Incidence Of Syndromes Research Articles

Assessment of cognitive disorders in elderly type 2 diabetic patients with obesity

ABSTRACT Background Cognitive impairment is common in the elderly and can result from many chronic illnesses. The risk of CI is around one-third for older persons with diabetes. Diabetes increases the incidence of numerous common geriatric syndromes in older persons, including polypharmacy, CI, depression, urine incontinence, injurious falls, and chronic pain. Additionally, obesity raises the risk of high blood pressure, and DM and promotes arterial aging, which are known to be independent risk factors for CI. Objective The current study evaluated cognitive disorders in elderly type 2 diabetic patients with obesity. Material and Methods A sample of 120 elderly persons was divided into 3 groups: Group (1): 40 elderly non-obese non-diabetics (Control), Group (2): 40 elderly obese non-diabetic patients, and Group (3): 40 elderly obese type 2 diabetic patients. Fasting plasma glucose (FPG), 2 hPPPG (2 hour post prandial plasma glucose), glycosylated hemoglobin (HA1C) were measured. Obesity was assessed using height, weight, body mass index (BMI), and waist circumference (WC). Cognitive impairment in the elderly was detected using a questionnaire called the Montreal Cognitive Assessment (MoCA). Results There was statistical significance between the three investigated groups concerning HbA1c, FPG, and 2-hour PPG. Also, there was statistical significance between the three study groups in terms of total MOCA score. Weight, BMI, and WC showed statistical significance between the three study groups. Conclusion: Cognitive impairment is related to obesity and type 2 diabetes in elderly.

In vivo imaging of alkaline phosphatase in lipid metabolic diseases with a photoacoustic probe

Lipid metabolic diseases have become an important challenge to global public health. Along with lifestyle changes, the incidence of obesity, diabetes and other metabolic syndromes is on the rise, and the number of patients with fatty liver disease is also increasing. Therefore, it is particularly important to develop effective lipid imaging strategies to monitor and manage fatty liver disease. Herein, based on the essential role of alkaline phosphatase (ALP) in both AS and OB, in vivo imaging of ALP was achieved in two lipid metabolic diseases models with a photoacoustic (PA) probe phosphorylated hemicyanine (P-Hcy). After being triggered by ALP, P-Hcy responded in different modalities including absorbance, fluorescence and, most significantly, PA-reporting. Notably, the PA signal showed the reliable linear correlation to the ALP level within the range of 0–800 U/L. The probe P-Hcy exhibited the advantages including high sensitivity, high selectivity, and steadiness in required biological conditions. The intracellular imaging results ensured that P-Hcy could visualize the ALP level in the foam cells induced from mouse mononuclear macrophages. In the healthy and lipid metabolic diseases models, P-Hcy was able to distinguish well between a lipid metabolic disease model and a healthy mouse model by photoacoustic imaging. By combining the ALP detection with P-Hcy in PA/fluorescence modality and traditional techniques such as blood biochemical testing and immunohistochemically staining, more potential strategy to accurately diagnose lipid metabolic diseases in the pre-clinical trials might be developed in future.

FOLFOX-Based Hepatic Arterial Infusion Chemotherapy with Sequential Drug-Eluting Bead Transarterial Chemoembolization for Unresectable Large Hepatocellular Carcinoma: A Single-Center Retrospective Cohort Study.

For patients with large unresectable hepatocellular carcinoma (HCC), the effectiveness of conventional transarterial chemoembolization (TACE) remains suboptimal, which necessitates the administration of substantial volumes of chemotherapy drugs and lipiodol, thereby increasing the risk of liver failure and other chemotherapy-related complications. Therefore, we devised a strategy of initial hepatic arterial infusion chemotherapy (HAIC) followed by sequential drug-eluting bead TACE (DEB-TACE). In our treatment design, a lower tumor burden after HAIC facilitated complete embolization of tumor vasculature, and the use of less amount of embolic agents reduced the incidence of liver failure and embolization syndromes. This retrospective study evaluated consecutive patients with unresectable large HCC with a maximum tumor diameter of ≥7 cm who received FOLFOX-HAIC combined with sequential DEB-TACE from April 2019 to February 2024. Efficacy was evaluated using the objective response rate (ORR), overall survival (OS), and progression-free survival (PFS); and safety was assessed using the frequency of key adverse events (AEs). Among the 76 patients included, the median maximum tumor diameter was 12.4 cm (range, 7.0-23.4 cm). The overall ORRs based on mRECIST and RECIST 1.1 criteria were 94.1% and 51.5%, respectively. The median OS was 28.1 months (95% CI, 22.7-33.4), and the median PFS was 11.7 months (95% CI, 7.7-15.8). All patients experienced AEs, but only 18.4% experienced grade 3 or 4 AEs, there was no treatment-related mortality. In this single-center, retrospective study, our results suggested that FOLFOX-HAIC with sequential DEB-TACE demonstrated promising efficacy and safety for patients with unresectable HCC with a maximum tumor diameter of ≥7 cm.

Cardiometabolic multimorbidity and neuropsychiatric disturbances in multiregional older adults

AbstractIntroductionTo investigate the association between cardiometabolic multimorbidity (CMM) patterns and dementia‐related neuropsychiatric symptoms (NPSs) among multiregional and ethnic seniors.MethodsFour Asian studies (discovery) and UK Biobank (validation) were included. CMM was defined as two or more of hypertension, hyperlipidemia, diabetes mellitus, stroke, and heart disease. The latent class analysis identified CMM patterns. Two‐step individual participant data (IPD) and Cox regressions explored associations between CMM and the presence and short‐term (1–2 years) incidence of four neuropsychiatric subsyndromes: psychosis, hyperactivity, affective, and apathy.ResultsA total of 2950 Asian and 40,424 UK participants were included. Metabolic multimorbidity (≥2 of hypertension, hyperlipidemia, and diabetes mellitus) was associated with the presence (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.00–1.81; and 1.93, 1.73–2.16; in the respective data set), and incidence (hazard ratio [HR] = 3.91, 1.53–10.01; and 6.94, 2.52–19.07) of affective subsyndrome. Cardio‐cerebrovascular multimorbidity (≥2 of hypertension, stroke, and heart disease) was not associated with any NPSs.DiscussionMetabolic multimorbidity may exacerbate the neuropsychiatric disturbances of possible dementia.Highlights Four Asian multiregional and ethnic studies were included as the discovery data set, with the UK Biobank being applied as the validation data set. Metabolic multimorbidity had a higher presence and short‐term incidence of affective syndromes. Cardio‐cerebrovascular multimorbidity was not associated with any neuropsychiatric symptoms.

The mitochondrial function of peripheral blood mononuclear cells in frail older patients

BackgroundFrailty increases the incidence of geriatric syndromes and even the risk of death in old adults. However, the diagnostic criteria for frailty are inconsistent because of complex pathological processes and diverse clinical manifestations. To determine the effective biomarker and recognize frail status early, we investigated the correlation of mitochondrial morphology and function of human peripheral blood mononuclear cells (PBMCs) with frailty status in older adults. MethodsThis Cross-sectional study followed 393 participants (aged 25–100 years, female 31.04 %) from the First Affiliated Hospital of Nanjing Medical University. The frailty status of subjects was assessed by the physical frailty phenotype (PFP) scale. We analyzed mitochondria functions including mitochondria copy number (mtDNAcn), the mRNA expressions of mitochondrial dynamics-related genes mitofusin 1(MFN1), mitofusin 2(MFN2), optic atrophy protein-1(OPA1), fission protein-1(FIS1) and dynamin-related protein 1(DRP1), mitochondrial oxidative respiration and reactive oxygen species(ROS) levels in PBMCs. Mitochondria morphology, size, and number were observed by transmission electron microscopy (TEM). ResultsAfter adjustment for sex and BMI, mtDNAcn, the mRNA expression of FIS1, mitochondrial respiratory function (proton leak, maximum oxygen consumption, and respiratory reserve) and ROS level were significantly correlated with age (P = 0.031, 0.030, 0.042, 0.003, 0.002, 0.022, respectively). After correcting for age, sex, and BMI, mtDNAcn and the mRNA expression of OPA1 were correlated with 4 m gait speed respectively (P = 0.003, 0.028, respectively). Compared with non-frail people, mtDNAcn, the mRNA expression of MFN1, mitochondrial basal respiration, proton leak, maximum oxygen consumption, ATP production and space capacity were significantly decreased in frail older adults (P = 0.013, 0.036, 0.026, 0.024, 0.012, 0.032, 0.020, respectively). ROS levels were significantly increased in the frail group (P = 0.016). Compared with non-frail people, the number, length, and perimeter, area of mitochondria were reduced in frail group under TEM (all P < 0.001). ConclusionMitochondrial dysfunctions (decreased mtDNAcn, impaired mitochondrial morphology, imbalanced mitochondrial dynamic, impaired mitochondrial respiratory function, and increased ROS levels) were significantly correlated with frail status.

Syndromic Surveillance in Public Health Emergencies: A Systematic Analysis of Cases Related to Exposure to 2023 Floodwaters in Romagna, Italy.

In May 2023, Romagna, Italy, faced a devastating flood resulting in 16 fatalities, forced displacement of 26,000 citizens, and significant economic losses. Due to potential water contamination, implementing public health strategies became imperative for the Local Health Authority to mitigate the health consequences, analyze the flood's impact on the local population's health, and detect early anomalies requiring timely public health interventions. Between June and July 2023, general practitioners who were part of the RespiVirNet surveillance network completed weekly structured forms. These forms collected data on individuals exposed or not to floodwaters and clinical syndromes. Rates per 1000 resident population aged > 14 were stratified by district, week of observation, and symptomatology. Missing data were addressed by imputation using second-order autoregressive modeling. An incidence of 3.52 syndromes potentially related to flood water exposure per 1000 individuals (95% CI 2.82-4.35) was estimated. Ravenna, the city most affected by the flood, recorded the highest rate (6.05 per 1000, 95% CI 4.59-7.82). Incidence decreased in the weeks post-event. Anxiety, or trauma and stress symptoms, exhibited higher rates among the exposed, diminishing over weeks. The incidence for the non-exposed (12.76 per 1000, 95% CI 10.55-15.29) showed no significant territorial differences compared to the exposed ones. Syndromic surveillance provided timely information on the flood's health impact, revealing a higher incidence of individual syndromes among the non-exposed. This study contributes to guiding the implementation of future public health preparedness and response strategies for populations facing similar natural disasters.

Prevalence and Rapid Screen Method of Diagnostic Criteria for Psychosomatic Research Syndromes in Human Papillomavirus-Infected Patients

Introduction: The early and rapid identification of psychosomatic symptoms is crucial to prevent harmful outcomes in patients with human papillomavirus (HPV) infection in busy comprehensive clinics. This study aimed to explore the prevalence and rapid screening method of the Diagnostic Criteria for Psychosomatic Research-revised (DCPR) syndromes in patients with HPV infection. Methods: A total of 504 participants underwent a clinical assessment that included DCPR, Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), the Social Support Rating Scale (SSRS), the Simplified Coping Style Questionnaire (SCSQ), fear of disease, sociodemographic and clinical characteristics. The prevalence of DCPR syndromes and DSM-5 diagnoses were compared between the HPV-positive and negative patients using χ2 tests. We explored the rapid screen indicator through multiple logistic regression analyses of the participants’ psychosocial factors, sociodemographic and clinical characteristics. Results: The incidence of DCPR syndromes in HPV-positive patients (56.6%) was significantly greater than that in HPV-negative patients (17.3%) and DSM-5 diagnoses (8.5%) in the HPV-positive group. Health anxiety, irritable mood, type A behavior, and demoralization were the most common psychosomatic syndromes in HPV-positive patients. As the degree of fear increased from 0 to 5 to 10, the risk of DCPR increased from 1.27 (95% CI: 0.21–7.63) to 3.24 (score range: 1–5, 95% CI: 1.01–10.39) to 9.91 (score range: 6–10, 95% CI: 3.21–30.62) in the HPV-positive group. Conclusion: The degree of fear, as an independent risk factor, could be used to quickly screen outpatients with a high risk of DCPR syndrome among women with HPV infection.

Features of the course of hydrocephalus in children after removal of a tumor of the posterior cranial fossa in the near and long term

The article presents the results of a study of the dynamics of the development of persistent hydrocephalus in children after surgical removal of a tumor of the posterior cranial fossa in the early and late postoperative period. The analysis of the incidence of neuropsychological syndromes: cerebellar cognitive-affective syndrome and cerebellar mutism syndrome in children of this group was carried out. Retrospective analysis included 30 patients under 18 years of age with a diagnosis tumor of the posterior cranial fossa complicated by occlusive hydrocephalus. All patients were operated on in the conditions of the Department of Neurosurgery for Children No. 7 of the Almazov National Medical Research Centre. As a result of the study, the risk groups for maintaining hydrocephalus after removal of the tumor of the posterior cranial fossa were determined, and the frequency of occurrence of neuropsychological syndromes in the postoperative period was determined.

Supplementation with dimethylglycine sodium salt improves lipid metabolism disorder in intrauterine growth-retarded pigs

This study aims to elucidate the mechanism of lipid metabolism disorder in intrauterine growth retardation (IUGR) pigs and the potential alleviating effects of dimethylglycine sodium salt (DMG-Na). A total of 60 male newborn piglets were selected for this study. Within each litter, one normal birth weight (NBW) male piglet (1.53 ± 0.04 kg) and two IUGR male piglets (0.76 ± 0.06 kg) were chosen based on their birth weight. The piglets were divided into three groups for the study: NBW pigs received a PBS gavage and a common basal diet (NBW-C group), IUGR pigs received the same PBS gavage and common basal diet (IUGR-C group), and IUGR pigs received a 70-mg DMG-Na gavage along with a common basal diet supplemented with 0.1% DMG-Na (IUGR-D group). At 150 d of age, all piglets underwent euthanasia by exsanguination following electrical stunning, after which plasma, liver, and longissimus dorsi (LM) samples were promptly collected. The IUGR-D group demonstrated improvements in plasma parameters (P < 0.05), with lower triglyceride and free fatty acid (FFA) values, and hormone levels (P < 0.05), with lower growth hormone, insulin, and homeostasis model assessment of insulin resistance values. Restoration of lipid metabolism was observed (P < 0.05), with lower triglyceride and FFA, and higher hepatic lipase and total lipase values in the liver, and lower triglyceride and FFA values in the LM. Mitochondrial ETC complexes showed increased levels (P < 0.05), including higher complex III values in the liver, and higher complex I, complex III, and complex V values in the LM. Enhanced levels of energy metabolites were noted (P < 0.05), with higher NAD+, NAD+/NADH, adenosine triphosphate, and mtDNA values, and lower NADH values in the liver and LM. Additionally, meat quality parameters showed improvement (P < 0.05), with higher pH 24 h and a∗ values, and lower drip loss 48 h, L∗, and b∗ values. The expressions of lipid metabolism and mitochondrial function-related genes and proteins were upregulated (P < 0.05) compared to the IUGR-C group. In conclusion, it was indicated that IUGR pigs experienced lipid metabolism disorders and diminished performance. However, supplementation with DMG-Na showed promise in mitigating these adverse physiological effects by safeguarding body tissues and modulating energy metabolism.

Epilepsies with onset during the first year of life: A prospective study on syndromes, etiologies, and outcomes.

Infantile seizures cause great concern for both doctors and parents. In addition to modern neuroimaging and genetics, clinical tools helpful in predicting the course of the disease are needed. We prospectively studied the incidence, electroclinical characteristics and etiologies of epilepsy syndromes with onset before the age of 12 months and looked for prognostic determinants of outcome by age 24 months. From February 2017 through May 2019, we recruited all eligible infants diagnosed with epilepsy at our unit. Data on electroclinical studies, genetic investigations and drug response were gathered prospectively. The infants were given a structured neurological examination (Hammersmith Infantile Neurological examination [HINE] and Griffiths scales) at predetermined intervals until age 24 months at which age neurocognitive evaluation with Bayley scales was performed. Included were 60 infants (27 female). The mean onset age of epilepsy was 5.3 (±2.5 standard deviation) months. The incidence of epilepsy in the population-based cohort was 131 (95% confidence interval 99-172)/100 000. Epilepsy syndrome was identified in 80% and etiology in 58% of infants. Self-limited infantile epilepsy was the second most common syndrome (incidence 18/100 000) after infantile epileptic spasms syndrome. PRRT2 was the most common monogenic cause. At age 24 months, 37% of the infants had drug-resistant epilepsy (DRE) and half had a global developmental delay (GDD). Abnormal first HINE was the strongest predictor of GDD, followed by DRE and identified etiology. DRE was associated with structural etiology and GDD. Those with normal first HINE and good response to treatment had favorable outcomes, irrespective of the identified etiology. Our results support a high incidence of self-limited epilepsy in infancy and PRRT2 as the genetic cause in the first year of life. Notwithstanding the advances in etiological discovery, we want to highlight the importance of clinical evaluation as standardized neurological examination with HINE proved a valuable tool in prognostication. One in every 700-800 babies develop epilepsy within the first year after birth. Our study identified an epilepsy syndrome in 80% and the cause of epilepsy in 60% of the participants. By age 2 years, over one-third of the children still experienced seizures, and almost half faced significant developmental delay. Structural brain abnormalities increased the likelihood of difficult epilepsy and developmental challenges. Babies whose epilepsy was caused by a gene defect varied widely in development and response to medications. Babies with normal neurological examination at first visit, especially if their seizures stopped quickly, had favorable development.

Punctal Atresia As a Clinical Indicator of Systemic Genetic Anomalies

ABSTRACT Background Punctal atresia or agenesis (PA) is a rare congenital anomaly characterized by the absence or closure of the tear duct puncta, potentially linked to systemic genetic anomalies. The necessity of a genetic workup based solely on the presence of PA remains uncertain. This study investigates a cohort of PA patients, examining the prevalence and types of associated syndromes. Methods A retrospective medical records review of all patients diagnosed with PA at the Children’s Hospital of Philadelphia between 2009–2023 was conducted, analyzing medical histories and genetic testing results. Primary outcomes included the prevalence of systemic syndromes, while secondary outcomes focused on the variety of associated syndromes. Results Forty-four patients were included, of which 31 were male (70%) with a mean ± SD age 3.3 ± 3.3 years. Overall, 87 puncta in the study cohort were affected, and 26 cases (59%) were bilateral. Systemic abnormalities or genetic syndromes were identified in 19 patients (43%), with the most common being Ectodermal Dysplasia and Down syndrome. Additional rare syndromes were demonstrated. No significant association was found between systemic abnormalities and gender, bilaterality, or the number of puncta involved. Conclusions A high incidence of systemic syndromes (43%) was observed in the study cohort. In individuals with PA who also exhibit extraocular disease, systemic evaluation and genetic workup should be considered. Syndromic diagnoses identified in our cohort also include: Branchio-oto-renal syndrome, 22q11.2 deletion syndrome, 1q21.1 microdeletion syndrome, NF1, monosomy 4q and trisomy 6q, which represent novel associations. The lack of correlation between PA’s phenotypic severity and systemic abnormalities highlights the need to obtain a comprehensive medical history and consider a systemic workup in PA patients.

Placental TLR recognition of salivary and subgingival microbiota is associated with pregnancy complications

BackgroundPre-term birth, the leading cause of neonatal mortality, has been associated with maternal periodontal disease and the presence of oral pathogens in the placenta. However, the mechanisms that underpin this link are not known. This investigation aimed to identify the origins of placental microbiota and to interrogate the association between parturition complications and immune recognition of placental microbial motifs.61FbVQciH1C2BbwKYgvy28Video MethodsSaliva, plaque, serum, and placenta were collected during 130 full-term (FT), pre-term (PT), or pre-term complicated by pre-eclampsia (PTPE) deliveries and subjected to whole-genome shotgun sequencing. Real-time quantitative PCR was used to measure toll-like receptors (TLR) 1–10 expression in placental samples. Source tracking was employed to trace the origins of the placental microbiota.ResultsWe discovered 10,007 functionally annotated genes representing 420 taxa in the placenta that could not be attributed to contamination. Placental microbial composition was the biggest discriminator of pregnancy complications, outweighing hypertension, BMI, smoking, and maternal age. A machine-learning algorithm trained on this microbial dataset predicted PTPE and PT with error rates of 4.05% and 8.6% (taxonomy) and 6.21% and 7.38% (function). Logistic regression revealed 32% higher odds of parturition complication (95% CI 2.8%, 81%) for every IQR increase in the Shannon diversity index after adjusting for maternal smoking status, maternal age, and gravida. We also discovered distinct expression patterns of TLRs that detect RNA- and DNA-containing antigens in the three groups, with significant upregulation of TLR9, and concomitant downregulation of TLR7 in PTPE and PT groups, and dense correlation networks between microbial genes and these TLRs. 70–82% of placental microbiota were traced to serum and thence to the salivary and subgingival microbiomes. The oral and serum microbiomes of PTPE and PT groups displayed significant enrichment of genes encoding iron transport, exosome, adhesion, quorum sensing, lipopolysaccharide, biofilm, and steroid degradation.ConclusionsWithin the limits of cross-sectional analysis, we find evidence to suggest that oral bacteria might translocate to the placenta via serum and trigger immune signaling pathways capable of inducing placental vascular pathology. This might explain, in part, the higher incidence of obstetric syndromes in women with periodontal disease.

Annual Variation in the Population-Based Incidence of Acute and Chronic Urticarial Syndromes: 2018 through 2022

Annual Variation in the Population-Based Incidence of Acute and Chronic Urticarial Syndromes: 2018 through 2022

Tele-ECG improves diagnosis of acute coronary syndrome and ST-elevation myocardial infarction in Côte d'Ivoire.

The emergence of cardiovascular risk factors in sub-Saharan Africa suggests an increasing incidence of acute coronary syndromes and STEMI. The aim of the study was to define the prevalence of STEMI and to describe the characteristics of patients diagnosed with STEMI within the tele-electrocardiogram (ECG) network in Côte d'Ivoire. A retrospective study was conducted from January 2015 to August 2019. All adult patients managed by one of the six hospitals within the telemedicine network who benefited from a remote interpretation of their ECG by the cardiology department of Bouaké University Hospital were included. The main reason for ECG interpretation, patient and ECG characteristics, diagnosis, response time and treatment were described. A total of 5649 patients were included. The prevalence of STEMI was 0.7% (n = 44 cases) with a mean age of 58.6 ± 11.8 years and a M/F sex ratio of 1.93. Among STEMI patients, chest pain was the main reason for ECG testing (56.8%). Most ECGs were interpreted within 12 hours (72.8%). The anterior inter-ventricular artery location (59.1%, n = 26) was predominant. The Q wave of necrosis was absent in 18% (n = 8) of cases. All patients received double anti-platelet aggregation and 50% (n = 22) additional heparin therapy. No patient underwent primary angioplasty or thrombolysis, 65.9% (n = 29) were referred to the Bouaké Cardiology Department and 34.1% (n = 15) to the Abidjan Heart Institute. Scheduled angioplasty was performed in 20% (n = 3) of patients in Abidjan. Tele-ECG was an effective means of STEMI screening in Côte d'Ivoire. Systematic telethrombolysis of all patients diagnosed could improve their prognosis.

The COVID-19 pandemic and the incidence of acute coronary syndromes at General Hospital of Veroia

Background: Although deaths from Acute Coronary Syndromes (ACS) are the most prevalent globally, during the outbreak of the new SARS-CoV-2 coronavirus pandemic, there was a declining trend in hospital admissions for ACS patients. Inevitably a reduction of invasive procedures in cardiac catheterization laboratories was observed. Moreover, an increase in sudden out-of-hospital cardiac deaths was recorded. On the other hand, patients that eventually treated in the hospital had a much worse outcome in terms of cardiac function. Inadequate treatment of acute myocardial infarction resulted in a further increase in mortality due to coronary artery disease. The aim of our study was the comparison of admissions of the patients with ACS before and during the COVID-19 pandemic. Methods: A retrospective single center study was conducted. We recorded all admissions with ACS underwent invasive interventions during the period of lockdown due to COVID-19 pandemic, in Greece, from 16 March 2020 to 1 May 2020 (study period A), as well as in the period of gradual withdraw of restrictions from 2 May 2020 to 1 June 2020 (study period B),. The data were compared with those of the periods of 2019 (control period A and B). Results: One hundred thirty eight patients were the group of study period and 158 were the group of the control period. The reduction rate was 12.7% in study period. The largest decrease in admissions concerned with elderly patients over 75 years old, as well as females (by 52% - 53% respectively). The severity of the restrictions but also the fear of the spread of the coronavirus may be relevant to the insufficient seek of help for these groups of patients. Conclusion: Our study showed that during the pandemic period, the invasive interventions were fewer than those of 2019. However, the expected reduction of catheterizations during this two and a half months period was mitigated by the increase of inter-hospital transfers of patients with ACS from neighboring hospitals, without a catheterization laboratory.

Abstract 15646: Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery

Background: The long-term outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass graft surgery (CABG) have received limited study. Methods: We examined the baseline characteristics and outcomes of CTO PCIs performed at 47 US and non-US centers between 2012 and 2023. Results: Of the 12,164 patients who underwent CTO PCI during the study period, 3,475 (29%) had prior CABG. Prior CABG patients were older, more likely to be men, with higher incidence of comorbidities and lower left ventricular ejection fraction and eGFR. Their CTOs were more likely to have moderate/severe calcification and proximal tortuosity, proximal cap ambiguity, longer lesion length and higher J-CTO scores. The first and final successful crossing strategy was more likely to be the retrograde approach. They had lower technical (82.1% vs 88.2%, p&lt;0.001) and procedural (80.8% vs 86.8%, p&lt;0.001) success, but similar incidence of in-hospital major complications. The incidence of in-hospital death (0.8% vs 0.3%, p&lt;0.001), acute myocardial infarction (0.9% vs 0.5%, p=0.007) and perforation (7.0% vs 4.2%, p&lt;0.001) was higher in prior CABG patients, while pericardial tamponade was less common (0.1% vs 1.3%, p&lt;0.001). At 2-year follow-up, the incidence of major adverse cardiac events, repeat PCI and acute coronary syndromes was significantly higher in prior CABG patients, while all-cause mortality was similar. Conclusions: Prior CABG patients undergoing CTO PCI have more complex clinical and angiographic characteristics and lower success rate, but similar incidence of in-hospital major complications, and had higher incidence of MACE but similar all-cause mortality during long-term follow-up. Abbreviations: eGFR= estimated glomerular filtration rate

Comparative study of visits to Hospital Emergency Department for opioid overdose in two periods

ObjectiveThe last few years have seen an increase in the use of opioid analgesics and in the incidence of opioid overdoses. The objective of this study was to evaluate the number of overdose-related visits to a university hospital emergency department at two different periods of time to analyze potential differences in terms of patient characteristics, prescription profile, and treatment. MethodThis is a retrospective observational study of opioid overdose-related visits in two periods of time: 2009-2014 and 2018-2020. ResultsThe study included 47 cases of opioid overdoses: 20 during the first period (3.3 cases/year) and 27 during the second (9 cases/year). A comparison between the two period showed a decrease in the patients’ age (81.1 vs 74.0; p = 0.044) and an increase in the number of acute trauma-derived pain treatments at the expense of chronic pain treatments (p = 0.002). No differences were observed in the opioids involved. As regards symptoms, there was a decrease in the incidence of confusional syndromes (p = 0.026) and an increase in deaths. ConclusionsEmergency room visits for opioid overdoses have increased in recent years, as has the mortality associated to them. A change has also been observed in the profile of affected patients, with a higher number of cases where pain is derived from acute trauma.

Incidence and clinical relevance of paraneoplastic syndromes in patients with renal cell carcinoma.

Paraneoplastic syndromes (PNS) are defined as the signs and symptoms attributed to cytokines or hormones released from a tumor or a patient's immune system. PNS have been reported with many cancers for decades and data supporting their relevance in renal cell carcinoma (RCC) are largely historical. The widespread use of electronic medical record (EMR) systems provides a more robust method to capture data. The objective of this study was to establish contemporary data regarding the incidence and relevance of PNS in patients undergoing nephrectomy for suspected RCC. In this retrospective single-institution study, 851 patients undergoing nephrectomy for suspected RCC between 2011 and 2018 were assessed for the presence or absence of PNS as defined by laboratory abnormalities. Factors associated with PNS and with all-cause mortality were examined. The incidence of PNS was 33.1% among 851 patients prior to nephrectomy. The most prevalent PNS were anemia (22.4%), thrombocytosis (7.5%), and elevated C-reactive protein (CRP) (7.4%). PNS were more common in women (39.2% vs. 29.4%, p = 0.0032) and higher stage RCC (31.1% of stage I vs. 54.2% of stage IV, p = 0.0036). Factors associated with the presence of PNS in multivariable analysis included female gender, high comorbidity, and stage IV RCC. Prenephrectomy PNS were associated with poorer survival in multivariable analysis (HR: 2.12, p = 0.0002). Resolution of PNS occurred in 52.1% of patients after nephrectomy, including 55.2% with stage I to III and 38.5% with stage IV RCC (p = 0.10). Using EMR data, laboratory evidence of PNS was present in one-third of a contemporary cohort of patients undergoing nephrectomy, with >50% of PNS resolving after surgery. Consistent with prior reports, PNS are more common in higher-stage RCC and are associated with poorer survival in RCC patients.

Gastrointestinal syndromes preceding a diagnosis of Parkinson’s disease: testing Braak’s hypothesis using a nationwide database for comparison with Alzheimer’s disease and cerebrovascular diseases

ObjectiveBraak’s hypothesis states that Parkinson’s disease (PD) originates in the gastrointestinal (GI) tract, and similar associations have been established for Alzheimer’s disease (AD) and cerebrovascular diseases (CVD). We aimed to...

Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis (Part 1): A clinical review

Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery.In this review, we present the role of MIS in this pathology and some cases treated in our hospital.