High Recurrence Research Articles

Pathophysiology, Diagnosis, Prognosis, and Prevention of Poststroke Epilepsy: Clinical and Research Implications.

Poststroke epilepsy (PSE) is associated with higher mortality and poor functional and cognitive outcomes in patients with stroke. With the remarkable development of acute stroke treatment, there is a growing number of survivors with PSE. Although approximately 10% of patients with stroke develop PSE, given the significant burden of stroke worldwide, PSE is a significant problem in stroke survivors. Therefore, the attention of health policymakers and significant funding are required to promote PSE prevention research. The current PSE definition includes unprovoked seizures occurring more than 7 days after stroke onset, given the high recurrence risks of seizures. However, the pathologic cascade of stroke is not uniform, indicating the need for a tissue-based approach rather than a time-based one to distinguish early seizures from late seizures. EEG is a commonly used tool in the diagnostic work-up of PSE. EEG findings during the acute phase of stroke can potentially stratify the risk of subsequent seizures and predict the development of poststroke epileptogenesis. Recent reports suggest that cortical superficial siderosis, which may be involved in epileptogenesis, is a promising marker for PSE. By incorporating such markers, future risk-scoring models could guide treatment strategies, particularly for the primary prophylaxis of PSE. To date, drugs that prevent poststroke epileptogenesis are lacking. The primary challenge involves the substantial cost burden due to the difficulty of reliably enrolling patients who develop PSE. There is, therefore, a critical need to determine reliable biomarkers for PSE. The goal is to be able to use them for trial enrichment and as a surrogate outcome measure for epileptogenesis. Moreover, seizure prophylaxis is essential to prevent functional and cognitive decline in stroke survivors. Further elucidation of factors that contribute to poststroke epileptogenesis is eagerly awaited. Meanwhile, the regimen of antiseizure medications should be based on individual cardiovascular risk, psychosomatic comorbidities, and concomitant medications. This review summarizes the current understanding of poststroke epileptogenesis, its risks, prognostic models, prophylaxis, and strategies for secondary prevention of seizures and suggests strategies to advance research on PSE.

FBXO22 is a potential therapeutic target for recurrent chondrosarcoma

Chondrosarcoma (CHS) is a malignant bone tumor with insensitivity to both radiotherapy and chemotherapy, and a high recurrence rate. However, the latent mechanism of recurrent CHS (Re-CHS) remains elusive. Here, we discovered that FBXO22 was highly expressed in clinical samples of Re-CHS. FBXO22 played a significant role in various cancers. However, the role of FBXO22 in Re-CHS remained unclear. Our research demonstrated that suppressing FBXO22 abated the proliferation and migration of CHS cells and facilitated their apoptosis. In addition, suppressing FBXO22 raised the expression of PD-L1 in Re-CHS. All these findings provide new evidence for using FBXO22 and PD-L1 as combined targets to prevent and treat Re-CHS, which may prove to be a novel strategy for immunotherapy of CHS, especially Re-CHS.

Defining "High Recurrence" of Depressive Episodes for Predicting Diagnostic Conversion from Major Depressive Disorder to Bipolar Disorder: A 5-year Retrospective Study.

This study determined the threshold for recurrent depressive episodes that predicted conversion from major depressive disorder (MDD) to bipolar disorder (BD). We retrospectively reviewed the medical records of 296 patients diagnosed with MDD for a minimum of 5 years in two university hospitals. We examined their the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnoses and detailed clinical information at the initial admission and yearly assessments after discharge to establish the threshold for recurrent depressive episodes indicating a risk of diagnostic conversion from MDD to BD. Optimal cut-offs were derived using receiver operating characteristic (ROC) curves. ROC curve analysis revealed that more than four recurrent depressive episodes was indicative of potential diagnostic conversion from MDD to BD (area under the curve, 0.604; sensitivity, 0.353; specificity, 0.855; positive predictive value, 0.421; negative predictive value, 0.816). These findings suggest that the best predictor of conversion from MDD to BD is more than four recurrent depressive episodes. Our findings have the potential to enhance diagnostic accuracy and treatment efficiency. To validate our results, longitudinal prospective studies are necessary.

Postoperative trachomatous trichiasis and associated factors among adults who underwent trachomatous trichiasis surgery in Ambassel District, North-East Ethiopia.

In Trachoma endemic countries, many people who underwent Trichiasis surgery faced a recurrence of the disease. Postoperative Trichiasis is a significant problem for patients and health care providers because it puts the eye at renewed risk of sight loss. Despite the low utilization of Trachomatous Trichiasis surgery and the high recurrence rate, evidence that elucidate why it recurs after surgery is limited. This study was aimed to assess the magnitude and associated factors of postoperative Trichiasis among 18 years and above individuals who underwent Trachomatous Trichiasis surgery between 2013 and 2019 in Ambassel District, Northeast Ethiopia, 2020. The community-based cross-sectional study design was conducted from March 10 to March 23/2020 in selected kebeles of Ambassel District. The required sample size (506) was calculated using EPI-INFO Version 7. A multi-stage sampling technique was used to employ study participants. Data were collected through the interviewer-administered structured pre-tested questionnaire and entered into EpiData version 3.1 and then exported to SPSS version 23.0 for analysis. Bi-variable and multivariable logistic regression models were fitted to identify associated factors of Postoperative Trachomatous Trichiasis. Four hundred ninety two individuals participated in this study with a response rate of 97.2%. In Ambassel district, the prevalence of postoperative Trichiasis was 23.8% (95% CI = 19.9-27.8). Among associated factors of postoperative Trachomatous Trichiasis: age 50-59 (AOR = 3.34, CI = 1.38-8.1), 60-69 (AOR = 3.24, CI = 1.38-7.61), ≥70 years (AOR = 6.04, CI = 2.23-16.41), duration since surgery (AOR = 1.7, CI = 1.35-2.14), complication (AOR = 2.98, CI = 1.24-7.2), washing the face two times (AOR = 0.25, CI = 0.13-0.47), washing the face three and more times (AOR = 0.1, CI = 0.41-0.25), taking Azithromycin following surgery (AOR = 0.19, CI = 0.09-0.41), pre-operative epilation history (AOR = 2.11, CI = 1.14, 3.9) and having a knowledge about TrachomaTtrichiasis (AOR = 0.21, CI = 0.08-0.58) showed a statistical significant association. The prevalence of postoperative Trichiasis in Ambassel District was higher than most Ethiopian studies. Age, frequency of face washing, medication following surgery, duration since the last surgery, knowledge about trachoma, pre-operative epilation history, and complication after surgery were identified to be independent factors. To minimize postoperative Trachomatous Trichiasis stakeholders need to consider health education for patients, provision of Azithromycin after surgery, and proper training for integrated eye care workers.

Tumor Cell Membrane‐Camouflaged Vortex Magnetic Nanoannulars Programmed by Low‐Frequency Magnetic Field: A Novel Anti‐Cancer Delivery System in Triple‐Negative Breast Cancer

AbstractTriple‐negative breast cancer (TNBC), a highly aggressive form of breast cancer, currently lacks targeted therapies and is associated with high recurrence rates in medical practice. In this study, the effectiveness of a specially developed magnetic nanodrug, namely doxorubicin (DOX)‐loaded Fe3O4 vortex magnetic nanoannulars coated with a cancer cell membrane (DOX‐VMAs@CM), against cancer under a varying low‐frequency magnetic field (MF), is investigated. This advanced nanodrug can specifically target and accumulate in tumors. Additionally, it considerably improves tumor suppression compared with that of DOX chemotherapy alone, indicating the possibility of homologous targeting of the cancer cell membrane and the vibrating effect of the MF. The DOX‐VMAs@CM nanoparticles (NPs) exhibit exceptional safety characteristics because of their ability to specifically target tumors. The results of RNA sequencing suggest that the potential mechanisms may involve cellular respiration, cell cycle, and ferroptosis regulation. Altogether, chemotherapy is successfully optimized by implementing a delivery system and MF intervention, and the developed DOX‐VMAs@CM NPs hold significant potential for use in the clinical treatment of TNBC.

MiRNAs in radiotherapy resistance of cancer; a comprehensive review.

While intensity-modulated radiation therapy-based comprehensive therapy increases outcomes, cancer patients still have a low five-year survival rate and a high recurrence rate. The primary factor contributing to cancer patients' poor prognoses is radiation resistance. A class of endogenous non-coding RNAs, known as microRNAs (miRNAs), controls various biological processes in eukaryotes. These miRNAs influence tumor cell growth, death, migration, invasion, and metastasis, which controls how human carcinoma develops and spreads. The correlation between the unbalanced expression of miRNAs and the prognosis and sensitivity to radiation therapy is well-established. MiRNAs have a significant impact on the regulation of DNA repair, the epithelial-to-mesenchymal transition (EMT), and stemness in the tumor radiation response. But because radio resistance is a complicated phenomena, further research is required to fully comprehend these mechanisms. Radiation response rates vary depending on the modality used, which includes the method of delivery, radiation dosage, tumor stage and grade, confounding medical co-morbidities, and intrinsic tumor microenvironment. Here, we summarize the possible mechanisms through which miRNAs contribute to human tumors' resistance to radiation.

Specifics of regional recurrences in lateral tissue of the neck after surgical treatment of highly differentiated thyroid cancer

Introduction. Despite the fact that highly differentiated thyroid cancer is included in the group of malignant neoplasms with a favorable prognosis, data on the high frequency and recurrence of relapses are reported. The presence of metastatic lymph nodes in HDTC increases the risk of regional relapse by up to 27%. According to the literature, the factors that increase the risk of recurrence are: histological type, stage, depth of extrathyroid invasion, the presence of metastatic lymph nodes, age, and the volume of primary surgical intervention. Lateral neck dissection should be performed in patients with morphologically verified metastatic thyroid cancer, but there is still no clear consensus on the volume of dissection.Aim. Assessment of factors affecting the risk of regional recurrence in the lateral neck tissue and the localization of recurrence.Materials and methods. The study included 56 patients with HDTC, in whom metastatic lateral neck nodes were identified and verified. All patients previously underwent unilateral or bilateral neck lymph node dissection in various institutions. During the period of dynamic follow-up, these patients revealed regional recurrences in the lateral tissue of the neck. The patients were observed and treated for recurrence at the N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia.Results. Age over 55 years is a prognostically significant factor affecting the frequency of regional relapse in the lateral neck tissue (p=0.002). The presence of metastatic nodes in the lateral tissue of the neck at the initial treatment is a prognostically significant factor that increases the risk of regional recurrence in the lateral tissue of the neck (p=0.017). According to the results of a single-factor analysis, a statistically significant effect of the stage on the risk of regional relapses in the lateral neck tissue was noted (p=0.014). In 35.7% of cases, recurrent nodes were localized in the level V.Conclusion. Main risk factors for relapse are clinico-morphological, such as age, aggressive type of HDTC, stage of the disease, N1b status after primary surgery, as well as technical defects during primary surgical treatment.

STAGED, LAPAROSCOPIC HYBRID EPAULI REPAIR FOR LARGE PARASTOMAL HERNIA – CASE REPORT

Abstract Background Managing large parastomal hernias poses significant challenges due to their high recurrence rates and the elevated risk for peri- and post-operative complications. Method Case report of a successful repair of a large parastomal hernia using a staged minimally invasive, hybrid approach. Results The patient underwent uncomplicated laparoscopic total colectomy in 2016 for ulcerative colitis. Several years later, in 2020, the patient presented to our hospital with a large parastomal hernia with obesity as comorbidity. To address this complex hernia, the patient was referred to the obesity team and underwent laparoscopic gastric sleeve resection in autumn 2021. In 2022, the patient's BMI had decreased to below 30, prompting the decision to proceed with hernia surgery. In May 2022, we performed chemical component separation using 300 units of Botox. Four weeks later, laparoscopic hybrid Epauli repair was undertaken. The laparoscopic component involved reducing hernia contents, abdominal wall dissection with Transversus Abdominis Release (TAR), mesh placement, and closing the posterior layer. Open surgery was interspersed throughout the laparoscopic procedure and at its conclusion. This included temporary stoma closure and reduction, temporary stoma site closure, medial repositioning of the stoma through rectus, excess skin excision, and stoma re-suturing. The patient experienced an uncomplicated recovery. In January 2023, the patient underwent complete abdominoplasty. A one-year postoperative CT scan and clinical control demonstrated a satisfactory outcome. Conclusion For complex and large parastomal hernias, hybrid surgery, combining open and minimally invasive approaches, offers a valuable operative strategy for managing such large hernias.

Possibilities of using lactobacilli metabolites for the treatment and prevention of bacterial vaginosis

Bacterial vaginosis is one of the most common reasons for pathological discharge from the genital tract in women of reproductive age, which, among other things, is characterized by a high recurrence rate after standard antibacterial treatment. To date, issues related to the prevention and treatment of bacterial vaginosis have remained relevant and unresolved. This review article discusses the feasibility of using lactobacilli metabolites in the treatment and prevention of bacterial vaginosis, taking into account the data accumulated. The use of lactic acid as an additional second stage of bacterial vaginosis treatment can be considered as a way to improve the effectiveness of therapy and patient adherence to treatment, as well as to reduce the likelihood of recurrences.

Upregulated lncRNA LINC01128 in colorectal cancer accelerates cell growth and predicts malignant prognosis through sponging miR-363-3p

PurposeColorectal cancer (CRC) refers to high-mortality tumors arising in the colon or rectum with a high rate of recurrence. The involvement of long non-coding RNAs (lncRNAs) contributes to the treatment and prognosis evaluation of CRC, and brings a new direction for the radical cure of patients. To identify the pathological mechanism and regulation of lncRNA LINC01128 (LINC01128) on CRC cells, and analyze its potential prognostic value.MethodsLINC01128 level in tissue and cell specimens from 122 CRC patients was evaluated by RT-qPCR. The clinical significance and prognostic value of LINC01128 in CRC were analyzed via Kaplan–Meier and Cox analysis. CCK8 and Transwell assays were used to study the function of LINC01128 in vitro. The relationship between LINC01128 and miR-363-3p was confirmed by luciferase reporter gene assay.ResultsThe overexpression of LINC01128 is associated with TNM stage and lymph node metastasis in CRC patients. Silencing LINC01128 inhibited the proliferation and metastasis of CRC cells. In addition, LINC01128 directly targeted and negatively regulated the miR-363-3p expression, while miR-363-3p inhibitor restored the inhibitory function of LINC01128.ConclusionAs an independent prognostic factor of CRC, upregulation of LINC01128 predicts poor prognosis and accelerates tumor deterioration through miR-363-3p.

Invasive micropapillary type male breast cancer: a case report

Male breast cancer is rarely seen and peaks at the age of 71. Hyperestrogenism, gonadal dysfunction, obesity, and alcohol are among the risk factors for male breast cancer. In hereditary cases, BRCA2 mutation is often observed. The most common symptom is a painless mass that is palpable behind the nipple. Most male breast cancers are ductal carcinomas (81%), papillary carcinomas (13%), and mucinous carcinomas (6%). The invasive micropapillary carcinoma of the breast is important due to its high rate of lymphnode metastasis, recurrence, and distant metastasis. Mortality is 50% higher in men with lymphnode involvement compared to non-involved cases. Furthermore, as the number of affected lymphnodes increases, the prognos is worsens. In this study, we examined a case of invasive micropapillary type male breast cancer with clinical presentation as a palpable mass, lymphnode involvement, and aimed to highlight the radiological considerations that need attention.

Medullary Thyroid Carcinoma

Medullary thyroid carcinoma is a rare malignant tumor of the thyroid. An early diagnosis is associated with a better prognosis. Calcitonin is the cornerstone of diagnosis. In this study, we will discuss the clinical and evolutionary characteristics of this condition through a retrospective study of thirty-three patients over a period of seven years between January 2013 and December 2019. Our study includes 33 patients, comprising 12 men and 21 women with a sex ratio of 0.57. The average age of our patients is 45 years. A family history of similar cases was present in six patients (18%). As for the circumstances of discovery in our study, all our patients consulted for a cervical swelling (100%). Seven patients (20%) presented with signs suggestive of malignancy (dysphonia), and fourteen patients (40%) had lymphadenopathy at the time of diagnosis. Calcitonin levels were measured preoperatively in eighteen patients with a very high recurrence rate (60%). Cervical lymph node metastases were present in 40% of cases (fourteen patients). Total thyroidectomy was performed in all patients in our series. It was performed initially in 70% of cases. For patients who initially underwent partial thyroidectomy, we performed totalization regarding the other thyroid lobe. Lymph node dissection was performed in 60% of cases. Radiotherapy was indicated for all patients in our series except for the two patients with normal postoperative calcitonin levels. Close surveillance was the therapeutic choice for these patients. MTC remains a relatively rare tumor. It mainly affects young adults and mainly manifests as an isolated thyroid nodule. It is a lymphophilic tumor, and lymph node involvement is very early. Calcitonin is the basis of preoperative diagnosis. It guides the stage of the disease, helps to guide surgery, constitutes a key element of follow-up, and is considered an important prognostic factor for survival. Despite advances in targeted therapy, complete surgical resection rem

Prediction of atrial fibrillation in patients with stroke: a systematic review with meta-analysis

Abstract Background Atrial fibrillation-related strokes have a high rate of recurrence,1 and are associated with substantial morbidity, long-term disability, and mortality.2,3 Detection of AF at the time of stroke may require extended cardiac rhythm monitoring,4-6 which is costly.7 Identifying patients with stroke at high risk for AF can be challenging but important for preventing recurrent strokes. Purpose To provide an overview of prediction tools for AF in patients with an acute stroke, and to determine suitability for clinical use by synthesising discriminatory abilities. Methods We performed a systematic review of prediction tools (including multivariable scores and individual parameters) derived, validated and/or augmented for AF prediction in patients with strokes using Medline and Embase through 25 October 2023. Discrimination measures for tools with c-statistic data from ≥3 cohorts were pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Summary discrimination values of <0.60, 0.60-0.70, 0.70-0.80, and >0.80 were defined a priori as inadequate, adequate, good and excellent.1 Results From 8125 unique records we included 71 studies from 135 cohorts with a mean age and percentage of women ranging from 43.0 years to 77.5 years, and 25.2% to 55.3%, respectively. We identified 99 prediction tools for incident AF after a stroke. 33 predictive tools used clinical variables, 13 only used Echocardiographic data, 14 only used electrocardiogram (ECG) data, and 39 used combinations of the above modalities. 87 tools were developed with Cox or logistic regression and 12 tools through machine learning approaches. 36 had undergone external validation, with 27 demonstrating a c-statistic >0.75 on external validation. Nine multivariable prediction models and two predictive factors (B-type natriuretic peptide and age) were eligible for meta-analysis. Of multivariable prediction models, 4 showed good summary discrimination with wide heterogeneity (Figure 1): LADS (n = 1286, summary c-statistic 0.713, 95% CI 0.534-0.882 95% PI 0.379 -0.979), CHASE-LESS (n = 22747 summary c-statistic 0.726, 95% CI 0.667-0.785 95% PI 0.608-0.836), AS5F (n = 31517, summary c-statistic 0.726, 95% CI 0.693-0.754 95% PI 0.645-0.808), STAF (n = 3759, summary c-statistic 0.771, 95% CI 0.679-0.859 95% PI 0.456-0.973). BNP showed excellent summary discrimination with acceptable heterogeneity (Figure 2), (n = 1343 summary c-statistic 0.832, 95% CI 0.776-0.886 95% PI 0.718-0.927). Conclusions Five prediction tools externally validated for prediction of risk of AF in those who have had an acute stroke demonstrate good predictive ability. In meta-analysis, BNP performed the best out of all the models and variables tested.

Association of spontaneous coronary artery dissection with bradycardia - a novel observational study

Abstract Introduction Spontaneous coronary artery dissection (SCAD) is a common cause of Myocardial infarction (MI) in women less than 50 years of age (1). SCAD has a high recurrent rate, and beta blockers are the only drug shown to reduce the recurrence of SCAD. However, in our clinical practice, we could not use beta-blockers in some of our patients due to sinus bradycardia of unclear cause. Therefore, we planned to study if SCAD could cause Bradycardia. Purpose To determine if Bradycardia is associated with SCAD. Methodology Utilising the National Inpatient Sample (NIS) from 2016 to 2020, we performed a multivariable logistic regression analysis to determine if SCAD was independently associated with Bradycardia (ICD-10 code R0.01) among adults. SCAD was defined as coronary artery dissection (ICD-10 code I25.42) after excluding patients who had PCI. Results A- A total of 2,561,434 (95% CI 2,526,646-2,596,222) weighted hospitalisations with Bradycardia and 18,049 (95% CI 17,288-18,811) with SCAD was included. Bradycardia was present in 5.2% (95% CI 4.6-6) of patients with SCAD and 1.7% (95% 1.7-1.7) in patients without SCAD. After adjusting for relevant causes of Bradycardia, SCAD was highly associated with Bradycardia (OR 3.04, 95% CI 2.61-3.55). Among all the risk factors studied, SCAD showed the 2nd highest strength of association (Table 1). Discussion We report the first described association of SCAD with Bradycardia in literature. Although the prevalence of Bradycardia with SCAD in our study is only 5.2%, Bradycardia is frequently not coded, and we suspect the true frequency of Bradycardia in SCAD is much higher. The exact mechanism for this association is unclear. Although the frequency of beta-blocker use is not available in our study, several other conditions, such as ischemic heart disease and cardiomyopathy, which involve more frequent beta-blocker use, did not show a degree of association as strong as SCAD with bradycardia. Therefore, we hypothesize Bradycardia could be from SCAD itself, and the current ongoing BA-SCAD (Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection) trial could shed light on this association (2).

Safety and efficacy of a temperature-controlled ablation system for ventricular tachycardia: first results from the TRAC-VT study

Abstract Background Catheter ablation using radiofrequency (RF) energy, is a well-recognized treatment option for patients with ventricular arrhythmias. However, procedural complications may be high, and efficacy is often suboptimal with high recurrence rates. Purpose The TRAC-VT study evaluated safety and efficacy of the DiamondTemp Ablation (DTA) System for the treatment of patients with ventricular arrhythmias by catheter ablation. Methods A temperature-controlled, irrigated RF catheter (with six thermocouples and an internal network of diamond coatings) was utilized to treat subjects with either sustained monomorphic ventricular tachycardia (VT) and structural heart disease or with frequent monomorphic symptomatic ventricular premature beats (VPBs) and normal hearts. Patients were enrolled at five hospital centers in five European countries and were followed for 6 months. Ablation was performed in temperature-control mode with an irrigation flow of 8 mL/min for all power deliveries. The target temperature was set to 55 or 60 °C with a power output limited to 50 Watts. RF energy was applied for a maximum of 45 seconds per target site, depending on impedance drop and electrogram abatement. Results The study enrolled 49 subjects (age 67±12 years, 80% male) in total (38 with sustained monomorphic VT and structural heart disease and 11 with symptomatic VPBs). In all cases, mapping and navigation was used with EnSite systems (Abbott). The average ablation time (defined as time from the insertion of the DTA catheter until removal from body) was 87 ± 44 minutes. During this time, RF energy was applied for an average of 28.2 ± 10.2 seconds with a power of 44.0 ± 7.0 W and a temperature of 50.9 ± 3.9 °C during 35.0 ± 23.2 applications. Acute procedural success was 100% (93%-100%), and it was defined as the elimination of VPBs or non-inducibility for sustained VT (using solely the DTA catheter). The primary safety procedure-related endpoint was an evaluation of cardiovascular-related death, stroke / TIA, cardiac tamponade/perforation, bleeding complication, myocardial infarction, thromboembolism, and pulmonary edema. In total review of the primary safety endpoint, one subject had a confirmation of a stroke / TIA event. Regarding longer term procedural efficacy, the 6-month follow-up was completed in 92% of subjects. For the whole study population chronic success from recurrence of ventricular arrhythmia (faster than 100 beats/min after 6 months) was 73.4% (58.6%-83.6%) for non-sustained ventricular arrhythmias (≥3 beats) and 87.7% (74.7%-94.3%) for sustained ventricular arrhythmias (≥30 sec). Conclusions VT/VPBs ablation using a temperature-controlled irrigated RF catheter was safe and effective with low VT recurrence at 6 months of follow-up.

Higher recurrence rate after ablation of persistent atrial fibrillation in patients with prolonged P-wave negativity in lead V1

Abstract Background Several ECG P-wave parameters, such as duration, amplitude and morphology reflect the electromechanical condition of the atria. P-wave features mainly served to identify patients prone to atrial fibrillation (AF) or to predict recurrence of paroxysmal AF after ablation. Purpose We sought to investigate which specific features derived from the P-wave might help identify patients with persistent atrial fibrillation (peAF) unresponsive to wide circumferential pulmonary veins isolation (WPVI). Methods 41 patients (63±10 y) with peAF (sustained duration 11±7 months) underwent a de-novo WPVI. A second WPVI was performed in patients with recurrent AF in order to provide complete PV disconnection. We defined "success" as patients who remained in sinus rhythm (SR) after one or two procedures, and "failure" otherwise. The average duration and amplitude of the P-waves on ECG lead II, and the duration and amplitude of positive and negative deflections on ECG lead V1 were extracted during SR after cardioversion at the end of the index WPVI. P-wave terminal force in V1 (PTFV1) was computed as the product of negative amplitude and duration in lead V1. Results Over a mean follow-up of 32±9 months, 24 patients remained free from AF (success group), while 11 patients had AF recurrence after 2 WPVIs (failure group). Six patients were lost to follow-up or declined the second WPVI. 45% (5/11) were ON antiarrhythmic drugs (AAD) during follow-up in the failure group, while 0.04% (1/24) were ON AAD in the success group (p<0.05). Other clinical characteristics (e.g. age, body mass index, left atrial volume or duration in sustained AF) were similar. The figure displays P-wave metrics of patients ON and OFF AAD during follow-up. No significant differences were found in P-wave duration (lead II; Panel A1), in PTFV1 (Panel A2), and in duration of V1 positive deflection (Panel A3). Interestingly, the failure group displayed longer duration of the negative deflection in V1 (76±17ms) than that of the success group (68±18ms, p<0.05; Panel A4). Panel B shows that the differences remained after exclusion of patients ON AAD during follow-up. No differences were found in P-wave amplitude in lead II or in amplitude of positive and negative deflections in lead V1 (data not shown). Conclusion Our results show that prolonged negativity in lead V1, which is indicative of left atrial electromechanical remodeling, is associated with failure to restore long-term sinus rhythm after WPVI of peAF.

Predictive value of guideline-referred risk scores in estimating left atrial low voltage areas and recurrence of atrial fibrillation in repeat ablation procedures

Abstract Background Despite advances in mapping and ablation techniques, atrial fibrillation (AF) recurrence remains a challenge after pulmonary vein isolation. Low voltage areas (LVA) in the left atrium are associated with higher recurrence rates after left atrial ablation. Risk scores for evaluating post-ablation recurrences are not well established, although a better patient selection for repeat procedures would be of great help in clinical practice. Purpose Risk scores for prediction of AF recurrence have not been tested in a cohort of repeat ablations. Methods This single-center study includes consecutive patients from the prospective Bernau ablation registry undergoing ultra-high-density (UHD) mapping and repeat ablation for AF/AT recurrence between 2016 and 2020. The potential of seven guideline mentioned risk scores (APPLE, DR-FLASH, MB-LATER, ATLAS, CAAP-AF, BASE-AF 2, ALARMEc) to predict (1) AF/AT recurrence beyond a three-months blanking period after repeat left atrial ablation (Re-PVI ± further LA ablation) and (2) the percentage of left atrial LVA in UHD mapping was investigated. LVA were defined as sites with a bipolar peak-to-peak voltage of <0.5 mV with an extent of >1cm². Optimal cutoff for sensitivity and specificity for LVA and AF/AT recurrence as endpoint was chosen using C statistics with receiver-operator characteristics (ROC). Further ROCs were performed to illustrate the predictive ability of the scores. Pearson correlation was used to test associations between variables. Results 160 patients (mean age 67.9 ± 9.1 years, 60.6% persistent AF, mean AF duration 4.6 ± 3.8 years) with complete left atrial UHD mappings (mean EGMs 9754 ± 5808) were included. Overall recurrence rate over a mean follow-up time of 16 ± 11 months was 55.6%. The predictive value of the investigated risk scores on AF/AT recurrence in our cohort was low (Table 1), with the highest power for CAAP-AF (p = 0.015, AUC = 0.615) and DR-FLASH score (p = 0.040, AUC = 0.594), Figure 1. With respect to left atrial LVA we found a better predictive power for the CAAP-AF (p < 0.001, AUC 0.702), APPLE (p < 0.001, AUC 0.687), DR-FLASH (p < 0.001, AUC 0.688), ATLAS (p = 0.005, AUC 0.634) and ALARMEc (p = 0.007, AUC 0.608) score to predict low voltage based on a calculated cut-off of 22% of total left atrial surface (Figure 1). Conclusion The predictive value of guideline-referred risk scores in estimating AF/AT recurrence after repeat ablation is low and does not seem to be of relevant help in patient selection for further interventional treatment. Some scores demonstrate a fairly good prediction for the amount of left atrial LVA and therefore might help in choosing the right mapping and ablation regime beforehand.

Integrating clinical variables with magnetic resonance imaging and electroanatomic mapping parameters to predict response to first-time and repeat atrial fibrillation ablation procedures

Abstract Background The heterogeneity in patient response to atrial fibrillation ablation mandates the development of methods to predict clinical outcomes. Several clinical risk scores exist to prognosticate patients post ablation. Magnetic resonance imaging can quantify anatomical and functional atrial properties, whilst electroanatomic mapping data provides unparalleled atrial substrate characterisation. These data could be leveraged to predict ablation outcomes more accurately. Purpose To incorporate magnetic resonance imaging and electroanatomic mapping parameters with clinical variables to predict response to 1) first-time and 2) repeat atrial fibrillation ablation. Methods A retrospective analysis of 123 consecutive patients undergoing first-time atrial fibrillation ablation including pre-procedural atrial magnetic resonance imaging was performed. Data were split into training (n=68) and test (n=55) cohorts depending on data availability for clinical risk score calculation. The APPLE, DR-FLASH, FLAME, HATCH, HATCH+OSA, CHA2Ds2VASc and CAAP-AF scores were calculated for patients in the training cohort. Univariate logistic regression was used to identify variables associated with arrhythmia recurrence which were then combined into a multivariate logistic regression model. Area under the curve receiver operating characteristic (AUC-ROC) analysis was used to compare the ability of clinical risk scores and the combined model to predict arrhythmia recurrence risk after one procedure. The model's ability to predict repeat ablation response was tested in 38 patients who underwent redo procedures. The ROC optimal cut-off score was used to divide patients into two groups (high and low arrhythmia recurrence risk) for time-to-event analysis. Results In univariate analysis, weight, age, hypertension, left atrial ejection fraction and mean left atrial bipolar voltage were associated with arrhythmia recurrence after one procedure. The multivariate logistic regression model achieved an AUC of 0.7491 (95% confidence interval (CI) 0.6269-0.8712) in the training cohort and 0.7457 (95% CI 0.6137-0.8778) in the test cohort for predicting arrhythmia recurrence at 12 months (Figure 1A). Amongst clinical risk prediction tools, CAAP-AF had the highest predictive value (AUC 0.6529, 95% CI 0.5265-0.7793) (Figure 1B). In patients undergoing repeat ablations, the combined model had an AUC of 0.7585 (95% CI 0.5989-0.9182) for predicting arrhythmia recurrence (Figure 2A). The Kaplan-Meier curves showed a higher risk of arrhythmia recurrence in the ‘high recurrence risk’ group at 12 months (log-rank p=0.029) (Figure 2B). Conclusion A logistic regression model integrating clinical, anatomical, functional, and electrophysiological parameters improved the accuracy of atrial fibrillation ablation outcome prediction compared to existing clinical risk scores. The model may be used to predict response to repeat procedures offering the potential to improve the patient selection process.

Feasibility and limitations of combined treatment for lateral pelvic lymph node metastases in rectal cancer

Colorectal cancer ranks among the most commonly diagnosed cancers globally, and is associated with a high rate of pelvic recurrence after surgery. In efforts to mitigate recurrence, pelvic lymph node dissection (PLND) is commonly advocated as an adjunct to radical surgery. Neoadjuvant chemoradiotherapy (NACRT) is a therapeutic approach employed in managing locally advanced rectal cancer, and has been found to increase the survival rates. Chua et al have proposed a combination of NACRT with selective PLND for addressing lateral pelvic lymph node metastases in rectal cancer patients, with the aim of reducing recurrence and improving survival outcomes. Nevertheless, certain studies have indicated that the addition of PLND to NACRT and total mesorectal excision did not yield a significant reduction in local recurrence rates or improvement in survival. Consequently, meticulous patient selection and perioperative chemotherapy may prove indispensable in ensuring the efficacy of PLND.

P.117 Antiplatelet and anticoagulation use and outcomes following chronic subdural hematoma drainage: systematic review and meta-analysis

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition which can be treated with surgical evacuation. A significant percentage of CSDH patients are on antiplatelet or anticoagulation therapy at baseline which may influence risk of recurrence and postoperative thromboembolic events Methods: A search was conducted in MEDLINE (1946 to April 6, 2023), Embase (1974 to April 6, 2023), and PubMed (up to April 6, 2023) on preoperative use of antiplatelet or anticoagulation therapy and outcomes following surgical evacuation of CSDH. Results: Our literature includes 14,410 patients ifrom 42 studies, with 3218 (22%) in the antiplatelet (AP) group, 1731(12%) in the anticoagulation (AC) group, and 9537 (66%) in the no antithrombotics (NA) group. The AP group had significantly higher recurrence compared to NA (OR = 1.21, 95% CI = 1.04 to 1.40, p = 0.01). The AC group also had significantly high recurrence compared to NA (OR = 1.39. 95% CI = 1.15 to 1.68, p = 0.0007). However, being on any antithrombotic therapy is also associated with significantly higher thromboembolic events (OR 5.41, 95% CI 3.16 to 9.26, p < 0.00001). Conclusions: Patients on antithrombotic therapy have both higher recurrence and higher thromboembolic risk compared to patients not on antithrombotic therapy.