One-year Outcomes Research Articles

Comparison of Surgical Techniques in Children with Autism Spectrum Disorder and Refractory Epilepsy: Efficacy and Cognitive Outcomes

Introduction: Refractory epilepsy is common in children with Autism Spectrum Disorder (ASD), significantly affecting their cognitive development and quality of life. Surgical interventions provide a therapeutic option, but it remains unclear which technique offers the best outcomes for this population. Objective: To compare the efficacy and safety of four surgical techniques—lesionectomy, temporal lobectomy, extratemporal cortical resection, and functional hemispherectomy—in children with refractory epilepsy, both with and without ASD, and evaluate their impact on cognitive and behavioral development and quality of life. Methodology: A retrospective study was conducted with 120 children diagnosed with refractory epilepsy, equally divided between those with and without ASD. Patients were assigned to one of four surgical groups (n = 15 per group) based on the intervention performed. Data on demographic and clinical characteristics, as well as one-year postoperative outcomes—including seizure control (Engel classification), intelligence quotient (WISC-V), adaptive behavior (Vineland-II), and quality of life (PedsQL)—were collected. Statistical analyses were applied to compare the results among groups, and logistic regression was used to identify the predictors of seizure freedom. Results: Lesionectomy and temporal lobectomy groups showed significantly higher rates of seizure freedom (80% and 73%, respectively) compared to extratemporal resection (60%) and functional hemispherectomy (67%). These groups also presented significant improvements in intelligence quotient, adaptive behavior, quality of life, and reductions in ASD symptoms (p < 0.01). Perioperative complications were notably lower in the lesionectomy and temporal lobectomy groups (7%) compared to extratemporal resection and functional hemispherectomy (40%; p = 0.007). Significant predictors of seizure freedom included the presence of structural anomalies on neuroimaging and a shorter duration of epilepsy before surgery (p < 0.05). Conclusions: Lesionectomy and temporal lobectomy are highly effective and safer surgical techniques for managing refractory epilepsy in children with ASD, providing significant benefits in seizure control, cognitive development, and quality of life. Importantly, the outcomes observed are not exclusive to children with ASD but likely reflect broader efficacy across pediatric epilepsy populations. The early identification of surgical candidates and comprehensive preoperative evaluations are essential for optimizing outcomes, emphasizing the importance of individualized treatment planning and further comparative research to validate these findings.

Irisin Predicts Poor Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction and Low Levels of N-Terminal Pro-B-Type Natriuretic Peptide

Background: Despite existing evidence of the high predictive value of natriuretic peptides (NPs) in patients with heart failure (HF), patients treated with guideline-directed therapy who have low or near-normal NP levels are unlikely to be correctly stratified for risk of clinical outcomes. The aim of this study is to detect plausible predictors for poor one-year clinical outcomes in patients with HFpEF and low NT-proBNP treated with in accordance with conventional guidelines. Methods: A total of 337 patients with HF with preserved ejection fraction (HFpEF) who had low levels of N-terminal natriuretic pro-peptide (NT-proBNP) at discharge due to optimal guideline-based therapy were enrolled in the study. The course of the observation was 3 years. Echocardiography and the assessment of conventional hematological and biochemical parameters, including NT-proBNP, tumor necrosis factor-alpha, high-sensitivity C-reactive protein (hs-CRP), adropin, irisin, visfatin, and fetuin-A, were performed at baseline and at the end of the study. Results: Three-year cumulative clinical endpoints (cardiovascular death, myocardial infarction or unstable angina or acute coronary syndrome, worsening HF, sudden cardiac death, or cardiac-related surgery or all-cause death) were detected in 104 patients, whereas 233 did not meet the endpoint. After adjusting for an age ≥ 64 years and a presence of atrial fibrillation, diabetes mellitus, chronic kidney disease (CKD) stages 1–3 and dilated cardiomyopathy, the multivariable Cox regression analysis showed that an irisin level of ≤7.2 ng/mL was an independent predictor of cumulative clinical endpoint. Moreover, patients with levels of irisin > 7.2 ng/mL had a better Kaplan–Meier survival rate than those with a lower serum irisin level (≤7.2 ng/mL). Conclusions: Multivariable analysis showed that an age ≥ 64 years; the presence of atrial fibrillation, diabetes mellitus, CKD stages 1–3 and dilated cardiomyopathy; an LAVI ≥ 39 mL/m2; and serum levels of hs-CRP ≥ 6.10 mg/L, irisin ≤ 7.2 ng/mL, and visfatin ≤ 1.1 ng/mL were predictors of poor clinical outcomes in HFpEF with low levels of NT-proBNP. A serum level of irisin ≤ 7.2 ng/mL could emerge as valuable biomarker for predicting long-term prognosis among HFpEF patients with low or near-normal levels of NT-proBNP.

Hybrid Full-Arch Rehabilitation Using Conventional And Zygomatic Implants: A Short-Term Retrospective Analysis.

To report one-year outcomes of prosthetic rehabilitation of the atrophic maxillae, supported by angled abutments on zygomatic implants and conventional implants. In the present retrospective analysis, edentulous maxillary areas treated with fixed-hybrid prostheses supported by angled abutments of 45, 52.5, and 60 degrees screwed to zygomatic implants inserted using an extrasinus surgical approach were included. Prosthesis, implant, and abutment success/survival rates, complications, Mucosal Seal Efficacy Evaluation (MSEE), modified PLaque Index (mPLI), modified Bleeding Index (mBI), and Zygomatic Implants Classification Level (ZICL) were assessed. Ninety-eight straight implants and 81 zygomatic implants (21 abutments of 45 degrees, 23 of 52.5 degrees, and 37 of 60 degrees) were inserted into 35 patients. Biological complications: postoperative sinus opacity was observed in seven patients, two of whom experienced a unilateral perforation of the sinus membrane. ZICL0-1 was recorded in 95% of zygomatic sites; the cumulative success rates were 100% and 94.3% when using the implant and prosthesis as units of analysis, respectively. Survival rate for the implants attested to the highest percentage (100%), whereas survival rate of the prostheses was 94.3%. No differences were registered among the clinical indices related to different inclinations of the abutments.

One-year clinical outcomes of endovascular revascularization in patients with acute limb ischemia.

Urgent revascularization should be performed to patients with acute limb ischemia (ALI) unless the ischemia is irreversible. In patients with severe ALI and multiple morbidities, surgical revascularization is not feasible; however, endovascular revascularization (EVR) may be an option. This study aimed to examine 1-year clinical outcomes of EVR in patients with ALI and determine prognostic factors. We retrospectively examined 90 EVR procedures performed in 81 patients with ALI between January 2018 and February 2024. The primary endpoint was 1-year amputation-free survival (AFS). Multivariable logistic regression was performed to identify predictors of 1-year AFS. Fifty-one procedures were performed for severe ALI (56.7%). Fifty-six patient were ambulatory at the time of procedures (62.2%). The 1-year AFS rate was 59.7%. Multivariable analysis revealed that hypertension (adjusted hazard ratio [aHR] 0.14; 95% confidence interval [CI], 0.05-0.47; P = 0.0007), presence of blood flow of both tibial arteries after EVR (aHR 0.19; 95% CI, 0.03-0.93; P = 0.04), and presence of arterial flow below the ankle after EVR (aHR 0.29; 95% CI, 0.09-0.84; P = 0.022) were independently associated with a higher AFS rate. Aortic plaque was independently associated with a lower AFS rate (aHR 3.98; 95% CI, 1.55-9.90; P = 0.048). EVR may be an acceptable treatment of ALI even in non-ambulatory patients and those with severe ALI. Achieving adequate blood flow of both tibial arteries and below the ankle by performing EVR may be important for improving patient outcomes.

Thrombus aspiration in primary percutaneous coronary intervention in acute ST-elevation myocardial infarction patients with high thrombus burden: one-year outcomes in a tertiary healthcare center in Ho Chi Minh City

Abstract Background Primary percutaneous coronary intervention (PCI) can dislodge atherosclerotic debris, risking microvascular embolism. Thrombus aspiration (TA) before stenting in ST-segment elevation myocardial infarction (STEMI) patients has been linked to reduced mortality, lower recurrence of heart attacks, and improved cardiac function. However, limited research exists on the effectiveness of TA in Vietnam, underscoring the need for further studies to enhance cardiovascular care. This prospective observational study was conducted to evaluate the role of TA in STEMI patients admitted with a substantial thrombus burden at Nguyen Tri Phuong Hospital. Results Out of 92 participants, 68 underwent TA treatment. Post-treatment, the TA group exhibited better TIMI and TMP flow grades and a higher rate of ST-segment normalization, with no significant difference in major adverse cardiac events (MACEs) at 30-day and 12-month follow-ups compared to those untreated. Conclusions TA during PCI enhances ST-segment normalization and TIMI and TMP scores in STEMI patients, improving myocardial perfusion. No difference in MACE occurrence was noted between groups after 30 days and 12 months, suggesting TA’s potential benefits without increasing adverse outcomes.

One-Year Clinical Outcomes in Patients with Coronary Bifurcation Lesions: A Result from a Single Centre.

One-Year Clinical Outcomes in Patients with Coronary Bifurcation Lesions: A Result from a Single Centre.

For upper ureteral stone, semirigid ureteroscopy or flexible ureteroscopy? Strengths and weaknesses

BackgroundFlexible and semirigid ureteroscopy are two often used modalities in treating for upper ureteral stone. How about the outcome of each procedure?MethodsA retrospective cohort study among 167 patients who underwent flexible or semirigid ureteroscopic lithotripsy was performed. The pre-, intra-, postoperative and one-year follow-up outcomes were taken into comparison.ResultsSignificantly higher instant stone-clearance rate (81.3% vs. 92.4%, p = .032) and less operative time (62.1 ± 27.6 min vs. 44.1 ± 24.6 min, p<.001) were found in semirigid ureteroscopy. However, the stone-clearance rate at one month (90.7% vs. 93.5%, p = .500) was similar. Baseline characteristics including patient demographics, stone characteristics, duration of stone symptoms, hospital stay, expense, and complications between groups were approximately same. Three cases of stricture were found in the flexible ureteroscopy, and two in the semirigid ureteroscopy. Outcomes showed no significant difference. Further analysis showed that flexible ureteroscopy was likely more negatively affected by hydronephrosis and stone size, and semirigid ureteroscopy was more affected by stone location.Conclusionflexible ureteroscopy and semirigid ureteroscopy both had high stone clearance rate in the treatment for upper ureteral stones. They had similar outcomes and follow-up results. However, they also had their each most suitable application object.

Initial treatment response can predict one-year treatment outcomes in neovascular age-related macular degeneration treated according to the observe-and-plan regimen.

To investigate if the initial treatment response can predict the 1-year treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) treated according to the observe-and-plan (O&P) regimen. In this prospective cohort study, treatment-naïve patients with nAMD were enrolled consecutively and followed for 1 year while being treated according to the O&P regimen. The treatment response was determined initially post-loading doses and after 1 year. The functional treatment response (fTR) was determined by the change in best corrected visual acuity, while the morphological treatment response (mTR) was assessed by central retinal thickness and the presence of sub- and intraretinal fluid on optical coherence tomography and categorized as good, partial, and poor responders. The relative risk (RR) of the initial treatment response for predicting 1-year treatment response was assessed. One hundred patients were included and 94 completed the 1-year follow-up. Patients with an initial good fTR and initial poor fTR had an RR of 4.1 (95% CI 1.8-9.2) and 4.3 (95% CI 2.2-8.3), respectively, of remaining in the same response category at 1 year. Similarly, patients with an initial good mTR and initial poor mTR had an RR of 3.0 (95% CI 1.8-4.8) and 8.7 (95% CI 3.0-25.1), respectively, of remaining in the same response category at 1 year. Both the anatomic and visual functional response after 3 loading doses are predictive of the anatomic and functional outcomes at 1 year in patients with nAMD treated according to the O&P regimen.

Obesity paradox of sepsis in long-term outcome: The differential effect of body composition

BackgroundThe obesity paradox has been widely studied recently; however, its impact on the long-term prognosis of sepsis and the protective mechanism of body mass have not yet been sufficiently revealed. MethodsWe retrospectively evaluated the association between obesity and 1-year survival after sepsis in a single university-affiliated hospital and examined the differential effects of muscle mass and adiposity. ResultsAdult patients with sepsis or septic shock (n = 1492)were classified into obese (n = 300) and nonobese (n = 1192) groups. One-year mortality due to sepsis was lower in the obese than in the nonobese (52.0 % vs. 64.8 %; p < 0.001). In multivariate Cox analysis, one-year mortality due to sepsis was independently associated with body mass index (BMI) (hazard ratio 0.96). In the subgroup analysis, 705 were divided into four groups according to the psoas muscle index (PMI) and body fat percentage (BFP) to assess the differential impact of body fat and muscle mass on the one-year outcome of sepsis. One-year mortality was significantly different among the four groups (high BFP/low PMI, 60.6 %; high BFP/high PMI, 42.1 %; low BFP/high PMI, 34.8 %; low BFP/low PMI, 63.2 %; p = 0.002). The adjusted hazards ratio of one-year mortality of sepsis, which was normalized to the low BFP/high PMI group, were 1.2 (p = 0.585), 2.2 (p = 0.016), and 2.3 (p = 0.009) in groups of high BFP/high PMI, high BFP/low PMI, and low BFP/low PMI, respectively. ConclusionAn obesity paradox has been observed in the long-term outcomes of patients with sepsis, and muscle mass may be more critical than fat mass as a protective mechanism against obesity. Implications for clinical practiceA high BMI is linked to a more favorable long-term prognosis in sepsis, with muscle mass playing a more critical role than fat mass. A proactive nutritional and conditioning program may benefit patients anticipating major procedures and potential ICU admission. Such preparation could enhance their resilience and improve outcomes when facing critical illness, including sepsis.

Intravascular Lithotripsy in Acute Coronary Syndromes: Procedural and One-Year Clinical Outcomes From the BENELUX-IVL Registry.

Despite the excellent success and safety of intravascular lithotripsy (IVL) in heavily calcified lesions, evidence in acute coronary syndromes (ACS) remains limited. This study aimed to evaluate the procedural and clinical outcomes of IVL in heavily calcified ACS. Patients who underwent IVL between 2019 and 2024 from the ongoing prospective BENELUX registry were eligible for inclusion. Patients were therefore classified in ACS and chronic coronary syndrome (CCS) groups. The primary technical endpoint was angiographic success < 30%, defined as the successful delivery of the IVL catheter across the target lesion and delivery of IVL pulses without angiographic complications and residual target lesion less than 30%. The primary clinical endpoint was in-hospital major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, or target lesion revascularization. A total of 454 patients underwent IVL, with 251 (55.3%) treated for CCS and 203 (44.7%) for ACS. The median SYNTAX score (p-value 0.17), the need for inotropes (p-value 0.09), and the use of mechanical circulatory support (p-value 0.71) were similar between CCS and ACS groups. Comparable angiographic success (< 30% residual stenosis) was observed between CCS and ACS groups (90.1% vs. 91.1%, p = 0.69). MACE were similar across groups during hospital stays (CCS 1.6% vs. ACS 3.0%, p = 0.33), at 30 days (CCS 3.2% vs. ACS 3.9%, p = 0.86), and at 12-month follow-up (CCS 8.4% vs. ACS 7.9%, p = 0.91). IVL provides high procedural success and consistent clinical outcomes in both CCS and ACS cases.

One-Year Outcomes of Aflibercept in Treat-and-Extend Versus Pro Re Nata Regimens for Bevacizumab-Resistant Diabetic Macular Edema: A Real-World Study.

The aim of this study was to compare the efficacy of the treat-and-extend (TAE) regimen versus the pro re nata (PRN) regimen in patients with bevacizumab-resistant diabetic macular edema (DME) treated with aflibercept, with or without adjunctive laser therapy. Ninety-one eyes from 91 patients who were switched to aflibercept after three consecutive intravitreal bevacizumab injections for the treatment of DME were included in this retrospective real-world study. The patients were categorized into three groups: TAE (n = 30), TAE + laser (n = 31), and PRN (n = 30). Changes in best-corrected visual acuity and central macular subfield thickness (CMST) at 12, 24, and 52weeks were defined as the primary functional and anatomical outcomes. A total of 91 eyes from 91 patients (49.5% female) with a mean age of 63.9 ± 7.1years were included in the analysis. At 52weeks, the mean letter gains were 8.03, 8.90, and 10.23 in the TAE, TAE + laser, and PRN groups, respectively. Anatomical improvements, as measured by CMST reduction, were 55.33µm, 33.35µm, and 48.96µm in the TAE, TAE + laser, and PRN groups, respectively. The average number of injections administered was 7.7, 8.1, and 8.1, respectively. The final extension interval for the TAE group was 8.7weeks, compared to 9.5weeks in the TAE + laser group. The PRN group demonstrated the highest functional improvement while the TAE group showed the greatest anatomical improvement. Overall, both anatomical and functional outcomes in the TAE regimen were comparable to the PRN regimen in patients with bevacizumab-resistant diabetic macular edema.

Sex Differences Among Patients Undergoing Transcatheter Tricuspid Valve Repair Using the Edge-to-Edge Technique.

Tricuspid valve regurgitation (TR) is more prevalent among females. Transcatheter tricuspid valve repair (TTVR) using the edge-to-edge technique represents an alternative to surgery in patients with severe TR and high surgical risk. This study aims to investigate sex differences among patients undergoing TTVR. All patients who underwent TTVR at our center were retrospectively included. We compared baseline characteristics, intra-hospital, and one-year outcomes between males and females. A total of 105 consecutive patients underwent TTVR. Females were more prevalent in the study cohort (n = 63, 60%). Coronary artery disease (CAD) was more evident in males than females (71.4% vs. 47.6%, p = 0.016). Left ventricular ejection fraction (LVEF) was also worse in males (48.8 ± 13.4 vs. 58 ± 6.8, p < 0.001). Other clinical characteristics were similar between both groups. The Success of the procedure (88.1% vs. 95.2%, p = 0.177) and intra-hospital mortality (4.8% vs. 11.1%, p = 0.255) were similar among males and females. At one-year follow-up, mortality was similar between both groups (24.3% vs. 25.9%, p = 0.863). Furthermore, hospitalization due to acute heart failure was also similar between both groups (40.5% vs. 37.5%, p = 0.768), as was a composite endpoint of death or hospitalization. In patients with successful procedures and who survived one year, TR severity was comparable between both groups. In our real-world cohort, more females underwent TTVR than males. No difference was observed in outcomes between males and females at one-year follow-up.

Risk Factors and Clinical Outcomes of Perioperative Hypotension in the Neck of Femur Fracture Surgery: A Case-Control and Cohort Analysis.

Introduction Neck-of-femur (NOF) fractures have high prevalence rates and require prompt surgical intervention for better outcomes. Perioperative hypotension (POH) in the geriatric population has poor outcomes with several contributing factors. The study intends to explore these risk factors and their correlation with patient outcomes. Methodology We studied a total of 276 patients who underwent surgical fixation of the NOF fracture at St Peter's Hospital, Surrey, from June 1, 2022, to June 1, 2023. Patients with POH were identified; the risk factors and one-year outcome were studied to obtain the results. We used odds ratio (OR), relative risk (RR), and multivariate regression to analyse the statistical association within the data. Results The incidence of POH was 68% (188/276) which included preoperative hypotension (9.78%), intraoperative hypotension (48.55%), and postoperative hypotension with a mean arterial pressure (MAP) of <65 mmHg (24.63%) and fall of systolic blood pressure to less than 80% (34.42%). Statistically significant risk factors were hypertension (OR: 1.330), heart disease (OR: 2.768), and hemoglobin (Hg) drop (OR: 1.42). The outcomes we studied were all statistically significant, with an RR of more than one. It includes postoperative delirium (RR: 2.037), postoperative 30-day morbidity (RR: 4.008), postoperative 30-day mortality (RR: 6.12), 365-day mortality (RR: 2.224), postoperative delay in mobilisation (RR: 1.329), and prolonged length of stay (RR: 1.273). Conclusion The study shows a clear association between POH and increased postoperative complications, highlighting the need for prompt intervention. This case-control study identified hypertension, history of heart disease, and perioperative blood loss as significant risk factors for developing POH. Also, this study demonstrates that POH is significantly associated with adverse outcomes, including the increased risk of delirium, prolonged hospital stays, and elevated 30-day morbidity in elderly patients undergoing hip fracture surgery.The findings also indicated that the duration of hypotension did not directly influence the outcomes; its occurrence alone is a significant factor in developing these complications.

Epi-off riboflavin with vitamin E TPGS (Ribocross®) cross-linking: one-year outcome.

To assess the short and mid-term outcomes of epithelium-off (epi-off) corneal collagen cross-linking using Riboflavin with Vitamin E TPGS (Epi-off Ribocross® CXL) for progressive keratoconus (KC). Retrospective, single-center non-comparative interventional study. Patients with progressive keratoconus who underwent CXL using (Epi-off Ribocross® CXL) from May 2021 to May 2022 who completed at least 12months of follow-up in Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Corrected distance visual acuity with spectable (CDVA), tomographic parameters (Belin ABCD) and topographic parameters were evaluated at baseline and at last follow up. Twenty eyes of twenty patients fulfilled inclusion criteria. CDVA remained stable at last follow up (0.88 ± 0.19 from 0.83 ± 0.21, p = 0.45) with a significant reduction in cylinder (1.97 ± 1.69 from 2.78 ± 2.19, p = 0.03). Kmax significantly improved from 53.18D ± 6.32 to 50.96 ± 5.3D (p = 0.005). At the last follow up, no case of progression was noted. Epi-off Ribocross® CXL proved to be a safe treatment for progressive KC, with a stabilization of all cases at the one year follow up. Further studies are needed to confirm long-term stability.

Arthroscopic meniscal posterior root repair combined with centralization reduces medial menicus extrusion associated with posterior root tears: One-year clinical outcomes.

This study aimed to assess the short-term clinical efficacy of combining posterior meniscal root repair with meniscal centralization technology in the treatment of medial meniscus posterior root tears (MMPRTs) and notable meniscus extrusion. In this retrospective analysis, patients aged 43-76 years with only chronic posterior root tears of the medial meniscus and notable extrusion were followed up for 12-14 months. (1) persistent medial knee joint pain affecting daily life, presenting with joint space tenderness; (2) showing the ineffectiveness of conservative treatment for a minimum of 3 months; conservative treatment includes non-invasive methods such as nonsteroidal anti-inflammatory drugs, physical therapy and massage, but does not include intra-articular injections. (3) Kellgren-Lawrence Grades 0-II osteoarthritis (OA) of the knee joint; and (4) diagnosis of a posterior root tear of the medial meniscus with notable meniscus extrusion confirmed through knee-joint plain magnetic resonance imaging (MRI) scans, where coronal image revealed a meniscus body extrusion of ≥3 mm. (1) Kellgren-Lawrence Grades III-IV OA in the knee joint; (2) presence of knee joint infection or other structural damage to the knee joint; (3) history of previous knee joint surgery; (4) demonstrating joint instability or abnormal lower-limb alignment (varus deformity >5°); and (5) presence of severe mental illness, coagulation disorders, or other serious medical conditions. The Lysholms score, the Hospital for Special Surgery (HSS) knee score, the visual analogue scale (VAS) score and meniscal extrusion values were evaluated before and after surgery in 23 patients through a comparative analysis. The results of the follow-up conducted 12-14 months post-operatively indicated a significant improvement in the patients' conditions. In particular, the Lysholms scores (preoperative: 50.9 ± 10.2; 1-year post-surgery: 72.0 ± 8.4), HSS knee scores (preoperative: 45.9 ± 10.6; 1-year post-surgery: 79.1 ± 11.1) and VAS scores (preoperative: 4.0 ± 1.1; 1-year post-surgery: 0.9 ± 0.7) exhibited notable enhancements. Furthermore, compared to the preoperative values, the degree of meniscus extrusion measured by coronal MRI of the knee joint significantly improved post-operatively (preoperative: 3.7 ± 0.8 mm; 1-year post-surgery: 2.2 ± 0.6 mm). These findings all yielded a p < 0.05, signifying statistical significance. In patients with chronic MMPRTs and notable extrusion, a combination of posterior meniscal root repair and centralization technology can effectively restore meniscus function and rectify the medial meniscus displacement, resulting in favourable short-term clinical outcomes. Level IV.

Long-Term Air Pollution Exposure and Severity of Idiopathic Pulmonary Fibrosis: Data from the IPF-PRO Registry.

While exposure to air pollution is a known risk factor for adverse pulmonary outcomes, its impact in individuals with idiopathic pulmonary fibrosis (IPF) is less well understood. To investigate the effects of long-term exposure to air pollution on disease severity and progression in patients with IPF and to determine whether genomic factors, such as MUC5B promoter polymorphism or telomere length, modify these associations. We performed analyses at enrollment and after one year of follow-up in the IPF-PRO Registry, a prospective observational registry that enrolled individuals with IPF at 46 US sites from June 2014 to October 2018. Five-year average pollution exposures (PM2.5, NO2, O3) prior to enrollment date were estimated at participants' residential addresses with validated national spatio-temporal models. Multivariable regression models estimated associations between pollution exposure and physiologic measurements (FVC, DLCO, supplemental oxygen use at rest) and quality of life measurements (St. George's Respiratory Questionnaire [SGRQ], EuroQoL, Cough and Sputum Assessment Questionnaire) at enrollment. Cox proportional hazard models estimated associations between pollutants and a composite outcome of death, lung transplant, or >10% absolute decline in FVC % predicted in the year after enrollment. Models were adjusted for individual-level and spatial confounders, including proxies for disease onset. Gene-environment interactions with MUC5B and telomere length were assessed. Of 835 participants, 94% were non-Hispanic Whites, 76% were male, mean (SD) age was 70 (7.7) years. In fully adjusted analyses, higher PM2.5 exposure was associated with worse quality of life per SGRQ activity score (3.48 [95% confidence interval (CI) 0.64, 6.32] per 2µg/m3 PM2.5) and EuroQoL scores (-0.04 [95%CI -0.06, -0.01] per 2µg/m3 PM2.5), and lower FVC % predicted and lower DLCO% predicted at enrollment. Each 3 parts per billion difference in O3 exposure was associated with a 1.57% [95% CI 0.15, 2.98] higher FVC % predicted at enrollment, although this effect was attenuated in multi-pollutant models. There was no association between NO2 and enrollment measures, between pollution exposure and one-year outcomes, or evidence for gene-environment interactions. In the IPF-PRO Registry, long-term exposure to PM2.5 was associated with worse quality of life and lung function at enrollment, but not with short-term disease progression or mortality. There was no evidence of effect modification by interaction of genomic factors with pollution. The reason for the unexpected relationship between O3 exposure and higher FVC is unclear.

Abstract 4136687: VTRNA2-1 Promoter Methylation as a Prognostic Biomarker in Peripheral Artery Disease: Implications for Maternal Nutritional Influence

Background: Peripheral artery disease (PAD) is associated with high morbidity and mortality and is closely related to diabetes mellitus (DM) and atherosclerosis. Recent advances in epigenetics have highlighted the critical relationships of non-coding RNA Vault RNA 2-1 (VTRNA2-1) promoter methylation and periconceptional nutritional status. Furthermore, the abundance of methylation of the VTRNA2-1 promoter is associated with glucose metabolism and cell aging. This study investigates the association between VTRNA2-1 promoter methylation and clinical outcomes in PAD patients requiring revascularization. Hypothesis: VTRNA2-1 promoter methylation status is associated with clinical outcomes in PAD patients requiring revascularization. Methods: A total of 133 PAD patients requiring revascularization were enrolled. Inclusion criteria included adults over 20 years old, consent to participate, and a requirement for angioplasty. Blood samples were processed to isolate leukocytes, and DNA was extracted using the DNeasy blood kit. Bisulfite pyrosequencing was performed to quantify CpG site-specific DNA methylation at the VTRNA2-1 promoter locus. General population samples from the National Health Research Institutes were used as the control group to compare the methylation status. Patients' one-year clinical outcomes were evaluated. Results: The study found significant differences in VTRNA2-1 promoter methylation status between PAD patients and the control group (P &lt; 0.001). Hypomethylation of VTRNA2-1 promoter was associated with a higher amputation rate in PAD patients (HR 2.19, 95% CI 1.09-4.42, p=0.027). Among patients without ESRD (N=79), those with hypomethylation had a significantly increased risk of major adverse limb events (MALE) (HR 2.78, 95% CI 1.11-6.97, p=0.024), amputations (HR 2.58, 95% CI 1.02-6.57, p=0.044), and progression to ESRD (p=0.039). Conclusion: The methylation status of VTRNA2-1 promoter is significantly different between PAD patients and the normal population, with hypomethylation linked to poorer clinical outcomes in PAD patients undergoing revascularization. These findings suggest that VTRNA2-1 promoter methylation status could serve as a valuable biomarker for predicting prognosis and guiding treatment strategies in PAD. Our results open a molecular link between the periconceptional environment and the risks of PAD.

Abstract 4129533: Phenotypes and clinical outcome of heart failure with preserved ejection fraction (HFpEF) patients in China: Findings from the Chinese Cardiovascular Association Database-Heart Failure Center Registry

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome with 5 phenotypes. We aimed to evaluate the clinical outcome of HFpEF patients with various phenotypes in China. Methods and Results: Data from the Chinese Cardiovascular Association (CCA) Database-HF Center Registry between January 2017 and December 2021 were analyzed, 51,466 hospitalized HFpEF patients with 1-year follow-up results were included in this analysis. The patients were categorized into five phenotypes based on published phenotyping method. Clinical characteristics and 1-year outcome and related risk factors of HFpEF patients with various phenotypes were explored. Results demonstrated significant differences in baseline characteristics and clinical outcomes among the phenotypes, patients with phenotype-3 (right heart and pulmonary-related HFpEF), phenotype-4 (valvular- and rhythm-related HFpEF) and phenotype-5 (extracardiac disease-related HFpEF) exhibited high incidence of adverse outcomes. Phenotype-3 and -4 exhibited high risk of heart failure rehospitalization, whereas phenotype-5 showed high cardiovascular mortality. The independent prognostic risk factors varied across different phenotypes as well. Conclusion: One-year outcome differs among HFpEF patients with various phenotyping. Future studies are warranted to validate if personalized treatment strategies based on HFpEF phenotypes could improve the individual outcome of HFpEF patients, especially for phenotype-3, -4 and -5 HFpEF patients. Keywords: Heart failure with preserved ejection fraction, phenotype, prognosis, population study, risk factors.

Investigating Nonadherence in an Integrated Diabetic Limb Salvage Programme: Reasons, Associated Factors, and Impacts on Care Outcomes.

Adherence to treatment plans is crucial for patients with diabetic foot ulcers (DFUs) to achieve positive outcomes. With limited understanding of nonadherence and its impacts on care outcomes, this study aimed to explore the reasons and factors associated with nonadherence in an integrated diabetic limb salvage (DLS) programme and evaluate its effects on care outcomes. This study included 2798 DFU patients who were enrolled in an integrated DLS programme across multiple institutions in central and northern Singapore from 2020 to 2021. Reasons for nonadherence were obtained via telephone interviews. Factors associated with nonadherence were identified using multiple logistic regression. Differences in one-year outcomes, including minor and major lower extremity amputation (LEA), mortality, LEA-free survival, and healthcare utilisation between adherent and nonadherent patients, were examined based on a significance level of P < .05. Nonadherence was observed in 40.2% of patients, with higher rates among younger patients, Malays and Indians, and those with higher HbA1c levels. Patient-related factors were the most commonly reported reasons for missed appointments (50.4%). Compared to adherent patients, nonadherent patients exhibited a relatively higher minor LEA rate (13.0% vs 10.2%, OR = 1.18, 95% CI: 0.93, 1.51), lower mortality rate (8.6% vs18.1%, OR = 0.50, 95% CI: 0.39, 0.65), higher overall LEA-free survival (76.4% vs 71.1%, OR = 1.27, 95% CI: 1.06, 1.53), and more hospitalisations (IRR = 1.22, 95% CI: 1.11, 1.33) and emergency visits (IRR = 1.27, 95% CI: 1.16, 1.39). While nonadherent patients showed relatively higher minor LEA rates and more healthcare utilisation, they also exhibited lower mortality and higher LEA-free survival. This suggests that nonadherence in this population may be associated with complex patient characteristics and behaviours that warrant further investigation to tailor interventions effectively.

To Treat or to Extract Necrotic First Permanent Molars Between 8 and 12 Years of Age: A Retrospective Cohort Study.

Background: First permanent molars (FPM) are highly susceptible to decay before the age of 15. When they are severely affected, the decision between conservation and extraction arises, particularly considering the potential for the second permanent molar (SPM) to replace the FPM. This cohort study aimed to evaluate clinical practices regarding FPM pulp necrosis treatment in children aged eight to twelve in two hospital departments in the Paris region. A second objective was to evaluate the one-year outcomes of the two therapies. Methods: A retrospective analysis was conducted using computerized billing software to identify patients aged eight to twelve who underwent either extraction or root canal treatment (RCT). Data collected included sex, age, arch involved, number of decayed surfaces, presence of Molar Incisor Hypomineralization (MIH), presence of infection, and treatment type. Results: A total of 66 patients were included, representing 61 extracted teeth and 23 RCT. Three main decision criteria were identified: presence of MIH (p < 0.005), extent of decay (p < 0.05), and SPM Nolla's stage. A total of 48% of the patients were seen at one year. A total of 16 of the 32 extractions and five of the nine RCTs had favorable evolution (p = 1). Conclusions: The question of whether to perform RCT or extraction of necrotic FPM in children aged eight to twelve is difficult to assess. It appears that five criteria need to be considered before the decision: possibility of long-term sealed coronal reconstruction, SPM Nolla's stage, follow-up possibilities, arch concerned, and presence of third permanent molar.