One-year Follow-up Research Articles

Family Functioning, Life Satisfaction, and Depressive Symptoms in Chinese Adults With Diabetes and Hypertension: A Cross-Lagged Model.

This study aims to evaluate the bidirectional relationship between family functioning and depressive symptoms, considering life satisfaction as a potential mediator and gender, age and income as a moderator of these associations. A longitudinal study was conducted with 708 Chinese adults with diabetes and hypertension (51.6% women; mean age: 64.1±7.7years) recruited from 12 community health services. Data were collected at baseline (T1), one-year follow-up (T2), and two-year follow-up (T3) using self-reported assessments of family functioning, depressive symptoms, and life satisfaction. Depressive symptoms negatively predicted family functioning from T1 to T2, and family functioning negatively predicted depressive symptoms from T2 to T3. Furthermore, life satisfaction mediated the relationship between family functioning and depressive symptoms from T1 to T3, and vice versa. Differences in gender, age, and income showed distinct patterns. Life satisfaction at T2 mediated the effect of family functioning at T1 on depressive symptoms at T3 for men, women, middle-aged and low-income adults, whereas life satisfaction mediated the effect of depressive symptoms at T1 on family functioning at T3 only among women and low-income adults. This study explores the relationships among family functioning, life satisfaction, and depressive symptoms, noting potential differences based on gender, age and income. Family-level interventions targeting life satisfaction could a helpful approach to addressing depressive symptoms among Chinese adults aged 45 and older with type 2 diabetes and/or hypertension.

Early Detection and One-Year Follow-Up of Subclavian Steal Syndrome Treated With Traditional Chinese Medicine: A Case Report.

Subclavian steal syndrome (SSS) often goes undiagnosed because of its variable and subtle symptoms, highlighting the need for innovative diagnostic approaches. This case report explores the integration of traditional Chinese medicine (TCM) in both diagnosing and managing SSS, marking a pioneering contribution to the field. An 80-year-old woman with persistent dizziness, unresponsive to conventional treatments, underwent TCM pulse diagnosis, which revealed significant inter-arm pulse discrepancies. Subsequent Western imaging confirmed SSS. The patient was treated with Chinese herbal medicines (CHMs) targeting Qi deficiency and blood stasis, resulting in significant symptom improvement and a reduction in inter-arm systolic blood pressure disparities. Follow-up over 1 year showed sustained benefits. The integration of TCM pulse diagnosis, CHMs, and Western imaging highlights their complementary roles and potential as adjunctive therapies for managing SSS, offering a novel and comprehensive therapeutic strategy.

One-Year Prognosis for Patients Diagnosed with Acute Coronary Syndrome Compared to Those with Chronic Coronary Syndrome Following Complex Coronary Procedures

Background: Acute coronary syndrome (ACS) remains the primary cause of mortality worldwide. Performing complex coronary intervention in patients with ACS is considered a significant factor for worsening prognosis. This study aimed to evaluate the prognosis of patients with ACS treated with complex procedures compared to patients with chronic coronary syndrome (CCS). Methods: Among 980 patients from the Polish Complex Registry, we enrolled 829 consecutive patients who underwent complex percutaneous coronary intervention (PCI) for acute or chronic coronary syndrome with a completed one-year follow-up. The primary endpoint is defined as the major adverse cardiac event (MACE) at 12 months, a composite endpoint including all-cause death, target lesion revascularization, target vessel revascularization, and non-fatal myocardial infarction. Results: The incidence of the composite endpoint of MACE at one-year follow-up was comparable between the patients with acute and chronic coronary syndrome who underwent complex PCI (12.4% vs. 7.6%, LogRank p = 0.035). Cox multivariate analysis indicated that ACS is an independent risk factor for death at one-year follow-up. Additionally, age and comorbidities, such as heart failure and chronic kidney disease, along with procedural factors, including lesion length and pre-procedural diameter stenosis, are independent predictors of death in patients with complex lesions. Independent risk factors for MACE at one-year follow-up include age, heart failure, previous PCI, in-stent restenosis, and pre-procedural diameter stenosis. Conclusions: The prognosis of patients with acute and chronic coronary syndrome in the annual follow-up is comparable in the context of cardiovascular events. The clinical presentation of ACS is an independent risk factor for all-cause death.

Ten years' single surgeon experience of excision and primary anastomosis urethroplasty for traumatic urethral stricture: an analysis of risk factors for urethral stricture recurrence.

Excision and primary anastomosis (EPA) urethroplasty is the standard treatment for traumatic urethral strictures, but managingthem remains challenging for urologists. Identifying factors leading to EPA urethroplasty failure benefits both patients andsurgeons. This study aims to analyze risk factors for urethral stricture recurrence after one-year follow-up of EPA urethroplasty. Data on male patients undergoing EPA urethroplasty at the Urology Department of Saiful AnwarGeneral Hospital from January 2013 until December 2023 were prospectively recorded. Successful urethroplasty, defined as theabsence of additional treatment necessity, was assessed until 12 months follow-up. Demographic data, time to surgery, strictureetiology, comorbidities, prior urethral interventions, and operationsteps were recorded. Univariate and multivariate Cox regression analyses were performed using IBM SPSS Statisticsversion 21. Total 95 patients were observed, and 89 patients wereincluded, averaging 41.2 ± 15.59 years old. EPA urethroplasty succeeded in 91% of cases over a median follow-up of 16.3months. Pelvic fracture urethral injury (PFUI) was the predominant etiology in 74% of cases, with an average stricture lengthof 25.4 ± 16.3 mm. The average time to surgery was performed on average 6.67 ± 4.07 months after diagnosis. In univariateanalysis, body mass index (BMI), time to surgery, and stricture length were associated with urethral stricture recurrence.However, only time to surgery showed a significant association in multivariate analysis. Obesity, the length of the stricture, and delayed surgical intervention are associated with an increased risk of urethral stricture recurrence in patients following EPA. EPA urethroplasty demonstrates a high success rate in managing traumatic urethral strictures.

P0826 Switching to standard-dose subcutaneous vedolizumab increases the percentage of patients in biochemical remission even in those intensified with intravenous vedolizumab: one year results of a Spanish multicentre observational study

Abstract Background Analyse the percentage of subcutaneous drug persistence and pharmacokinetics in patients undergoing intravenous (iv) vedolizumab after switching to Subcutaneous (sc) vedolizumab. In addition, the relationship between treatment with intensified iv vedolizumab versus patients without intensification. Methods A multicentre, descriptive, observational, and retrospective study of a cohort of 54 patients diagnosed with Ulcerative Colitis (UC) and Crohn´s disease (CD) treated with iv vedolizumab, who underwent a switch to sc vedolizumab. Analyse clinical, biochemical, and analytical parameters; vedolizumab levels during follow-up and need for intensified intravenous treatment in patients on iv vedolizumab treatment and subsequent switch to sc vedolizumab with follow-up during weeks 4, 12, 24, and 52. Results 32 patients (59%) had a diagnosis compatible with UC and 22 patients (41%) with CD. Biochemical remission was achieved in 32 patients (86%). All patients achieved clinical remission. In addition, a progressive increase in vedolizumab levels was evident after switching to sc vedolizumab with statistical significance (p<0.05) during follow-up. Up to 14 patients (25.9%) were on an intensified regimen before switching to sc vedolizumab. All patients were maintained on sc vedolizumab at a dose of 108mg/2 weeks without requiring intensification at medical criteria during the one-year follow-up. Conclusion Up to 20% more patients, after switching from iv to sc vedolizumab, achieved biochemical remission, which was higher in the intensified group (34%), after one year of follow-up with a standard dose of sc vedolizumab.

Comparison of a Novel Temperature-Controlled Diamond-Tip Catheter and a Power-Controlled Gold-Tip Catheter for the Irrigated Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter

Background/Objectives: Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) is a recommended treatment option for typical atrial flutter (AFL). While power-controlled ablation has been the current standard, a novel temperature-controlled ablation system has been introduced. We aimed to compare the procedural efficacy and one-year outcome of a temperature-controlled diamond-tip catheter with an established power-controlled gold-tip catheter. Methods: Consecutive patients undergoing ablation of CTI-dependent AFL using a power-controlled catheter or the novel temperature-controlled catheter were enrolled. Patients were followed up using a 7-day electrocardiogram after 3, 6, and 12 months. The primary endpoint was acute efficacy (procedural success, total RF, and procedure time). The secondary endpoint was the recurrence of typical AFL during follow-up. Results: In total, 38 patients undergoing temperature-controlled ablation were enrolled and compared to 283 patients undergoing power-controlled ablation. A bidirectional CTI block was achieved in 100% in the temperature-controlled group and 97.5% in the power-controlled group (p = 0.7). The total RF time (median: 192 sec (IQR 138–311) vs. 643 sec (IQR 386–1079), p < 0.001) and total procedure time (median: 45 min (IQR 34–57) vs. 52 min (IQR 39–70), p = 0.01) were shorter with temperature-controlled ablation. At the one-year follow-up, there was no difference in the recurrence of typical AFL between groups. Conclusions: Utilization of temperature-controlled ablation for typical AFL increased procedural efficiency with shorter RF and procedure times compared to power-controlled ablation. The recurrence rate of typical AFL after one year was low and did not differ amongst groups.

P1277 Cost-effectiveness of BOOST online intervention for supported self-management of pain, fatigue and bowel incontinence in Inflammatory Bowel Disease

Abstract Background People with IBD often experience symptoms of abdominal pain, fatigue and bowel incontinence that affect substantially their daily lives1. IBD-BOOST is the first randomised controlled trial (RCT) assessing the effectiveness of an online self-management intervention, BOOST, in managing these symptoms in IBD2. We report the cost-effectiveness of BOOST intervention compared to care as usual for people with IBD. Methods A cost-utility analysis was conducted alongside the pragmatic IBD-BOOST RCT of 780 patients requesting help for pain, fatigue or incontinence symptoms (mean age 49 years, 67% women, 55% with Crohn’s disease)3. The BOOST intervention costs and costs from patient-reported health service use, out-of-pocket expenses and time off work were calculated for each participant over the 12 months of follow-up. Quality-adjusted life-years (QALYs) over the 12 months were evaluated using the EQ-5D-5L questionnaires administered to participants at baseline, 6- and 12-months. Missing data (13% at 6 months and 38% at 12 months across the trial arms) was imputed using multiple imputation. Differences in total costs and QALYs between study arms were estimated using mixed effects models adjusting for pre-specified baseline factors. Incremental cost effectiveness ratios (ICERs) and net monetary benefit from UK healthcare and societal perspectives are reported. Results At recruitment, study participants reported quality of life (EQ-5D utility) of 0.73 (SD 0.22) and overall IBD-related costs of £2321 (SD 3170) over the previous 3 months with cost of biologics accounting for 47% of these costs, followed by hospital outpatient services (22%) and work productivity loss costs (14%) (Figure 1). After missing data imputation and controlling for covariates, the BOOST intervention (£151 per participant) was estimated to have led to health care cost savings of £746 (SE 356), other costs savings of £89 (SE 236) and incremental QALYs of 0.017 (SE 0.007) over the one-year follow-up per participant resulting in cost savings per QALY gained of £34,599 from the health services perspective and £39,745 from the societal perspective. The probability that the BOOST intervention was cost effective when compared with usual care was above 98% for willingness-to-pay thresholds of £20,000 to £30,000 from both health services and societal perspectives (Figure 2). Conclusion Our findings indicate that the BOOST intervention for supported self-management of symptoms of pain, fatigue and bowel incontinence in people with IBD is cost-effective.

Hypomagnesemia, insulin secretion and action in patients without diabetes, 1 year after kidney transplantation

IntroductionHypomagnesemia after kidney transplantation has been reported as a potential risk factor for development of post-transplant diabetes mellitus.MethodsIn kidney transplant recipients undergoing an oral glucose tolerance test during one-year surveillance follow-up we estimated insulin sensitivity with the Matsuda index, a modified Stumvoll index, and HOMA-2IR. First and second phase insulin secretion was assessed using the Stumvoll equation. Participants were categorized into tertiles by plasma magnesium levels, (<0.7, 07–0.78,>0.78 mmol/L).ResultsWe included 208 patients (62% men, median age 51 years). Patients in the lowest compared to the highest magnesium tertile had higher measured GFR (mean 59 vs. 49 mL/min, p = 0.002), tacrolimus trough concentration (mean 6.7 vs. 5.5 μg/L, p < 0.001), and fasting plasma glucose (mean 5.5 vs. 5.3 mmol/L, p = 0.03). There was no significant difference in the Matsuda index between magnesium tertiles, nor in insulin sensitivity assessed by modified Stumvoll index, HOMA-2IR, first or second phase insulin. Results indicate a non-significant trend toward lower disposition index in the lowest vs. highest tertile (p = 0.052).ConclusionIn kidney transplant recipients with lower compared to normal plasma magnesium levels we found a higher fasting plasma glucose but no differences in insulin sensitivity indexes nor dynamic insulin measurements.

P0953 Real world effectiveness and safety of filgotinib in Ulcerative Colitis: 1 year follow-up results of the ICC registry

Abstract Background Filgotinib is a preferential JAK1-inhibitor approved for the treatment of ulcerative colitis (UC). The ICC registry was developed to evaluate the effectiveness and safety of advanced therapies in inflammatory bowel disease (IBD). Here, we report the one-year follow-up results of filgotinib in patients with UC. Methods Fourteen hospitals prospectively enrolled UC patients initiating filgotinib in the Dutch ICC registry. Treatment persistence was assessed by Kaplan-Meier survival analysis. Clinical remission (i.e. Simple Clinical Colitis Activity Index [SCCAI] ≤ 2) and corticosteroid-free clinical remission rates were assessed at 12, 24 and 52 weeks for all patients who were not in remission at baseline, based on SCCAI score, faecal calprotectin and/or endoscopy. Patients lost to follow up were considered as treatment failure. Reasons for treatment discontinuation and adverse events were recorded. Results Eighty-three UC patients (47% females) were enrolled between January 2022 and October 2023. Mean age and disease duration at baseline were 41 [sd ± 16] and 12 years [sd ± 9], respectively. A total of 49 (59%) patients had used up to two advanced therapies and 34 (41%) patients had used three or more. At baseline, 75 patients (90%) had active disease of whom 24 (32%) used oral corticosteroids. After one year of follow-up, 58.8% of patients still used filgotinib (Figure 1). At week 12, 24 and 52, corticosteroid-free clinical remission rates were 57.1%, 32.7% and 34.6% respectively (Figure 2). Reasons for treatment discontinuation were primary non-response (n=17), secondary loss of response (n=13), side effects (n=3) or other reasons (n=4). Fifty-seven adverse events were recorded (19 infections). Ten infections required treatment with antibiotics or antiviral therapy, none of them led to hospitalization or therapy discontinuation. No thromboembolic events were reported. Conclusion The results of this real world study show that, even in a therapy-refractory UC population with an average disease duration of 12 years, more than half of the patients still used filgotinib and one third of patients was in corticosteroid-free clinical remission after one year of follow-up. No new safety signals were found.

Interprosthetic Joint Motion in Bipolar Partial Hip Arthroplasty After One-Year Follow-up

Background: Partial hip arthroplasty is the treatment of choice for displaced femoral fractures in the elderly. The bipolar prosthesis was developed to lessen the acetabular erosion encountered with the unipolar prosthesis. However, bipolar prostheses lose their motion between the inner or outer articulation (interprosthetic joint motion) after three months, rendering them biomechanically like unipolar prostheses. Literature has shown that the interprosthetic joint is mobile radiographically up to one year after the surgery. Objective: This study evaluated and quantified the interprosthetic joint motion (motion between the outer and inner articulations) of bipolar prostheses one year after partial hip arthroplasty for proximal femoral fractures in a tertiary hospital. We also investigated the effect of adding the hip measurement in adduction. Methodology: This retrospective cohort study measured the motion of the outer and inner articulations of locally available bipolar prostheses and the interprosthetic joint movement using one-year postoperative radiographs of patients who underwent bipolar partial hip arthroplasty for femoral fractures in a tertiary hospital from 2019 to 2021. Immediate and one-year post-operative AP radiographs in neutral, maximum hip abduction, and maximum hip adduction were measured and compared. The interprosthetic joint motion was calculated from the difference in pelvic-head angles and pelvic-shaft angles. Results: Twelve patients were included in the study. The interprosthetic joint in bipolar prosthesis was still mobile even after one year in 75% of patients (p = 0.0001). Adding hip adduction measurements resulted in a significantly higher mean of 74.69 degrees as compared to only 34.67 degrees (p = 0.0006). Conclusion: Most patients retained a mobile interprosthetic joint at one year post-op. Hip adduction radiographs gave additional information on the total interprosthetic joint motion. At both time points studied, the inner head articulation contributed more to the interprosthetic joint motion. All five local implant systems used showed good motion after one year.

Parental psychosocial factors and children’s oral health-related quality of life: Data from a caries prevention study with phone-based support

BackgroundCaries burden in children disproportionately affects minority and socioeconomically disadvantaged populations. Severe early childhood caries requiring general anesthesia (GA) is a significant concern, with high caries relapse rates in subsequent years.AimTo examine associations between parental psychosocial factors, children’s caries burden, and oral health-related quality of life (OHRQoL), including group differences, following a phone-based parental support intervention for children treated under GA for severe Early Childhood Caries (ECC).MethodsData were collected during a randomized controlled trial examining a phone-based parental support program. Parental stress was assessed using the Swedish Parenthood Stress Questionnaire (SPSQ), dental fear was measured with the Corah Dental Anxiety Scale (CDAS), and dental attitudes were evaluated using the Dental Beliefs Survey (DBS-R). Children’s OHRQoL was assessed using the Parental-Caregivers Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS). The Total Observed Caries Experience index was used to calculate the child’s cumulative caries burden. Unadjusted analyses were performed using t-tests, with effect sizes calculated as Cohen’s d. A two-step path analysis examined how parental factors, intervention, and baseline caries influenced caries burden at a one-year follow-up, while also assessing caries burdens impact on children's well-being.ResultsAt the one-year follow-up, the intervention group demonstrated significantly improved OHRQoL with lower mean scores on the P-CPQ and FIS compared to the control group, indicating fewer oral health issues and less impact on family life. No statistical differences were found in parental stress, dental fears, or dental beliefs between groups. Path analysis identified baseline caries and treatment group as significant predictors of caries burden, while intervention group predicted better OHRQoL outcomes. The model explained 86.2% of caries burden variance and 12.9% of OHRQoL variance.ConclusionA phone-based parental support program significantly improved children’s OHRQoL, even with a higher caries burden in the intervention group at the one-year follow-up. Parental stress, dental fears, and attitudes showed no differences and did not predict caries burden. Preventing early childhood caries in high-risk groups remains challenging, highlighting the importance of preventive initiatives that empower parents and foster collaboration with key stakeholders to reduce severe ECC.Registered at https://clinicaltrials.gov/ Identifier: NCT02487043.

Longitudinal Recovery Trajectories and Ventilatory Modalities in Covid-19 ARDS Survivors

IntroductionThe impact of the different ventilatory support modalities and the timing of intubation on longitudinal lung recovery trajectories in patients with severe COVID-19 is unknown.MethodsA multicenter, prospective observational study conducted in 52 Spanish intensive care units (ICUs) involving critically ill COVID-19 patients admitted between February 25th, 2020, to February 28th, 2021. 1854 COVID-19 patients were followed after hospital discharge at 3, 6 and 12 months with lung diffusing capacity (DLCO) and a chest imaging. Patients were classified regarding the ventilatory support received during the ICU stay: noninvasive mechanical ventilation (NIMV), high-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) divided into early IMV (intubation <24 h) and late IMV (intubation >24 h). The primary objective is to evaluate the impact of the different respiratory support modalities during the ICU stay and time of intubation on DLCOmeasurements and their recovery trajectories over a one-year follow-up. Secondary outcomes include other pulmonary function parameters and chest imaging findings.ResultsA total of 360 (19.4%) and 290 (15.6%) patients received HFNC and NIMV, respectively. 1204 (64.9%) patients underwent IMV; 966 received early IMV and 238 late IMV. The latter exhibited a significantly worse percentage of predicted DLCOduring the one-year follow-up with adjusted differences (95%CI; p-value) of 6.9 (3.9 to 10; p<0.001), 4.2 (1.1 to 7.2; p=0.007) and 4.9 (1.7 to 8.2; p=0.003) at 3, 6 and 12 months compared with early IMV. NIMV patients exhibited greater lung damage at follow-up than those under HFNC with an adjusted difference of DLCOvalues of 5.2 (1.7 to 8.7; p=0.003) at 6 months and greater presence of radiological abnormalities during the follow-up. Matched and sensitivity analysis showed results consistent with those reported.ConclusionsDelay in intubation implies the worst outcomes; however, patients with NIMV exhibited a slower lung recovery in terms of DLCOmeasurements and more radiological abnormalities compared with HFNC patients. These results should be used to optimize follow-up protocols for COVID-19 ARDS survivors. These findings may serve as a valuable consideration for optimizing follow-up protocols for survivors of COVID-19 ARDS.

Identification of Key Predictors of Cryoglobulinemia Severity at Diagnosis: Threshold, Type, and Severity Score at Diagnosis.

Background: Cryoglobulinemia (CG) syndrome is a heterogeneous condition characterized by the presence of cryoglobulins in serum, often leading to vasculitis with protean clinical manifestations. Understanding the presentation of cryoglobulinemia-related symptoms based on cryoprecipitate levels, GC type, and severity at diagnosis is essential for effective management. Hence, this study aimed to provide a comprehensive analysis of patients with positive cryoglobulin detection to investigate these aspects. Methods: We conducted a retrospective review of clinical charts from patients with positive cryoglobulin detection at Colmar Hospital between May 2015 and April 2019. Results: Among 166 patients with positive cryoglobulins, the median cryoprecipitate value was 37 mg/L [IQR: 25-70], with 62% of patients below the 50 mg/L threshold. High cryoprecipitate levels were associated with C-virus hepatitis (p = 0.0007), increased fatigue (p = 0.001), fever (p = 0.0013), weight loss (p = 0.028), and musculoskeletal symptoms (p = 0.002). These patients also exhibited decreases in complement fractions (p-values 0.017 to 0.006). At the end of the one-year follow-up, they required frequent renal replacement therapy (p < 0.0001) and had a higher mortality rate (p = 0.02). Based on the CG type, patients with type I GC had splenomegaly (p = 0.039) and hemopathy (p = 0.001). According to severity at initial presentation, the severe patients had more purpura (p < 0.001), Raynaud's phenomenon (p = 0.039), and leukocytoclastic vasculitis on skin biopsy (p < 0.001), along with higher cryoprecipitate levels (p = 0.011). Multivariate analysis identified purpura (OR: 10.25), hematological malignancy (OR: 7.06), Raynaud's phenomenon (OR: 6.41), and cryoprecipitate levels (OR: 1.02) as significant markers of disease severity serving for the development of a severity score for clinical practice. Conclusions: This study identifies severity markers in patients with positive cryoprecipitate and proposes a score related to severity at diagnosis.

Pulmonary Arterial Hypertension Incidence in Scleroderma Patients Treated with Bosentan for Digital Ulcers: Evidence from the Italian SPRING Registry.

Bosentan (BOS) is approved for treating pulmonary arterial hypertension (PAH) and preventing digital ulcers (DU) in systemic sclerosis (SSc). Our study aimed to evaluate whether BOS prescribed for DU could reduce the incidence of PAH in a large SSc cohort from the SPRING registry. Patients with SSc from the SPRING registry, meeting ACR/EULAR 2013 classification criteria with data on PAH onset, DU status, BOS exposure, and at least a one-year follow-up between 2015 and 2020, and no known PAH at baseline were included. PAH was diagnosed with right heart catheterization during the follow-up, and its incidence rate (IR) was calculated. Kaplan-Meier curves were determined, and multivariate regression identified PAH risk factors. Among 727 eligible patients with SSc, followed for a median of 2.0 years, 54 (7.4%) developed PAH [IR 3.71 per 100 patients/years]. Patients with DU who were never exposed to BOS had a higher incidence of PAH [IR 4.90 per 100 patients/years] compared to those exposed to BOS, whose rates matched those without DU and who were never exposed to BOS. Risk factors independently associated with PAH development included DU (HR 1.85), age (HR 1.05), modified Rodnan Skin Score (mRSS) >4 (HR 2.07), ILD (HR 2.29), and acetylsalicylic acid treatment (HR 1.78). In our cohort, DU were confirmed as a leading risk factor for PAH development, and BOS use for DU prevention may reduce this risk. Only patients with DU who were not on BOS had an increased PAH incidence.

Proprietary surgical approach to the treatment of large radicular cyst with retrograde filling of resected root canals: a clinical case report

Relevance. Radicular cysts account for 86% of all odontogenic cysts. Recurrence rates following cystotomy and cystectomy range from 18% to 36%, and in some cases, up to 55%. The primary causes include incomplete removal of pathological tissues, damage to adjacent anatomical structures, insufficient pathogen eradication, and inadequate bone tissue regeneration.Clinical case description. This paper presents a clinical case of a large radicular cyst affecting teeth 3.1, 4.1, 4.2, and 4.3 of the mandible. The treatment process was carried out in two stages. In the first stage, endodontic treatment was performed on the affected teeth. Seven days after the exudation subsided, the second stage involved filling the canals with a fast-setting material (FSM) Rootdent SM DMT as a sealer, followed by the placement of silver pins. Three hours after completing the endodontic treatment, a cystectomy was performed using a proprietary method that combined guided tissue regeneration, apical resection of the affected teeth, and retrograde filling of their root canals with FSM. A one-year follow-up showed full recovery, including complete bone regeneration and no gingival scarring.Conclusion. The proposed treatment strategy for large radicular cysts has the potential to greatly minimize the need for extracting the affected teeth.

Fusion of FDG and FMZ PET Reduces False Positive in Predicting Epileptogenic Zone.

Epilepsy, a globally prevalent neurological disorder, necessitates precise identification of the epileptogenic zone (EZ) for effective surgical management. While the individual utilities of FDG PET and FMZ PET have been demonstrated, their combined efficacy in localizing the epileptogenic zone remains underexplored. We aim to improve the non-invasive prediction of epileptogenic zone (EZ) in temporal lobe epilepsy (TLE) by combining FDG PET and FMZ PET with statistical feature extraction and machine learning. This study included 20 drug-resistant unilateral TLE patients (14 mesial TLE, 6 lateral TLE), and two control groups (N=29 for FDG, N=20 for FMZ). EZ of each patient was confirmed by post-surgical pathology, and one-year follow-up, while propagation zone (PZ) and non-involved zone (NIZ) were derived from the epileptogenicity index based on presurgical stereo-encephalography (SEEG) monitoring. Whole brain PET scans were obtained with dual tracers [18F]FDG and [18F]FMZ on separate days, from which standard uptake value ratio (SUVR) was calculated by global mean scaling. Low-order statistical parameters of SUVRs and t-maps derived against control groups were extracted. Additionally, fused FDG and FMZ features were created using arithmetic operations. Spearman correlation was used to investigate the associations between FDG and FMZ, while multiple linear regression analysis was used to explore the interaction effects of imaging features in predicting epileptogenicity. Crafted imaging features were used to train logistic regression models to predict EZ, whose performance was evaluated using 10-fold cross-validation at ROI-level, and leave-one-patient-out cross-validation at patient-level. FDG SUVR significantly decreased in EZ and PZ compared to NIZ, while FMZ SUVR in EZ significantly differed from PZ. Interaction effects were found between FDG and FMZ in their prediction of epileptogenicity. Fusion of FDG and FMZ provided the best prediction model with an area under the curve (AUC) of 0.86 [0.84-0.87] for EZ vs. NIZ and an AUC of 0.79 [0.77-0.81] for EZ vs. PZ, eliminating 100% false positives in 50% of patients, and ≥80% FPs in 90% patients at patient level. Combined FDG and FMZ offer a promising avenue for non-invasive localization of the epileptogenic zone in TLE, potentially refining surgical planning. AUC = Area under the curve; EI = Epileptogenicity index; EZ = Epileptogenic zone; FMZ = Flumazenil; GABAA = Gammaaminobutyric acid type A; NIZ = Not-involved zone; PZ = Propagation zone; SEEG = Stereo-electroencephalography; SUVR = Standard uptake value ratio; TLE = Temporal lobe epilepsy.

Evaluation of the long-term autonomic dysfunction after the recovery of COVID-19 disease

Aims: Beyond the acute phase of the COVID-19 disease, many patients experience persistent symptoms, collectively termed "post-COVID syndrome," which includes autonomic dysfunction. Heart rate variability (HRV) is a well-established method to assess autonomic nervous system (ANS) function. This study aimed to investigate the long-term impact of COVID-19 on autonomic function through evaluating the changes in HRV. Methods: This retrospective study included 225 participants divided into two groups: 117 post-COVID patients and 108 age and gender matched controls. HRV was assessed using 24-hour Holter monitoring. Time-domain and frequency-domain indices were analyzed, including standard deviation of normal-to-normal intervals (SDNN), root mean square of successive RR interval differences (RMSSD), and low frequency (LF)/high frequency (HF) ratio. Statistical comparisons were performed using independent t-tests, Mann-Whitney U tests, and correlation analyses. Results: Post-COVID patients exhibited significantly lower HRV indices compared to controls. Time-domain metrics such as SDNN (135.7±39.5 ms vs 149.1±34.2 ms, p=0.007) and RMSSD (32.7±13.7 ms vs 37.5±14.7 ms, p=0.012) were reduced in the COVID-19 group. Frequency-domain indices, including total power (TP) and HF power, were also diminished. Correlation analysis revealed no significant association between the duration of time post-COVID (one-year follow-up) and most HRV parameters. Conclusion: Post-COVID patients experience significant autonomic dysfunction, marked by reduced parasympathetic activity and increased cardiovascular risks, with some evidence of partial recovery during sleep. Routine HRV monitoring and targeted interventions, alongside further research with larger cohorts, are crucial for better understanding of the long-term effects and improving patient outcomes.

Risk factors for one-year mortality in 440 femoral peri-implant fractures: insights from the PIPPAS prospective, multicentre, observational study.

The Peri-Implant and PeriProsthetic Survival AnalysiS (PIPPAS) study aimed to investigate the risk factors for one-year mortality of femoral peri-implant fractures (FPIFs). This prospective, multicentre, observational study involved 440 FPIF patients with a minimum one-year follow-up. Data on demographics, clinical features, fracture characteristics, management, and mortality rates were collected and analyzed using both univariate and multivariate analyses. FPIF patients were elderly (median age 87 years (IQR 81 to 92)), mostly female (82.5%, n = 363), and frail: median clinical frailty scale 6 (IQR 4 to 7), median Pfeiffer 4 (1 to 7), median age-adjusted Charlson Comorbidity Index (CCI) 6 (IQR 5 to 7), and 58.9% (n = 250) were American Society of Anesthesiologists grade III. Overall, 90.5% (n = 398) of the patients were treated surgically, 57.0% (n = 227) retained the implant, and 88.7% (n = 353) managed with fixation. Mortality rates were 8.2% (n = 3.6) in-hospital, 11.4% (n = 50) at 30 days, 21.1% (n = 93) at six months, and 21.6% (n = 95) at 12 months. Medical complications, mainly delirium, were common in the acute setting (52.7%, n = 215). The nonunion rate was 4.1% (n = 18). Mortality risk factors in the univariate analysis were age, living at a nursing home, no walking outdoors, frailty variables, fractures in the distal epiphysis, fractures around a proximal nail, discharge to a healthcare facility, and no osteoporotic treatment at discharge. Protective factors against mortality in the univariate analysis were surgical treatment by an experienced surgeon, management without an arthroplasty, allowing full weightbearing, mobilization in the first 48 hours postoperatively, and geriatric involvement. Risk factors for mortality in the multivariate analysis were cognitive impairment (Pfeiffer's questionnaire) (hazard ratio (HR) 1.14 (95% CI 1.05 to 1.23), p = 0.002), age-adjusted CCI (HR 1.18 (95% CI 1.07 to 1.30), p = 0.001), and antiaggregant or anticoagulant medication at admission (HR 2.00 (95% CI 1.19 to 3.38), p = 0.009). Haemoglobin level at admission was protective against mortality (HR 0.85 (95% CI 0.74 to 0.97), p = 0.018). Mortality in FPIFs occurs mainly within the first six months of follow-up. Early co-management and clinical optimization, particularly targeting frail older patients, is crucial in reducing mortality following these fractures.

A Pilot Case Series on the Use of a Large Mushroom-Shaped Corneal Graft for the Surgical Management of Post-Penetrating Keratoplasty Ectasia and Endothelial Failure.

Objective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet's membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 ± 4.5 D to 43.5 ± 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 ± 0.4 to 0.3 ± 0.2 LogMAR; the central corneal thickness was reduced from 629 ± 39 μm to 532 ± 45 µm; and the endothelial cell density was 1926 ± 199 cells/mm2. None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation.

Identifying and treating metabolic dysfunction-associated steatotic liver disease among at-risk Veterans.

Metabolic dysfunction-associated steatotic liver disease (MASLD), an increasing public health concern, remains challenging to diagnose and risk-stratify. We assessed the 1) prevalence of MASLD risk factors among Veterans in Veterans Health Administration (VA) care, 2) factors associated with MASLD diagnosis; and 3) associations between MASLD diagnosis and receipt of care. Veterans with MASLD risk factors, including obesity, pre-diabetes, diabetes, or dyslipidemia, were identified using International Classification of Diseases-10 codes and followed in 2019-2022. Multivariable logistic regression and propensity score-adjusted models identified demographic and clinical characteristics associated with a diagnosis of MASLD or cirrhosis and receipt of elastography, specialty care for liver disease, VA weight management (MOVE!) participation, and glucagon-like peptide-1 (GLP-1) analog prescriptions. Among approximately 9 million Veterans, 4,159,699 (45%) had risk factors for MASLD and were included in further analysis. MASLD or cirrhosis was diagnosed in 6% of the at-risk cohort. At-risk Veterans diagnosed with MASLD were younger with more metabolic risk factors, increased rates of alcohol use disorder, and higher FIB-4 scores and ALT values. Over one-year follow-up, 6% engaged in MOVE!, 9% had specialty care for liver disease, 3% were prescribed GLP-1 analogs, and 2% underwent staging elastography. MASLD diagnosis was significantly associated with receipt of MOVE!, specialty care consultation, and GLP-1 analog prescription. Few at-risk Veterans carried a MASLD diagnosis or had undergone staging elastography. Because MASLD diagnosis was associated with linkage to hepatology care and weight loss therapy services, implementation of population screening and management services for MASLD is critically needed.