Wall Inflammation Research Articles

Abstract 3002: Pcsk9 In Abdominal Aortic Aneurysm - Beyond Hypercholesterolemia

Background: Our lab has identified a role for proprotein convertase subtilisin/kexin type9 (Pcsk9) in murine abdominal aortic aneurysm (AAA). Beyond its pathological effects on degradation of LDL-receptors, and enhancement of tissue inflammation via the NF-kB pathway, reports suggest that it alters vascular smooth muscle cell (VSMC) senescence and metabolism. However, the specific cellular mechanisms connecting Pcsk9 to AAA disease (particularly SMC-derived Pcsk9) are still unclear. Hypothesis: Intercellular communication between VSMCs and macrophages via enhanced local Pcsk9 expression drives macrophages towards pro-inflammatory polarization and promotes AAA growth by upregulated aortic wall inflammation. Pcsk9 also enhances mitochondrial metabolism in VSMCs, contributing to cell senescence. Pcsk9 knockdown inhibits these effects. Aims: We explored the impacts of SMC-derived Pcsk9 on aortic inflammation and VSMC behavior, seeking to further understand AAA pathophysiology and provide a basis for re-purposing Pcsk9 inhibitors as a treatment for non-surgical AAA. Methods: Single-cell RNASeq of murine AAA tissue (porcine pancreatic elastase model) utilizing control and Pcsk9-knockout mice (systemic) was performed to examine local changes in aortic wall cell-subtype gene expression. Pcsk9 silenced VSMCs (with siRNA) were co-cultured with macrophages to assess polarization towards pro-inflammatory phenotype and pro-inflammatory gene/protein expression was identified. VSMCs were also treated either with exogenous Pcsk9 or Pcsk9 siRNA in vitro to assess mitochondrial metabolism via Seahorse assay. Results: Pcsk9 knock-out AAA tissue exhibited reductions in pro-inflammatory gene expression profiles in vascular cell sub-populations (compared to wildtype). In vitro, Pcsk9-silenced VSMC-cocultured macrophages presented decreased inflammatory profile assessed by flow cytometry. Further, exogenous Pcsk9-treated-VSMCs displayed metabolic changes compared to control (Mann-Whitney Test). Conclusions: Our data suggest significant mechanistic involvement of Pcsk9 in AAA disease at the cellular level. Absence of Pcsk9 appears to mitigate vascular inflammation and alter VSMC metabolism in ways that may decelerate AAA.

PD-L1 Expression in Nonbacterial Chronic Cystitis and Bladder Cancer.

The objective was to assess PD-L1 expression in nonbacterial chronic cystitis (NCC) and bladder cancer (BC). The present study included 20 NCC and 20 BC patients. The degree of inflammation of the bladder wall was assessed on slides stained with H&E. Viral pathogens (herpes simplex virus, Epstein-Barr virus, cytomegalovirus, and high-risk HPVs) were detected using real-time polymerase chain reaction analyses of the bladder specimens. Immunohistochemistry was performed to assess the PD-L1 expression in bladder tissue. Expression of PD-L1 was detected in 40% of NCC patients and 85% of BC patients. Viral pathogens were found in 50% of NCC patients and 60% of BC patients, with EBV being the most common. In NCC patients the immune cell score correlated strongly with the degree of inflammatory infiltration of the bladder wall (r = 0.867, p < 0.001), the presence of lymphoid aggregates in the submucosa (r = 0.804, p < 0.001), koilocytosis (r = 0.620, p = 0.004), and the presence of viral pathogens (r = 0.784, p < 0.001). In BC patients the immune cell score correlated with the degree of inflammatory infiltration of the bladder wall (r = 0.534, p = 0.015) and the presence of viral pathogens (r = 0.626, p = 0.003), but not with the presence of lymphoid aggregates in the submucosa (r = 0.083, p = 0.729), and koilocytosis (r = 0.366, p = 0.112). Expression of PD-L1 was detected in a cohort of NCC patients, although the PD-L1 positivity rate was lower than that in BC. Our results demonstrate that the degree of PD-L1 expression in bladder tissue is associated with the presence of viral infections and with the degree of inflammatory infiltration of the bladder wall in both NCC and BC.

The Association between Circulating Cytokines and Body Composition in Frail Patients with Cardiovascular Disease.

The burden of cardiovascular disease and the percentage of frail patients in the aging population will increase. This study aims to assess the circulating levels of several cytokines in frail patients. This is an ancillary analysis of the FRAPICA trial. The ratio of men/women changed from robust through frail groups from 3:1 to 1:2. The groups are comparable in terms of age and body measurements analysis (weight, height, and BMI), yet the frail patients have significantly reduced fat-free mass, and more often have been diagnosed with diabetes. Frail patients have higher fibroblast growth factor basic (FGF basic) and follistatin levels (borderline significance). In multiple linear regression modeling of fat-free mass, we identified FGF basic, osteopontin, stem cell factor, soluble suppression of tumorigenicity 2, soluble epidermal growth factor receptor, soluble human epidermal growth factor receptor 2, follistatin, prolactin, soluble interleukin 6 receptor alfa, platelet endothelial cell adhesion molecule 1, soluble vascular endothelial cell growth factor receptor 1, leptin, soluble angiopoietin/tyrosine kinase 2, and granulocyte colony-stimulating factor. We have identified a few cytokines that correlate with fat-free mass, a hallmark of frailty. They comprise the kinins implicated in bone and muscle metabolism, fibrosis, vascular wall function, inflammation, endocrine function, or regulation of bone marrow integrity.

A novel ultrasound-based score for assessing carotid artery activity in Takayasu's arteritis.

The role of ultrasonography for evaluating vessel wall inflammation in Takayasu's arteritis (TAK) is well-recognised; however, an effective approach for the quantitative assessment of disease activity remains lacking. This study aimed to develop a novel ultrasound-based score for determining TAK activity. TAK patients with carotid artery involvement were prospectively followed-up for 6 months. Our proposed ultrasonographic activity score (ULTRAS, range between 0-12) consisted of wall thickness (TS, range between 0-8) and semi-quantitative echogenicity scores (ES, range between 0-4). The diagnostic performance of ULTRAS for disease activity was evaluated in terms of area under the receiver operating characteristic curve (AUC). Internal validation was subsequently performed. The patients were divided into training and validation groups (n=136 and 30. respectively). In the training group, 83 (61.0%) had active disease. At an optimal cut-off of 7, ULTRAS showed good diagnostic accuracy for active TAK (AUC, 0.88; 95% CI, 82-94). Improved diagnostic performance was achieved when combined with ESR (AUC, 0.91; 95% CI, 86-96) or CRP (AUC, 0.90; 95%CI, 86-95). In the verification group, the AUCs were 0.88, 0.95, and 0.92 for ULTRAS, ESR plus ULTRAS, and CRP plus ULTRAS, respectively. At post-treatment follow-up, the TS, ES, and ULTRAS paralleled the patients' disease remission and symptom recovery. At 3-month follow-up, an improvement in wall thickness of ≥0.3 mm correlated with symptom recovery in 50% of the patients. Our proposed ultrasound-based score carries the potential in the detection of active disease among TAK patients.

Enfermedad inflamatoria intestinal. Colitis ulcerosa

Inflammatory bowel disease (IBD) is a set of immune-mediated diseases with a poorly understood pathogenesis that result in uncontrolled inflammation in the gastrointestinal tract wall. Ulcerative colitis (UC) and Crohn's disease are the two most important diseases within IBD. UC affects the colon, almost constantly, the rectum, and extends back to varying lengths of the colon. Patients with UC usually present with rectal rectorrhagia, diarrhea, tenesmus, and fecal urgency. The cornerstone of a diagnosis is performing an ileocolonoscopy with biopsy collection, which allows establishing a diagnosis as well as the extent and severity of the endoscopic lesions, aspects that are related to prognosis. Once treatment is established, monitoring can be performed using biomarkers in the blood (C-reactive protein) and stool (fecal calprotectin). However, on occasion, a colonoscopy with biopsy collection is performed again to assess whether there has been a change in the extent and severity of the lesions and whether there is endoscopic and histological healing, as well as to screen for colorectal cancer.

Increased Interferon Signaling in Vaginal Tissue of Patients With Primary Sjögren Syndrome.

Vaginal dryness is an important factor influencing sexual function in women with primary Sjögren syndrome (pSS). Previous studies showed a higher degree of inflammation in vaginal biopsies from patients with pSS compared to non-pSS controls. However, the molecular pathways that drive this inflammation remain unclear. Therefore, the aim of this study was to investigate inflammatory pathway activity in the vaginal tissue of patients with pSS. Vaginal biopsies of 8 premenopausal patients with pSS experiencing vaginal dryness and 7 age-matched non-pSS controls were included. Expression of genes involved in inflammation and tissue homeostasis was measured using NanoString technology and validated using TaqMan Real-Time PCR. Vaginal tissue sections were stained by immunohistochemistry for myxovirus resistance protein 1 (MxA) and CD123 (plasmacytoid dendritic cells [pDCs]). The most enriched pathway in vaginal biopsies from patients with pSS compared to non-pSS controls was the interferon (IFN) signaling pathway (P < 0.01). Pathway scores for Janus kinase and signal transducer and activator of transcription (JAK-STAT) and Notch signaling were also higher (P < 0.01 for both pathways). Conversely, transforming growth factor-β signaling and angiogenesis pathway scores were lower in pSS (P = 0.02 and P = 0.04, respectively). Differences in IFN signaling between patients with pSS and non-pSS controls were confirmed by PCR and MxA tissue staining. No CD123+ pDCs were detected in vaginal biopsies. IFN-stimulated gene expression levels correlated positively with CD45+ cell numbers in vaginal biopsies and serum anti-SSA/Ro positivity. Upregulation of IFN signaling in vaginal tissue of women with pSS, along with its association with tissue pathology, suggests that IFNs contribute to inflammation of the vaginal wall and potentially also to clinical symptomatology (ie, vaginal dryness).

Therapeutic Approaches for the Treatment of Interstitial Lung Disease: An Exploratory Review on Molecular Mechanisms.

Interstitial Lung Diseases (ILDs) are characterized by shortness of breath caused by alveolar wall inflammation and/or fibrosis. Our review aims to study the depth of various variants of ILD, diagnostic procedures, pathophysiology, molecular dysfunction and regulation, subject and objective assessment techniques, pharmacological intervention, exercise training and various modes of delivery for rehabilitation. Articles are reviewed from PubMed and Scopus and search engines. ILD is a rapidly progressing disease with a high mortality rate. Each variant has its own set of causal agents and expression patterns. Patients often find it challenging to self-manage due to persistent symptoms and a rapid rate of worsening. The present review elaborated on the pathophysiology, risk factors, molecular mechanisms, diagnostics, and therapeutic approaches for ILD will guide future requirements in the quest for innovative and tailored ILD therapies at the molecular and cellular levels. The review highlights the rationale for conventional and novel therapeutic approaches for better management of ILD.

Ophthalmic Artery Vessel Wall Inflammation in a Patient With Giant Cell Arteritis Presenting With Vision Loss: A Case Report.

Ophthalmic Artery Vessel Wall Inflammation in a Patient With Giant Cell Arteritis Presenting With Vision Loss: A Case Report.

Hubungan Antara Pengetahuan dan Perilaku Pencegahan Gastritis Pada Penderita Gastritis di Ruang Lumba Bawah Blud RSUD Palabuhanratu

Hubungan Antara Pengetahuan dan Perilaku Pencegahan Gastritis Pada Penderita Gastritis di Ruang Lumba Bawah Blud RSUD Palabuhanratu

Calprotectin as a new inflammatory marker of abdominal aortic aneurysm: A pilot study.

Abdominal aortic aneurysm (AAA) is a relevant clinical problem due to the risk of rupture of progressively dilated infrarenal aorta. It is characterized by degradation of elastic fibers, extracellular matrix, and inflammation of the arterial wall. Though neutrophil infiltration is a known feature of AAA, markers of neutrophil activation are scarcely analyzed; hence, the main objective of this study. Plasma levels of main neutrophil activation markers were quantified in patients with AAA and a double control group (CTL) formed by healthy volunteers (HV) and patients with severe atherosclerosis submitted for carotid endarterectomy (CE). Calprotectin, a cytoplasmic neutrophil protein, was quantified, by Western blot, in arterial tissue samples from patients with AAA and organ donors. Colocalization of calprotectin and neutrophil elastase was assessed by immunofluorescence. Plasma calprotectin and IL-6 were both elevated in patients with AAA compared with CTL (p ⩽ 0.0001) and a strong correlation was found between both molecules (p < 0.001). This difference was maintained when comparing with HV and CE for calprotectin but only with HV for IL-6. Calprotectin was also elevated in arterial tissue samples from patients with AAA compared with organ donors (p < 0.0001), and colocalized with neutrophils in the arterial wall. Circulating calprotectin could be a specific AAA marker and a potential therapeutical target. Calprotectin is related to inflammation and neutrophil activation in arterial wall and independent of other atherosclerotic events.

Assessment of central nervous system vasculitis in children based on high-resolution vascular wall imaging.

Central nervous system vasculitis (CNSV) is a rare disease. High-resolution vessel wall imaging (HR-VWI) enables the identification of inflammatory changes within the vessel wall. Few studies have applied HR-VWI to assess CNSV in children. This study delves into the utility of HR-VWI for diagnosing and treating CNSV in children, with the aim of enhancing clinical diagnosis and efficacy evaluation. Imaging data were acquired from children who underwent HR-VWI examinations. The study meticulously analysed clinical data and laboratory tests to discern the characteristics and distribution patterns of diverse vasculitis forms. In children, CNSV mainly involves medium vessels with grade 1 and 2 stenosis (grade 4 stenosis is rare), and the imaging features generally show centripetal and moderate enhancement, suggesting that this feature is specific for the diagnosis of CNSV. High-grade stenosis, concentric enhancement and strong enhancement of the vasculature indicate more severe disease activity. Remarkably, HR-VWI proved to be significantly more sensitive than magnetic resonance angiography in detecting CNSV. Among the 13 cases subjected to imaging review, 8 demonstrated a reduction or resolution of vessel wall inflammation. In contrast, five patients exhibited worsening inflammation in the vessel wall. HR-VWI demonstrated that changes in vessel wall inflammation were closely correlated with changes in brain parenchymal lesions and symptoms. This study underscores the diagnostic value of HR-VWI in CNSV assessment and treatment monitoring, offering a quantitative evaluation of CNSV in children.

Low shear stress induces macrophage infiltration and aggravates aneurysm wall inflammation via CCL7/CCR1/TAK1/ NF-κB axis

BackgroundThis study aimed to elucidate the mechanism by which wall shear stress (WSS) influences vascular walls, accounting for the susceptibility of intracranial aneurysms (IAs) to rupture. MethodWe collected blood samples from the sacs of 24 ruptured and 28 unruptured IAs and analyzed the expression of chemokine CCL7 using enzyme-linked immunosorbent assay (ELISA). Univariate and multivariate logistic regression analyses were employed to assess clinical data, aneurysm morphology, and hemodynamics in both groups. Pearson correlation analysis investigated the relationship between CCL7 expression in aneurysm sac blood and WSS. Additionally, we established a bionic cell parallel plate co-culture shear stress model and a mouse low shear stress (LSS) model. The model was modulated using CCL7 recombinant protein, CCR1 inhibitor, and TAK1 inhibitor. We further evaluated CCL7 expression in endothelial cells and the levels of TAK1, NF-κB, IL-1β, and TNF-α in macrophages. Subsequently, the intergroup differences in expression were calculated. ResultsCCL7 expression was significantly higher in the ruptured group compared to the unruptured group. Hemodynamic analysis indicated that WSS was an independent predictor of the risk of aneurysm rupture. A negative linear correlation was observed between CCL7 expression and WSS. Upon addition of CCL7 recombinant protein, upregulation of CCR1 expression and increased levels of p-TAK1 and p-p65 were observed. Treatment with CCR1 and TAK1 inhibitors reduced inflammatory cytokine expression in macrophages under LSS conditions. Overexpression of TAK1 significantly alleviated the inhibitory effects of CCR1 inhibitors on p-p65 and inflammatory cytokines. ConclusionLSS prompts endothelial cells to secrete CCL7, which, upon binding to the macrophage surface receptor CCR1, stimulates the release of macrophage inflammatory factors via the TAK1/NF-κB signaling pathway. This process exacerbates aneurysm wall inflammation and increases the risk of aneurysm rupture.

Increased inferior vena cava wall thickness as a sign of extensive venous inflammation in Behçet's Disease.

Behçet's disease (BD) affects both arterial and venous vessels. We have previously shown that common femoral vein wall thickness (WT) is increased in BD and can be used as a diagnostic test. However, there is limited data assessing large veins. Therefore, this study seeks to assess inferior vena cava wall thickness (IVC) by transthoracic echocardiography (TTE) in BD compared to healthy controls (HC). Age- and gender-matched 70 BD patients and 51 HC were included. IVC wall thickness and common femoral vein WT were measured by TTE and Doppler ultrasonography, respectively. All examinations were performed on the same day as the clinical assessment. The mean IVC wall thickness of BD patients was significantly higher than HC (2.9mm (0.3) vs 2.6mm (0.3), p < 0.001). Patients with mucocutaneous involvement (2.8mm (0.3)) and major organ involvement (2.9mm (0.3)) had significantly thicker walls compared to HC (p = 0.003, p < 0.001, respectively). IVC wall thickness was higher in patients with vascular involvement compared to those with nonvascular major organ involvement (3.1mm (0.3) vs 2.8mm (0.2), p = 0.04). There was a moderate correlation between IVC and common femoral vein WT (r = 0.49 for the right, r = 0.43 for the left, p = 0.01 for both). This study shows that venous wall inflammation is not limited to lower extremity veins and is also present in IVC walls of BD patients regardless of IVC involvement. Vascular wall inflammation is probably a widespread vascular event of all venous walls in BD. Key Points • Venous wall inflammation is not limited to lower extremity veins and is present also in IVC wall in Behçet's disease. • Extensive venous wall inflammation in Behçet's disease includes large venous structures despite not being clinically involved.

Ventilatory capacity in CLAD is driven by dysfunctional airway structure

Chronic lung allograft dysfunction (CLAD) encompasses three main phenotypes: bronchiolitis obliterans syndrome (BOS), restrictive allograft syndrome (RAS) and a Mixed phenotype combining both pathologies. How the airway structure in its entirety is affected in these phenotypes is still poorly understood. A detailed analysis of airway morphometry was applied to gain insights on the effects of airway remodelling on the distribution of alveolar ventilation in end-stage CLAD. Exvivo whole lung μCT and tissue-core μCT scanning of six control, six BOS, three RAS and three Mixed explant lung grafts (9 male, 9 female, 2014-2021, Leuven, Belgium) were used for digital airway reconstruction and calculation of airway dimensions in relation to luminal obstructions. BOS and Mixed explants demonstrated airway obstructions of proximal bronchioles (starting at generation five), while RAS explants particularly had airway obstructions in the most distal bronchioles (generation >12). In BOS and Mixed explants 76% and 84% of bronchioles were obstructed, respectively, while this was 22% in RAS. Bronchiolar obstructions were mainly caused by lymphocytic inflammation of the airway wall or fibrotic remodelling, i.e. constrictive bronchiolitis. Proximal bronchiolectasis and imbalance in distal lung ventilation were present in all CLAD phenotypes and explain poor lung function and deterioration of specific lung function parameters. Alterations in the structure of conducting bronchioles revealed CLAD to affect alveolar ventilatory distribution in a regional fashion. The significance of various obstructions, particularly those associated with mucus, is highlighted. This research was funded with the National research fund Flanders (G060322N), received by R.V.

The Evolving Role of Dendritic Cells in Atherosclerosis.

Atherosclerosis, a major contributor to cardiovascular morbidity and mortality, is characterized by chronic inflammation of the arterial wall. This inflammatory process is initiated and maintained by both innate and adaptive immunity. Dendritic cells (DCs), which are antigen-presenting cells, play a crucial role in the development of atherosclerosis and consist of various subtypes with distinct functional abilities. Following the recognition and binding of antigens, DCs become potent activators of cellular responses, bridging the innate and adaptive immune systems. The modulation of specific DC subpopulations can have either pro-atherogenic or atheroprotective effects, highlighting the dual pro-inflammatory or tolerogenic roles of DCs. In this work, we provide a comprehensive overview of the evolving roles of DCs and their subtypes in the promotion or limitation of atherosclerosis development. Additionally, we explore antigen pulsing and pharmacological approaches to modulate the function of DCs in the context of atherosclerosis.

Relationship between ultrasound imaging of dorsalis pedis artery and foot health symptoms in people with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is an autoimmune connective tissue disease which affects joint function and multiple body systems. Poor foot health for people with RA has a negative impact on mobility, functional capacity, and quality of life. Additional to joint pain, people with RA may develop vascular disease e.g., vasculitis, which can have increasingly detrimental effects on foot health, quality of life and longevity. If identified early, adverse effects may be prevented. However, the link between foot health symptoms and ultrasound identified precursory changes for vasculitis is yet to be established. ObjectivesThis study aimed to examine the association between foot health symptoms and the integrity of the dorsalis pedis artery (DPA). MethodsWe recruited 47 participants with RA and 47 characteristic-matched controls. All participants completed an online survey which included demographic questions and Foot Health Status Questionnaire (FHSQ). Ultrasound imaging measured participants’ proximal DPA in terms of degree of wall inflammation, lumen diameter, artery diameter, lumen-to-artery diameter ratio and peak systolic velocity. ResultsSignificant differences (p < 0.001) were noted between groups for degree of wall inflammation, artery diameter and lumen to artery diameter ratio, while lumen diameter and peak systolic velocity demonstrated no statistical difference. Degree of wall inflammation demonstrated stronger association with FHSQ score (r = −0.454, p < 0.001) than artery diameter (r = −0.361, p < 0.001) and lumen-to-artery diameter ratio (r = 0.404, p < 0.001), while FHSQ score did not relate to lumen diameter (p = 0.798) nor peak systolic velocity (p = 0.258). ConclusionWe identified specific vascular ultrasound parameters were associated with foot symptoms among people with RA. This non-invasive imaging technique may be a viable method to monitor foot health and disease management.

The relationship between right atrial wall inflammation and poor prognosis of atrial fibrillation based on 18F-FDG positron emission tomography/computed tomography.

Atrial fibrillation (AF) has been identified to increase stroke risk, even after oral anticoagulants (OACs), and the recurrence rate is high after radiofrequency catheter ablation (RFCA). Inflammation is an essential factor in the occurrence and persistence of AF. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is an established molecular imaging modality to detect local inflammation. We aimed to investigate the relationship between atrial inflammatory activity and poor prognosis of AF based on 18F-FDG PET/CT. A total of 204 AF patients including 75 with paroxysmal AF (ParAF) and 129 with persistent AF (PerAF) who underwent PET/CT before treatment were enrolled in this prospective cohort study. Clinical data, electrocardiograph (ECG), echocardiography, and cardiac 18F-FDG uptake were collected. Follow-up information was obtained from patient clinical case notes or telephone reviews, with the starting point being the time of PET/CT scan. The follow-up deadline was either the date of AF recurrence after RFCA, new-onset stroke, or May 2023. Cox proportional hazards regression models were used to identify predictors of poor prognosis and hazard ratios (HRs) with 95% confidence intervals (CIs) was calculated. Median follow-up time was 29 months [interquartile range (IQR), 22-36 months]. Poor prognosis occurred in 52 patients (25.5%), including 34 new-onset stroke patients and 18 recrudescence after RFCA. The poor prognosis group had higher congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, prior stroke or transient ischemic attack (TIA) or thromboembolism (doubled), vascular disease, age 65-74 years, sex category (female) (CHA2DS2-VASc) score [3.0 (IQR, 1.0-3.75) vs. 2.0 (IQR, 1.0-3.0), P=0.01], right atrial (RA) wall maximum standardized uptake value (SUVmax) (4.13±1.82 vs. 3.74±1.58, P=0.04), higher percentage of PerAF [39 (75.0%) vs. 90 (59.2%), P=0.04], left atrial (LA) enlargement [45 (86.5%) vs. 104 (68.4%), P=0.01], and RA wall positive FDG uptake [40 (76.9%) vs. 79 (52.0%), P=0.002] compared with the non-poor prognosis group. Univariate and multivariate Cox proportional hazard regression analysis concluded that only CHA2DS2-VASc score (HR, 1.29; 95% CI: 1.06-1.57; P=0.01) and RA wall positive FDG uptake (HR, 2.68; 95% CI: 1.10-6.50; P=0.03) were significantly associated with poor prognosis. RA wall FDG positive uptake based on PET/CT is tightly related to AF recurrence after RFCA or new-onset stroke after antiarrhythmic and anticoagulation treatment.

Diagnostic accuracy of bowel ultrasonography in patients with inflammatory bowel disease: a systematic review and meta-analysis.

Bowel ultrasonography (BUS) is emerging as a promising noninvasive tool for assessing disease activity in inflammatory bowel disease (IBD) patients. We evaluated the diagnostic accuracy of BUS in IBD patients against the gold standard diagnostic method, standard colonoscopy. Major databases were searched from inception to May 2023 for studies on BUS diagnostic accuracy in IBD. Outcomes of interest were pooled sensitivity, specificity, positive (PPV), and negative (NPV) predictive values. Endoscopic confirmation served as ground truth. Standard meta-analysis methods with a random-effects model and I2 statistics were applied. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Twenty studies (1094 patients) were included in the final analysis. The majority (75%) of studies considered bowel wall thickness >3 mm as abnormal. Endoscopic evaluation was performed between days 3 and 180. The pooled diagnostic accuracy of BUS in IBD was 66% (95% confidence interval [CI] 58-72%; I2=78%), sensitivity was 88.6% (95%CI 85-91%; I2=77%), and specificity 86% (95%CI 81-90%; I2=95%). PPV and NPV were 94% (95%CI 93-96%; I2=25%) and 74% (95%CI 66-80%; I2=95%), respectively. On subgroup analysis, small-intestine contrast-enhanced ultrasonography (SICUS) demonstrated high sensitivity (97%, 95%CI 91-99%; I2=83%), whereas BUS exhibited high specificity (94%, 95%CI 92-96%; I2=0%) and NPV (76%, 95%CI 68-83%; I2=80.9%). Meta-regression revealed a significant relation between side-to-side anastomosis and BUS specificity (P=0.02) and NPV (P=0.004). The high diagnostic accuracy of BUS in detecting bowel wall inflammation suggests utilizing regular BUS as the primary modality, with subsequent consideration of SICUS if clinically warranted.

Multimodality magnetic resonance evaluating the effect of enhanced physical exercise on the growth rate, flow haemodynamics, aneurysm wall and ventricular-aortic coupling of patients with small abdominal aortic aneurysms (AAA MOVE trial): a study protocol for an open-label randomised controlled trial

IntroductionThe best lifestyle for small abdominal aortic aneurysms (sAAA) is essential for its conservative management. Physical exercise can improve the cardiopulmonary function of the patients, but it remains unclear which...

PET imaging of unruptured intracranial aneurysm inflammation (PET-IA) study: a feasibility study protocol

IntroductionPositron emission tomography (PET) imaging can be used to evaluate arterial wall inflammation in extracranial vascular diseases. However, the application of PET imaging in unruptured intracranial aneurysms (UIA) remains unexplored....