Management Strategies For Patients Research Articles

Racial disparities in secondary metastasis in patients with hepatocellular carcinoma: A 5-year National Inpatient Sample study.

523 Background: Hepatocellular carcinoma (HCC), a primary liver malignancy, is one of the leading causes of cancer-related mortality worldwide. The incidence and outcomes of HCC vary significantly across racial groups. Secondary metastasis, a key factor in disease progression and prognosis, also appears to differ by race, though these disparities remain poorly understood. This study aims to explore how race influences the metastatic progression of HCC, providing valuable insights into potential racial differences in disease outcomes. Methods: A retrospective analysis of National Inpatient Sample (NIS) data from 2016 to 2020 was conducted, identifying adults with HCC using International Classification of Diseases, Tenth Revision (ICD-10) codes, and categorizing them based on the presence of metastasis. The primary outcome was racial differences in organ metastasis. Multivariable logistic regression models were used to adjust for potential confounders and to evaluate the impact of race on all metastatic patterns, with Caucasians as the reference category. Statistical significance was defined as p-values ≤ 0.05. Results: The study cohort included 236,985 adult patients with HCC, of whom 34,875 had secondary metastasis. The cohort was predominantly male (77.37%), with 22.63% female. The racial distribution was 52.61% Caucasian, 19.08% African American, 15.04% Hispanic, and 13.27% from other racial groups. After adjusting for confounders, African American patients had significantly higher odds of lung (aOR 1.42, P<0.001), bone (aOR 1.51, P<0.001), and brain metastasis (aOR 1.47, P=0.02), but lower odds of adrenal gland metastasis (aOR 0.74, P=0.003) compared to Caucasians. Asian/Pacific Islander patients demonstrated increased odds of lung (aOR 2.00, P<0.001) and brain metastasis (aOR 1.95, P=0.02). In contrast, Hispanic patients had lower odds of abdominal lymph node (aOR 0.69, P=0.008) and bone metastasis (aOR 0.83, P=0.007). Conclusions: This study highlights significant racial disparities in the metastatic patterns of hepatocellular carcinoma, emphasizing the need to consider these differences in clinical management and treatment strategies for HCC patients. Further research is required to investigate the underlying causes of these disparities and their impact on long-term survival.

Insights into neuromyelitis optica spectrum disorder and pregnancy from a single-center study in Thailand

Our study focused on assessing disease and pregnancy outcomes in Thai patients with Neuromyelitis Optica Spectrum Disorder (NMOSD), a condition that disproportionately affects women of childbearing age and poses risks to both mother and fetus. We retrospectively analyzed eight NMOSD patients with a total of 10 pregnancies from our central nervous system inflammatory demyelinating diseases (CNS-IDDs) registry. Over a 12-months spanning from before pregnancy to 12 months postpartum, we observed 13 relapses, with a notable 76.92% occurring postpartum. The mean annualized relapse rate (ARR) peaked at 1.2 (SD ± 1.93) during specific postpartum intervals (0–3 and 6–9 months postpartum), significantly increasing from 0.20 (SD ± 0.42) in the 12 months before pregnancy (BP) to 1.00 (SD ± 1.49) during the 12 months postpartum (PP). Disability, assessed using the Expanded Disability Status Scale (EDSS) scores, worsened from 1.56 (SD ± 2.18) before pregnancy to 2.1 (SD ± 2.63) at six months postpartum. Maternal and fetal complications were prevalent, with six out of nine pregnancies experiencing adverse outcomes such as false labor, premature rupture of membranes, postpartum hemorrhage, intrauterine growth restriction, preterm birth, stillbirth, and low birth weight. Based on our findings, azathioprine and rituximab may be suitable treatment options for maintaining therapy throughout pregnancy, particularly in cases of high disease activity. Our study highlights the critical need for comprehensive management strategies for NMOSD patients of childbearing age. Preconception planning and counselling, along with early obstetrical consultation and closely monitored treatments during pregnancy and postpartum, are vital to mitigating pregnancy-related relapses and adverse fetal outcomes in this vulnerable patient population.

The value of magnetic resonance imaging in predicting vesicovaginal fistula in cervical cancer with bladder invasion treated with definitive chemoradiotherapy.

To assess the predictive value of magnetic resonance imaging for vesicovaginal fistula development in cervical cancer patients with bladder invasion treated with definitive chemoradiotherapy. A retrospective review was conducted of the medical records of 43 cervical cancer patients with bladder invasion between 1999 and 2015. Bladder invasion was confirmed through magnetic resonance imaging (scores ≥3) or cystoscopic findings, with or without biopsy. Treatment included weekly cisplatin plus pelvic external beam radiotherapy, with extended-field radiotherapy. After external beam radiotherapy, patients received intracavitary brachytherapy or an external beam boost. Vesicovaginal fistula was diagnosed based on reported symptoms and relevant imaging tests during follow-up. The median follow-up period was 67.4months. The 5-year disease-free and overall survival rates were 66.4%, and 71.8%, respectively. Vesicovaginal fistula developed in five patients (12.8%), with three cases occurring within 1year post-treatment and two others at 16.7 and 64.5months, respectively. In multivariate analysis, the height of bladder wall involvement on magnetic resonance imaging was the only significant predictor of vesicovaginal fistula (p=0.041). Specifically, Vesicovaginal fistula occurred in 25% of cases when bladder wall involvement was ≥20.3mm, in 50% of cases at ≥31.1mm, and in 75% of cases at ≥41mm. The height of bladder wall involvement on magnetic resonance imaging is a significant predictor of vesicovaginal fistula formation in cervical cancer patients with bladder invasion. This finding can aid clinicians in better predicting this complication, improving patient counseling and management strategies.

Development and validation of a nomogram for predicting perioperative transfusion in children undergoing cardiac surgery with CPB

BackgroundTimely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).MethodsFrom September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model’s performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts.ResultsAfter multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880–0.891) in the training cohort and 0.883 (95% CI: 0.875–0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit.ConclusionsOur predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.

Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study.

Active surveillance is a recommended management strategy for patients with clinical stage I (CSI) seminoma. This study aims to identify patterns of relapse detection methods in an unselected population-based cohort of CSI patients and provide evidence for a risk-adapted follow-up program. A total of 924 patients with CSI seminoma were identified in the prospective Danish Testicular Cancer database. Retrospectively collected clinical data were used for descriptive analyses of patterns in detection methods. Additionally, we explored a risk-adapted surveillance approach based on recently identified risk factors for relapse, classifying patients into low- and non-low-risk groups. At 60 months, the 5-year cumulative relapse risk was 16%, with 146 relapses during surveillance. Relapses were detected by imaging alone in 71% of cases, imaging combined with elevated serum tumor markers (STMs) in 18%, isolated elevation of STMs in 8%, and by self-referral due to symptoms in 3%. No relapses were detected by abnormal findings at a physical examination. In total, 134 (92%) relapses were localized to retroperitoneal lymph nodes, primarily without additional spread. The 5-year relapse risk in patients with low risk of relapse was 9% compared to 28% in patients in the non-low-risk group. This study highlights that the surveillance program can detect relapses at an early stage. Reduction of visits and omission of routine physical examinations can safely be considered for patients with a low risk of relapse, while further research is needed to optimize follow-up and treatment for patients at higher risk of relapse.

Peritoneal dialysis and kidney transplantation: Your questions answered.

Peritoneal dialysis (PD) and kidney transplantation are important therapeutic options in patients with advanced kidney disease. This article delineates the relationship between PD and kidney transplantation in several key domains, including: (1) Comparative merits and limitations of PD versus center-based hemodialysis prior to kidney transplantation, (2) Patient outcomes after kidney transplantation in individuals receiving PD prior to kidney transplantation, (3) Perioperative management strategies of patients receiving PD at the time of kidney transplantation, and (4) The relative advantages and clinical outcomes of PD use following kidney allograft failure compared to other modalities. This article aims to provide comprehensive guidance for optimizing care across the PD-kidney transplant transitions continuum.

Development of a CT radiomics prognostic model for post renal tumor resection overall survival based on transformer enhanced K-means clustering.

Kidney tumors, common in the urinary system, have widely varying survival rates post-surgery. Current prognostic methods rely on invasive biopsies, highlighting the need for non-invasive, accurate prediction models to assist in clinical decision-making. This study aimed to construct a K-means clustering algorithm enhanced by Transformer-based feature transformation to predict the overall survival rate of patients after kidney tumor resection and provide an interpretability analysis of the model to assist in clinical decision-making. This study was based on a publicly available C4KC-KiTS-2019 dataset from the TCIA database, including preoperative computed tomography (CT) images and survival time data of 210 patients. Initially, the radiomics features of the kidney tumor area were extracted using the 3D slicer software. Feature selection was then conducted using ICC, mRMR algorithms, and LASSO regression to calculate radiomics scores. Subsequently, the selected features were input into a pre-trained Transformer model for feature transformation to obtain a higher-dimensional feature set. Then, K-means clustering was performed using this feature set, and the model was evaluated using receiver operating characteristic (ROC) and Kaplan-Meier curves. Finally, the SHAP interpretability algorithm was used for the feature importance analysis of the K-means clustering results. Eleven important features were selected from 851 radiomics features. The K-means clustering model after Transformer feature transformation showed AUCs of 0.889, 0.841, and 0.926 for predicting 1-, 3-, and 5-year overall survival rates, respectively, thereby outperforming both the K-means model with original feature inputs and the radiomics score method. A clustering analysis revealed survival prognosis differences among different patient groups, and a SHAP analysis provided insights into the features that had the most significant impacts on the model predictions. The K-means clustering algorithm enhanced by the Transformer feature transformation proposed in this study demonstrates promising accuracy and interpretability in predicting the overall survival rate after kidney tumor resection. This method provides a valuable tool for clinical decision-making and contributes to improved management and treatment strategies for patients with kidney tumors.

Outcomes of electrical injuries in the emergency department: epidemiology, severity predictors, and chronic sequelae.

Electrical injuries (EIs) represent a significant clinical challenge due to their complex pathophysiology and variable presentation, ranging from minor burns to severe internal organ damage. Despite their prevalence in both; domestic and occupational settings, there remains a rareness of systematic guidelines and comprehensive literature to aid clinicians in effectively managing these injuries. Understanding these factors is crucial for developing protocols that can mitigate the risk of delayed complications, such as cardiac arrhythmias, in patients who initially appear stable. This study aims to elucidate the epidemiology, clinical outcomes, and predictors of severe presentation in EIs, providing insights to improve patient assessment and management strategies. A retrospective study was conducted over 4 years. Data were collected from standardized medical records. The group of patients with severe complications included those who presented a life-threatening cardiac, respiratory, neurological, or biological impairment or died within the first 48 h of the EI. We enrolled 118 cases of electrical injury (EI). Ages ranged from 4 to 82 years, with 31.3% under 15. EI incidence peaked in summer, with 63.5% being home accidents. High-voltage injuries occurred in 13.6%. The most common ED complaints were burns in children (59.5%) and trauma in adults (48.1%). ECG abnormalities correlated with tetany (p = 0.016), and palpitations (p = 0.014). Complications included cardiac arrest (n = 8), rhabdomyolysis (n = 23), and acute renal injury (n = 9). Severe EI was linked to respiratory distress and creatine kinase levels higher than ≥ 253 UI/l. A normal ECG within 1 h post-injury was correlated to a low risk of severe EI. At 2-year follow-up, 43.9% of survivors reported aesthetic sequelae, 25.3% had psychological disorders, and 7% of adults could not return to their previous occupations. EIs are frequent, with diverse clinical presentations requiring multidisciplinary care. Awareness of potential delayed complications is essential, and prevention is crucial.

Multi-center evaluation of the Alinity m HR HPV assay with liquid-based cytology cervical specimens in the United States.

Incorporating molecular testing for human papillomavirus (HPV) into the screening of cervical specimens can improve risk stratification and, in turn, patient management. Infection with a high-risk (HR) HPV genotype is associated with greater risk for persistent infection, viral integration, and progression of cervical neoplasia. Current guidelines consider HPV 16 or HPV 18 clinically actionable with referral to colposcopy; however, 12 Other HR HPV genotypes have been associated with cervical cancer risk, suggesting a benefit of extended genotyping. In this multi-center study, we evaluated the performance of the Alinity m HR HPV assay, which reports HPV 16, 18, and 45 individually and aggregates of HPV 31/33/52/58 and HPV 35/39/51/56/59/66, compared with cobas HPV and Aptima HPV assays, across a variety of cytology result categories. A total of 746 de-identified residual cervical specimens, collected as part of routine cervical cancer screening programs, were tested using Alinity m HR HPV and at least one comparator assay. The overall percent agreement was ≥90.7% for results from the Alinity m HR HPV assay and cobas HPV assays and 90.5% for results from the Alinity m HR HPV and Aptima HPV assay. In patients with any abnormal cytology result, Alinity m identified 78 specimens with non-HPV 16/18 results, underscoring the benefit of detecting additional HR HPV genotypes to guide patient management more accurately. Among specimens with normal cytology, Alinity m detected 14 additional specimens with non-HPV 16/18 genotypes. Extended HR HPV testing can provide additional information to triage patients for appropriate testing and follow-up.IMPORTANCEExtended genotyping for high-risk human papillomavirus (HPV) types enhances diagnostic precision by identifying additional oncogenic HPV types beyond 16 and 18 therefore offering a more nuanced risk profile. This more comprehensive detection may aid in identifying persistent infections that are more likely to progress, thereby supporting future risk-based patient management strategies.

Association of liver fibrosis with aneurysm size and mortality risk in patients undergoing open abdominal aortic aneurysm repair

Abdominal Aortic Aneurysm (AAA) poses a significant health risk due to its silent nature and high mortality upon rupture. The Fib-4 index, initially designed for liver fibrosis assessment, presents potential beyond its scope. This study aims to investigate the association of FIB-4 with aneurysm size and mortality risk, exploring its utility as a risk predictor for enhanced clinical management. This retrospective longitudinal research studied 141 AAA open repair surgery patients (92% male, mean age of 70 years (SD: 11.5)) from October 2016 to September 2021 for a median follow-up 35 months (IQR: 0.7 – 56.6). All-cause mortality was the primary outcome. Adjusted hazard ratios (aHR) were calculated for each Fib-4 cut-off between 1.5 and 3.25. FIB-4 cut-off range of 2.58–2.74 was associated with higher mortality risk in adjusted HR. Specifically, FIB-4 ≥ 2.67 increased mortality by 78% (aHR:1.78, 95% CI: 1.06 – 3.00). Furthermore, FIB-4 ≥ 2.67 was significantly associated with a baseline aneurysm size ≥ 8cm (aOR: 2.67, 95% CI: 1.17 – 6.09). FIB-4 was independently associated with a higher mortality risk and higher aneurysm size. These findings suggest that FIB-4 assessment in clinical practice may enhance risk profiling, aiding in more precise stratification and management strategies for AAA patients.

Prevalence of accessory navicular in Japanese children: A cross-sectional study using ultrasound-Katsuragi Integrated Defense for Locomotive Syndrome in children study.

The accessory navicular (AN) is an accessory bone located on the posteromedial aspect of the navicular tuberosity that can cause pain following overuse or trauma, particularly during childhood. However, the detailed epidemiological characteristics of AN in children have not been well studied. This study aimed to clarify the prevalence of AN and painful AN among Japanese children by examining the characteristics according to sex and age. This cross-sectional study used data from the Katsuragi Integrated Defense for Locomotive Syndrome in Children Study, focusing on musculoskeletal disorders in 875 children aged 6-15 years, with 1750 feet being assessed. Children were divided into five age groups: 6-7, 8-9, 10-11, 12-13, and 14-15. AN was detected using ultrasound to avoid radiation exposure. The sex- and age-group-dependent prevalence of AN and painful AN were calculated, and statistical analyses examined sex differences in prevalence by age group. The overall prevalence of AN was 15.1%, higher in females (17.9%) than in males (12.3%). The prevalence of AN increased with age in both sexes. Among cases diagnosed with AN, 20.8% were symptomatic, with a unimodal peak observed at ages 12-13 in males and 10-11 in females. No statistically significant differences were observed in the proportion of painful AN between sexes. This is the first large-scale epidemiological study on AN in children. The overall prevalence of AN was 15.1%, higher in females than in males. Additionally, 20.8% of patients with AN experienced pain. The results of this study provide important epidemiological data to support clinical management strategies for pediatric patients with AN.

Development and validation of a novel artificial intelligence algorithm for precise prediction the postoperative prognosis of esophageal squamous cell carcinoma

BackgroundEsophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy, and current postoperative prognostic assessment methods remain unsatisfactory, underlining the urgent to develop a reliable approach for precision medicine. Given the similarities with gametogenesis, cancer/testis genes (CTGs) are acknowledged for regulation unrestrained multiplication and immune microenvironment during oncogenic processes. These processes are associated with advanced disease and poorer prognosis, indicating that CTGs could serve as ideal prognostic biomarkers in ESCC. The purpose of this study is to develop a novel clinically prognostic prediction system to facilitate the individualized postoperative care.MethodsWe conducted LASSO regression analysis of protein-coding CTGs and clinical characteristics from 119 pathologically confirmed ESCC patients to recognize powerful predictive variables. We employed nine supervised machine learning classifiers and integrated best predictive machine learning classifiers by weighted voting method to construct an ensemble model called PPMESCC. Additionally, functional assay was conducted to examine the potential effect of top-ranking CTG HENMT1 in ESCC.ResultsLASSO regression identified five CTGs and TNM stage as optimized prognostic features. Six machine learning classifiers were integrated to construct an ensemble model, PPMESCC, which exhibited outstanding performance in ESCC prediction. The AUC for PPMESCC was 0.9828 (95% confidence interval: 0.9608 to 0.9926), with an accuracy of 98.32% (95% CI: 96.64–99.16%) in the discovery cohort and 0.9057 (95% CI: 0.8897 to 0.9583) of AUC with an accuracy of 90% (95% CI: 89.08–93.28%) in validation cohort. In addition, the top-ranking CTG HENMT1 encodes 2’-O-methyltransferase of piRNAs that was confirmed positively correlated with the proliferation capacity of ESCC cells. Then we systematically screen piRNAs associated with esophageal carcinoma based on GWAS, eQTL-piRNA, and i2OM databases, and successfully discovered 8 piRNAs potentially regulated by HENMT1.ConclusionThe study highlights the clinical utility of PPMESCC algorithm in prognostic prediction that may facilitate to establish the personalized screening and management strategies for postoperative ESCC patients.

A PARK7 Mutation-Induced Early-Onset Parkinson's Disease in a Moroccan Family: Expanding the Geographic Spectrum.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor symptoms, with a significant genetic component. Early-onset Parkinson's disease (EOPD), manifesting before age 45, is often linked to mutations in genes such as PARK2, PINK1, and PARK7, the latter coding for the protein DJ-1. We present the first reported cases of EOPD carrying a previously undescribed homozygous PARK7 mutation, p.Thr110Pro. Whole exom sequencing was performed on two inbred Moroccan siblings with early-onset Parkinson's disease (EOPD). Detailed clinical assessments, including neurological evaluations and cognitive testing, were conducted to understand the clinical presentation of the patients. Genetic analysis was also carried out to examine their genetic background. Therapeutic responses to treatments were monitored to assess the effectiveness of management strategies. The sequencing revealed that both siblings carried the homozygous PARK7 mutation, p.Thr110Pro. Both siblings presented with typical EOPD features, including motor and non-motor symptoms. The patients both presented with cognitive impairment, with the male sibling exhibiting more pronounced symptoms. He also developed compulsive behaviors, which underscore the varied clinical presentations and therapeutic responses associated with this genetic variant. This case study expands the genetic and geographic diversity of PD presentations, highlighting cognitive and behavioral challenges and variable therapeutic outcomes. It underscores the necessity for genetic screening and individualized management strategies for patients with PD.

What Are the Implications of Choosing a TAVR-First Strategy in the Lifetime Management of Aortic Stenosis?: A Critical Review of TAVR-Explant- and Redo-TAVR.

Some patients with aortic stenosis may require multiple valve interventions in their lifetime, and choosing transcatheter aortic valve replacement (TAVR) as the initial intervention may be appealing to many. If their transcatheter heart valve degenerates later in life, most will hope to undergo redo-TAVR. However, if redo-TAVR is not feasible, some may have to undergo surgical explantation of their transcatheter heart valve (TAVR-explant). With rising numbers of TAVR in younger patients, we address the practical implications of choosing a TAVR-first strategy. In this review we explore potential factors contributing to higher-than-expected mortality after TAVR-explant, synthesize available outcomes data for TAVR-explant for structurally degenerated valves, and describe strategies to standardize and optimize surgical techniques for TAVR-explant. We also discuss clinical outcomes of redo-TAVR within the context of limitations in currently published series and highlight the potential benefit of virtual planning to assess the feasibility of future redo-TAVR before implanting the first valve. Finally, we highlight areas for future investigation to inform management strategies in patients who may require multiple aortic valve interventions.

Association between insulin resistance indices and outcomes in patients with heart failure with preserved ejection fraction

BackgroundInsulin resistance (IR) plays a pivotal role in the interplay between metabolic disorders and heart failure with preserved ejection fraction (HFpEF). Various non-insulin-based indices emerge as reliable surrogate markers for assessing IR, including the triglyceride-glucose (TyG) index, the TyG index with body mass index (TyG-BMI), atherogenic index of plasma (AIP), and the metabolic score for insulin resistance (METS-IR). However, the ability of different IR indices to predict outcome in HFpEF patients has not been extensively explored.MethodsPatients having HFpEF were recruited from January 2012 and December 2023. The outcome was defined as major adverse cardiovascular event (MACE), encompassing all-cause mortality and rehospitalization for heart failure. The potential linear relationship was visualized by the restricted cubic spline (RCS) curve. Both univariable and multivariable Cox proportional hazards models were employed to examine the association between the IR indexes and MACE. Furthermore, to assess the incremental prognostic value of the TyG index, we conducted comprehensive analyses using area under the curve (AUC), the continuous net reclassification index (cNRI), and the integrated discrimination index (IDI).ResultsA total of 8693 patients met the inclusion criteria and were included in the final analysis. The mean age of the patients was 70.59 ± 10.6 years, with 5045 (58.04%) being male. The Kaplan-Meier survival analysis revealed that higher degree of the four IR indexes was associated with higher risk of MACE (all log-rank P < 0.05). When treated as a continuous variable, the TyG index showed a significant association with MACE (HR 2.1, 95% CI 1.98–2.23, P < 0.001 in model 1; HR 1.81, 95% CI 1.73–1.9, P < 0.001 in model 2; HR 1.68, 95% CI 1.6–1.76, P < 0.001 in model 3). When categorized into quartiles, the highest quartile of the TyG index (Q4) was significantly associated with MACE (HR 2.48, 95% CI 2.24–2.76, P < 0.001 in model 3). Similar significant associations were found between TyG-BMI, AIP, METS-IR, and MACE. The TyG index was found to enhance the risk stratification capability of the MAGGIC score (AUC from 0.601 to 0.666). When compared to other IR indicators, the TyG index exhibited superior discrimination and reclassification abilities in predicting MACE. Additionally, the TyG-BMI index revealed a U-shaped correlation with MACE, indicating that both an elevated and a lower TyG-BMI index were associated with an increased risk.ConclusionAll four IR indices are independently associated with MACE in patients with HFpEF. Notably, these IR indices significantly enhance the predictive accuracy of the MAGGIC score, a widely used risk assessment tool in HFpEF. Among these indices, the TyG index demonstrated the highest discriminatory and reclassification abilities, providing the greatest incremental value in predicting MACE and exhibiting significant superiority compared to the other indices. These findings highlight the importance of assessing IR indices, particularly the TyG index, in the risk assessment and management strategies for HFpEF patients. However, it should be noted that our findings need to be validated in diverse populations to ensure their applicability and generalizability.Graphical

P0464 exploring the Relationship Between Gender, Age at Onset, and the Presence and Severity of Ano-Perineal Lesions in Inflammatory Bowel Disease

Abstract Background Ano-perineal lesions (APLs), including fissures, abscesses, fistulae, and thrombosed hemorrhoids, are common complications in inflammatory bowel disease (IBD). While several factors have been linked to the development of APLs, the impact of gender and age at disease onset on the prevalence and severity of these lesions remains underexplored. This study investigates the relationship between gender, age at IBD onset, and the presence and severity of APLs. Methods A retrospective cohort study was conducted on IBD patients to assess the relationship between gender, age at disease onset, and the presence and severity of ano-perineal lesions. The severity of APLs was categorized as mild (isolated lesions) or severe (complex fistulae, extensive abscesses). Age at onset was classified as early (&amp;lt;30 years) or late (&amp;gt;30 years). Statistical analysis, including chi-squared tests and multivariate logistic regression, was used to determine the correlation between these variables. Results • Gender differences: Male patients were more likely to present with fistulae (45%) and abscesses (34%) compared to females (fistulae: 32%, abscesses: 22%). Women, however, were more likely to have thrombosed hemorrhoids (25% vs. 15% in males). • Age at onset: Patients with early onset of IBD (&amp;lt;30 years) had a significantly higher likelihood of developing severe APLs (OR: 2.8, p &amp;lt; 0.01). Early onset was also associated with a higher prevalence of fistulae and abscesses (40% and 35%, respectively) compared to those with late-onset disease (30% and 20%). • Severity correlation: Early-onset IBD patients had more complex ano-perineal lesions, with severe fistulae and abscesses noted in 55% of cases. In contrast, late-onset patients had a significantly lower severity (25% of cases were severe). Gender further influenced severity, with males more likely to develop severe APLs (fistulae and abscesses) than females, particularly among early-onset cases. • Multivariate analysis: Gender (p = 0.02) and early age at onset (p = 0.01) were independently associated with a higher likelihood of severe APLs, with males showing a higher risk of complex lesions. Conclusion Both gender and age at onset are significant predictors of the presence and severity of ano-perineal lesions in IBD patients. Early-onset disease and male gender are associated with more severe and complex APLs, especially fistulae and abscesses. These findings emphasize the importance of early diagnosis and gender-specific management strategies for patients at higher risk of developing severe ano-perineal complications in IBD.

Pulmonary Atresia with Intact Ventricular Septum, an Evolving Strategy in the Era of PDA Stenting: Single Center Experience.

Repair or palliation of pulmonary atresia with intact ventricular septum (PA/IVS) often falls into one of 4 categories: cardiac transplant, 2-ventricular circulation, 1.5 ventricle circulation, or single ventricle circulation. The optimal management strategy has been an area of much debate. We sought to review the management strategy of patients with PA/IVS at our institution to better understand what metrics can be used to guide management and initial interventions. The study aims to examine the outcomes of a single-center approach to managing patients with PA/IVS. Our cohort included 29 patients; one patient underwent a planned transplant at ten days of life (3.4%), 12 underwent repair via a two-ventricle circulation (41.4%), 7 underwent repair with 1.5 ventricle circulation (24.1%), and 7 underwent repair with single ventricle circulation (24.1%). Survival was achieved in 93.1% with two patients (6.9%) expiring. The TV annulus z-score was significantly different between the three groups, with the 1V group having the smallest median TV annulus z-score at -4.04 (IQR -4.60- -3.60) and the 2V group having the largest median TV z-score at -1.4 (IQR -2.24- -0.12). Six patients underwent late right ventricular decompression. We present a post-hoc algorithm to help guide treatment strategies for patients with PA/IVS.

Artificial intelligence-based, non-invasive assessment of the central aortic pressure in adults after operative or interventional treatment of aortic coarctation

BackgroundAortic coarctation (CoA) is a congenital anomaly leading to upper-body hypertension and lower-body hypotension. Despite surgical or interventional treatment, arterial hypertension may develop and contribute to morbidity and mortality. Conventional...

Telling Ghost Stories Around a Bonfire-A Literature Review of Acute Bleeding Secondary to Pancreatitis.

Bleeding is a rare but serious complication of pancreatitis, significantly increasing morbidity and mortality. It can arise from various sources, including erosion of blood vessels by inflammatory processes, formation of pseudoaneurysms, and gastrointestinal bleeding. Early diagnosis and timely intervention are crucial for patient survival. Imaging modalities such as computed tomography and angiography are essential for identifying the bleeding source, where endoscopy may help in detecting and treating intraluminal hemorrhage. Management strategies for patients with extraluminal bleeding may involve angioembolization or surgical intervention, depending on the severity and location of the bleeding. While advances in diagnostic and therapeutic techniques have improved outcomes, bleeding in pancreatitis remains a challenging clinical problem requiring a multidisciplinary approach. This review aims to focus its attention specifically on the bleeding complications of pancreatitis.

Comprehensive Review of Lipid Management in Chronic Kidney Disease and Hemodialysis Patients: Conventional Approaches, and Challenges for Cardiovascular Risk Reduction.

Background/Objectives: Lipid disorders are very prevalent in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), leading to heightened cardiovascular risk. This review examines the effectiveness of lipid-lowering agents in these populations and explores gaps in the current research. The goal of this review is to assess the efficacy of lipid-lowering therapies in CKD and ESRD patients and identify future research needs. It aims to provide a clearer understanding of how these treatments impact cardiovascular risk in high-risk populations. Methods: We conducted a literature search in Embase, PubMed, Cochrane, and Google Scholar databases using keywords including but not limited to: chronic kidney diseases, dialysis, hemodialysis, dyslipidemia, statins, ezetimibe, and lipid-lowering drugs. Findings from included studies were synthetized to provide an overview of the current management of dyslipidemia in ESRD and HD. Results: Statins show mixed results in CKD and ESRD, with limited benefits in reducing cardiovascular events in dialysis patients. Agents like PCSK9 inhibitors show promising results but require further research, while non-statin therapies like fibrates and omega-3 fatty acids have limited evidence for use in this population. Conclusions: The review underscores the need for further research into lipid-lowering agents in CKD and ESRD patients, highlighting the need for tailored lipid management strategies in vulnerable patients with unique risk factors. More studies are needed to refine treatment strategies and assess the role of exercise and accurate risk calculators in managing cardiovascular outcomes.