Long-term Follow-up Of Patients Research Articles

Common variable immunodeficiency 10, due to a novel variant in the NFKB2 gene, presenting as alopecia universalis and vitiligo.

Our work demonstrates one CVID patient with novel variants in NFKB2, which emphasizes the importance of genetic testing and long-term follow-up in patients with combined autoimmune manifestations.

Impact of CT-angiography derived plaque characteristics on cardiac events in patients with a negative invasive fractional flow reserve.

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) improves outcomes compared with angiography-guided PCI, however cardiac events still occur during long-term follow-up of FFR-negative patients. In the PREVENT study preventive PCI reduced cardiac-events in lesions which were FFR-negative (FFR>0.80) and had intracoronary imaging defined vulnerable plaque. Coronary computed tomography angiography (CTA)-defined high risk plaque (HRP) is known to predict future cardiac events. We hypothesized that CTA defined HRP would identify which FFR-negative patients were at greatest risk of future cardiac events. We examined 373 consecutive CCS patients undergoing CTA followed not more than 90days later by invasive FFR. Cardiac events were defined as cardiac death, non-fatal acute coronary syndromes, and ischemia-driven revascularization. Clinical follow-up was performed in all patients at a median of 32months. Revascularization was performed in 131 of the 373 patients due to an FFR≤0.80 (Treat group), with the remaining 242 having revascularization deferred (Defer group) due to an FFR>0.80. In the Treat group the cardiac event rates between patients with and without HRP on CTA were similar (9.4% versus 10.1%, p=0.90), whilst in the Defer group they were higher in patients with HRP (21.1% versus 4.7%, Log-rank-p<0.0001). In multivariate Cox hazard analysis the presence of HRP (Hazard-ratio 12.79, 95%confidence-intervals: 3.57-45.83, p<0.0001) was an independent predictor for cardiac events in the Defer group. HRP on CTA was associated with future cardiac events in patients in whom revascularization was deferred due to a negative invasive-FFR (UMIN000054067; CAPTURE).

Thirty-year compliance with a surveillance program for patients with familial adenomatous polyposis.

Familial adenomatous polyposis is an inherited genetic disorder responsible for multiple anomalies. Lifelong surveillance protocols are essential to detect and prevent adverse developments. However, limited data exist regarding the long-term feasibility of such programs. This study aims to evaluate the compliance with a surveillance program for patients with familial adenomatous polyposis. The study collated data from all patients who underwent surgery between January 1981 and December 1993, excluding non-French residents. Recorded characteristics included medical history, follow-up results, the indications for operations or other procedures, outcomes of these interventions, and patient status at the end of the follow-up period. One hundred and sixty-four patients were enrolled, comprising 86 females (52.4%). The median age at the time of colorectal resection was 29.6 years [10-67]. Thirty-six (22.0%) were diagnosed with cancer at the time of their surgery. Fifty-eight patients (35.3%) passed away at a median age of 52 years [18-95]. During the follow-up period, 47 patients developed duodenal or reservoir adenomas requiring invasive procedures, or desmoid tumors necessitating treatment. After a possible 30 years of follow-up, 49 survivors (46.2%) are still under observation, while 57 (53.8%) have been lost to follow-up. After 30 years of follow-up, the survival rate was 74.2% for patients who remained under observation, but only 58.2% for those lost to follow-up. Long-term follow-up of patients with familial adenomatous polyposis is associated with a high rate of loss to follow-up. However, those who remain under observation maintain an excellent prognosis. Understanding the reasons for loss to follow-up is challenging but may help in reducing this high attrition rate.

Long-term survival from a randomized controlled trial of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for early-stage lung cancer.

We previously did a randomized clinical trial of lobectomy by VATS or thoracotomy for early-stage lung cancer and found that patients who underwent VATS had less postoperative pain and better quality of life compared with thoracotomy. VATS has since been regarded the preferred surgical method for early-stage lung cancer. It is assumed that long-term survival is not influenced by surgical approach, but this assumption primarily rests on non-randomized comparative studies. We decided to do a long-term follow-up of patients who entered our previous randomized trial. Between 2008 and 2014 we randomly assigned 206 patients to VATS (n = 103) or anterolateral thoracotomy (n = 103) for proven or suspected early-stage NSCLC. Records from patients with NSCLC on final pathology were identified in the national electronic patient-record system and the Danish Lung Cancer Registry. Overall, disease-free, and cancer-specific survival were estimated using the Kaplan-Meier method and log-rank test was used to compare the two interventions. A total of 196 patients had NSCLC on final histopathology. Four patients were lost to follow-up and the remaining 192 were included in this follow-up study with 128 events used for overall survival analysis, 100 events for disease-free survival analysis and 79 events for cancer-specific survival analysis. VATS was used in 99 patients versus 93 by thoracotomy. Median age at time of surgery was 66 years (range 41-85 years). After a median follow-up time of 12.8 years (range 9.9-15.8 years), 33% of patients were alive. Overall, disease-free, and cancer-specific survival were not significantly different between VATS and thoracotomy: Overall survival (p = 0.29), disease-free survival (p = 0.17) and cancer-specific survival (p = 0.31). We did not find any statistically significant differences in overall, disease-free, or cancer-specific survival between VATS and thoracotomy. However, larger trials with better power for survival analysis are needed to fully explore if there are differences. Alternatively, differences in survival between thoracotomy and VATS for early-stage NSCLC could be investigated by pooling survival data from two similar randomized trials that have since been published.

P0920 Long term follow-up of patients with ulcerative colitis after suspension of infliximab for stable deep remission

Abstract Background Infliximab (IFX) is the first anti-TNF biologic drug approved for treating moderate to severe ulcerative colitis (UC). While IFX is effective in inducing mucosal healing and enhancing quality of life, concerns persist about the long-term safety and cost-effectiveness of extended immunosuppression. Current guidelines lack clarity on when to discontinue treatment after achieving stable deep remission. Moreover, existing literature is limited to studies characterised by small sample sizes and heterogenous criteria for defining remission. We aimed to evaluate the outcomes in UC patients who discontinued IFX after achieving stable deep remission, to identify predictors of relapse post-discontinuation, and to examine the clinical course in those who experienced a relapse. Methods In this single-center, retrospective, observational study, we analyzed UC patients at our tertiary IBD Referral Center who discontinued IFX due to sustained deep remission, defined as the combination of partial Mayo subscore ≤ 1 and endoscopic Mayo score = 0, and who had at least 1 year of follow-up post treatment withdrawal. We assessed the relapse rates at intervals of 6 months, 1 year, 2 years, and beyond 2 years post-IFX discontinuation. For patients who relapsed, we recorded the therapeutic strategy and its effectiveness, including the necessity for colectomy. We performed univariate and multivariate analyses to identify relapse predictors post-treatment suspension. Results From 2006 to 2022, 790 UC patients received IFX treatment at our center; 113 patients suspended IFX due to stable deep remission with at least 1 year of follow-up and were included in this study. Of these, 41.6% maintained remission over a median of 5.17 years. Flare rates were 14.2%, 23.9%, and 35.5% within 6, 12, and 24 months, respectively, with 58.4% experiencing a flare overall. Multivariate analysis showed that longer treatment duration reduced relapse risk (p=0.001), while steroid use during IFX treatment and early IFX initiation post-diagnosis increased relapse risk (p=0.004 and p=0.043, respectively). Most patients who relapsed were successfully managed medically either with a course of steroids, restarting IFX, or initiating a different type of biologic/small molecule, whereas the rate of colectomy was 7.1%. Conclusion This study is one of the largest to date with the longest follow-up that evaluates outcomes post-IFX discontinuation in UC patients in deep remission. Our findings suggest that withdrawal of IFX treatment can be considered in carefully selected cases. In patients who relapse after IFX suspension, medical treatment is often effective, and the rate of colectomy is low. Further studies are warranted to better identify ideal candidates for treatment withdrawal.

Long-term side effects of neurotoxicity of antitumor therapy in children who survived lymphoid tumors

Relevance. Improving the diagnosis and treatment of children with lymphoid tumors (LT) contributes to an increase in the number of cured patients. Antitumor therapy has a side effect on the nervous system, and can lead to neurotoxic consequences. Due to the increased life expectancy of children cured of LT, the assessment of the long-term neurotoxic effects of antitumor therapy is relevant.Objective: based on the literature data, to study the long-term neurotoxic side effects of antitumor therapy in children cured of LT.Material and methods. When writing a literature review, data were analyzed in specialized medical databases Pubmed, Scopus, Web of Science on research in children cured of lymphoid tumors from 1993 to 2023.Results. In cured children from lymphoid tumors, the long-term neurotoxic effects of therapy containing methotrexate in high doses are manifested by neurocognitive decline and structural changes in the brain. Late peripheral neuropathy caused by vincristine affects the quality of life of patients in physical and social aspects. However, the prognostic parameters of long-term neurotoxic effects in children cured of LT have not been determined. The issues of monitoring patients in the long term have not been sufficiently studied. This will contribute to the rehabilitation and long-term follow-up of patients with oncohematological diseases, and improve their quality of life.

Towards implementing new payment models for the reimbursement of high-cost, curative therapies in Europe: insights from semi-structured interviews.

New ways of reimbursement for high-cost, one-shot curative therapies such as advanced therapy medicinal products (ATMPs) are a growing area of interest to stakeholders in market access such as industry representatives, legislative and accounting experts, physicians, hospital managers, hospital pharmacists, patient representatives, policymakers, and sickness funds. Due to the complex nature of ATMPs, new payment models and reimbursement modalities are proposed yet not widely applied across Europe. This study aimed to elicit opinions on and insights into the governance aspect of implementing outcome-based spread payments (OBSP) in Belgium for the reimbursement of innovative therapies. Stakeholders' responsibilities and roles were analysed and proposed solutions or general beliefs were assessed to identify necessary or sufficient conditions to establish outcome-based spread payments. Semi-structured interviews (n = 33) were conducted with physicians (n = 2), hospital pharmacists (n = 4), hospital managers (n = 2), Belgian policymakers (n = 6), legislative experts (n = 2), accounting experts (n = 5), representatives of patients (n = 3), of industry (n = 5), and sickness funds (n = 4). The interviews took place between July 2020 and October 2020. The framework method analysis was performed using Nvivo software (version 20.4.1.851). Statements were allocated into six main topics: payment structure, spread payments, outcome-based agreements, governance, transparency, and regulation. Interviews revealed the necessary conditions that, fulfilled together, are seen to be sufficient for the successful implementation of OBSP, including consensus on pricing, payment logistics, robust data infrastructure and financing, clear agreement terms (duration, outcome parameters, payment triggers), long-term patient follow-up solutions, an external multi-stakeholder governance body, and transparency regarding agreement types. Despite the interest, the effective implementation of OBSP falls behind due to a lack of consensus on how this new reimbursement method can be a sustainable solution. By stating the necessary conditions that, when fulfilled together, are deemed sufficient for successful OBSP implementation, this study provides a framework towards overcoming implementation barriers and realizing the potential of OBSP in transforming healthcare reimbursement practices.

Impact of hysterectomy on opioid use in patients with adenomyosis: A nationwide register study.

Dysmenorrhea and heavy menstrual bleeding are the most common symptoms in adenomyosis, in addition to infertility and chronic pelvic pain. Hysterectomy is a common treatment for adenomyosis symptoms with curative effect on heavy menstrual bleeding but with less studied effects on pain reduction. This is a nationwide retrospective register-based cohort study including all hysterectomized patients with pathology-verified adenomyosis between 1 January 2012 and 31 December 2015 with a long-term follow-up three years pre- and three years postoperatively. Two national registers were linked in order to describe the primary outcome of proportion with use of opioids among hysterectomized patients with and without adenomyosis pre- and postoperatively. Logistic and multinomial regression models were used. A total of 2,228 (15%) patients had pathology-verified adenomyosis. Overall opioid use was 18.6% and 21.1% three years before and three years after surgery, respectively. Results showed a significantly increased risk of opioid use three years after hysterectomy in patients with preoperative use of opioids and antidepressants (adjusted Odds Ratio (aOR) 5.7, 95% Confidence Interval (CI) 4.5-7.2 and aOR 1.4, 95% CI 1.1-1.8). The risk of needing long-term opioids was higher among patients with smaller uteri (<300g, aOR 2.8, 95% CI 1.7-4.7) compared to women with uterine sizes ≥600g. Hysterectomy does not reduce opioid use among adenomyosis patients in long-term follow-up, although the subjective reduction of pain was not investigated in this study. Women with preoperative use of opioids/antidepressants and uterine size <300g are at increased risk for chronic opioid use.

Can Topical Glyceryl Trinitrate be Effective in the Treatment of Levator Ani Syndrome?

Levator ani syndrome (LAS) is a pathology that is both difficult to diagnose and treat. The effectiveness of current treatments, which are mostly administered with special devices in advanced healthcare centers, is controversial. The aim of the study is to investigate the effects of glyceryl trinitrate, which is easily accessible and can be applied by the patient, in the treatment of LAS. The study cohort comprised 16 patients with LAS diagnosed and received 0.4% topical glyceryl trinitrate treatment rectally. At the first month of treatment, it was observed that the symptoms and puborectal muscle tension of 15 (93.7%) patients had completely resolved. One patient with persisted symptoms was referred to an advanced center. Symptomatic relief continued in 14 (87.5%) of the 15 patients at the third month of treatment and there were no pathological findings in the rectal examination. The visual analog scale score significantly decreased after the treatment (P < .001). It is thought that topical glyceryl trinitrate treatment may be at least as effective as current treatment methods. Although the number of patients is small, our study is inspiring as it is the first time this molecule has been tried in the treatment of LAS in the literature. More comprehensive randomized controlled studies with long-term follow-up of patients are needed.

Commentary: Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Commentary: Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Costal fracture assessment for relief and enhancement of quality of life-CARE study.

Rib fractures account for 10-15% of trauma-related hospital admissions. Few data are available regarding long-term follow-up of patients undergoing non-operative management. Our aim is to evaluate quality of life at 1, 2, 4, 12 and 24weeks from the trauma. Pain management, respiratory infection rate and length of hospitalization (LOS) will be recorded. Patients with rib fractures older than 18years of age will be prospectively included. cognitive impairment, chronic pain due to pathologic fractures, active cancer. Patients will be asked to complete a specific survey at 1, 2, 4, 12 and 24weeks from the trauma to assess their quality of life. Pain management, respiratory infection rate and LOS will be recorded. gov ID NCT06405841. The study will provide a detailed quality of life assessment for patients with rib fractures treated conservatively. It will identify the most effective types of analgesic therapies in controlling rib fracture-related pain, respiratory infections rate, and LOS. The results could have broad practical applications, providing guidance on best practices for rib fracture treatment. This could lead to greater efficacy in management protocols, reducing or increasing the need for surgical interventions. The study could have a significant impact on the health-care system by providing evidence to optimize healthcare resources through more targeted management. If the results demonstrate that conservative treatment is ineffective for certain types of fractures, these patients could be selected for surgical treatment, resulting in savings for the healthcare system and improvement in patient quality of life.

Long-Term Effects of COVID-19 on Optic Disc and Retinal Microvasculature Assessed by Optical Coherence Tomography Angiography.

Objectives: To evaluate the long-term effects of coronavirus disease (COVID-19) on optic disc and macular microvasculature. Methods: 40 post-COVID-19 and 40 healthy subjects were included. Optical coherence tomography angiography (OCTA) was performed for all subjects at the first visit and repeated in the fourth and twelfth months. Radial peripapillary capillary (RPC) vessel density (VD), retinal nerve fiber layer (RNFL) thickness, foveal avascular zone (FAZ) area, FAZ perimeter, VDs of the fovea, parafovea, and perifovea at superficial capillary plexus (SCP) and deep capillary plexus (DCP), and central macular thickness (CMT) were evaluated. The OCTA measurements of the COVID-19 group were compared with the control group. Results: The COVID-19 group showed lower VD values than the control group in the nasal parafoveal quadrant of the SCP at all visits (p = 0.009, p = 0.47, p = 0.042) and in the superior perifoveal quadrant of the DCP in the twelfth-month visit (p = 0.014). At all visits, FAZ area and FAZ perimeter were higher (p = 0.02, p = 0.02, p = 0.002; p = 0.002, p = 0.003, p = 0.005), foveal VD values of both SCP and DCP were lower (p < 0.001, p < 0.001, p < 0.001; p = 0.005, p = 0.001, p = 0.001), and CMT was lower (p < 0.001, p = 0.001, p = 0.001) in the COVID-19 group. The COVID-19 group had higher temporal quadrant RPC at all visits (p = 0.003, p = 0.003, p < 0.001) and higher average, superior and inferior RNFL at first and fourth-month visits (p = 0.014, p = 0.020; p = 0.001, p = 0.003; p = 0.021, p = 0.024). Conclusions: There are long-term changes that mainly point to the ischemia in the COVID-19 patients. We emphasize the need for long-term ophthalmologic and systemic follow-up of COVID-19 patients regarding potential complications.

Ostéome sinonasal géant inattendu après une chirurgie pour rhinosinusite chronique avec polypes : à propos d’un cas

Osteomas are the most frequently observed benign bone tumors of paranasal sinuses. These slow-growing, benign tumors are often asymptomatic and typically discovered incidentally on radiological exams conducted for unrelated complaints. However, their potential for significant complications arises when they grow to a size or position that impacts adjacent structures. Large osteomas may obstruct sinus drainage, leading to secondary infections such as chronic sinusitis, or extend into the orbit or intracranial space, causing symptoms like proptosis, diplopia, vision loss, headaches, and even cerebrospinal fluid leaks in cases of dural invasion. Intracranial extension, while rare, can lead to serious complications, including meningitis, brain abscess, and mucocele formation. This article presents a 70-year-old male with recurrent chronic rhinosinusitis and nasal polyps, who had undergone functional endoscopic sinus surgery three years prior. At follow-up, the recurrence of nasal polyps was observed alongside a newly developed ethmoidal osteoma. Cases like this underline the importance of regular postoperative imaging, especially in patients with recurrent sinonasal issues, as osteomas can develop post-surgically. Some studies suggest that local factors such as inflammation or surgical trauma may play a role in the growth or initiation of osteomas, though this remains to be fully understood. This case highlights the clinical value of CT and MRI in the identification, differentiation, and management of paranasal sinus osteomas, as well as the importance of vigilance in long-term follow-up for patients with chronic sinonasal conditions.

Metachronous Liver Metastasis during Long-term Follow-up after Endoscopic Submucosal Dissection of a Small Rectal Neuroendocrine Neoplasm

A 67-year-old woman underwent a screening colonoscopy, which revealed a 7-mm rectal subepithelial lesion. Endoscopic submucosal dissection (ESD) confirmed a grade 1 rectal neuroendocrine neoplasm (NEN), and no further treatment was administered. One year after ESD, she was diagnosed with lung cancer, which recurred 4 years later and required chemotherapy. Nine years after ESD, multiple liver metastases from the rectal NEN were found, which were well controlled with radiofrequency ablation. The patient died 13 years after ESD due to the progression of lung cancer. This case highlights the need for long-term follow-up in patients with small rectal NENs treated with endoscopic resection.

Sex Differences in Sudden Cardiac Death During Long-Term Follow-up in Patients With Chronic Heart Failure ― A Report From the CHART-2 Study ―

Although sudden cardiac death (SCD) generally occurs more frequently in men than in women, there are limited data on sex differences in SCD in patients with chronic heart failure (HF) across a range of left ventricular ejection fraction (LVEF). We examined sex differences in SCD incidence, timing, and risk factors in 4,683 patients with chronic HF (3,186 men, 1,497 women) from a multicenter prospective observational cohort study (CHART-2). Over a median follow-up of 8.8 years after study enrollment, there were 215 SCDs (160 in men, 55 in women). The SCD incidence rates in men and women were 6.1 and 4.6 per 1,000 person-years, respectively (P=0.088). Among women, more than half the SCDs occurred in the first 5 years of follow-up. Beyond 5 years, the SCD incidence rate was significantly lower in women than in men (3.6 vs. 5.9 per 1,000 person-years, respectively; P=0.044). After adjusting for confounders, age, increased B-type natriuretic peptide, and LVEF <50% were common prognostic factors. After 5 years of follow-up, left ventricular (LV) enlargement was a risk factor for SCD in both sexes. These results indicate that there are sex differences in SCD, especially beyond 5 years of follow-up, with a lower prevalence in women. LV enlargement is a common long-term prognostic factor in both sexes, suggesting the importance of preventing LV remodeling in HF management.

Multiparametric cardiovascular magnetic resonance in patients with myocarditis with consecutive follow-up and a comparison between non-COVID-19 and COVID-19-associated myocarditis.

The pattern of myocardial injury and dysfunction development during follow-up is unclear in patients with myocarditis. This study aims to explore the developmental pattern of myocardial injury and cardiac dysfunction during the follow-up of myocarditis by cardiac magnetic resonance (CMR) and differences in short-term follow-up CMR performance between patients with coronavirus disease 2019 (COVID-19)-associated myocarditis (CAM) and non-COVID-19-associated myocarditis (NCAM). Data of patients with clinically diagnosed myocarditis who underwent follow-up CMR were retrospectively collected. Patients were divided into the NCAM follow-up and CAM follow-up groups. A portion of patients with normal CMR and volunteers was categorized as control. Qualitative and quantitative assessments of CMR images were used to analyze cardiac structure, function and myocardial damage; compare the differences between the groups; and reveal the developmental pattern in the consecutive follow-up for patients with myocarditis. This study included 75 patients with NCAM, 25 patients with CAM and 75 cases as control group. Compared with the control group, there was an increase in left ventricular volume, right ventricular volume, extracellular volume in the NCAM follow-up (the last time) group, left ventricular volume, right ventricular ejection fraction, global radial strain (GRS), global circumferential strain, global longitudinal strain (GLS), post-contrast T1 value were decreased. The area under the curve of the GLS was the best (0.836) in discriminating between the two groups, with 78.7% sensitivity and 84.0% specificity. The discriminatory efficacy of the combined right ventricular ejection fraction, GRS, and GLS multiparameter showed the best area under the curve at 0.847, with 80.0% sensitivity and 85.3% specificity. Between the CMR parameter of short- (3 months), medium-, and long-term follow-up (>6 months) for patients with NCAM, a decrease in native T1 (1,256.50±18.63 vs. 1,248.30±17.87 ms, P=0.007) and T2 (49.00±1.34 vs. 47.50±0.97 ms, P=0.015) values was noted in the short-term follow-up group. The short-term follow-up group showed increased ventricular volume, decreased ejection fraction, and impaired myocardial strain in CAM and NCAM compared with the control group. The CAM short-term follow-up group showed an increased T2 value (52.56±3.64 vs. 49.08±3.84 ms, P=0.008) compared with the NCAM short-term follow-up group, and the T2 value was identified with an area under the curve of 0.772, 76% sensitivity, and 83% specificity for the discrimination. This study revealed that myocarditis led to myocardial damage, cardiac remodeling, and dysfunction during follow-up. An improvement in myocardial edema in the medium- and long-term follow-up groups was observed. In the short-term follow-up, CAM showed more severe myocardial edema. These findings may contribute to the clinical assessment and management of post-myocarditis status.

Chronic kidney disease as a predictor of long-term adverse cardiovascular outcomes in patients with aortoiliac disease: a prospective cohort study.

Aortoiliac disease poses a significant cardiovascular (CV) risk, especially in individuals with chronic kidney disease. This study aimed to assess the predictive role of chronic kidney disease in long-term major adverse CV events in patients submitted to aortoiliac revascularization due to severe aortoiliac atherosclerotic disease. From 2013 to 2023, patients who underwent aortoiliac revascularization for TASC II type D lesions, including those with chronic kidney disease, were selected from a prospective cohort study. Demographic, clinical, and postoperative data were collected. Prognostic factors were evaluated for their independent impact on outcomes using survival analysis with a multivariate Cox regression model. The study included 135 patients, 93.3% male, with a mean age of 62.39±9.20 years. Chronic kidney disease was associated with higher prevalence of short-term myocardial injury after noncardiac surgery (54.5%, P=0.014) and was a long-term predictor of acute heart failure (Hazard Ratio=4.884; 95% confidence interval 2.377-22.802; P=0.007), major adverse CV events (HR 2.992; 95% CI 1.498-5.975, P=0.002) and all-cause mortality (HR 3.296; 95% CI 1.626-6.682, P<0.001). The multivariable analysis revealed significant associations between major adverse CV events and the following predictors: chronic kidney disease (adjusted HR=2.416, 95% CI 1.171-4.984, P=0.017) and congestive heart failure (adjusted HR=2.633, 95% CI 1.233-5.623, P=0.012). Chronic kidney disease is a recognized CV risk factor and an independent predictor of long-term acute heart failure, major adverse CV events, and all-cause mortality. These findings underscore the importance of early identification of CV complications and stricter long-term follow-up for chronic kidney disease patients undergoing aortoiliac revascularization.

Long-term Follow-up of Patients Undergoing Nephrectomy for Urolithiasis.

This prospective study aimed to identify risk factors associated with progression to stage 3 chronic kidney disease (CKD) and the occurrence of kidney stone formation or growth following nephrectomy for urolithiasis. From January 2006 to May 2013, patients undergoing nephrectomy for urolithiasis were enrolled. Renal function was assessed using estimated glomerular filtration rate (eGFR) via the Chronic Kidney Disease Epidemiology Collaboration equation, while kidney stone events were detected using computed tomography. Among 107 patients followed for an average of 83.5 months, type 2 diabetes mellitus (T2DM) significantly increased the risk of progression to stage 3 CKD by 34.79-fold (p=0.004). Age was associated with a 15% increase in the odds of developing stage 3 CKD per year (p=0.01), while higher preoperative eGFR was protective (OR=0.84, p<0.01). DMSA-99mTc values below 15% were less likely to lead to renal function deterioration. New kidney stone formation occurred in 15.9% of patients and stone growth observed in 12.1%. Contralateral kidney stones (p<0.01) and hypercalciuria (p=0.03) were identified as risk factors for kidney stone events. T2DM and age were predictors of CKD progression, while higher preoperative eGFR was protective. Hypercalciuria and contralateral kidney stones increased the risk of kidney stone formation and/or growth post-nephrectomy for urolithiasis.

Clinical features and long-term follow-up of patients with West syndrome: 5-year developmental outcomes

Objectives: West syndrome (WS) is an early childhood epileptic encephalopathy characterized by spasms, typically occurring within the first year of life. The International League Against Epilepsy reclassified WS as “infantile epileptic spasm syndrome” to enhance early diagnosis and treatment. It is marked by a triad of epileptic spasms, psychomotor retardation or regression, and hypsarrhythmia on EEG. The prognosis and response to classical anti-epileptic treatments are often poor, and factors influencing prognosis remain unclear. Methods: This study retrospectively analyzed 75 patients with WS over five years, assessing etiology, MRI findings, and neurodevelopmental outcomes according to ILAE guidelines. Results: The cohort comprised 35 females (46.7%) and 40 males (53.3%). The most common etiology was structural, observed in 41 patients (54.7%), followed by unknown causes in 19 patients (25.3%). Genetic, metabolic, and infectious causes were less common. Brain MRI findings were normal in 23 patients (30.7%). Treatment primarily involved Vigabatrin, which was used in 54.7% of cases, followed by Adrenocorticotropic hormone (ACTH) in 25.3%. Seizure control improved over time, with 24% of patients fully controlled at one year and 42.8% at five years. However, 28% showed no change in seizure frequency. The presence of structural abnormalities correlated with a poorer prognosis, while early and complete seizure control was associated with better outcomes. Mortality was 5.3%, with four patients passing away during the follow-up period. Conclusion: The study highlights that while the etiology remains a significant factor in the prognosis of WS, early intervention and effective seizure management are crucial for improving long-term outcomes.

Long-Term Follow-Up in Patients with Modified Fontan: Assessing Outcomes, Complications, and Management Strategies for Single-Ventricle Survivors

Long-Term Follow-Up in Patients with Modified Fontan: Assessing Outcomes, Complications, and Management Strategies for Single-Ventricle Survivors