Segment Involvement Research Articles

Posterior segment involvement in systemic lupus erythematosus – A series from South India

Purpose: To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE). Methods: Retrospective study at a tertiary referral eye center in south India between 2016 and 2022. Results: Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS-related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases. Conclusion: Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy.

Assessment of Left Ventricular Myocardial Fibrosis in Adult Patients With Ebstein Anomaly: A Retrospective Cohort Study Based on Cardiac Magnetic Resonance and Histopathological Samples.

The association between Ebstein anomaly and myocardial fibrosis, particularly in the left ventricle, has been controversial. We aimed to assess the prevalence of replacement fibrosis with a focus on the left ventricle (LV) using cardiac magnetic resonance (CMR), make a histopathological association between LV fibrosis and CMR findings, and explore whether LV fibrosis is an independent risk factor for cardiovascular disease mortality using a derived risk score. We performed a 12-year (2009-2021) retrospective cohort of adult patients with Ebstein anomaly who underwent CMR. The CMR evaluation included a comprehensive assessment of myocardial fibrosis by late gadolinium enhancement (LGE). Four postmortem samples were obtained from our cohort and stained using Masson trichrome to characterize LV fibrosis. We used Cox-regression analysis to identify and derive a prediction score that associated LV fibrosis with cardiovascular disease mortality. We included 57 adults with Ebstein anomaly (52% men; median age, 29.52 [interquartile range, 21.24-39.17] years), of whom 12 died during follow-up. LGE prevalence by CMR was observed in 52.6% in any chamber; LV-LGE in 29.8%. Histopathological findings revealed a mid-wall pattern with predominantly interstitial fibrosis and minimal replacement fibrosis. LV-LGE was associated with increased risk of cardiovascular disease mortality (hazard ratio, 6.02 [95% CI, 1.22-19.91]) attributable to lateral and mid-wall LV segment involvement. Our mortality score achieved an overall good prediction capacity (R2, 0.435; C statistic, 0.93; Dxy, 0.86). There is a high prevalence of LV fibrosis replacement in adults with Ebstein anomaly, characterized by specific CMR and histological patterns. Furthermore, LV-LGE fibrosis is an independent predictor of cardiovascular disease mortality, which could be integrated into risk assessment in clinical management.

Comparison of prognostic value between CAD-RADS 1.0 and CAD-RADS 2.0 evaluated by convolutional neural networks based CCTA

ObjectivesThe aim of the present study was to investigate the prognostic value of the novel coronary artery disease reporting and data system (CAD-RADS) 2.0 compared with CAD-RADS 1.0 in patients with suspectedcoronary artery disease (CAD) evaluated by convolutional neural networks (CNN) based coronary computed tomography angiography (CCTA). MethodsA total of 1796 consecutive inpatients with suspected CAD were evaluated by CCTA for CAD-RADS 1.0 and CAD-RADS 2.0 classifications. Kaplan-Meier and multivariate Cox models were used to estimate major adverse cardiovascular events (MACE) inclusive of all-cause mortality or myocardial infarction (MI). The C-statistic was used to assess the discriminatory ability of the two classifications. ResultsIn total, 94 (5.2%) MACE occurred over the median follow-up of 45.25 months (interquartile range 43.53–46.63 months). The annualized MACE rate was 0.014 (95% CI: 0.011–0.017). Kaplan-Meier survival curves indicated that the CAD-RADS classification, segment involvement score (SIS) grade, and Computed Tomography Fractional Flow Reserve (CT-FFR) classification were all significantly associated with the increase in the cumulative MACE (all P < 0.001). CAD-RADS classification, SIS grade, and CT-FFR classification were significantly associated with endpoint in univariate and multivariate Cox analysis. CAD-RADS 2.0 showed a further incremental increase in the prognostic value in predicting MACE (c-statistic 0.702, 95% CI: 0.641–0.763, P = 0.047), compared with CAD-RADS 1.0. ConclusionsThe novel CAD-RADS 2.0 evaluated by CNN-based CCTA showed higher prognostic value of MACE than CAD-RADS 1.0 in patients with suspected CAD.

Posterior Segment Ocular Findings in HLA-B27 Positive Patients with Uveitis: A Retrospective Analysis.

To describe the prevalence and characteristics of posterior segment manifestations in patients with HLA-B27-associated uveitis using wide field imaging. Medical records of patients diagnosed with HLA-B27-associated uveitis from a tertiary uveitis clinic were reviewed. Posterior segment involvements including but not limited to peripheral vasculitis, optic disc inflammation, and macula edema documented based on medical records and various imaging modalities including wide field fluorescein angiography and optical coherence tomography, were noted. Demographic characteristics, accompanied with systemic diseases as well as duration and chronicity of uveitis, were also evaluated. Patients with significant systemic and ocular comorbidities were excluded. Statistical analyses including chi-squared tests and paired t-tests were employed. Of the 44 patients with HLA-B27 associated uveitis, 22 patients (50%) were noted to demonstrate posterior segment involvement. Disc leakage and peripheral vasculitis were the most common findings of posterior involvement. Those with anterior chamber inflammation were found to have a significantly increased risk of posterior involvement. Those with posterior involvement were also noted to have a statistically significant decreased visual acuity. No significant association was found between documented duration of disease and posterior segment involvement. The prevalence of posterior segment involvement in HLA-B27 associated uveitis is higher compared to previous reports when evaluated with wide angle imaging modalities. Careful examination of the posterior segment is required in patients with HLA-B27 associated uveitis.

D77. In-fracture and Out-fracture: Novel Conceptions of Nasoorbitoethmoid Injury

PURPOSE: Nasoorbitoethmoid (NOE) fractures are commonly categorized by the Markowitz-Manson classification system, which grades severity of injury by degree of comminution and involvement of the medial canthal tendon. However, this system does not account for directionality of bony injury, which may impact clinical findings. We propose these fractures may be conceived as either in-fractured, resulting in nasal airway obstruction, or out-fractured, resulting in traumatic telecanthus. METHODS: A retrospective review was conducted of all patients with NOE fractures referred to plastic surgery at a tertiary academic medical center from 2017—2022. Radiographic data (CT) were evaluated to assess for directionality of NOE segment involvement. Frequencies of in-fracture and out-fracture across NOE type were compared by chi-squared test. RESULTS: Among 57 adults, 73 NOE fractures were identified with 39.7% (29) as Type 0 (non-displaced), 43.8% (32) as Type I, 12.3% (9) as Type II, and 4.1% (3) as Type III. Type I fractures were significantly associated with in-fracture (p < 0.0001), whereas Type III fractures were more likely out-fractured (p = 0.02). Type II fractures were not significantly associated with either presentation (p = 0.32). CONCLUSION: We discover that Type I NOE fractures more frequently present with in-fracture, whereas comminuted injuries such as Type III are typically out-fractured. Further study will validate these findings in a larger cohort and correlate radiography with clinical symptoms.

Presence of deep tendon reflexes may not exclude a diagnosis of Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) (P11-8.015)

<h3>Objective:</h3> To identify if there are chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients who do not meet clinical criteria but satisfy electrodiagnostic criteria. Our hypothesis is that these patients do not differ from patients who meet criteria for CIDP and possible CIDP. <h3>Background:</h3> The diagnosis of CIDP remains challenging due to lack of a biomarker or a single diagnostic test. The European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) 2021 revision of the diagnostic criteria for CIDP advocate a stepwise approach to the diagnosis of CIDP which requires clinical criteria including absent or reduced deep tendon reflexes before the application of electrodiagnostic criteria. <h3>Design/Methods:</h3> We applied the 2021 EAN/PNS criteria to our cohort of 39 patients receiving intravenous immunoglobulin (IVIG) for CIDP. We compared clinical and electrodiagnostic criteria between those who fulfilled electrodiagnostic criteria but not clinical criteria and patients with CIDP or possible CIDP <h3>Results:</h3> Of our cohort 39-patients, 21 (53.8%) were classified as CIDP, 6 (15.3%) as possible CIDP and 12 patients didn’t meet criteria. Of the 10 patients who didn’t meet clinical criteria, 6/10 (60%) met electrodiagnostic criteria. These patients did not qualify as CIDP or Possible CIDP due to the presence of reflexes. There were no significant differences in the clinical phenotypes and demographics between these patients and CIDP or possible CIDP patients in our cohort. There was also no significant difference in the electrodiagnostic parameters between these patients and those with CIDP or possible CIDP. However, the patients with preserved reflexes tended to have more frequent conduction velocity slowing (p = 0.08) than patients with CIDP or possible CIDP. <h3>Conclusions:</h3> The presence of reflexes should not exclude the diagnosis of CIDP if the patient meets electrodiagnostic criteria. This could be indicative of a subset of patients with CIDP who have more involvement of the intermediate segments of nerve rather than proximal segments. <b>Disclosure:</b> Dr. Strathdee has nothing to disclose. The institution of Dr. Rodrigues has received research support from Australian Brain Foundation. The institution of Dr. Kapoor has received research support from Bethlehem Griffiths Research Foundation . Dr. Zhang has nothing to disclose. Dr. Faragher has stock in Argo P/L. Dr. Faragher has stock in Australian Foundation P/L. Dr. Faragher has stock in Argo Infrastructure P/L. Bruce Day has nothing to disclose. The institution of Dr. Hutton has received research support from Lundbeck. The institution of Dr. Hutton has received research support from Daewoong Pharmaceuticals . The institution of Dr. Hutton has received research support from Xalud. The institution of Dr. Hutton has received research support from Ipsen. The institution of Dr. Hutton has received research support from Abbvie. The institution of Dr. Hutton has received research support from Cerecin. Dr. Hutton has a non-compensated relationship as a Board Member with Brain Foundation (Vic) that is relevant to AAN interests or activities. Dr. Hutton has a non-compensated relationship as a President-elect with Australian and New Zealand Headache Society that is relevant to AAN interests or activities. Dr. Stark has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Stark has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Stark has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva. Dr. Stark has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Stark has stock in CSL. Dr. Stark has stock in Multiple ASX listed (non-medical) companies. Dr. Stark has received personal compensation in the range of $10,000-$49,999 for serving as a TCMC Committee chair with AMA Victoria.

Prognostic Implications of Left Ventricular Systolic Dysfunction in Patients with Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome. Clinical features, angiographic findings, management and outcomes of SCAD patients who present reduced left ventricular ejection fraction (LVEF) remain unknown. The Spanish multicentre prospective SCAD registry (NCT03607981), included 389 consecutive patients with SCAD. In 348 of these patients left ventricular ejection fraction (LVEF) could be assessed by echocardiography during the index admission. Characteristics and outcomes of patients with preserved LVEF (LVEF ≥50%, n=295, 85%) were compared with those with reduced LVEF (LVEF<50%, n=53, 15%). Mean age was 54 years and 90% of patients in both groups were women. The most frequent clinical presentation in patients with reduced LVEF was ST-segment elevation myocardial infarction (62% vs. 36%, p < 0.001), especially anterior STEMI. Proximal coronary segment and multi-segment involvement were also significantly more frequent in these patients. No differences were found on initial revascularization between groups. Patients with reduced LVEF significantly received more often neurohormonal antagonist therapy, and less frequently aspirin. In-hospital events were more frequent in these patients (13% vs. 5%, p = 0.01), with higher rates of death, cardiogenic shock, ventricular arrhythmia and stroke. During a median follow-up of 28 months, the occurrence of a combined adverse event did not statistically differ between the two groups (19% vs. 12%, p = 0.13). However, patients with reduced LVEF had higher mortality (9% vs. 0.7%, p < 0.001) and readmission rates for heart failure (4% vs. 0.3%, p = 0.01). Patients with SCAD and reduced LVEF show differences in clinical characteristics and angiographic findings compared with SCAD patients with preserved LVEF. Although these patients receive specific medications at discharge, they had higher mortality and readmission rates for heart failure during follow-up.

MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP41-08 PROGNOSTIC SIGNIFICANCE OF PT3A STAGING SUBCLASSIFICATIONS IN NON-CLEAR CELL RENAL CELL CARCINOMA Michael Rezaee, Maximilian Pallauf, Roy Elias, Sean Fletcher, Christian Pavlovich, Ezra Baraban, Yasser Ged, and Nirmish Singla Michael RezaeeMichael Rezaee More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Roy EliasRoy Elias More articles by this author , Sean FletcherSean Fletcher More articles by this author , Christian PavlovichChristian Pavlovich More articles by this author , Ezra BarabanEzra Baraban More articles by this author , Yasser GedYasser Ged More articles by this author , and Nirmish SinglaNirmish Singla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003279.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies in clear cell renal cell carcinoma (RCC) have suggested that the pT3a staging subclassification based on perinephric fat, renal sinus fat, and renal vein invasion may represent an overly heterogenous group of patients with varying survival trajectories. A similar evaluation has not yet been performed in patients with non-clear cell pathology. Therefore, we examined the prognostic significance of perinephric fat, renal sinus fat, and renal vein invasion in pT3a non-clear cell RCC (nccRCC) patients. METHODS: A population-based retrospective cohort study of patients with pT3aN0M0 nccRCC was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2010 through 2019. Patients were grouped by pT3a subclassification: perinephric fat, renal sinus fat, and segmental or renal vein invasion. Cox proportional hazards models were used to examine the relationship between pT3a subclassification groups and cancer-specific survival, overall and by histological subtype (papillary, chromophobe, and other nccRCC tumors). RESULTS: The final analysis sample consisted of 1,640 pT3aN0M0 nccRCC patients with a median follow up of 4 years. Compared to perinephric fat invasion, segmental or renal vein invasion was associated with significantly worse cancer-specific survival (hazard ratio [HR] 3.0, 95% CI: 2.1 – 4.3, Figure 1) overall. Of these patients, 51.1%, 38.4%, and 10.5% had papillary, chromophobe, and other nccRRC tumors, respectively. Among patients with papillary (HR 4.8, 95% CI: 2.8 – 8.3) and chromophobe (HR 2.9, 95% CI: 1.1 – 7.9) pT3a tumors, segmental or renal vein invasion was associated with significantly worse cancer-specific survival compared to perinephric fat invasion. No difference was observed in cancer-specific survival by pT3a subgroups for other nccRCC tumors. Patients with two pT3a characteristics had significantly worse cancer-specific survival compared to those with only one (HR 2.1, 95% CI: 1.5 to 3.1). CONCLUSIONS: Cancer-specific survival is significantly worse in pT3a nccRCC patients with segmental or renal involvement, particularly in those with papillary and chromophobe tumors. Current RCC staging guidelines may underestimate the prognostic value of segmental or renal vein involvement relative to other pT3a criteria. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e557 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rezaee More articles by this author Maximilian Pallauf More articles by this author Roy Elias More articles by this author Sean Fletcher More articles by this author Christian Pavlovich More articles by this author Ezra Baraban More articles by this author Yasser Ged More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...

Preoperative T Staging of Gastrointestinal Malignancy By MDCT– An Essential Tool for Surgical Management

Background: Malignancy with respect to the stomach and small and large intestines can present as a mass or focal/diffuse bowel wall thickening, with associated perienteric abnormalities. The role of multidetector computed tomography (MDCT) in gastrointestinal malignancy is pivotal, as it provides high-resolution images for accurate preoperative staging of gastrointestinal tumors and can help in the surgical management of patients. Aim and Objectives: The goal of this study was to evaluate the role of MDCT in the evaluation of gastrointestinal malignancy, to differentiate between benign and malignant gastrointestinal disorders, and to stage a malignant lesion preoperatively. Materials and Methods: This study was conducted at the Radiodiagnosis Department of AVBRH, a teaching hospital of DMIHER, Sawangi (Meghe), Wardha. It was a prospective cross-sectional study. A purposive convenience sampling method with a desired sample size of 50 participants for the study was conducted over a duration of 2 years. Results: Our study included 51 subjects, of which the majority, 32 (62.75%), were male, and the rest, 19 (37.25%), were female. Among the study population, 46 (90.2%) were malignant lesions, and the rest, 5 (9.8%), were benign, according to the MDCT diagnosis. The majority, i.e. 32 (62.75%) individuals, had colorectal cancer. The majority of individuals with malignancy, i.e. 46 (90.2%), had a heterogeneous pattern of gastrointestinal wall enhancement along with asymmetric wall thickening in 44 (86.27%) individuals. Segmental gastrointestinal wall involvement was seen in 35 (68.63%) individuals. Conclusion: MDCT can accurately differentiate benign and malignant diseases based on the pattern of wall thickening and offers information on any accompanying pericolic abnormalities, the existence of nodal or distant metastases, and the invasion of nearby organs. The accurate planning of surgery and patient care is made possible by the preoperative staging of malignant lesions by MDCT.

Eye damage in COVID-19. Part 2: posterior segment complications, neuro-ophthalmic manifestations, vaccination and risk factors

Posterior eye segment involvement in COVID-19 has varied manifestations: vascular, inflammatory, and neuronal. All of them are triggered by SARS-CoV-2 virus but they cannot be viewed as exclusively specific to COVID-19. According to the literature, the mean age of the patients varies from 17 to 75 with the median of 50 years. The median duration between the appearance of ophthalmic symptoms and the detection of COVID-19 was 12 days. The disease affects both men and women equally. Direct exposure to the virus, immune-mediated tissue damage, activation of the coagulation system, the prothrombotic state caused by a viral infection, concomitant diseases and medications used in the treatment contribute to the development of eye pathologies. Ophthalmologists should be aware of the possible relations of posterior eye segment pathologies, orbit and neuro-ophthalmic disorders with SARS-CoV-2, as well as the possible exacerbation of chronic forms of inflammatory eye diseases and autoimmune disorders due to anti-COVID-19 vaccination.

Risk Factors of Complications from Central Bisectionectomy (H458) for Hepatocellular Carcinoma: A Multi-Institutional Single-Arm Analysis

This study aims to clarify the perioperative risk factors and short-term prognosis of central bisectionectomy (CB) for hepatocellular carcinoma (HCC). Surgical data from 142 selected patients out of 171 HCC patients who underwent anatomical CB (H458) between 2005 and 2020 were collected from 17 expert institutions in a single-arm retrospective study. Morbidities recorded by the International Study Group of Liver Surgery (ISGLS) from grade BC post-hepatectomy liver failure (PHLF) and bile leakage (PHBL), or complications requiring intervention were observed in 37% of patients. A multivariate analysis showed that increased blood loss (iBL) > 1500 mL from PHLF (risk ratio [RR]: 2.79), albumin level < 4 g/dL for PHBL (RR, 2.99), involvement of segment 1, a large size > 6 cm, or compression of the hepatic venous confluence or cava by HCC for all severe complications (RR: 5.67, 3.75, 6.51, and 8.95, respectively) (p < 0.05) were significant parameters. Four patients (3%) died from PHLF. HCC recurred in 50% of 138 surviving patients. The three-year recurrence-free and overall survival rates were 48% and 81%, respectively. Large tumor size and surrounding tumor involvement, or compression of major vasculatures and the related iBL > 1500 mL were independent risk factors for severe morbidities in patients with HCC undergoing CB.

Panuveitis of undetermined origin after diagnostic pars plana vitrectomy: clinical characterization and long-term outcome from a tertiary referral center.

To identify the characteristics and outcome of panuveitis of undetermined origin (PUO) after diagnostic vitrectomy. Retrospective analysis of all patients who underwent vitrectomy for diagnostic/therapeutic purposes from 2013 to 2020, whose vitreous biopsies turned out negative and final diagnoses were not clinically supported. Of 122 operated eyes, 36 eyes (29.5%) were defined as PUO (67.8 ± 14.9years). The presenting clinical picture revealed a predominantly bilateral condition (70% of eyes) with significant posterior segment involvement: 3.1 ± 0.6 vitritis, 61.1% of eyes with retinal vasculitis, 44.4% with macular edema, and 30.6% with exudative retinal detachment. Presenting visual acuity was 1.2 ± 0.7 logMAR, and up to 90% remained stable or improved vision over a ~ 3.5year observation period. None of the presenting clinical features turned out to be predictive of final visual outcome or survival. PUO is present in up to 30% of cases after diagnostic/therapeutic vitrectomy. This mainly bilateral condition shows chronic and overall stable long-term outcome, generally with retained steady visual function.

The impact of lymphovascular space invasion on survival in early stage low-grade endometrioid endometrial cancer

BackgroundThe lymphovascular space invasion (LVSI) is suggested as a prognostic factor for endometrial cancer in many studies, but it has not yet been employed in FIGO staging system. The present study was aimed to evaluate the impact of LVSI on survival in patients with early stage endometrioid endometrial cancer.MethodsThis retrospective cohort was conducted on early stage endometrial cancer patients who underwent surgical staging [total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)] and omental biopsy at Referral Teaching Hospitals of Tehran from 2005 to 2021. Patient’s age, menopause status, tumor grade, tumor size, depth of myometrial invasion, LVSI and lower segment involvement were recorded. Data were analyzed with SPSS 22.Results415 patients with stage I and grade 1–2, endometrioid endometrial cancer were analyzed. 100 patients (24.1%) were LVSI-positive. 3-year and 5-year survival rates were 97.1% and 88.9%, respectively. Recurrence occurred in 53 patients (12.8%). 3-year overall survival rates in LVSI-negative and LVSI-positive were 98.7% and 92%. These rates for 5-year survival were 92.1% and 79%, respectively. Recurrence rates in LVSI-negative were 8.9% while it was 25% in LVSI-positive cases. Multivariate analysis showed that LVSI has significant correlation with 3-year and 5-year overall survival rates.ConclusionsLVSI in early stage endometrial cancer significantly and independently influences 3-year and 5-year survival rates and acts as a strong prognostic factor in these patients. LVSI should be implemented in endometrial cancer staging systems due to its significant correlation with cancer recurrence rates and 5-year survival rates.

Abstract Number: LBA7 Outcomes of Endovascular Thrombectomy Versus Medical Treatment in Ischemic Strokes Secondary to Medium Vessel Occlusion

Introduction Acute ischemic stroke (AIS) from arterial occlusions are treated with emergent endovascular thrombectomy (EVT) when clinically appropriate. Clinical outcomes of EVT in medium vessel occlusion (MVO) compared to large vessel occlusion (LVO) have neither been well established nor compared to alternate medical management. Our aim was to evaluate outcomes of patients with AIS secondary to MVO undergoing EVT. Methods We conducted a retrospective chart review of patients presenting to our comprehensive stroke center with MVO‐associated AIS undergoing EVT or aggressive intra‐arterial thrombolytic treatment with concurrent administration of IV eptifibatide. We assessed occlusion site, NIHSS (presentation, 7 day or discharge, 3 months), modified Rankin Scale (baseline, 90‐day), and intracranial hemorrhage (ICH) rate. MVO was defined as occlusion of pure M2 middle cerebral artery without M1 segment involvement, anterior cerebral artery A1 segment or more distal, and posterior cerebral artery P1 segment or more distal. Mann‐Whitney U test, Fisher exact test statistic, and T‐test statistic were used for analysis. Social science statistics software was used for data analysis. Results From August 2020 to December 2021, out of 175 patients who underwent EVT, 50 had MVO (n = 33 M2 occlusion, n = 12 M3 occlusion, n = 1 for P1, P2, A1, A2, A3 each). Twelve subjects with MVO received aggressive medical management with concurrent IV eptifibatide. Subjects between arms were similar at baseline (median NIHSS 11 [95% CI 10.75, 14.32]; mean age 71.5 [95% CI 69.24, 73.77]; male 48.39% [n = 30]). The difference between initial NIHSS and discharge NIHSS was statistically significant in the EVT arm (Z‐Score = 4.03; p‐value &lt; .00001) but not in the medical arm (Z‐score = 1.96; p‐value 0.05). Hemorrhagic transformation occurred in 28% (n = 14) of EVT arm and 16.67% (n = 2) of medical arm. This was not statistically significant (Fisher value: 0.71). Median 90 day mRS was 1 (95% CI [0.89, 2.11]). The difference between 90 day mRS was not significantly different (Z‐score = ‐1.20; p‐value 0.23). Conclusions In our patient cohort, endovascular therapy was safe in medium vessel occlusion and may have more favorable clinical outcomes as illustrated by higher delta NIHSS in the endovascular thrombectomy group. Larger, prospective studies are needed to validate our results.

Shear Wave Elastography in Patients with Spinal Muscular Atrophy Types 2 and 3.

This study aimed to investigate selective muscle involvement by shear wave elastography (SWE) in patients with spinal muscular atrophy (SMA) types 2 and 3 and to compare SWE values with magnetic resonance imaging (MRI) in demonstrating muscle involvement. Seventeen patients with SMA types 2 and3 were included in the study. SWE was used to evaluate stiffness of the upper and lower extremities and paraspinal muscles. Involvement of the paraspinal muscles was evaluated using 1.5-T MRI. Among the upper extremity muscles, SWE values were the highest for the triceps brachii; however, no significant difference was noted (p = 0.23). In post hoc analysis, a significant difference was observed between triceps brachii and biceps brachii (p = 0.003). Patients with a longer disease duration have the highest SWE values for the triceps brachii (r = 0.67, p = 0.003). Among the lower extremity muscles, SWE values for the iliopsoas were significantly higher than the gluteus maximus (p < 0.001). A positive correlation was found between SWE values and MRI scores of paraspinal muscles (r = 0.49, p = 0.045; r = 0.67, p = 0.003). This is the first study to report muscle involvement assessed by SWE in patients with SMA types 2 and 3. Our findings are similar to the presence of selective muscle involvement demonstrated in previous studies, and also SWE and MRI values were similar. SWE is an alternative noninvasive practical method that can be used to demonstrate muscle involvement in patients with SMA, to understand the pathogenesis of segmental involvement, and to guide future treatments or to monitor the effectiveness of existing new treatment options.

COVID -19 hastalarında arka segment optik koherens tomografi bulguları

Abstract: &#x0D; Purpose: COVID – 19 which is still the leading health problem in the world, is not yet fully understood, therefore the study aims to investigate the posterior segment of the eye in patients with COVID – 19 using optical coherence tomography (OCT).&#x0D; Materials and Methods: The present study was designed prospective and cross-sectional. Patients with a positive test result of COVID – 19 and healthy controls who were older than 18 years were included in the study. Excluded from the study were the patients with any systemic comorbidity and ocular disease. The demographic and clinical data, including ocular findings and the OCT data, including hyper-reflective (HR) lesions, retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and macular thicknesses (MT) were recorded as outcomes and analyzed. &#x0D; Results: Twenty patients with SARS-CoV-2 and 20 healthy subjects were included in this study. There was no difference between COVID -19 patients and healthy controls in terms of the RNFL, GCC, and macular thicknesses (P &gt; 0.05). HR lesions were detected in 18(45%) eyes of 9(45%) patients with COVID – 19 and 15(37,5%) eyes of 8(40%) healthy subjects’ retinae with no significant difference between groups (P = 0.165). &#x0D; Conclusions: Hyper-reflective lesions could only be retinal vessels' tangential cuts seen in OCT B-Scans. There was not enough data that could indicate posterior segment involvement of COVID – 19.

A Coronary CT Angiography Radiomics Model to Identify Vulnerable Plaque and Predict Cardiovascular Events.

Background A noninvasive coronary CT angiography (CCTA)-based radiomics technique may facilitate the identification of vulnerable plaques and patients at risk for future adverse events. Purpose To assess whether a CCTA-based radiomic signature (RS) of vulnerable plaques defined with intravascular US was associated with increased risk for future major adverse cardiac events (MACE). Materials and Methods In a retrospective study, an RS of vulnerable plaques was developed and validated using intravascular US as the reference standard. The RS development data set included patients first undergoing CCTA and then intravascular US within 3 months between June 2013 and December 2020 at one tertiary hospital. The development set was randomly assigned to training and validation sets at a 7:3 ratio. Diagnostic performance was assessed internally and externally from three tertiary hospitals using the area under the curve (AUC). The prognostic value of the RS for predicting MACE was evaluated in a prospective cohort with suspected coronary artery disease between April 2018 and March 2019. Multivariable Cox regression analysis was used to evaluate the RS and conventional anatomic plaque features (eg, segment involvement score) for predicting MACE. Results The RS development data set included 419 lesions from 225 patients (mean age, 64 years ± 10 [SD]; 68 men), while the prognostic cohort included 1020 lesions from 708 patients (mean age, 62 years ± 11; 498 men). Sixteen radiomic features, including two shape features and 14 textural features, were selected to build the RS. The RS yielded a moderate to good AUC in the training, validation, internal, and external test sets (AUC = 0.81, 0.75, 0.80, and 0.77, respectively). A high RS (≥1.07) was independently associated with MACE over a median 3-year follow-up (hazard ratio, 2.01; P = .005). Conclusion A coronary CT angiography-derived radiomic signature of coronary plaque enabled the detection of vulnerable plaques that were associated with increased risk for future adverse cardiac outcomes. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by De Cecco and van Assen in this issue.

Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography

Adverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown. To assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening. Cross-sectional study of a population-based cohort of women in Sweden (n = 10 528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected. Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures. Coronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100. A median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk. Among Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.

Posterior segment involvement in Infantile Nephropathic Cystinosis – A review

Cystinosis is a rare lysosomal storage disease with a prevalence of 1:100.000-1:200.000 cases. It is caused by biallelic mutations in the CTNS gene, which encodes cystinosin that transports cystine out of lysosomes. Due to its dysfunction cystine crystals accumulate in the lysosomes and ultimately cause apoptosis of the cell. Since cystinosin is ubiquitously present in the body, cystine crystals are deposited in every body structure and lead to the dysfunction of various organ systems in the course of time. Cystine crystals deposited in the cornea are a clinical hallmark of the disease, while there is less awareness of concomitant posterior segment alterations. Frequently, symmetrical pigment epithelial mottling and patches of depigmentation starting in the periphery, which progress towards the posterior pole, can be encountered upon fundus biomicroscopy. Spectral Domain Optical Coherence tomography (SD-OCT) represents an elegant tool for visualizing chorioretinal cystine crystals at the posterior pole. An SD-OCT-based clinical grading of the severity of the chorioretinal manifestation can potentially be applied as a biomarker for systemic disease status and monitoring of oral therapy adherence in the future. Along with previous histological examinations, it may also give information about the location of cystine crystals in the choroid and retina. This review aims to increase the awareness of vision-threatening retinal and choroidal changes in cystinosis and the concomitant findings in SD-OCT. Die Cystinose ist eine seltene, autosomal rezessiv vererbte lysosomale Speicherkrankheit der Aminosäure Cystin mit einer geschätzten Prävalenz von 1:100.000 bis 1:200.000. Ursächlich sind Mutationen im CTNS-Gen, welche für den lysosomalen Aminosäure-Transporter Cystinosin kodieren. Die Fehlfunktion des Cystinosins führt zu einer Akkumulation von Cystin im Lysosom und letztlich zur Apoptose der Zelle Das intrazelluläre Cystinosin ist ubiquitär im Körper vorhanden, sodass sich Cystin-Kristalle in jedem Gewebe ablagern und zu einer Dysfunktion verschiedener Organsysteme führen. Korneale Cystinkristallablagerungen sind pathognomonisch für die Erkrankung, während begleitende Veränderungen am hinteren Pol bislang weniger Beachtung fanden. Fundoskopisch sind häufig symmetrische retinale Pigmentepithelauflockerungen und depigmentierte Areale zu erkennen, die in der Peripherie beginnen und zum hinteren Pol fortschreiten. Die optische Kohärenztomografie (SD-OCT) eignet sich sehr gut zur Visualisierung chorioretinaler Cystinkristallablagerungen. Eine SD-OCT-basierte klinische Einstufung des Schweregrads der chorioretinalen Manifestation kann in Zukunft möglicherweise als Biomarker für den systemischen Krankheitsstatus und für die Überwachung der oralen Therapieadhärenz eingesetzt werden. In Zusammenschau mit früheren histologischen Untersuchungen können OCT-morphologische Aufnahmen Aufschluss über die genaue Lokalisation der Cystinkristalle in der Aderhaut und Netzhaut geben. Diese Übersichtsarbeit soll das Bewusstsein für visusbedrohende Netzhaut -und Aderhautveränderungen in der infantilen nephropathischen Cystinose und die begleitenden Befunde im SD-OCT schärfen.

Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS

Background and aimsElevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change. MethodsWe used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS). ResultsThe probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p < 0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women. ConclusionsSimilar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.