their HV deformity. The recurrence group had greater changes in the C1-C2 distance; the median widening in the recurrence group was 0.7 mm (IQR, 0.6-0.8), whereas the nonrecurrence group was 0.3 mm (IQR, 0.1-0.4, P < .001). Regression analysis showed that increase in the C1-C2 distance were significantly associated with recurrence (odds ratio, 1.79; 95% CI, 1.18-3.77; P = .0015). Although no preoperative imaging parameters were associated with a change in the C1-C2 distance, increasing postoperative sesamoid position (r = 0.32, P = .022) and HVA (r = 0.28, P = .046) were correlated with a greater change in the C1-C2 joint gapping. Our study results suggest a possible association between early postoperative widening of the C1-C2 joint and the recurrence of the HV deformity following a modified Lapidus procedure. This raises, but does not answer, the question as to whether the routine stabilization of intercuneiform joint directly or indirectly may help reduce the rate of hallux valgus recurrence when performing the modified Lapidus procedure.

NCOG-22. ELDER AGE INSTEAD OF LOW EDUCATION PREDICTS POOR LANGUAGE FUNCTION IN RECURRENT LEFT HEMISPHERIC DIFFUSE GLIOMA PATIENTS

Abstract PURPOSE Language processing is multifactorial, requiring interactions between cognitive functions and connections of cerebral cortexes and subcortical fibers in dominant hemisphere. Previously, we identified distinct patient factors and tumor characters influencing language performance in treatment-naïve diffuse glioma. In this study, we aimed to investigate predictive factors between treatment-naïve and recurrent patients with diffuse glioma. MATERIALS AND METHODS Grade 2 to 4 diffuse glioma patients who underwent awake surgery with completed preoperative language assessment were included. The Chinese version of the short-form Boston Diagnostic Aphasia Examination (sfBDAE) was used for language testing. Patient age, sex, education level, tumor grade, language pathway involvement, T1 contrast enhanced (C+), and FLAIR (T2) volume were selected as variables. Univariate and multivariate logistic regression analysis were used on language function impairment. The statistical significance was defined as a p-value less than 0.05 by SPSS20.0. RESULTS 50.7% of all awake surgeries (112 of 221) in 171 patients had repeated operations in the retrospective cohort. Comparing to treatment-naïve patients, patients with recurrent tumor had higher academic year (p=0.016), more subventricular zone invasion (p=0.03), and more subcortical language pathway involvement (p=0.035), whereas showed no difference on language performance. In language function analysis, low education was the sole predictive factor for poor language function in treatment-naïve patients. In sharp contrast with low education, elder age factor was exclusively correlated with poor language function in recurrent patients. Furthermore, times of craniotomy was also an independent predictive factor in recurrent group. CONCLUSIONS Neurocognitive reserve is considered a protective factor against brain damage. Both age and education level are critical factors for cognitive reserve. Whether the phenomenon of a distinct and mutually exclusive patient factor affecting language function between treatment-naïve and recurrent diffuse glioma patients could be explained by the model of cognitive reserve necessitate more study.

High-density lipoprotein cholesterol to c-reactive protein ratio predicts atrial fibrillation recurrence after electrical cardioversion.

Atrial fibrillation (AF) recurrence after cardioversion is common, and inflammation plays a critical role in its pathophysiology. We aimed to elucidate the predictive role of the ratio of high-density lipoprotein cholesterol to c-reactive protein (HDL-C/CRP) as an inflammatory marker in AF recurrence after electrical cardioversion (ECV). We analyzed patients who underwent elective ECV for atrial fibrillation between June 2020 and December 2023. Baseline levels of HDL-C and CRP were obtained. Ninety-six patients were included. The median age was 59 years, and 48% were female. Atrial fibrillation recurred after ECV in 56 patients (58%). In the AF recurrence group, CHA2DS2-VASc score was higher (2 [1-3] vs. 1[0-2]; p = 0.013), left atrial diameter was larger (43 ± 5 vs. 40 ± 6 mm; p = 0.015), and HDL-C/CRP ratio was lower (5.6 [2.7-13.0] vs. 14.0 [4.8-38.0]; p = 0.003) compared with the sinus rhythm group. Cox regression analysis showed that HDL-C/CRP was a predictor of AF recurrence at follow-up (unadjusted HR = 0.97; CI 95%: 0.95-0.99; p = 0.004; adjusted HR = 0.98; CI 95%: 0.96-0.99; p = 0.030). ROC curve showed that HDL-C/CRP ratio was able to predict AF recurrence after ECV (AUC = 0.68; p = 0.003). Kaplan-Meier analysis showed that patients with baseline HDL-C/CRP <7.4 had higher AF recurrence (log-rank test p = 0.013). Our research demonstrated that the lower HDL-C/CRP ratio predicted AF recurrence after ECV during follow-up.

Preoperative Predictors of Recurrent Tricuspid Regurgitation After Annuloplasty: Insights into the Role of 3D Echocardiography.

While tricuspid annuloplasty (TAP) is an effective treatment option for tricuspid regurgitation (TR), understanding the echocardiographic factors contributing to recurrent TR can help in developing more effective preventive measures to reduce the rate of recurrent TR after TAP. This study was designed as a prospective observational cohort study to investigate factors contributing to recurrent TR following surgical tricuspid valve (TV) repair in patients with moderate or severe functional TR caused by left heart valvular disease, with severe mitral regurgitation as the dominant pathology. The study included 66 patients who underwent preoperative two-dimensional (2D) and three-dimensional (3D) echocardiographic assessments. Patients were divided into two groups based on TAP outcomes: the effective TAP group and the recurrent TR group. The analysis revealed that 3D-derived both septal-lateral diastolic and systolic tricuspid annulus (TA) diameter (odds ratio (OR) 1.77; 95% confidence interval (CI) 1.17-2.68 and OR 1.62; 95% CI 1.14-2.29, respectively), and major axis diastolic TA diameter (OR 1.59; 95% CI 1.15-2.2) had the highest OR among all echocardiographic parameters. The further univariate analysis of predefined echocardiographic values unveiled that the combined effect of heightened 3D-measured TA major axis diastolic diameter and increased right ventricle (RV) basal diameter exhibited the highest OR at 12.8 (95% CI 2.3-72.8) for a recurrent TR. Using ROC analysis, diastolic major axis (area under the curve (AUC) 0.848; cut-off 48.5 mm), septal-lateral systolic (AUC 0.840; cut-off 43.5 mm) and diastolic (AUC 0.840; cut-off 46.5 mm) TA diameter demonstrated the highest predictive value for recurrent TR from all TV parameters. Recurrent moderate or severe TR after TAP is associated with preoperative TA size, right atrium and RV geometry, but not with changes of RV function. The predictive capacity of 2D-assessed echocardiographic parameters was found to be lower when compared to their corresponding 3D parameters.

Final Results of the GRECCAR-6 Trial on Waiting Period Following Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer: 5 Years of Follow-up.

The potential oncological benefit of extending the waiting period between neoadjuvant radiochemotherapy and surgical resection for rectal cancer is debated. To evaluate the impact of prolonging this waiting period on the 5-year oncological prognosis and 2-year functional result of locally advanced rectal adenocarcinoma. Phase III, multicenter, randomized, open-label, parallel-group, controlled trial. Patients were enrolled from 24 colorectal centers. Patients with non-metastatic mid or lower cT3-4 or TxN+ rectal adenocarcinoma who had received radio-chemotherapy (45 to 50 Gy with fluorouracil or capecitabine). Patients were randomly assigned to undergo total mesorectal excision either 7 weeks (W7) or 11 weeks (W11) after radiochemotherapy. Overall survival and disease-free survival at 5 years of follow-up and low anterior resection syndrome score assessed after 2 years of follow-up. Among 265 patients enrolled, 133 were randomized in the 7-week group and 132 in the 11-week group. Twelve patients were excluded as they did not undergo resection. Among 253 patients analyzed, 5-year overall survival was not different between the two groups (81.6% in 7-week group versus 82.6% in 11-week group, p = 0.827), as well as for the 5-year disease-free survival (70.4% in 7-week group versus 69.5% in 11-week group, p = 0.856). No difference was observed between the two groups for distant recurrence (27.4% in 7-week group versus 25.7% in 11-week group, p = 0.777) or local recurrence (8.4% in 7-weeks group versus 10.2% in 11-week group, p = 0.543). Low anterior resection syndrome score was similar between the 7-week (25.0 IQR [15.0-34.0]) and 11-week groups (23.0 IQR[14.2-32.0], p = 0.743). The response rate to the LARS questionnaire was only 52%. Extending the waiting period between radiochemotherapy and resection from 7 to 11 weeks does not modify the 5-year oncological prognosis in rectal cancer and the 2-year low anterior resection occurrence.

Artificial intelligence algorithms enhance urine cytology reporting confidence in postoperative follow-up for upper urinary tract urothelial carcinoma.

In Taiwan, the incidence of urothelial carcinoma of the upper urinary tract (UTUC) is high and intravesical recurrence is approximately 22%-47%. Thus, postoperative cystoscopy and urine cytology follow-up, which require experienced cytologists, are needed. The AIxURO system aligns with The Paris System (TPS) guidelines for reporting urinary cytology. This study assessed the benefit of early detection of intravesical recurrence after nephroureterectomy using the AIxURO system. Urine cytology slides (n = 296) from 113 patients with UTUC were retrieved and patient data, pre-operative and postoperative cytology, pathology, and follow-up series for the intravesical recurrence group were collected. Cytology slides were digitized and independently assessed by the AIxURO system, and the results were compared to cytology reports. From January 2022 to August 2023, 113 patients with UTUC underwent nephroureterectomy. Eighty-eight patients (88/113, 77.8%) received 1 or 2 cytology examinations pre-operatively, 44 slides (44/204, 21.5%) were positive and 34 patients (34/113, 30.1%) were diagnosed with UTUC. Postoperative intravesical recurrence was detected in 27 patients (27/113, 23%) at an average of 190.62days. Thirty-four slides (34/56, 60.7%) were negative for UTUC. Eight patients (8/27, 29.6%) met the criteria for early diagnosis of intravesical recurrence. The AIxURO system identified two more patients (10/27, 37.0%) with early intravesical recurrence. The AIxURO system enhanced postoperative urine cytology reporting confidence and could identify some underdiagnosed slides to enhance the early detection of UTUC with intravesical recurrence. AIxURO may be used for post-nephroureterectomy follow-up and reduce the necessity for cystoscopy.

Ultrashort Cell-Free DNA Fragments and Vimentin-Positive Circulating Tumor Cells for Predicting Early Recurrence in Patients with Biliary Tract Cancer.

Background/Objectives: Biliary tract cancer (BTC) is a rare but aggressive malignancy that requires surgical treatment. However, postoperative recurrence rates are high, and reliable predictors of recurrence are limited. This study aimed to investigate the effectiveness of cell-free DNA (cfDNA) and circulating tumor cells (CTCs) in predicting early recurrence after curative surgery and complete adjuvant therapy in patients with BTC. Methods: Twenty-four patients who underwent R0 and R1 resections and completed adjuvant therapy for BTC between September 2019 and March 2022 were followed up until March 2024. Patients were categorized into early recurrence (ER) and non-ER groups, using one year as the cutoff for recurrence. Results: The combination score derived from ultrashort fragments of cfDNA, vimentin-positive CTCs, and carbohydrate antigen (CA) 19-9 levels showed a statistically significant difference between the ER and non-ER groups (p-value < 0.001). The receiver operating characteristic curve from the combination score and CA 19-9 levels yielded areas under the curve of 0.891 and 0.750, respectively. Conclusions: Although further research is required, these findings suggest that cfDNA and CTCs may increase the accuracy of predicting postoperative recurrence in patients with BTC.