Patients Mean Age Research Articles

Covert perioperative strokes in older patients having non-cardiac surgery (PRECISION): a prospective cohort analysis

Background: Perioperative strokes may promote postoperative neurocognitive dysfunction. We thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from non-cardiac surgery. Methods: PRECISION was a two-center prospective cohort study. We evaluated patients aged ≥60 years who had elective, non-cardiac inpatient surgery at two Chinese academic centers. Postoperative strokes were evaluated by scheduled magnetic resonance brain imaging within 7 days. Our primary outcome was the cumulative incidence of postoperative stroke. Secondary outcomes included postoperative delirium within the first 5 days after surgery, neurocognitive decline at 12 months and the association between stroke and neurocognitive dysfunction. Results: Among 934 patients (mean age, 67 years; 45% male) included in the analyses, two-thirds had neurosurgical craniotomies. There were 111 (11.9%, 95% CI 9.8% to 14.0%) covert strokes within 7 days after surgery, and no overt strokes. Postoperative delirium was observed in 117 patients (12.5%, 95% CI 10.4% to 14.7%) within 5 days and neurocognitive decline observed in 147 patients (18.8%, 95%CI 16.0% to 21.5%) at 1 year after surgery. Postoperative covert strokes were significantly associated with delirium (adjusted odds ratio 2.18, 95% CI 1.31 to 3.62; P=0.003), and 1-year neurocognitive decline (adjusted OR 2.33, 95% CI 1.31 to 4.13, P=0.004) in overall participants. Conclusions: One in 9 patients aged 60 years and older who had major non-cardiac surgery, mainly intracranial, experienced a perioperative covert stroke. Covert strokes more than doubled the risk of postoperative delirium and long-term neurocognitive decline. Covert perioperative strokes are common and clinically meaningful.

Lack of association between revision ACL reconstruction and preoperative, intraoperative and post-operative factors at primary ACL reconstruction in children and adolescents.

To evaluate factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR in children and adolescents. Children and adolescents (age <20 years at surgery) who underwent primary hamstring tendon ACLR at the Capio Artro Clinic, Stockholm, Sweden, between January 2005 and December 2018 were identified. Revision ACLR within 5 years of primary ACLR was captured in the Swedish National Knee Ligament Registry. Univariable and multivariable logistic regression analyses were used to evaluate the associations between revision ACLR and preoperative (age, sex, body mass index, time from injury to surgery, pre-injury Tegner activity level, medial collateral ligament injury, passive contralateral knee hyperextension [≤-5°]), intraoperative (medial meniscus and lateral meniscus [LM] resection or repair, cartilage injury and graft diameter) and post-operative (KT-1000 side-to-side anterior knee laxity, limb symmetry index for extension and flexion strength and single-leg-hop (SLH) test performance at 6 months) factors at primary ACLR. A total of 1888 patients (mean age: 16.0 ± 2.0, range: 8-19 years) who underwent primary ACLR were included. The overall incidence of revision ACLR within 5 years was 9.0% (170 out of 1888). Univariable analysis revealed that a time from injury to primary ACLR of <5 months (odds ratio [OR]: 2.27, 95% confidence interval [CI]: 1.61-2.35, p < 0.001) and LM resection (OR: 1.49, 95% CI: 1.00-2.20, p = 0.04) increased the odds of revision ACLR. Multivariable analysis showed that revision ACLR was significantly associated only with a time from injury to primary ACLR of <5 months (OR: 2.56, 95% CI: 1.72-3.70, p < 0.001). There was a lack of association between revision ACLR and preoperative, intraoperative and post-operative factors at primary ACLR in children and adolescents. A time from injury to primary ACLR of <5 months was the only factor associated with revision ACLR within 5 years. Level III.

A systematic review of parent-child communication in pediatric asthma.

Parent-child communication is integral to pediatric asthma management. This review evaluates parent-child communication among youth with asthma and their caregivers. It aims to characterize the type of communication according to a unifying framework (Murphy, L. K., Murray, C. B., & Compas, B. E., Guest Editors: Cynthia A. Gerhardt, Cynthia A. Berg, Deborah J. Wiebe and Grayson N. Holmbeck (2017). Topical review: Integrating findings on direct observation of family communication in studies comparing pediatric chronic illness and typically developing samples. Journal of Pediatric Psychology, 42, 85-94. https://doi.org/10.1093/jpepsy/jsw051), assess sociodemographic factors associated with communication, and examine the relationship between parent-child communication and youth psychosocial and health-related outcomes. A systematic literature search was conducted using PubMed, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Embase databases (June 2021; updated May 2024). Included studies reported original, peer-reviewed research on the relationship between parent-child communication and youth psychosocial or health outcomes among pediatric patients (mean age <18 years) with asthma and their primary caregiver(s). Study quality was evaluated using the Study Quality Assessment Tools of the NHLBI. Sixty-six articles were included with data from 5,373 youth with asthma. Studies assessed both positive (warm and structured) and negative (hostile/intrusive and withdrawn) communication. Most studies used questionnaires and cross-sectional designs. Associations between sociodemographic and communication variables were largely nonsignificant. Greater positive and less negative communication was associated with better youth psychosocial and asthma outcomes overall. Parent-child communication may be an important target for interventions aimed at improving youth outcomes. More research is needed to develop communication-focused interventions that aim to enhance parents' and youths' communication skills (i.e., increase their use of positive communication approaches and/or reduce their use of negative communication approaches) and evaluate their impact on youth outcomes. Future research should also use more discussion tasks and longitudinal designs.

Analysis of SMOC2 gene variants in familial and non-familial primary open angle glaucoma Pakistani patients.

To find out the association of secreted protein acidic and rich in cysteine (SPARC)-related modular calcium binding 2 (SMOC2) gene variants rs2255680 and rs13208776 with genotypic and phenotypic characteristics in both familial and non-familial primary open angle glaucoma (POAG) patients. A total of 212 POAG patients, comprising 124 familial and 88 non-familial, were enrolled. For genotyping the SMOC2 variant rs2255680, amplification refractory mutation system (ARMS)-polymerase chain reaction (PCR) method and PCR-restriction fragment length polymorphism (PCR-RFLP) were utilized for analyzing rs13208776 variant. The mean age of familial POAG patients was 50.92±9.12y, with 78 males and 46 females. The mean age of non-familial POAG patients was 53.14±13.44y, with 52 males and 36 females. The SMOC2 gene variant rs13208776 showed the significant association with POAG between familial and non-familial groups. The homozygous G/G variant was frequent among non-familial (60.2%) whereas the heterozygous G/A variant was more frequent in familial POAG patients (46%). There were significant differences in G/A variant between familial and non-familial glaucoma patients, and the risk was decreased to 0.53-fold in non-familial glaucoma patients [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.29-0.94; P=0.033] in codominant model. The risk was further reduced to 0.49-fold (95%CI: 0.28-0.86; P=0.012) in dominant model for non-familial patients. No significant association of SMOC2 gene variant rs2255680 between familial and non-familial glaucoma patients was found in our population. The haplotype analysis showed the decreased risk for TA [OR: 0.48 (95%CI: 0.29-0.79); P=0.004] and an increased risk for TG [OR=2.28 (95%CI: 1.22-4.25); P=0.01] haplotypes. Current findings show significant association of SMOC2 gene variant rs13208776 with POAG between familial and non-familial Pakistani patients.

Differential Expression of Immune T-Cell Subpopulations and Pathologic Features in Dermatomyositis, Inclusion Body Myositis and Nonspecific Inflammatory Myopathies

Background: The immune T-cell subpopulations in inflammatory myopathies (IMs) play a crucial role in the lymphocytic environment. Objectives: This study aimed to investigate the prevalence of T-cells and MHC-I expression across different types of IMs. Methods: A retrospective cohort of 34 patients with dermatomyositis (DM), inclusion body myositis (IBM), and nonspecific IMs (NSIMs) was examined for CD4, CD8, and MHC-I expressions. The relationships between these subsets were analyzed. Results: The mean age of patients was 44 years. The cases were categorized into three subgroups: Dermatomyositis (n = 9), IBM (n = 9), and NSIM (n = 16). All muscle biopsies exhibited classical features of IM. In DM, the inflammatory infiltrate was present in both the perimysium and endomysium, whereas in IBM, the inflammation was predominantly localized to the endomysium. No statistically significant difference was observed in the distribution of CD4 and CD8 T-cells among the three subgroups (P-value = 0.358). However, CD4+ T-cells were more frequently seen in DM, while CD8+ T-cells were predominant in IBM. There were no notable differences in T-cell subpopulations among NSIM. Significant statistical differences in MHC-I expression patterns and mitochondrial abnormalities were identified among the three subsets (P-value &lt; 0.05). Perifascicular pathology (PFP) was predominantly observed in all DM cases, whereas 5 out of 9 IBM cases exhibited rimmed vacuoles in their muscle biopsies. None of the DM cases showed rimmed vacuoles or protein aggregates. Mitochondrial abnormalities were exclusively identified in IBM cases. Conclusions: Immune T-cell subpopulations and pathological features differ distinctly among DM, IBM, and NSIM. CD4+ T-cells and PFP are predominant in DM, whereas CD8+ T-cells, rimmed vacuoles, and mitochondrial abnormalities are characteristic of IBM. MHC-I expression is present in all subsets, but its patterns are variable and unpredictable.

The role of vitamin D in treated and refractory ulcerative colitis patients: a case-control study

BackgroundUlcerative colitis is a form of chronic inflammatory bowel disease (IBD) marked by ongoing inflammation of the mucosal lining that extends from the rectum to the upper part of the colon. Vitamin D regulates immune responses in several autoimmune and inflammatory diseases, including ulcerative colitis. Therefore, the study aims to investigate the role of vitamin D in the pathogenesis and treatment of ulcerative colitis.MethodsThis case-control study included 94 participants who were divided into four groups. Group 1: people with ulcerative colitis who responded to treatment (n = 24). Group 2: family members of patients who responded to treatment and did not have the disease (n = 24). Group 3: People with ulcerative colitis who are resistant to treatment (n = 23). Group 4: family members of treatment-resistant patients who does not have the disease (n = 23). Groups 1 and 3 were considered as patient groups (n = 47) and groups 2 and 4 as control groups (n = 47). Blood samples were taken and analyzed for complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum vitamin D levels.ResultsThe mean age of treatment-responsive patients (group 1) was 45.88 ± 18.51 years, while treatment-resistant patients (group 3) averaged 41.30 ± 13.01 (P = 0.33) years. Serum Vitamin D levels were 24.96 ± 9.66 ng/mL in group 1 and 27.70 ± 12.28 ng/mL in group 3, showing no significant correlation with ulcerative colitis (P = 0.41). All groups had a BMI within the normal range, and mean CRP levels varied significantly across groups. Hemoglobin was significantly lower in group 3 compared to group 1 (P = 0.029), but ESR results showed no significant relationship with ulcerative colitis. Vitamin D levels were highest in patients with lower BMI, and no significant relationships were found between Vitamin D and other risk factors, although extensive colitis was associated with higher Vitamin D levels compared to distal colitis.ConclusionIn this study, there was no significant association between ulcerative colitis and serum levels of vitamin D. However, the small number of patients may limit the conclusions that can be drawn regarding the role of vitamin D in the treatment of ulcerative colitis. Future studies should aim for larger cohorts to provide more definitive insights into this important issue.

Optimizing prone CT use for suspected interstitial lung abnormalities.

We investigated whether supine chest CT alone suffices for diagnosing ILAs, thereby reducing the need for prone chest CT. Patients who underwent prone chest CT for suspected ILAs from January 2021 to July 2023, with matching supine CT within 1 year, were retrospectively evaluated. Five multinational thoracic radiologists independently rated ILA suspicion and fibrosis scores (1 to 5-point) and ILA extent (1-100%) using supine CT first, then combined supine-prone CT after a 1-month washout. We categorized ILA suspicion and fibrosis scores into four diagnostic groups; normal, non-fibrotic, indeterminate-type, and fibrotic ILAs. The areas under the receiver operating characteristic curve (AUCs) of ILA suspicion scores, inter-reader agreement on diagnostic categories, and intra-reader/inter-reader reliability for ILA extent were evaluated. This study included 69 patients (mean age 67.2 ± 7.2 years; 36 women), with 23 age- and sex-matched patients in each group: normal, non-fibrotic ILAs, and fibrotic ILAs. The pooled AUC for ILA suspicion and inter-reader agreement on diagnostic categories improved for non-fibrotic ILAs with prone CT (AUC 0.76 to 0.92, p < 0.001; Fleiss kappa 0.25 to 0.51, p = 0.004), but not for fibrotic ILAs (AUC 0.94 to 0.99, p = 0.06; Fleiss kappa 0.63 to 0.72, p = 0.08). ILA extent was 1-2% smaller with prone CT for both ILA types (p < 0.001). For fibrotic ILAs, supine CT alone exhibited substantial diagnostic accuracy and inter-reader agreement, while the diagnosis of non-fibrotic ILAs benefited from adding prone CT. Supine CT alone slightly overestimated extent regardless of ILA type. Question Prone CT is recommended when interstitial lung abnormalities (ILAs) are suspected on supine CT, but its benefits remain underexplored. Findings Supine CT alone sufficed for diagnosing fibrotic ILAs, while prone CT improved non-fibrotic ILA diagnosis and reduced extent overestimation for both types. Clinical relevance Omitting prone CT reduces extra time, space, and radiation exposure without compromising the diagnosis of fibrotic ILAs, which have higher rates of progression and mortality risks, enhancing patient comfort and simplifying patient management.

Increased epicardial adipose tissue is associated with left ventricular reverse remodeling in dilated cardiomyopathy

BackgroundEpicardial adipose tissue (EAT) has been suggested to play paradoxical roles in patients with heart failure. The role of EAT in dilated cardiomyopathy (DCM) patients remains unclear. We aimed to assess the associations between the dynamic changes EAT and left ventricular reverse remodeling (LVRR) in DCM patients based on baseline and follow-up CMR.MethodsIn this prospective study, we consecutive enrolled DCM patients with baseline and follow-up cardiac magnetic resonance (CMR) examinations. All participating patients underwent 1–2 years of guideline-directed medical therapy (GDMT) at follow-up. The EAT was measured as pericardial and epicardial fat thickness, and paracardial fat volume, while the abdominal adiposity was measured in terms of subcutaneous and visceral fat thickness. The univariable and multivariable logistic regression analyses were performed to evaluate the associations of changes in abdominal and epicardial adiposities with the presence of LVRR.ResultsA total of 232 patients (mean age, 45.7 ± 15.1 years, 157 male) at baseline were enrolled. After a period of GDMT with a median duration of 15.5 months (interquartile range, 12.5–19.1 months) all participants underwent follow-up CMR with the same standardized protocol. Patients who reached LVRR showed a significant increment in EAT parameters compared to those who did not. After adjusting for age, sex, and delta changes of body mass index (BMI), the increment of pericardial fat thickness (odds ratio [OR]: 1.53; 95% confidence interval [CI]: 1.27 to 1.83; p < 0.001), epicardial fat thickness (OR: 2.10; 95% CI: 1.68 to 2.63; p < 0.001), and paracardial fat volume (OR: 1.01; 95% CI: 1.01 to 1.02; p = 0.001) were significantly associated with LVRR.ConclusionsIn DCM patients, the CMR-derived EAT parameters increased after 1–2 years of GDMT and significantly correlated with improved ventricular structure and function, independent of changes in BMI and abdominal adiposity, which may indicate the potential protective role of EAT in DCM patients.Trial registration: URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR1800017058.Graphical abstract

Greater baseline cortical atrophy in the dorsal attention network predicts faster clinical decline in Posterior Cortical Atrophy

BackgroundPosterior Cortical Atrophy (PCA) is a clinical syndrome characterized by progressive visuospatial and visuoperceptual impairment. As the neurodegenerative disease progresses, patients lose independent functioning due to the worsening of initial symptoms and development of symptoms in other cognitive domains. The timeline of clinical progression is variable across patients, and the field currently lacks robust methods for prognostication. Here, evaluated the utility of MRI-based cortical atrophy as a predictor of longitudinal clinical decline in a sample of PCA patients.MethodsPCA patients were recruited through the Massachusetts General Hospital Frontotemporal Disorders Unit PCA Program. All patients had cortical thickness estimates from baseline MRI scans, which were used to predict longitudinal change in clinical impairment assessed by the CDR Sum-of-Boxes (CDR-SB) score. Multivariable linear regression was used to estimate the magnitude of cortical atrophy in PCA patients relative to a group of amyloid-negative cognitively unimpaired participants. Linear mixed-effects models were used to test hypotheses about the utility of baseline cortical atrophy for predicting longitudinal clinical decline.ResultsData acquired from 34 PCA patients (mean age = 65.41 ± 7.90, 71% females) and 24 controls (mean age = 67.34 ± 4.93, 50% females) were analyzed. 62% of the PCA patients were classified as having mild cognitive impairment (CDR 0.5) at baseline, with the rest having mild dementia (CDR 1). Each patient had at least one clinical follow-up, with the mean duration of 2.78 ± 1.62 years. Relative to controls, PCA patients showed prominent baseline atrophy in the posterior cortical regions, with the largest effect size observed in the visual network of the cerebral cortex. Cortical atrophy localized to the dorsal attention network, which supports higher-order visuospatial function, selectively predicted the rate of subsequent clinical decline.ConclusionsThese results demonstrate the utility of a snapshot measure of cortical atrophy of the dorsal attention network for predicting the rate of subsequent clinical decline in PCA. If replicated, this topographically-specific MRI-based biomarker could be useful as a clinical prognostication tool that facilitates personalized care planning.

Refractive Astigmatism Consistency Pre- and Post-Cycloplegia in Pediatric Population

Background: Cycloplegic refraction is crucial in pediatric eye assessments. While spherical refraction changes due to cycloplegia are well-documented, astigmatic alterations remain unclear. This study assessed the agreement between spherical and astigmatic refraction pre- and post-cycloplegia. Methods: We enrolled 96 patients (mean age: 12.5 ± 2.4 years), including 35 myopes, 30 emmetropes, and 31 hyperopes. Pre- and post-cycloplegia autorefraction and keratometry (Myopia Master) were conducted using 1% cyclopentolate. Ocular residual astigmatism (ORA) was calculated as the difference between refractive and keratometric astigmatism. Astigmatism was analyzed using Fourier analysis (J0 and J45). Results: Cycloplegia resulted in a more positive spherical equivalent (SE) (+0.80 D), with myopes showing the smallest (+0.38 D) and hyperopes showing the highest variation (+1.47 D) in SE. With-the-rule (WTR) astigmatism predominated in the refractive and keratometric measurements, while ORA was against-the-rule (ATR). Cycloplegia shifted the refractive J0 (+0.06 D) towards more WTR and decreased ORA J0 (+0.05 D). No effect was observed in the J45 component. About 25% of patients exhibited astigmatism changes above 0.25 D, with refractive J0 variation being positively correlated with accommodation relaxation (0.044 D per D of relaxation). Conclusion: Cycloplegia induces clinically significant changes in the spherical component, but minimal variations in astigmatic components, predominantly in hyperopic eyes, likely reflecting alterations in crystalline lens anatomy.

Association between red cell distribution width and 30-day mortality in patients with sepsis-associated liver injury: a retrospective cohort study

BackgroundSepsis-associated liver injury (SALI) is a critical component of sepsis-induced multiple organ dysfunction with high mortality. Identifying biomarkers for risk stratification is essential. Red cell distribution width (RDW), indicating variation in red blood cell volume, has been linked to adverse outcomes in various diseases. This study aimed to evaluate the association between RDW and 30-day mortality in SALI patients.MethodsA retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care-IV database. Patients admitted to the intensive care unit (ICU) with SALI were included. RDW was recorded within the initial 24 h. The primary outcome was 30-day mortality. A multivariable Cox regression analysis was performed to examine the relationship between RDW and mortality.ResultsAmong 529 SALI patients (mean age 68.7 years, 61.8% male), 46.1% had RDW &amp;gt; 15.5%. The 30-day mortality rate was 35.5%. RDW was significantly higher in non-survivors compared to survivors (17.2 ± 3.0 vs. 15.4 ± 2.3, P &amp;lt; 0.001). Cox regression identified RDW as an independent risk factor for 30-day mortality (HR 1.14, 95% CI 1.09 to 1.19, P &amp;lt; 0.001). Subgroup analyses demonstrated that the findings were consistent across the various groups.ConclusionElevated RDW is independently associated with higher 30-day mortality in patients with SALI, suggesting its potential role in risk stratification and clinical management.

A prospective, multicentre study evaluating safety and efficacy of a fixed dose combination of Remogliflozin etabonate, Vildagliptin, and Metformin in Indian patients with type 2 diabetes mellitus (Triad-RMV)

AimsThe ICMR INDIAB-17 study revealed a diabetes prevalence of 11.4% in India, emphasizing the need for effective treatment for glycemic control. A Phase IV study was conducted to evaluate the safety and efficacy of a Fixed Dose Combination (FDC) of Remogliflozin, Metformin and Vildagliptin (RMV) in Type 2 Diabetes Mellitus (T2DM) patients uncontrolled on Metformin plus SGLT2 inhibitor or Metformin plus DPP4 inhibitor dual therapy.MethodsA total of 215 patients (mean age: 46.4 years; 64% male, 36% female) were enrolled across multiple centers in India. The study population included patients with a baseline HbA1c ≥ 8% at the time of screening. The primary objective was to assess safety based on treatment-emergent adverse events (TEAEs), while the secondary. aim was to evaluate effectiveness in terms of glycemic (HbA1c, fasting plasma glucose, postprandial glucose) and extra-glycemic measures (renal and lipid parameters). Statistical analysis was conducted using paired t-tests and the Wilcoxon signed-rank test for within-group comparisons, and the Bonferroni correction was applied to adjust for multiple comparisons. Effectiveness was evaluated at baseline, week 12, and week 24.ResultsThe study demonstrated statistically significant reductions in mean HbA1c levels from baseline to both week 12 and week 24 (p < 0.00001). At 24, weeks, 45.1% of patients achieved target HbA1c levels of ≤ 7%. Significant reduction was also observed in fasting plasma glucose (FPG) and postprandial glucose (PPG) levels. Renal parameters remained stable or improved, and lipid profile parameters, including LDL-C and triglycerides, showed favorable changes. Adverse events of special interest, including hypoglycemia and urinary tract infections, were reported in 4.7% of patients, with no serious adverse event recorded.ConclusionsThe twice daily triple FDC of RMV was well tolerated, safe and effective in patients with Type 2 Diabetes Mellitus uncontrolled on dual drug therapy of Metformin plus SGLT2i or Metformin plus DPP4i. The treatment led to significant improvements in glycemic control and other metabolic parameters over 24 weeks, without compromising renal function or causing serious adverse events.Trial registrationCTRI, CTRI/2022/05/042581. Registered 17 May 2022, https//ctri.nic.in/Clinicaltrials/rmaindet.php? trialid=68,757&EncHid=36127.16500&modid=1&compid=19.

Characterizing TIA and stroke symptomatology in a population-based study: implications for and diagnostic value of FAST-based public education

BackgroundUrgent medical treatment is crucial after stroke and transient ischemic attack (TIA), but hindered by extensive prehospital delays. Public education campaigns based on FAST (Face-Arm-Speech-Time) have improved response after major stroke, but not minor stroke and TIA. We aimed to provide strategies to improve public education on a national level, by characterizing TIA and stroke symptoms in a population-based cohort, and extrapolating findings to the general Dutch population.MethodsWe included all patients with first-ever stroke or TIA from 2002–2016 in the population-based Rotterdam Study (N = 17,931). We determined the prevalence of focal neurological symptoms and their combinations by event severity (i.e., TIA, minor stroke [National Institutes of Health Stroke Scale (NIHSS) 0–3], and major stroke [NIHSS > 3]). We assessed sensitivity of the FAST test for TIA and stroke, and estimated specificity using survey data on the incidence of focal neurological symptoms of non-vascular origin from the same source population. Finally, we determined the diagnostic value of adding visual symptoms and vertigo to the FAST test.ResultsOf all 900 patients (mean age: 77.6 years, 57.2% women), 409 (45.4%) had a TIA, 254 (28.2%) had minor stroke, and 237 (26.3%) had major stroke. At least one FAST symptom was present in 233/237 (98.3%) of patients with major stroke, compared to 186/254 (73.2%) patients with minor stroke, and 250/402 (62.2%) with TIA. Minor strokes and TIA not captured by the FAST test most commonly involved visual symptoms (52.7%), dizziness/vertigo (19.5%), disturbed coordination (19.1%), and sensory disturbance (18.2%). Sensitivity of FAST for TIA/minor stroke increased from 66.4 to 80.8% with the addition of visual symptoms, and to 86.1% with further incorporation of dizziness/vertigo, albeit with a > 40% increase in the number of false positive events. Nearly all patients with major stroke (97.5%) experienced a combination of multiple symptoms, whereas 58.9% of patients with TIA and 26.4% of those with minor stroke reported only a single symptom.ConclusionsIn contrast to major stroke, sensitivity of the FAST test is limited to around 65% for TIA and minor stroke in a population-based setting. Sensitivity increases by incorporating visual symptoms and vertigo, but this comes with a large number of false positives. Findings of this study may favor a focus on the importance of isolated or transient symptoms, rather than additional symptoms, in future stroke public education campaigns.

Observational study for multiparametric assessment of cardiac congestion in outpatient worsening heart failure (EVOLUTION).

We sought to characterize the clinical course of patients following worsening heart failure (WHF) treated in an outpatient setting and to identify factors associated with a poor response to standard of care with loop diuretics. Between September 2022 and March 2023, 44 eligible patients (mean age 66.3 years, 84% male) with ejection fraction <50% and with WHF symptoms in the preceding week treated in an outpatient setting were enrolled. Patients were assessed weekly over 4 weeks following the WHF episode. At week 4, responses to fluid expansion and furosemide administration were assessed in 39 patients to unmask persistent subclinical congestion. Patients were on stable doses of guideline-directed medical therapy (GDMT) with a mean daily furosemide dose of 47.4 mg. Patient-reported and physician-assessed symptoms and quality of life improved over the 4 weeks. At 1 h following 1 L Ringer solution infused over 2 h, the median (interquartile range) urine volume and urine sodium excreted over 3 h were 300 (200.0-500.0) ml and 39.6 (12.4-63.0) mEq, respectively. Receiver-operating characteristic curves suggest that cystatin C >1.2 ng/ml, N-terminal pro-B-type natriuretic peptide (NT-proBNP) >1500 pg/ml, and high-sensitivity troponin T >20 pg/ml represent good predictors of non-response to a fluid challenge (diuresis, natriuresis, and rales) following an outpatient WHF, with having all three markers associated with the worst response. Patients with high levels of troponin, or NT-proBNP, or cystatin C who develop WHF despite being treated with a loop diuretic, need novel therapies for WHF.

Comparative analysis of metabolic characteristics and prognostic stratification of HER2-low and HER2-zero breast cancer using 18F-FDG PET/CT imaging

BackgroundRecent advancements in novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates (ADCs) have highlighted the emerging HER2-low breast cancer subtype with promising therapeutic efficacy. This study aimed to comparatively analyze the metabolic characteristics and prognostic stratification of HER2-low and HER2-zero breast cancer using baseline fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging.MethodsConsecutive patients with newly diagnosed breast cancer who underwent 18F-FDG PET/CT prior to therapy in our hospital were retrospectively reviewed. The relationship between metabolic parameters (maximum standardized uptake value (SUVmax), tumor-to-liver SUV ratio (TLR), total lesion glycolysis (TLG), and metabolic tumor volume (MTV)) in primary lesions and HER2 expression was analyzed. The survival analyses were performed to identify the prognostic factors for disease-free survival (DFS) in patients with HER2-negative (HER2-low versus -zero).ResultsIn total, 258 patients (mean age: 54 ± 12 years) were included. In hormone receptor (HR)-positive subgroup, SUVmax and TLR were significantly higher in HER2-low than in HER2-zero (P = 0.045 and 0.03, respectively). But in HR-negative subgroup, there was no significant metabolic difference between HER2-low and HER2-zero (All P > 0.05). The four metabolic parameters were significant predictors of DFS in HER2-negative patients (All P < 0.01), but there was no significant difference in DFS between HER2-low and -zero, regardless of tumor metabolism. Moreover, in HER2-zero patients, the DFS of patients with high metabolism was significantly shorter than that of patients with low metabolism (PSUVmax = 0.002, PMTV = 0.03, PTLG= 0.005, PTLR < 0.001, respectively), but without a similar finding in HER2-low patients.ConclusionOur study demonstrated the HR-positive HER2-low breast cancer exhibited a particularity in glucose metabolic profile. Additionally, HER2-zero patients with elevated metabolism were associated with inferior prognosis and warranted careful attention in clinical evaluations.

Demographic Distribution and Contributing Factors of Traumatic Brain Injury: A Tertiary Care Centre Study

Objective To determine the demographic distribution and contributing factors of Traumatic Brain Injury (TBI). Materials and Methods Using total enumeration sampling technique, 61 patients during October-December 2020, were enrolled in the study. Data was collected using a pre-validated questionnaire. Results Mean age of patients was 41.16 ± 15.1 (range 6–70) years. Majority were male (78.7%) and married (73.8%). Most of the patients belonged to Punjab state (47.5%) and rural areas (72.1%). Major cause of TBI was a road-side accident (RSA) in 70.5% patients. One-quarter (24.6%) of the patients had consumed alcohol at the time of injury. One-third (34.4%) of the patients did not suffer immediate loss of consciousness. However, 65.6% patients lost consciousness immediately after injury of which only 55.7% regained it within six hours. Three-quarters (75%) of the patients received help within 30 minutes of TBI. Around 30% of the cases reported poor road infrastructure as contributing factors to RSA. Nearly half (48.8%) of the patients were driving a 2-wheeler while 27.9% were pillion riders. None of the 2-wheeler occupants wore helmets. Around half (46.5%) of the patients had collision/hit as the mechanism of injury while it was a loss of balance and slip/skid in 16.3% and 9.3% patients, respectively. Among 25% of the patients who had fallen, 43.8% had fallen from height followed by fall from stairs in 37.5% patients. The remaining 3% of TBI patients were assaulted as a result of quarrels due to property disputes or alcohol consumption by some blunt physical objects. Conclusion The present study reported RSA as the major cause of TBI contributed by poor road infrastructure and negligence towards road safety rules.

Virtual Monoenergetic Imaging of Thoracoabdominal Computed Tomography Angiography on Photon-Counting Detector Computertomography: Assessment of Image Quality and Leveraging Low-keV Series for Salvaging Suboptimal Contrast Acquisitions

Background: The aim of this study was to assess the possibility of image improvement of ECG-gated, high-pitch computed tomography angiography (CTA) of the thoracoabdominal aorta before transaortic valve replacement (TAVR) on a novel dual-source photon-counting detector CT (PCD-CT) in the setting of suboptimal low-contrast attenuation. Methods: Continuously examined patients who underwent an ECG-gated, high-pitch CTA of the aorta on a PCD-CT with a contrast decrease of at least 50% between the ascending aorta and the common femoral arteries (CFA) were included. Patient characteristics were documented. Virtual monoenergetic imaging (VMI) reconstructions with three keV settings were generated. CT values and noise were measured for five vascular segments of the aorta and the CFA. Signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were calculated. Two independent board-certified radiologists rated the images with the focus on vascular attenuation, vessel sharpness, and image quality using a 5-point Likert scale. Results: Fifty-five patients (mean age 77.4 ± 8.5 years; 15 women) were included. The SNR was significantly higher at 40 and 45 keV VMI compared to reference 70 keV (p &lt; 0.001 and p = 0.005, respectively). The same was shown for the CNR (p &lt; 0.001 and p = 0.0049, respectively). Subjective image evaluation showed a significant increase in vessel attenuation in the lower keV reconstructions, while the overall image quality decreased only slightly. Furthermore, 50% (8/16) of primarily non-diagnostic scans were considered diagnostic when using low-keV reconstructions (p &gt; 0.05). Conclusions: ECG-gated CTA of the aorta in high-pitch mode on PCD-CT with suboptimal contrast enhancement at the level of the CFA can be salvaged by using low-keV VMI. This implies the possibility of radiation dose reduction by eliminating the need for repeat scans.

Modular Stems in Revision Hip Arthroplasty: A Three-Step Technique

Background: Complications such as periprosthetic fractures necessitate challenging revision surgeries. In particular, femoral stem revisions can be complicated by poor bone quality, making primary stability and leg length restoration difficult to achieve. Modular fluted tapered stems (MFTSs) have emerged as a viable option for these complex cases. This study aims to describe a reproducible three-step technique for femoral stem revision using MFTSs. The technique focuses on (1) obtaining distal primary stability, (2) restoring leg length, and (3) ensuring overall implant stability. Materials and methods: We conducted a retrospective analysis of ten patients who underwent revision THA using this three-step technique, with a minimum follow-up of 12 months. The mean patient age was 70.7 years, and the average follow-up was 24.2 months. Limits were the small sample size, the lack of clinical outcomes and the short-term follow-up. Results: There was no subsidence, a mean leg length discrepancy of 4 mm (p: 0.604), and no dislocations. However, heterotopic ossifications (HOs) were observed in 25% of patients, although no trochanteric migrations occurred. One patient experienced an intraoperative femoral fracture, which was successfully treated. Conclusions: This three-step approach can break down the revision procedure, making it more accessible to surgeons. The findings suggest that this technique is effective in achieving reliable outcomes in femoral stem revisions, potentially improving the standard of care for patients requiring complex THA revisions.

Sacubitril/Valsartan and Dapagliflozin in Patients with a Failing Systemic Right Ventricle: Effects on the Arrhythmic Burden

Background/Objectives: Angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are essential medications in heart failure (HF) therapy, and their potential antiarrhythmic effects have been reported. Recently, ARNI and SGLT2i use for HF in adult congenital heart disease (ACHD) has been studied. However, whether any beneficial effects may be achieved on the arrhythmic burden in the complex population of ACHD with a systemic right ventricle (sRV) is still to be determined. Methods: We retrospectively collected all significant arrhythmic events from a cohort of patients with a failing sRV attending our tertiary care center on optimal guideline-directed medical therapy (GDMT) with ARNI and/or SGLT2i. Results: A total of 46 patients (mean age 38.2 ± 10.7 years, 58% male) on sacubitril/valsartan were included. Twenty-three (50%) patients were also started on dapagliflozin. After a median follow-up of 36 [Q1–Q3: 34–38] months, arrhythmic events occurred globally in 13 (28%) patients. Survival analysis showed significant reduction of clinically relevant atrial and ventricular arrhythmia at follow-up (p = 0.027). Conclusions: Our findings suggest that GDMT including sacubitril/valsartan and dapagliflozin may also offer an antiarrhythmic effect in ACHD patients with a failing sRV, by reducing the incidence of arrhythmic events at follow-up.

Pattern of Uveitis in Northern Vietnam

ABSTRACT Purpose To characterize the spectrum of uveitis in patients visiting three tertiary hospitals in Hanoi, Vietnam. Methods This study collected prospective and multicenter data from patients diagnosed with uveitis at three tertiary hospitals in Hanoi City, Vietnam, between January 2022 and January 2024. Data on age, sex, clinical and laboratory findings, and etiology were collected. Results Of 410 patients included, 54.6% were women. The mean age of patients was 39.9 years. Most cases were unilateral and chronic. Anterior uveitis was the most common case (40%), followed by panuveitis (30%), posterior uveitis (26.1%), and intermediate uveitis (3.9%). Undifferentiated uveitis, accounting for 32%, was the most prevalent form across all anatomical groups. The leading etiologies for anterior uveitis included Posner–Schlossman syndrome (18.5%), cytomegalovirus (CMV)-induced uveitis (11%), and Herpes simplex virus–induced uveitis (8.5%). For posterior uveitis, the primary causes were Vogt–Koyanagi–Harada (VKH) syndrome (17.8%), toxocariasis (10.3%), and toxoplasmosis (6.5%). The identified causes of panuveitis included VKH syndrome (24.4%), Behcet’s disease (15.4%), and CMV-induced panuveitis (5.7%). We observed six cases of uveitis associated with Haemophilus influenzae (1.5%) without any concomitant systemic symptoms. In our patient population, the most common complication was cataract (11.2%), followed by uveitic macular edema (11%). Conclusions Various uveitis patterns were observed among Vietnamese patients, with non-infectious uveitis being predominant.