Long-term Follow-up Research Articles

Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure

In the study, we comment on the article by Qu et al . Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.

Risk of Recurrent Prolapse by Extent of Mesh Excision Procedures: A Multicenter Study.

There is limited evidence guiding surgeons in how much mesh to resect when treating mesh complications. The aim of the study was to compare rates of recurrent prolapse after mesh excisional surgical procedures for prolapse mesh complications. This multicenter, retrospective cohort study included patients, identified by Current Procedural Terminology codes, who were treated surgically for prolapse mesh complications at 8 institutions between 2010 and 2019. Excisional surgical procedures were categorized as major (total vaginal, extravaginal, and total mesh excisions) or minor (partial vaginal excisions and mesh revisions). The primary outcome was prolapse recurrence 1 year after mesh excision surgery. Secondary outcomes included long-term prolapse recurrence. Prolapse recurrence was evaluated by Kaplan-Meier survival analysis and Cox proportional hazards regression. Two hundred sixty-one patients met inclusion criteria with 188 (72%) undergoing minor and 73 (28%) major excisions, with a median follow-up time of 1.0 years. Groups differed in parity, location of implant surgery, and number of vaginal compartments involved in excision. Within the first year, major excisions had a higher prolapse recurrence rate (8.7%) than minor excisions (2.9%), P < 0.05. Adjusting for mesh implant type, the hazard ratio for pelvic organ prolapse was 6.1 in the major compared to minor excision. In the entire study period, prolapse recurrence was 33.8% and did not differ between groups. Patients undergoing major excision surgical procedures may have higher rates of prolapse at 1 year compared to those undergoing minor excisions. However, in long-term follow-up, recurrence rates were not different. Our findings may aid surgeons in expectation setting prior to excisional procedures.

Methods for Identifying Epilepsy Surgery Targets Using Invasive EEG: A Systematic Review

Background: The pre-surgical evaluation for drug-resistant epilepsy achieves seizure freedom in only 50–60% of patients. Efforts to identify quantitative intracranial EEG (qEEG) biomarkers of epileptogenicity are needed. This review summarizes and evaluates the design of qEEG studies, discusses barriers to biomarker adoption, and proposes refinements of qEEG study protocols. Methods: We included exploratory and prediction prognostic studies from MEDLINE and Scopus published between 2017 and 2023 that investigated qEEG markers for identifying the epileptogenic network as the surgical target. Cohort parameters, ground truth references, and analytical approaches were extracted. Results: Out of 1789 search results, 128 studies were included. The study designs were highly heterogeneous. Half of the studies included a non-consecutive cohort, with sample sizes ranging from 2 to 166 patients (median of 16). The most common minimum follow-up was one year, and the seizure onset zone was the most common ground truth. Prediction studies were heterogeneous in their analytical approaches, and only 25 studies validated the marker through post-surgical outcome prediction. Outcome prediction performance decreased in larger cohorts. Conversely, longer follow-up periods correlated with higher prediction accuracy, and connectivity-based approaches yielded better predictions. The data and code were available in only 9% of studies. Conclusions: To enhance the validation qEEG markers, we propose standardizing study designs to resemble clinical trials. This includes using a consecutive cohort with long-term follow-up, validating against surgical resection as ground truth, and evaluating markers through post-surgical outcome prediction. These considerations would improve the reliability and clinical adoption of qEEG markers.

Electrocardiographic strain and relationship with LV remodelling and clinical outcomes in patients with aortic stenosis undergoing transcatheter aortic valve implantation

Introduction: Left ventricular (LV) remodelling and fibrosis is known to occur in patients with aortic stenosis (AS) and is linked to post-intervention outcomes. These myocardial changes may be detected upon the routine 12-lead electrocardiogram by the presence of a LV strain pattern (LVS-ECG). Although LVS-ECG has been related to excessive cardiovascular morbidity and mortality in multiple patient populations, there is currently a dearth of data upon its impact in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the current study was to investigate the prevalence, predictors and prognostic value of LVS-ECG. Methods: Between 2012 and 2019, 640 consecutive patients underwent TAVI at Haukeland University Hospital, Bergen. Of these, 600 patients with severe AS were included in the TAVI-NOR study. Patients with known bundle branch block (n=85) or permanent pacing (n=25) were excluded, leaving 490 patients (mean age 81±6years, 52% females) eligible for the analyses. LVS-ECG was defined as down-sloping, convex ST-segment depression with asymmetric T-wave inversion in V5 or V6. Results: LVS-ECG was present in 25.7% patients. Higher levels of NT-proBNP (OR 1.96; 95% CI:1.08-3.55, p=0.028), LVEF&lt;50% (OR 3.14; 95% CI:1.61-6.13, p=0.001), increase in LV mass index per SD (32g/m2) (OR 1.37; 95 CI:1.06-1.76, p=0.014), and the presence of LV hypertrophy on ECG (OR 3.23; 95% CI:1.97-5.32, p&lt;0.001) were independent predictors of LVS-ECG in the multivariable-adjusted analysis. Although all-cause mortality was significantly higher in patients with LVS-ECG compared to those without (54.8% vs 44.2%, p=0.041), the presence of LVS-ECG did not predict all-cause mortality during a median follow-up of 64±24 months (HR 1.05; 95% CI:0.79-1.39, p=0.742). Patients with LVEF &lt;50% and concomitant LVS-ECG had a worse prognosis than those with LVEF &gt;50% and no LVS-ECG (p&lt;0.001). Conclusions: LVS-ECG may represent a simple marker of structural and functional LV remodelling that signals a propensity to excess mortality during long-term follow-up after TAVI, as it is strongly associated with other prognosticators such as reduced LVEF and increased levels of NT-proBNP.

Perioperative outcomes and hospitalization costs of radical vs. conservative surgery for hepatic cystic echinococcosis: A retrospective study

Background Surgical intervention is a crucial treatment for hepatic cystic echinococcosis. However, the choice between radical and conservative surgery remains controversial. This study aimed to compare the perioperative outcomes and hospitalization costs between radical and conservative surgery for hepatic cystic echinococcosis. Method A retrospective cohort study was conducted on patients undergoing surgical treatment at the First People’s Hospital of Kashi Prefecture from July 1, 2012, to October 1, 2023. Propensity score-matching analysis was utilized to mitigate patient selection bias between the two surgical groups. Result Of the 434 patients included, 324 underwent conservative surgery and 110 underwent radical surgery. After propensity score-matching, 182 conservative surgery and 102 radical surgery patients were compared. Radical surgery patients experienced longer operative time, higher intraoperative blood loss, increased blood transfusion, and higher costs compared to conservative surgery patients. However, no differences were observed in short-term outcomes, including overall morbidity, death, bile leak, effusion, pulmonary infection, incision infection, intestinal obstruction, ICU stay, abdominal drainage time, and postoperative hospital stays. Conclusion This study suggests that radical surgery is associated with greater surgical complexity and higher hospitalization costs, while it doesn’t offer a significant short-term advantage. Conservative surgery may be a viable option in resource-limited settings or for patients unsuitable for complex procedures. Further research with long-term follow-up is needed to determine the optimal approach.

Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery in Patients Without Diabetes: a Propensity Score-Matched Analysis

Abstract Background Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity. However, the incidence and long-term risk of hypoglycemia after surgery in patients without diabetes remains unclear. This study aimed to investigate the prevalence of hypoglycemia following RYGB surgery in patients with obesity and without diabetes. Methods A retrospective cohort study was conducted using the TriNetX database. The study population included 15,085 patients with obesity (BMI ≥ 30 kg/m2) who underwent RYGB surgery and 3,200,074 non-surgical controls, all without a history of diabetes or GLP-1 receptor agonist use. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of hypoglycemia, defined by ICD-10-CM codes or laboratory values (glucose ≤ 70 mg/dL). Cox regression analysis was employed to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results In the overall study population, the risk of hypoglycemia was significantly higher in the RYGB group (18.70%, n = 2,810) compared to the control group (3.80%, n = 120,923; HR 4.3, 95% CI 4.14–4.46, p &lt; 0.001). After propensity score matching (n = 14,916 per group), RYGB patients maintained an elevated risk (18.70%, n = 2,795) compared to matched controls (5.0%, n = 749; HR 3.7, 95% CI 3.44–4.05, p &lt; 0.001). Time-series analysis revealed consistently higher hypoglycemia risk in the RYGB group, with hazard ratios ranging from 5.37 (95% CI 4.09–7.03) at 1 week to 3.75 (95% CI 3.45–4.06) at 10 years post-surgery (all p &lt; 0.001). Subgroup analysis of RYGB patients who developed hypoglycemia showed a 30-day hospitalization rate of 21.3% and a mortality rate of 0.71%. Conclusion RYGB surgery is associated with a significantly increased risk of hypoglycemia in patients with obesity and without diabetes, both in the short-term and long-term follow-up. These findings underscore the importance of monitoring and managing hypoglycemia in patients undergoing RYGB surgery, even in the absence of preexisting diabetes. Graphical Abstract

BS SO02 - A systematic review to summarise and appraise the reporting of surgical innovation: A case study in robotic Roux-en-Y gastric bypass

Abstract Background Robotic Roux-en-Y gastric bypass (RRYGB) is an innovative alternative to the laparoscopic approach, however its clinical benefits are uncertain. The Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework was developed to improve the evaluation of surgical innovations alongside their adoption into clinical practice. Studies investigating the benefits of RRYGB have been published, however the reporting quality and robustness of literature has not been assessed. The aim of this systematic review was to summarise and appraise the reporting of RRYGB as a case study of a surgical innovation in relation to the IDEAL framework. Method Systematic searches for primary studies evaluating totally RRYGB were undertaken. Their IDEAL stages were determined using a standardised algorithm. Information pertaining to study characteristics, governance/ethical factors, patient selection, demographics, surgeon expertise/training, technique description and outcomes were extracted. A narrative summary was formulated, with descriptive statistics and data arranged chronologically. All methodology was done in accordance with PRISMA guidance. Results Fourty-seven studies published between 2005-2024 were included: case report (n=1), case series (n=11), non-randomised comparative (n=28) and retrospective analysis of registry databases (n=7). IDEAL stages were assigned as follows: stage 1 (n=1), stage 2a (n=6), stage 2b (n=40), stage 3 (n=0), stage 4 (n=0). There was a lack of sequential progression through IDEAL stages as time progressed since the inception of RRYGB. There was incomplete and inconsistent reporting of governance, ethics, patient selection criteria, surgeon expertise/training and technique description. Outcomes were heterogenous and rarely corresponded to progress through the IDEAL model of surgical innovation. Conclusion Reporting of RRYGB literature correlated poorly with IDEAL recommendations. This indicates poor reporting quality of available literature, impeding the ability for surgeons to draw meaningful conclusions from available evidence. This also complicates patients’ ability to take part in shared decision-making and give informed consent. Future studies should report findings in a structured way using IDEAL guidance or a similar reporting standard. This will ensure future research is transparent, robustly designed, prospective, uses COSs and follows an ethos of incremental learning. This may reduce research waste and the premature adoption of surgical innovations, ensuring their safe introduction into clinical practice.

Sutureless Bioprostheses for Aortic Valve Replacement: An Updated Systematic Review with Long-Term Results

Background: In recent years, in case of aortic valve replacement (AVR), a significant increase in the use of bioprostheses has been observed. The Perceval sutureless bioprosthesis has proven to be safe and reliable in the short and mid-term, with limited but promising long-term results. An updated systematic review with the long-term results of patients who underwent a sutureless bioprosthesis implantation with a Perceval biological valve is herewith presented. Methods: Studies published between 2015 and 2024, including the long-term outcomes—with clinical as well as echocardiographic information for up to five years—of patients who underwent a Perceval implantation for AVR were selected from the published literature. The Cochrane GRADE system was used to assess the study quality, and the risk of bias in non-randomized studies (ROBINS-I) tool was used to evaluate studies. Results: Ten studies were selected with an overall number of 5221 patients. The long-term survival ranged from 64.8 to 87.9%, freedom from structural valve degeneration (SVD) from 96.1 to 100%, freedom from significant paravalvular leak from 98.5 to 100%, freedom from prosthetic endocarditis from 90.7 to 99%, and freedom from reintervention from 94 to 100%. The long-term mortality ranged from 6.5 to 27.4%. SVD was observed in 0–4.8% patients. Significant paravalvular leak was observed in 0–3.4% patients, and infective endocarditis was observed in 0–3.4%. A bioprosthesis-related reintervention at long-term follow-up was required for 0–4.3% of patients, and 1.7–7.1% of patients required a late new pacemaker implantation. The transprosthetic mean pressure gradient ranged from 9 to 14.7 mmHg, peak pressure gradient ranged from 17.8 to 26.5 mmHg, and EOA ranged from 1.5 to 1.7 cm2. Conclusions: This systematic review shows that there is still a paucity of data about sutureless bioprostheses. Nevertheless, the clinical results from prospective studies or retrospective series are encouraging. Medium- and long-term results seem to support the increasing use of this type of prosthesis.

Choroidal and retinal alteration after long-term use of tadalafil: a prospective non-randomized clinical trial

Abstract Objectives The purpose of this study is to investigate choroidal and retinal vascular features in patients taking PDE5is by measuring dynamic vascular alterations and neurostructural features of the retina before and after oral tadalafil administration. Methods The current clinical research involved 22 patients treated with tadalafil 20 mg on alternate days (OAD) after nerve-sparing robotic radical prostatectomy (NS-RARP) for prostate cancer. Patients underwent SD-OCT to assess ganglion cell complex (GCC), retinal nerve fiber layer (RNFL), and subfoveal choroidal thickness (SFCT), as well as OCTA to assess superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), foveal avascular zone (FAZ), and radial peripapillary capillary thickness (RPC). All patients were evaluated at baseline (t0), and 3 (t1) and 6 (t2) months after the use of oral tadalafil. Results A statistically significant reduction in DCP and CC vessel density was found at t2 compared to baseline. According to the SFCT parameter, a statistically significant increase was observed from t0 to t1, and from t1 to t2. GCC parameter increased at t2 compared to baseline in a statistically significant way. No statistically significant differences were recorded between t0, t1 and t2 for the SCP, RPC, FAZ area, RNFL parameter. Conclusions Retinal and optic disc toxicity may be detected using modifications of capillary vessel density. Further studies are needed to detect the possible progression or regression of ocular or systemic vascular complications in long-term follow-up.

The New Era of mRNA Vaccines: The Success of the Covid-19 Vaccines and the Safety Concerns in Adolescents

Abstract A remarkable scientific achievement during the Covid pandemic is the rapid development and deployment of the mRNA vaccines which played a crucial role in reducing the Covid-related morbidity and mortality. The first-time safe use of the mRNA vaccine platform in humans opened up a new era in vaccinology. In the near future, the mRNA vaccine platform is likely to be used for other diseases as well. Though the Covid mRNA vaccine has been found to be safe in children, a matter of concern is the rare adverse event myocarditis, which was mostly observed among male adolescents. In this setting, we briefly discuss mRNA vaccine-related myocarditis and suggest that the safety concerns need to be alleviated by larger studies with long-term follow-up. We also stress the need for the generation of safety data from children in lower- and middle-income countries as there is limited experience with mRNA vaccines in such settings. The underlying mechanisms need to be understood well as the mRNA vaccine platform holds enormous promise for the future development of vaccines for several diseases.

Long-term clinical follow-up of irritant-induced occupational asthma

BackgroundOccupational exposure to irritants is associated with poor asthma control, but the long-term clinical characteristics of irritant-induced occupational asthma (IIA) are poorly known.ObjectiveTo evaluate whether any distinguishable features contribute to IIA patients’ poor outcomes and whether clinical characteristics change over time.MethodsWe re-evaluated 28 IIA patients with a median of 6.8 years (IQR 4.6–11.1) after their diagnosis at the Finnish Institute of Occupational Health in 2004–2018. We measured their lung function, non-specific bronchial hyper-responsiveness, inflammation profile and exercise capacity using an ergometric bicycle test. The participants also underwent an Asthma Control Test (ACT) and responded to questionnaires assessing their laryngeal hypersensitivity (LHQ) and dysfunctional breathing (Nijmegen Questionnaires, NQ).ResultsAt follow-up, 22 (79%) participants used inhaled corticosteroids, 4 (14%) had asthma exacerbation within 1 year, 11 (39%) had ACT&lt;20 (ie, poor asthma symptom control), 7 (26%) had abnormal spirometry and 8 (36%) had a positive methacholine challenge test result. 17 (61%) participants showed at least one elevated eosinophilic inflammation marker. Six (23%) had an abnormal LHQ score and 7 (26%) had an abnormal NQ score. 15 (58%) participants showed reduced physical capacity that was related to extensive asthma medication, poor asthma symptom control and acute IIA phenotype. A higher ACT score was the only significant change between diagnosis and follow-up (p=0.014).ConclusionMost of the IIA patients had normal lung function at follow-up, which had only changed a little over time. Reduced physical capacity was a common finding and appears to be related to poor asthma symptom control.

Canadian Spine SocietyCPSS-01. Abstract ID 48. Is long-term follow-up required for low-grade spondylolisthesis? A prospective study of 247 children followed until skeletal maturityCPSS-02. Abstract ID 101. Major complications following anterior vertebral body tethering surgeryCPSS-03. Abstract ID 164. Late referral of adolescent idiopathic scoliosis: the impact of socioeconomic status and health care utilizationCPSS-04. Abstract ID 97. The impact of curve correction

Canadian Spine SocietyCPSS-01. Abstract ID 48. Is long-term follow-up required for low-grade spondylolisthesis? A prospective study of 247 children followed until skeletal maturityCPSS-02. Abstract ID 101. Major complications following anterior vertebral body tethering surgeryCPSS-03. Abstract ID 164. Late referral of adolescent idiopathic scoliosis: the impact of socioeconomic status and health care utilizationCPSS-04. Abstract ID 97. The impact of curve correction

Abstract 4144521: Racial disparities in heart transplantation: long term graft survival and non-mortality outcomes

Background: There is conflicting evidence on whether racial disparities still exist in heart transplant (HT) outcomes, with prior studies focusing primarily on differences in short-term mortality. We examined disparities in HT survival over a longer follow-up duration alongside a broader range of post-HT outcomes. Methods: Using the United Network for Organ Sharing (UNOS) database, we evaluated adult HT recipients between 2017 and 2022 and classified each according to race as either Black, non-Hispanic White and Other. The primary outcome was graft survival and secondary outcomes included rejection, renal dysfunction, and post-transplant diabetes. Chi-squared tests were used to compare baseline clinical factors and selected outcomes by racial group. Kaplan-Meier and Cox proportional hazards analyses were performed to compare risks of the primary outcome by race. Results: Among 15,873 recipients (63% non-Hispanic White, 23% Black, 14% Other), Black recipients were more often female, less often college educated, and more often had public (vs. private) insurance. Blacks had higher use of durable ventricular assist devices (VAD) and intra-aortic balloon pump (IABP) at the time of HT. Graft survival at one year did not differ by race (91.8% for Blacks vs. 91.1% for non-Blacks), but at three years was significantly lower for Blacks (83.4%) than non-Blacks (85.7%). Blacks had higher risk of graft failure after adjustment for baseline socioeconomic status (SES) and clinical variables (HR 1.28, CI 1.17 - 1.41). Blacks also had significantly higher prevalences of acute rejection (12.4% vs. 10.2%), diabetes (10.8% vs. 7.1%), and progression of renal dysfunction at 3-years post HT (40.9% vs. 37.1%; p &lt; 0.05 for all). Conclusions: Racial disparities in graft survival after HT remain in the contemporary era but are only evident after longer-term follow-up. These survival disparities could be mediated by concurrent disparities in shorter term outcomes such as development of acute rejection, chronic kidney disease, and new onset diabetes.

Abstract 4138374: Coronary Endothelial Dysfunction Plays Important Roles on Development of Acute Coronary Syndrome and Fatal Cardiovascular Events During Long-Term Follow-up Over 10 Years

Introduction: Although coronary endothelial dysfunction is thought to affect coronary atherothrombogenic processes, there has been little practical evidence for the relationship between clinical evolution of fatal or non-fatal acute coronary syndrome and coronary endothelial dysfunction. Hypothesis: We assessed hypothesis that coronary endothelial dysfunction has clinical impacts on development of acute coronary syndrome and fatal cardiovascular events. Methods: Coronary endothelial dysfunction was practically graded by the flow-mediated endothelium-dependent reactive changes in coronary artery diameter (CFMD) to infusion of adenosine triphosphate (ATP ; 50μg) into the normal left coronary artery using quantitative coronary arteriography in 150 patients with stable coronary artery disease. The enrolled patients were categorized into tertile groups according to the values of CFMD, and we prospectively followed-up major adverse clinical cardiac events including acute coronary syndrome and cardiovascular death. Results: For a mean follow-up period of 132 months (range; 120 to 144) with complete follow-up, the patients in the lower third with severe coronary endothelial dysfunction (Group-L) more frequently developed acute coronary syndrome than those in the middle third with mild coronary endothelial dysfunction (Group-M) plus those in the higher third without coronary endothelial dysfunction (Group-H) [Group-L versus Group-M plus Group-H: 15(30%) versus 5(10%) plus 0(0%), p&lt;0.001, by Kaplan-Meier analysis]. Majority of the patients who resulted in cardiovascular death belonged to Group-L, [6(12%) versus 1(2%) plus 0(0%), p=0.014, by Kaplan-Meier analysis]. Cox hazard proportional model analyses including clinical and angiographical variables indicated that severe coronary endothelial dysfunction was the strong predictor for future acute coronary syndrome (hazard ratio=7.53, 95%confidential interval; 1.78-12.25, p&lt;0.001) and future cardiovascular death (hazard ratio=13.50, 95%confidential interval; 1.55-25.25, p=0.005). Conclusions: This is the novel and longest follow-up investigation that demonstrates coronary endothelial dysfunction plays important roles on development of acute coronary syndrome and fatal cardiovascular events and therefore the strategies based on practical status of coronary endothelial dysfunction are required to prevent major adverse ischemic cardiac events.

Abstract 4118242: Impact of Pregnancy on Individuals with Hypertrophic Cardiomyopathy: Long-Term Clinical Outcomes - Population-Based Study

Background: The effect of pregnancy on individuals with Hypertrophic Cardiomyopathy (HCM) is not well investigated. Objective: To assess the impact of pregnancy on all-cause mortality and clinical outcomes among individuals with HCM Methods: Using the TriNetX research network, we identified individuals within reproductive age ( ≥ 18-45 years) with a diagnosis of HCM between 2012 and 2022 (n=10,936). Patients were stratified based on pregnancy history into two groups (a) those with a history of pregnancy/high-risk pregnancy supervision and (b) those without a history of pregnancy or subsequent antenatal/pregnancy supervision encounters throughout the study period. Propensity-score matching resulted in 3,399 patients in each cohort. The primary outcome was all-cause mortality. Secondary outcomes include a composite of arrhythmic events (SCD and SCD equivalents), major adverse cardiovascular events (MACE), and acute heart failure (HF) exacerbation during 10 years of follow-up. Results: Pregnancy in patients with HCM was associated with a comparable risk of all-cause mortality (adjusted OR:0.89; 95% CI: 0.7-1.14; p =0.37) at 10 years follow-up. MACE and acute HF exacerbation outcomes were lower in the pregnancy group; however, the arrhythmic events (SCD) did not differ between groups (adjusted OR: 0.93, 95%CI: 0.73-1.18; p =0.55). Conclusion: Pregnancy in individuals with HCM was not associated with a higher risk of adverse outcomes at long-term follow-up. Further efforts are warranted to better understand the short-term outcomes in this high-risk population

Ocular involvement of oak processionary caterpillar hairs: Clinical outcome up to one year

Abstract Purpose To evaluate a consecutive series of patients that presented with ocular findings after contact with the oak processionary caterpillar (OPC) during an epidemic reproduction of the OPC in Germany in 2019 and to assess the 1-year outcome of those eyes with persisting OPC hairs in the cornea. Methods Retrospective analysis of 11 eyes (11 patients) that presented in June/July 2019 with acute ocular symptoms after outdoor activity or caterpillar nest removal. Evaluation of patients charts and slit-lamp images up to one year. Assessment of the incidence of patients with OPC-associated ocular complaints in the subsequent years (2020–2023). Results All patients had conjunctival injection, foreign body sensation, pain, itching and/or burning sensation. In 9/11 eyes, multiple caterpillar hairs could be detected in the superficial and deeper cornea. Hair removal was attempted in 8/9 eyes; in one eye hair removal was impossible due to its deep stromal location (lost-to-follow-up). Entire hair removal was successful in 2/9 eyes, hence, six eyes with persisting hairs within the cornea were followed. Stromal haze developed adjacent to the hairs in all eyes and individual hairs disappeared (n = 4) and/or showed migration within the cornea (n = 3). Until 2023, the number of patients with OPC-associated ocular complaints decreased continuously. Conclusions Ophthalmologists should be aware of the possibility of caterpillar hairs in patients with acute eye symptoms after outdoor acitivities, especially in early summer; the incidence may fluctuate, though. Hair removal is recommended to avoid possible intraocular migration, still residing hairs did not cause any serious long-term complications in our cohort. Key Messages What is known Within the late spring and early summer season, mass reproduction of the oak processionary carterpillar (OPC) can lead to an increased number of patients with OPC-related eye complaints (pain, itching and burning sensation) caused by OPC hairs within a very short period of time. Within that season, people should be (more) actively sensitized to avoid trees with OPC hairs, take precautions and avoid eye rubing when having complaints What is new Complete surgical removal of the hairs can be difficult and is often unsuccessful due to their tiny size and often stromal location most possibly resulting from eye rubbing In the longer-term, residing hairs have shown to develop haze adjacent to the hair, migrate within the cornea or disappear/resolve. Since this may go along with an inflammatory reaction, long-term follow-up and topical steroids may be useful

Abstract 4120924: Effect Of Colchicine On Myocardial Infarction: Updated Systematic Review And Meta-analysis Of Randomized Controlled Trials

Background: Colchicine, in multiple ways, has beneficial as well as adverse effects on patients with myocardial infarction. Objective: Our current study aims to study the efficacy as well as harmful effects of colchicine on patients with myocardial infarction. Methods: A comprehensive search was conducted on PubMed, the Cochrane Library, Scopus, Google Scholar, and Clinical trials till May 2024, and Randomized controlled trials were searched investigating the effect of Colchicine on patients with Myocardial Infarction. The quality of trials was assessed with the Cochrane risk of bias tool. Our primary Outcomes include adverse cardiovascular events while secondary outcomes include All-cause Mortality, adverse gastrointestinal effects, levels of hs-CRP, incidence of stroke, cardiac arrest, and hospitalization urgency. Risk ratios and mean differences were pooled under the Random-effect Model. Results: Statistical analysis shows that colchicine did not impact all-cause Mortality (RR =1.00, 95% CI=0.72-1.39, P=0.98, I2=0%), cardiac arrest (RR=0.81, 95% CI=0.33-1.95, P=0.63, I2=0), incidence of stroke(RR=0.45, 95% CI= 0.17-1.19, P=0.11, I2=36%) recurrent myocardial infarction (RR=0.78, 95%CI=0.57-1.06, P=0.11, I2=11%) and levels of hs-CRP (MD= -0.87, 95% CI=-1.80-0.06, P=0.07, I2=67%). However, colchicine shows statistically significant reduction in cardiovascular events(RR=0.75, 95%CI=0.60-0.94 , P=0.01, I2= 48%) , hospitalization urgency(RR=0.46, 95% CI=0.31-0.68, P=0.0001, I2=0%) and statistically significant increase adverse gastrointestinal events (RR=1.86, CI=1.14-3.02, P=0.01, I2=79%). Conclusion: Hence, we conclude that colchicine reduces adverse cardiovascular events, hospitalization urgency and increases adverse gastrointestinal events especially diarrhea in patients with myocardial infarction. However, colchicine did not reduce all-cause deaths, cardiac arrest, stroke incidence, the incidence of recurrent myocardial infarction, and hs-CRP; we still believe that the effect of colchicine on myocardial infarction needs further investigation and encourages the researcher to conduct more trials, especially with long-term follow-up.

Late Local Recurrence of Carcinoma &amp;lt;i&amp;gt;in situ &amp;lt;/i&amp;gt;- Only Bladder Cancer

Late recurrence (LR) of bladder cancer after radical cystectomy (RC) is rare, and few studies have been conducted. We report a case of local LR of bladder cancer 10.3 years after RC. The pathology at RC was almost carcinoma &amp;lt;i&amp;gt;in situ&amp;lt;/i&amp;gt; (CIS) only. The patient underwent metastasectomy, and treatment with an immune checkpoint inhibitor (ICI) achieved a complete response (CR). A 61-year-old woman was referred to our hospital for macrohematuria and bladder irritability in June 2012. She underwent RC along with pelvic lymph node dissection and ileal conduit creation. The pathologic findings were CIS, G2&amp;gt;G3, pT1, pN0. She visited our hospital with complaints of lower abdominal discomfort in November 2022, and recurrence was found on the pelvic floor by abdominal computed tomography. Metastasectomy confirmed metastasis of urothelial carcinoma. As salvage therapy, systemic chemotherapy with a platinum agent and an ICI were administered, leading to CR. Long-term follow-up should be considered for patients with bladder cancer, even for early-stage CIS-only tumors. Metastasectomy could be the primary option for LR of bladder cancer after RC.

Abstract 4140140: Cardiology Follow-Up as a Determinant of LDL-C Management Success in Secondary Cardiovascular Prevention

Managing low-density lipoprotein (LDL) cholesterol is crucial for secondary cardiovascular prevention. Despite ACC/AHA recommendations for maintaining LDL below 70 mg/dL, achieving this target remains suboptimal. This study investigates the impact of consistent cardiologist involvement on LDL cholesterol management. Methods: We conducted a multicenter, cross-sectional cohort study within the Steward Healthcare System in Massachusetts, analyzing data from 10,211 patients hospitalized from January 2019 to March 2024. This study offers a detailed snapshot of data across the study period, capturing both recent and long-standing cases identified through ICD codes for conditions like NSTEMI, CAD, STEMI, or CABG, specifically as markers for secondary cardiovascular prevention. We utilized the most recent LDL cholesterol measurements for our analysis and compared the distribution of lipid-lowering medications across groups. Notably, follow-ups with cardiologists outside our network were not tracked, potentially omitting relevant data. Statistical analysis employed the Chi-square test for categorical variables and binary logistic regression to adjust for confounders. Results: showed that patients with regular cardiology visits more often achieved LDL levels below 70 mg/dL (57.45% vs. 46.67%; OR 1.54, 95% CI: 1.42-1.68; P&lt;0.0001). These patients also had lower mean LDL levels (68.72 ± 27.02) compared to those without cardiology follow-up (75.82 ± 30.27; P&lt;0.0001). Higher usage of PCSK9 inhibitors and non-statin medications was noted among the visiting group, with an adjusted OR of 1.43 (95% CI: 1.29-1.59; P&lt;0.0001). Conclusion: Our study shows that cardiologist involvement significantly enhances cholesterol management in CAD patients, as evidenced by a higher proportion achieving optimal LDL levels and more aggressive use of lipid-lowering medications. Despite these benefits, some patients discontinue their follow-ups with cardiologists after coronary events, shifting cholesterol management to primary care providers (PCPs). This transition often results in less aggressive treatment strategies, evidenced by elevated LDL levels in patients lacking recent cardiology care. To sustain effective cholesterol management and stringent LDL targets, long-term follow-up with a cardiologist is crucial. Furthermore, equipping PCPs with the necessary tools and protocols to adopt more aggressive treatment approaches could bridge the care gap when specialist visits are infrequent.

Long-term Follow-up Study for Fractured and Non-Fractured Hand Enchondromas Treated by Sole Curettage

Background: Enchondromas are the most common primary tumors in the small tubular bones of the hand and fractures are often the result of thinned cortical bone. The main question was whether fractured enchondromas influence the long-term clinical and radiological outcome. Methods: Between 2000 and 2019, 57 patients with previously treated fractured (group I) and non-fractured (group II) hand enchondromas (34 female, 23 male, mean age was 39.4 years, ± 13.7) were evaluated for clinical and radiological treatment outcomes. SF-36 and DASH questionnaires as well as patient reported experience measures were used to assess subjective health outcomes. Subsequently, 43 patients underwent clinical and radiological follow-ups. Comparative evaluation of objective treatment outcomes in both groups was conducted in terms of hand functionality, perioperative complications, recurrence rates, and osteogenesis. Results: Almost half the patients suffered enchondromas with fractures (49.1%, n=28). Two patients received additional k-wire-stabilization due to intraoperative instability. Defect resolution could be reached in 97.7% (n=42) of all cases. No recurrence of enchondroma was observed. Groups were equal regarding radiological and clinical outcomes. The patient reported experiences were predominantly positive (86%), both cohorts had good to very good results with a DASH mean score of 4 (±6.3). The SF-36 demonstrated a return to normal quality of life in both groups. Mean follow-up time was 7.78 years (±4.8). Conclusions: Sole curettage of enchondromas yields effective outcomes with good to excellent results regardless of the presence of a fracture. Long-term radiological follow-up is not required until symptomatic recurrence. .