Patients In Group A2 Research Articles

Age-Specific Outcomes of Bioprosthetic vs. Mechanical Aortic Valve Replacement: Balancing Reoperation Risk with Anticoagulation Burden.

The choice of prosthesis for aortic valve replacement (AVR) remains challenging. The risk of anticoagulation complications vs. the risk of aortic valve reintervention should be weighed. This study compared the outcomes of bioprosthetic vs. mechanical AVR in patients older and younger than 50. This retrospective study was conducted from 2009 to 2019 and involved 292 adult patients who underwent isolated AVR. The patients were divided according to their age (above 50 years or 50 years and younger) and the type of valves used in each age group. The outcomes of bioprosthetic valves (Groups 1a (>50 years) and 1b (≤50 years)) were compared with those of mechanical valves (Groups 2a (>50 years) and 2b (≤50 years)) in each age group. The groups had nearly equal rates of preexisting comorbidities except for Group 1b, in which the rate of hypertension was greater (32.6% vs. 14.7%; p = 0.025). This group also had higher rates of old stroke (8.7% vs. 0%, p = 0.011) and higher creatinine clearance (127.62 (108.82-150.23) vs. 110.02 (84.87-144.49) mL/min; p = 0.026) than Group 1b. Patients in Group 1a were significantly older than Group 2a (64 (58-71) vs. 58 (54-67) years; p = 0.002). There was no significant difference in the NYHA class between the groups. The preoperative ejection fraction and other echocardiographic parameters did not differ significantly between the groups. Re-exploration for bleeding was more common in patients older than 50 years who underwent mechanical valve replacement (p = 0.021). There was no difference in other postoperative complications between the groups. The groups had no differences in survival, stroke, or bleeding rates. Aortic valve reintervention was significantly greater in patients ≤ 50 years old with bioprosthetic valves. There were no differences between groups in the changes in left ventricular mass, ejection fraction, or peak aortic valve pressure during the 5-year follow-up. The outcomes of mechanical and bioprosthetic valve replacement were comparable in patients older than 50 years. Using bioprosthetic valves in patients younger than 50 years was associated with a greater rate of valve reintervention, with no beneficial effect on the risk of bleeding or stroke.

Effectiveness of preoperative ultrasonography in predicting metachronous contralateral inguinal hernia in children: a single-arm prospective study using a historical control for comparison.

To analyze the value of ultrasonography in predicting metachronous contralateral inguinal hernia (MCIH) and diagnosing contralateral persistent processus vaginalis (CPPV) in children with unilateral inguinal hernia, a prospective study was conducted. All participants underwent a preoperative ultrasound on the contralateral groin. Patients in group A1 received operating procedure according to ultrasound results (patients with negative contralateral US results received hernia repair on the affected side), and patients in group A2 received operation according to laparoscopic results (patients received hernia repair and CPPV ligation). All patients were followed up 2years and compared to a historical control (group B) who underwent open hernia repair only on the affected side regardless of contralateral US results. In groups A1 and A2, laparoscopic exploration revealed the presence of a CPPV in 490 cases. Ultrasound was found to be accurate in 104 out of the 490 cases with four false-positive and 386 false-negative results. This yielded an accuracy of 59.3%, a sensitivity of 21.2%, and a specificity of 99.2%. 10 patients in group A1, and 74 patients in group B developed MCIH. The accuracy, sensitivity, and specificity of the value of ultrasonography in predicting MCIH were 89.3%, 52.4%, and 92.5%, respectively. Preoperative ultrasonography of the contralateral groin is currently unable to accurately detect CPPV, but it appears to be a promising method in predicting MCIH by using rigorous diagnosing criteria.

PRESCRIPTIVE APPROPRIATENESS OF CHOLESTEROL-LOWERING DRUGS AMONG PATIENTS ATTENDING CARDIAC REHABILITATION AFTER ATHEROSCLEROTIC CARDIOVASCULAR DISEASE. RETROSPECTIVE STUDY

Objective: Cardiovascular (CV) diseases still represent one on the main causes of death. The promotion of a healthy lifestyle and active treatment of CV risk factors such as cholesterol level is mandatory to reduce risk of unfavourable outcome. Aim of the present study was to investigate the prescriptive appropriateness of cholesterol-lowering drugs among patients who experienced an atherosclerotic CV disease (ASCVD). Design and method: We investigate 155 patients who experienced an ASCVD and underwent cardiac rehabilitation in 2020. The ESC 2021 guidelines on CVD prevention and 2019 ESC Guidelines on dyslipidaemias were followed to detect appropriateness; SCORE2 and SCORE2-OP risk estimation were used to detect patients’ CV risk profile. For the analysis patients were divided into two groups: 1 (n = 118) patients admitted for the first CV event, 2A (n = 18) patients who experienced a previous CV event and were admitted for a second event, 2B (n = 19) patients within a previous CV event within 2 years. LDL cholesterol (c-LDL) was detected at admission to hospital, during rehabilitation and at the first visit after rehabilitation, within 6 to 12 months. Results: Mean age of study participants was 66 years (41-88), 88.4% were males, 72% were overweight/obese, 25% diabetic, 37% smokers, 60% hypertensives, 57% dyslipidemic. Among group 1 patients, with no previous CV events, only 5.1% had low/moderate risk, 44.1% high risk and 50.8 very high risk according to SCORE2 or SCORE2-OP calculator. Mean c-LDL at admission to hospital was 121.5 mg/dl, 58.8 mg/dl during rehabilitation 58mg/dl at the subsequent medical visit. 32.6% reached c-LDL<55 mg/dl, 96.6% with high intensity statin (as monotherapy or associated to ezetimibe). 67.4% did not reach c-LDL<55mg/dl, despite 93.3% were treated with high intensity statin alone or plus ezetimibe. Among group 2A patients 47.1% reached c-LDL<55 mg/dl by mean of high intensity statin (87.5%), while among 2B patients only 3 subjects reached c-LDL<40 mg/dl. Conclusions: This retrospective study confirmed the importance of primary prevention and the utility to calculate CV risk profile. The main limitations for the efficacy lipid lowering drugs resulted: patient's compliance, drugs side effects, lifestyle habits and collaboration with general practitioner.

Lichen Sclerosus Throughout Childhood and Adolescence: Not Only a Premenarchal Disease

ABSTRACT Lichen sclerosus (LS) is a chronic dermatologic condition most commonly seen in prepubertal girls or postmenopausal women that causes inflammation and epidermal thinning in the anogenital region. Lichen sclerosus is suspected to have a genetic component due to a strong association with family history and is associated with various autoimmune diseases. Treatment involves medium- and high-potency topical corticosteroids, as well as calcineurin inhibitors; however, the optimal treatment regimen is unknown. LS follows a chronic and recurring pattern that causes significant discomfort and impaired quality of life over time; however, little data exist on the disease course in adolescent patients. This retrospective cohort study aimed to characterize and compare symptoms and physical examination findings of a cohort of pediatric, adolescent, and young adult females with vulvar LS. Patients 21 years or younger presenting to the University of Michigan between January 2006 and September 2020 with vulvar LS were included. Demographic data, personal and family history of autoimmune disease, specialty of provider, age of onset, age at menarche, presenting symptoms, and physical examination findings were abstracted from the chart. Patients were grouped for analysis based on symptom onset, first clinical visit, and the most recent clinical visit. Group 1 was patients who were premenarchal at their first clinic visit, and group 1a included those within group 1 who were postmenarchal at the most recent clinical visit. Group 2 included patients who were postmenarchal at the first clinic visit, and group 2a were those within group 2 who reported first onset of symptoms postmenarche. A total of 196 patients met inclusion criteria, with 141 in group 1, 26 in group 1a, 55 in group 2, and 36 in group 2a. The average age in group 1 was 7.02 years and in group 2 was 19.08 years. Patients in group 2 were more likely to have a personal history of autoimmune disease compared with group 1 (P = 0.04). Of the 26 patients in group 1a, 10 (38.5%; 95% CI, 19.8–57.2) continued to have symptoms of LS after undergoing menarche. Compared with patients with symptom onset postmenarche (group 2a), the premenarchal cohort (group 1) was significantly more likely to present with vulvar itching (70.2% vs 52.8%), vulvar bleeding (26.2% vs 5.6%), and bowel symptoms (16.3% vs 0%). The premenarchal cohort (group 1) was significantly more likely than the postmenarchal cohort (group 2a) to have subepithelial hemorrhages (24.8% vs 5.6%), whereas the postmenarchal group (group 2a) was significantly more likely to have architectural changes of the vulva including clitoral adhesions (25.0% vs 4.3%) and loss of labia minora (47.2% vs 2.1%). Of the 55 postmenarchal patients (group 2), 39 had at least 1 architectural change of the vulva, and among the 36 with first onset of symptoms postmenarche (group 2a), 20 (55.6%) had at least 1 vulvar skin change. This study of the largest cohort to date of young patients with vulvar LS demonstrates approximately 40% of patients with LS that went through puberty continued to have symptoms, and that symptoms and examination findings were different and often more severe among those who developed symptoms postmenarche versus premenarche.

Evaluation of Survival Following Surgical Resection for Small Nonfunctional Pancreatic Neuroendocrine Tumors

The number of patients with small nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs) is increasing. However, the role of surgery for small NF-PanNETs remains unclear. To evaluate the association between surgical resection for NF-PanNETs measuring 2 cm or smaller and survival. This cohort study used data from the National Cancer Database and included patients with NF-pancreatic neuroendocrine neoplasms who were diagnosed between January 1, 2004, and December 31, 2017. Patients with small NF-PanNETs were divided into 2 groups: group 1a (tumor size, ≤1 cm) and group 1b (tumor size, 1.1-2.0 cm). Patients without information on tumor size, overall survival, and surgical resection were excluded. Data analysis was performed in June 2022. Patients with vs without surgical resection. The primary outcome was overall survival of patients in group 1a or group 1b who underwent surgical resection compared with those who did not, which was evaluated using Kaplan-Meier estimates and multivariable Cox proportional hazards regression models. Interactions between preoperative factors and surgical resection were analyzed with a multivariable Cox proportional hazards regression model. Of the 10 504 patients with localized NF-PanNETs identified, 4641 were analyzed. These patients had a mean (SD) age of 60.5 (12.7) years and included 2338 males (50.4%). The median (IQR) follow-up time was 47.1 (28.2-71.6) months. In total, 1278 patients were in group 1a and 3363 patients were in group 1b. The surgical resection rates were 82.0% in group 1a and 87.0% in group 1b. After adjustment for preoperative factors, surgical resection was associated with longer survival for patients in group 1b (hazard ratio [HR], 0.58; 95% CI, 0.42-0.80; P < .001) but not for patients in group 1a (HR, 0.68; 95% CI, 0.41-1.11; P = .12). In group 1b, interaction analysis found that age of 64 years or younger, absence of comorbidities, treatment at academic institutions, and distal pancreatic tumors were factors associated with increased survival after surgical resection. Findings of this study support an association between surgical resection and increased survival in select patients with NF-PanNETs measuring 1.1 to 2.0 cm who were younger than 65 years, had no comorbidities, received treatment at academic institutions, and had tumors of the distal pancreas. Future investigations of surgical resection for small NF-PanNETs that include the Ki-67 index are warranted to validate these findings.

Evaluating surgical treatment options for small nonfunctional pancreatic neuroendocrine tumors in the NCDB.

645 Background: The role of surgery for small (≤2 cm), nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) remains controversial due to the wide range of tumor aggressiveness. Consensus guidelines of the US, Europe, and Japan offer different recommendations for treatment of small NF-PNETs. The objective of this study is to evaluate the survival benefit of surgical resection for small NF-PNETs. Methods: Patients with NF-PNETs were identified in the National Cancer Database from 2004 to 2018. Small NF-PNETs were divided into two groups: group 1a (tumor ≤1 cm) and group 1b (tumor 1.1 – 2.0 cm). Cox regression models were used to compare the overall survival between resected and unresected small NF-PNETs patients. Interactions between preoperative factors and surgery were estimated using subgroup analyses. Results: We identified 1,278 patients in group 1a and 3,363 patients in group 1b. After adjusting for preoperative factors, surgery was associated with longer survival for patients in group 1b (HR, 0.58; 95% CI, 0.42–0.80; P &lt;0.001), but not for patients in group 1a (HR, 0.68; 95% CI, 0.41–1.11; P = 0.122). Interaction analysis found that age younger than 65 years, fewer comorbidities, treatment at academic institutions, distal pancreatic tumors, and clinical lymph node metastasis were factors associated with longer survival in group 1b by surgery. Conclusions: Findings from this large study support surgical resection for some patients with NF-PNETs (1.1 – 2.0 cm). This, of course, must be taken in context with the patient’s clinical situation. Based on data available for analysis in this study, resection for subcentimeter NF-PNETs does not appear to be of general benefit, but should also be investigated in the context of Ki-67 index.[Table: see text]

Clinical Features of Crohn's Disease Stratified by Age at Diagnosis According to Montreal Classification.

The differences of clinical characteristics stratified by age at diagnosis especially according to Montreal classification were rarely studied in China. This study aimed to evaluate and compare the clinical features in various groups of CD patients stratified by age at diagnosis. A cross-sectional study of CD patients was conducted through a stratified sampling according to Montreal classification. Patients were divided into three groups by age at diagnosis: group A1 (<17 years old), group A2 (17 to 40 years old), and group A3 (>40 years old). The clinical characteristics, laboratory tests, radiographic, and endoscopic features were analyzed by statistics. We enrolled 259 CD patients for the study. There was male predominance under 40 years old. Compared to group A1, more female patients were presented in group A3. There were more patients had perianal fistulas in group A1 compared to group A2 and group A3. Compared with group A1, patients in group A2 were associated with lower total protein (TP) levels. The mean TP and platelet count (PC) levels in group A3 were lower than group A1. Patients in group A1 had a lower rate of stricturing (B2) disease behavior than group A2 and group A3, and patients in group A3 who had a B2 disease behavior were higher than group A2. Those differences could guide early treatment or inventions for CD patients who might progress to a more complex disease behavior. CD patients stratified by age at diagnosis according to Montreal classification had different clinical symptoms, laboratory test results as well as disease locations and behaviors.

Differential Diagnosis of IgG4-related Pancreatitis and Pancreatic Cancer by MRI Features and Its Correlation with Serum IgG4 Level.

It was to analyze the diagnostic value of MRI in immunoglobulin G (IgG4)-related autoimmune pancreatitis (AIP) and pancreatic cancer (PC) and its relationship with serum IgG4 level. 35 patients with IgG4-related AIP (group A1) and 50 patients with PC (group A2) were enrolled. MRI was performed to determine serum IgG4 levels. Spearsman was used to analyze the relationship between MRI characteristics and serum IgG4 level. It was found that patients in group A1 showed double duct sign (DDS), pancreatic duct (PD) perforation sign, the proportion of main PD truncation, and main PD diameter/pancreatic parenchymal width ratio, which were different from those of patients in group A2 (P < 0.05). MRI had a sensitivity (Sen) of 88%, specificity (Spe) of 91.43%, accuracy (Acc) of 89.41%, positive predictive value (PPV) of 0.936, and negative predictive value(NPV) of 0.842 for the diagnosis of IgG4-related AIP and PC. Serum IgG4 levels were significantly negatively correlated with DDS and main PD truncation, significantly positively correlated with PD penetration sign, and extremely significantly negatively correlated with main PD diameter/pancreatic parenchymal width (P < 0.001). The results showed that MRI had high sensitivity and specificity for differentiating IgG4-related AIP from PC, and the diagnostic effect was good, which had a high correlation with serum IgG4 levels in patients.

P166 Calprotectin in patients with perianal fistula: the CANALS study

Abstract Background Previous studies suggest that faecal calprotectin can be used to discriminate Crohn’s disease (CD) perianal fistulas from cryptoglandular (CG) perianal fistulas. The aim of this research was to prospectively validate these findings and further investigate local calprotectin production inside fistula tracts. The aim of the current study was to prospectively analyse the clinical value of calprotectin levels in both the faeces and the fistula tract. Methods In this prospective study, all consecutive patients with an active perianal fistula undergoing examination under anesthetics were included. Faecal and scraping calprotectin levels collected during surgery were measured. The primary objective was to differentiate between active CD perianal fistulas and CG perianal fistulas based on faecal calprotectin. Secondary outcome parameters were the levels of local calprotectin in fistula tracts and the correlation with fistula characteristics and clinical prognostic parameters like the Geldof Classification system. Results Sixty-three fistula patients were included in this study (CD n=45; CG n=18). Faecal calprotectin values were significantly higher in CD patients compared to CG patients (396.8 [61.9-1136.8] vs. 47.3 [14.6-233.6] ug/g, p=0.004). The Area Under the Curve (AUC) was 0.733 (95% CI [0.644 to 0.903] with an optimal FC cut-off value of 344ug/g. Faecal calprotectin was not related to calprotectin levels in fistula scrapings which was not significantly different in CD and cryptoglandular fistulas (p=0.893). Calprotectin in fistula scrapings was also not related to fistula characteristics like number of tracts, duration of disease or (previous) seton drainage. However, a significant correlation was found between scraping calprotectin and fistula disease severity and prognosis as defined by a new Geldof classification system: Patients in group 2a (amenable for fistula repair) had significantly lower calprotectin levels (140 [31.0-149.0])ug/g) when compared to class 2b (symptom control) (706 [198.5 – 1936]ug/g, p=0.054) and class 2c (gradually debilitating disease) (3464.0 [328.5-5692.0]ug/g, p=0.008). Patients in class 3 (exhausted perineum) had the highest calprotectin levels highest (5928.0 [2605.0-6000]ug/g). Conclusion CD and CG perianal fistulas can be distinguished by measuring faecal calprotectin levels. The difference can not be explained by local fistula calprotectin production as calprotectin in fistula scrapings is not predictive of CD. However, the results of this study suggest that scraping calprotectin levels may be used to classify fistula patients and predict outcome of fistula treatment.

P12.01.B Systemic metabolic features associated with significant insulin resistance in diabetes mellitus type 2 patients are related to the presence of gemistocytes in glioblastoma

Abstract Background Gemistocytes (GCs) are unique phenotype of reactive astrocytes. In diffuse low-grade gliomas, they are associated with grim prognosis. Less is known regarding their pathogenesis and prognostic significance in glioblastoma (GBM). Previous data on-neoplastic central nervous system (CNS) lesions has linked the presence of GCs with states of uncontrolled hyperglycaemia in diabetes mellitus type 2 patients. study purpose is to find a correlation between systemic metabolic features and the presence of GCs in patients with GBM.Also, to try and correlate between the presence of GCs, molecular changes, and use of anti-diabetic drugs on overall survival of GBM patients. Methods Electronic medical records from newly diagnosed GBM patients were retrospectively reviewed and extracted for demographic, clinical, metabolic, radiological and pathological variables with emphasis on different metabolic - related features. A statistic-based comparison was made between GBM patients with and without GCs for the same variables. We compared DM2 GC-GBM patients to DM2 non-GC GBM patients in a cohort of poorly controlled DM2 (i.e., HBA1C ≥ 8.0). A possible influence of metformin administration on OS of DM2 GBM patients, with and without GCs, and with and without TP53 mutations was investigated. Results A total of 220 patients with newly diagnosed GBM were included in the study. 14.5% were defined as GC-GBM (group 1, n=32) and 85.5% were defined as non-GC GBM (group 2, n=188). The incidence of DM2 was 25% in both groups. The rate of poorly-controlled DM2 was nearly as twice in group 1 than in group 2 (18.75% vs. 9.5%; p=0.130). In the DM2 GBM group, significant differences were found between DM2 GC-GBM (group 1a, n=9) and DM2 non-GC GBM (group 2a, n=49) patients with male gender predominance (89% vs. 50%, p=0.073) and obesity. Patients in group 1a were more likely to have weight ≥85kg (OR 6.16; 95% CI 1.3336 to 28.5147, p=0.0019) and had higher BMI values (mean BMI of 34.1±11.42 vs. 28.7±5.44 for group 1a and 2a respectively; OR= 1.095, 95%CI 1.053-1.207;p=0.034). Similar significant findings were in the poorly-controlled DM2 subgroup. None of the poorly-controlled DM2 GC-GBM patients were using insulin prior to diagnosis (0% vs. 61.10%, p=0.016). Survival analyses have shown trends for differences in overall survival between subgroups in correlation with presence of GCs, p53 mutations and use of metformin. Conclusion GBM patients with systemic metabolic factors that are associated with marked insulin resistance and are not using insulin at time of diagnosis are significantly more likely to have GCs in their initial pathology. This is a novel finding that may add to data on glucose metabolism in astrocytes and in astrocytes-associated tumors. The presence of GCs, molecular changes in the tumor, and under the influence of anti-diabetic drugs such as metformin, may affect the prognosis of different GBM subgroups.

Rapid clinical progression of stage III-IV oral and oropharyngeal cancer after upfront surgery and difficulty in the assessment of the effectiveness of adjuvant radiotherapy

Introduction. Surgery with adjuvant radiation is the standard for treatment of advanced oral and oropharyngeal cancer. with the absence of randomized trials the assessment of the role of postoperative radiotherapy is difficult. Such assessments are usually based on retrospective analyses, whereas patient and tumor status during the time period between the operation and planned start of radiotherapy is not addressed.The study objective is to assess the role of adjuvant radiotherapy in the treatment of stage III—IV oral and oropharyngeal cancer not associated with human papillomavirus with regard to rapid clinical disease progression after upfront surgical treatment.Materials and methods. The case histories and outpatient records of 260 patients with oral and oropharyngeal cancer of stage III—IV, not associated with human papillomavirus, from 30 to 82 years old (average age - 56.52 years), operated in 2009-2018, were analyzed. Two groups of patients were identified. group 1 included 152 patients (58 %) irradiated postoperatively and group 2 consisted of 108 patients (42 %) treated surgically only. 22 patients of group 2 experienced rapid clinical disease progression, were deemed unsuitable for adjuvant treatment and formed group 2a. Comparison of the Kaplan-Meier overall survival and locoregional control was made for group 1 and the entire group 2 (formal analysis) and after exclusion from the latter patients of group 2a, based on the hypothesis of inability of radiotherapy to improve oncologic results in patients with such an unfavorable disease course.Results. Mean follow up was 33.2 months (range 2-121 months). Locoregional control and 5 year overall survival were statistically higher in group 1: 70.4 % versus 45.4 % (р = 0.000) and 40.2 % versus 24.9 % (р = 0.000) that may imply a significant advantage of the combined over monomodal approach. After exclusion of group 2a patients from the analysis both differences considerably narrowed and were 70.4 % versus 55.8 % for locoregional control, 40.2 % versus 31.3 % for overall survival and became statistically insignificant (p = 0.067 and 0.111, respectively).Conclusion. Rapid clinical disease progression in the time frame between surgical treatment and adjuvant radiotherapy is not a rare phenomenon with a very poor prognosis. It can be one of the reasons for postoperative treatment refusal. formal retrospective analyses of the role of adjuvant treatment without considering causes for its refusal may lead to the overestimation of the combined approach effectiveness.

Appraisal of vitreous syphilis antibody as a novel biomarker for the diagnosis of syphilitic uveitis: a prospective case-control study.

To determine the sensitivity and specificity of syphilis antibody tests in vitreous samples and to propose an algorithm using vitreous syphilis antibody as a supplementary test to confirm syphilitic uveitis (SU). A prospective case-control study was conducted at the Retina and Uveitis Clinic from May 2017 to January 2020. Initially, patients were classified based on syphilis serology into group 1 (positive testing) and group 2 (negative testing). Group 1 was further divided into 2 subgroups (group 1A and 1B) depending on their relevant clinical manifestations and clinical improvement. Group 2 served as a control group. Thirty-eight patients were enrolled in the study: 14 in group 1A, 5 in group 1B, and 19 in group 2B. No patient was assigned to group 2A. All patients in group 1A, representing definite SU, completed syphilis test (rapid plasma reagin [RPR], enzyme immunoassay [EIA], and fluorescent treponemal antibody-absorption [FTA-ABS]) for vitreous, and all vitreous samples yielded positive results. Of the 5 subjects in group 1B, 3 cases were considered to be not SU with different conditions, and 2 were indeterminate for SU. They presented with different features not typical of SU, and they had variable and fewer positive syphilis antibody responses. The most sensitive test for detecting syphilis antibodies in vitreous was EIA (90.9%), followed by RPR (80.0%) and FTA-ABS IgG (78.9%). EIA and FTA-ABS had the highest specificity, detecting 100% of the syphilis antibody. Vitreous analysis of syphilis antibody can serve as a supplementary test to confirm SU in selected cases as the proposed algorithm.

Changes in Tear Meniscus Analysis of Children Who Have Type 1 Diabetes Mellitus, With and Without Vitamin D Deficiency.

The aim of this study was to quantitatively evaluate dry eye test parameters of pediatric patients with and without vitamin D deficiency (VDD) in type 1 diabetes mellitus. In this prospective cross-sectional study, the Ocular Surface Disease Index, Schirmer test, tear film breakup time, corneal staining score, and anterior segment optical coherence tomography were used to determine the dry eye test parameters of pediatric patients with type 1 diabetes mellitus (T1-DMPs) (group 1) and a healthy pediatric control group (group 2). Group 1 was divided into 2 subgroups based on their vitamin D status: group 1a, who had a VDD, and group 1b, who had vitamin D levels that were within the normal range. This study compared 90 eyes of 90 pediatric T1-DMPs with 80 eyes of 80 healthy controls. The demographic characteristics of the groups were similar ( P > 0.05). The tear film breakup time, Schirmer test, corneal staining score, and values of the tear meniscus height and area were observed to have been lower in the patients in group 1a than the healthy pediatric control group, at P < 0.001. The same parameters were statistically significantly lower in the patients in group 1a when compared with group 1b ( P < 0.05 for both). The tear measurements of the pediatric T1-DMPs were lower than those in the healthy pediatric control group. The accompanying VDD made this situation more pronounced.

Sex-specific platelet activation through protease-activated receptor-1 in patients undergoing cardiac catheterization

Background and aimsProtease-activated receptor (PAR)-1-mediated platelet activation may vary according to sex and clinical situation. In order to investigate sex-specific platelet activation through PAR-1, we assessed platelet response to thrombin receptor-activating peptide (TRAP) in 562 patients undergoing cardiac catheterization without (Group 1A) and with (Group 1B) acute coronary syndrome (ACS). Subsequently, we sought to confirm our findings in 287 patients undergoing elective (Group 2A) or acute (Group 2B) percutaneous coronary intervention. MethodsTRAP-stimulated platelet surface expression of P-selectin and activated glycoprotein IIb/IIIa (GPIIb/IIIa) were measured by flow cytometry in Group 1. Light transmission aggregometry (LTA) and multiple electrode aggregometry (MEA) in response to TRAP were assessed in Group 2. ResultsIn Group 1A, platelet activation in response to TRAP was significantly higher in women compared to men (P-selectin: 511 MFI [443–597 MFI] vs. 471 MFI [393–552 MFI]; GPIIb/IIIa: 84 MFI [58–119 MFI] vs. 70 MFI [47–103 MFI]; both p ≤ 0.002). In contrast, in Group 1B, TRAP-stimulated P-selectin and activated GPIIb/IIIa were similar in men and women (both p ≥ 0.3). Likewise, TRAP-stimulated platelet aggregation was significantly higher in female patients in Group 2A (LTA: 66% [54–76%] vs. 51% [41–65%]; MEA: 78 AU [66–107 AU] vs. 62 AU [52–88 AU]; both p ≤ 0.02), whereas men and women in Group 2 B had similar platelet aggregation (p = 0.5). The occurrence of ischemic endpoints did not differ significantly between men and women in Group 1A and Group 1B. ConclusionsPlatelet PAR-1 signaling is more pronounced in women than in men without ACS. In ACS, however, PAR-1-mediated platelet activation is similar in male and female patients.

Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry

BackgroundOver the course of the COVID-19 pandemic, the care of patients with COVID-19 has changed and the use of extracorporeal membrane oxygenation (ECMO) has increased. We aimed to examine patient selection, treatments, outcomes, and ECMO centre characteristics over the course of the pandemic to date.MethodsWe retrospectively analysed the Extracorporeal Life Support Organization Registry and COVID-19 Addendum to compare three groups of ECMO-supported patients with COVID-19 (aged ≥16 years). At early-adopting centres—ie, those using ECMO support for COVID-19 throughout 2020—we compared patients who started ECMO on or before May 1, 2020 (group A1), and between May 2 and Dec 31, 2020 (group A2). Late-adopting centres were those that provided ECMO for COVID-19 only after May 1, 2020 (group B). The primary outcome was in-hospital mortality in a time-to-event analysis assessed 90 days after ECMO initiation. A Cox proportional hazards model was fit to compare the patient and centre-level adjusted relative risk of mortality among the groups.FindingsIn 2020, 4812 patients with COVID-19 received ECMO across 349 centres within 41 countries. For early-adopting centres, the cumulative incidence of in-hospital mortality 90 days after ECMO initiation was 36·9% (95% CI 34·1–39·7) in patients who started ECMO on or before May 1 (group A1) versus 51·9% (50·0–53·8) after May 1 (group A2); at late-adopting centres (group B), it was 58·9% (55·4–62·3). Relative to patients in group A2, group A1 patients had a lower adjusted relative risk of in-hospital mortality 90 days after ECMO (hazard ratio 0·82 [0·70−0·96]), whereas group B patients had a higher adjusted relative risk (1·42 [1·17−1·73]).InterpretationMortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers.FundingNone.

Correction of eating disorders in patients with oral and oropharyngeal cancer after reconstructive plastic surgery

The study objective – to evaluate the feasibility of correcting eating disorders in patients undergoing surgery for oral and oropharyngeal cancers using various reconstructive techniques to restore postoperative defects.Materials and methods. Between 2012 and 2019, a total of 56 patients with stage II–IV oral and oropharyngeal cancer underwent reconstructive surgery after either hemiglossectomy or glossectomy. The patients ranged in age from 26 to 70 years. The patients were divided into two groups. Group I consisted of 36 (64.3 %) patients who underwent tongue reconstruction using rotation flaps. For reconstruction of hemiglossectomy defects, a chin flap was used, and for reconstruction of glossectomy defects, a pectoral flap was used. Group II comprised 20 (35.7 %) patients who underwent tongue reconstruction using free revascularized flaps. For the tongue reconstruction after hemiglossectomy, the radial flap, medial sural perforator flap and fasciocutaneous anterolateral thigh flap were used. For the tongue reconstruction after glossectomy, the fasciocutaneous anterolateral thigh flap was used. The acts of chewing and swallowing were restored during speech rehabilitation due to the activation and coordination of the work of the muscles of the cheeks, lips, soft palate, pharynx, and the reconstructed tongue. Eating disorders were assessed by interviewing patients. A comparative analysis of eating disorders included mobility and coordination of facial muscles and reconstructed tongue, increased sensitive in the oral cavity, the presence of aspiration and nasal regurgitation, and subjective difficulties of patients. The time before the start of rehabilitation and its duration were taken into account. Patients were interviewed before the start of the combined treatment, at the beginning and after the completion of rehabilitation.Results. After the completion of rehabilitation, all patients received food by the oral route. The best outcomes were achieved in group 2a patients, who underwent tongue reconstruction with free revascularized flaps. This group of patients had a lower percentage of the asymmetry of facial muscles and limited mobility of the tongue compared to other groups of patients.In the subgroups of patients undergoing glosssectomy, most of the studied parameters did not have statistically significant differences in values. However, it should be noted that in group 2b, the period from the date of surgical treatment to the beginning of rehabilitation was significantly longer than in group 1b.Conclusion. The use of the microvascular surgical techniques using various donor flaps creates the basis for a more complete functional recovery and expands the rehabilitation potential of patients after surgical treatment of oral and oropharyngeal cancer.

Cerebral venous drainage in patients with dural arteriovenous fistulas: correlation with clinical presentation.

Dural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets. Their associated symptoms may be mild or severe and are related to the patient's venous anatomy. With the hypothesis that the patient's venous anatomy determines the development of symptoms, the authors aimed to identify which venous anatomy elements are important in the development of major symptoms in patients with a DAVF. A multicenter study was performed based on the retrospective analysis of cerebral angiographies with systematic assessment of brain drainage pathways (including fistula drainage) in patients over 18 years of age with a single DAVF. The patients were divided into two groups: those with minor (group 1, n = 112) and those with major (group 2, n = 89) symptoms. Group 2 was subdivided into two groups: patients with hemorrhage (group 2a, n = 47) and patients with severe nonhemorrhagic symptoms (group 2b, n = 42). The prevalence of stenosis in DAVF venous drainage and the identification of tiny anastomoses between venous territories were significantly higher in group 2 (32.6% and 19.1%, respectively) compared with group 1 (2.68% and 5.36%, respectively). Stenosis of DAVF venous drainage was significantly more frequent in group 2a than in group 2b (51.1% vs 11.9%, p < 0.001). Group 2b patients had increased prevalence of shared use of the cerebral main drainage pathway (85.0% vs 53.2%, p = 0.002), the absence of an alternative route (45.0% vs 17.0%, p = 0.004), and the presence of contrast stagnation (62.5% vs 29.8%, p = 0.002) compared with group 2a patients. In patients with high-grade fistulas, the group with major symptoms had increased prevalence of a single draining direction (31.3% vs 8.33%, p = 0.003), stenosis in the draining vein (35.0% vs 6.25%, p = 0.000), the absence of an alternative pathway for brain drainage (31.3% vs 12.5%, p = 0.017), and the presence of contrast stagnation (48.8% vs 22.9%, p = 0.004). Major symptoms were observed when normal brain tissue venous drainage was impaired by competition with DAVF (predominance in group 2b) or when DAVF venous drainage had anatomical characteristics that hindered drainage, with consequent venous hypertension on the venous side of the DAVF (predominance in group 2a). The same findings were observed when comparing two groups of patients with high-grade lesions: those with major versus those with minor symptoms.

Hypothalamic-Pituitary Autoimmunity and Related Impairment of Hormone Secretions in Chronic Fatigue Syndrome.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe chronic illness that reduces the quality of life. A potential role of neuroendocrine autoimmune dysfunction has been hypothesized. This work aims to investigate the occurrence of antipituitary (APA) and antihypothalamic (AHA) antibodies and possible related hypothalamic/pituitary dysfunctions in ME/CSF patients. This is a case-control study conducted in a university hospital setting (Stanford, California, USA; and Naples, Italy). Thirty women with ME/CSF (group 1) diagnosed according to Fukuda, Canadian, and Institute of Medicine criteria, at Stanford University, were enrolled and compared with 25 age-matched healthy controls. APA and AHA were detected by immunofluorescence; moreover, we investigated hormonal secretions of anterior pituitary and respective target glands. APA and AHA titers both were assessed and the prevalence of pituitary hormone deficiencies was also investigated. Patients in group 1 showed a high prevalence of AHA (33%) and APA (56%) and significantly lower levels of adrenocorticotropin (ACTH)/cortisol, and growth hormone (GH) peak/insulin-like growth factor-1 (IGF-1) vs controls (all AHA/APA negative). Patients in group 1A (13 patients positive at high titers, ≥ 1:32) showed ACTH/cortisol and GH peak/IGF-1 levels significantly lower and more severe forms of ME/CFS with respect to patients in group 1B (7 positive at middle/low titers, 1:16-1:8) and 1C (10 antibody-negative patients). Both AHA and/or APA at high titers were associated with hypothalamic/pituitary dysfunction, suggesting that hypothalamic/pituitary autoimmunity may play an important role in the manifestations of ME/CFS, especially in its more severe forms.

Impact of preoperative body mass index on perioperative outcomes is optimized by enhanced recovery protocols in laparoscopic radical cystectomy with intracorporeal urinary diversion.

BackgroundWe aimed to examine whether body mass index (BMI) had an impact on clinical outcomes of laparoscopic radical cystectomy with intracorporeal urinary diversion. Furthermore, we analyzed the optimization of enhanced recovery protocols (ERPs) on the impact of BMI on clinical outcomes.MethodsBy searching our database, data of 83 consecutive patients were retrospectively collected, including 37 patients with a BMI <24 kg/m2 (group A) and 46 patients with a BMI ≥24 kg/m2 (group B). The baseline and peri-operative variables of the two groups were compared. Subgroup analysis was conducted for ERPs (11 patients in group A1, 18 patients in group B1) and conventional recovery protocols (CRPs; 26 patients in group A2, 28 patients in group B2). The primary outcomes were 30-day overall complication rate and ΔALBmin (reduction proportion of minimum albumin). The secondary outcomes were operative time and length of stay.ResultsThe baseline variables were similar between the two groups (P>0.05). The 30-day overall complication rate, operative time, and length of stay were similar between the two groups (P>0.05). But post-operative nausea and vomiting (PONV) was higher in group A than in group B (32.4% vs. 8.7%, P=0.014). Group A was associated with lower serum albumin level pre-operatively and on post-operative days 1–3. ΔALBmin was higher in group A than in group B (33.08%±9.88% vs. 27.92%±8.52%, P<0.05). In the subgroup analysis, the CRPs group presented similar results, with group A2 showing higher PONV rate, lower albumin level pre- and post-operatively, and higher level of reduction proportion (P<0.05). For the ERPs group, the PONV rate, pre-operative albumin level, and reduction proportion were similar between group A1 and B1 (P>0.05). Multivariable analysis showed that PONV and CRPs were independently associated with ΔALBmin ≥34% (P<0.05).ConclusionsBMI had no impact on the 30-day overall complication rate, operative time, and length of stay of patients who underwent laparoscopic radical cystectomy with intracorporeal urinary diversion. BMI <24 kg/m2 was associated with higher PONV rate and more albumin loss, both of which could be optimized by ERPs.

The effectiveness of the combined use of RF therapy and laser technology in the correction of involutive changes in the skin of the face

Bipolar radio-frequency devices have all the theoretical prerequisites for use in combination with phototechnologies, while the properties of electro-optical synergy are manifested.&#x0D; Material and method. The study included 125 patients aged 40 to 50 years. Depending on the therapy, patients were divided into 4 groups and subgroups A and B, depending on the identified predictors of the effectiveness of laser therapy.&#x0D; The results of the study. After applying the combined methods, a more significant improvement in the quality characteristics of the skin was noted: an increase in skin moisture in the 1A group, the corneometry index increased by 24.6%, in the 1st group by 28.3%, in the 2A group by 38.9%, in the 2B group by 37.3%, in the 3A group by 29.1%, in the 3B group by 27.5%, in the 4A group by 38.8%, in the 4B group by 38.8%; an increase in skin elasticity in group 1A, the Ua/Uf indicator increased by 13.2%, in group 1B by 13.9%, in group 2A by 27.9%, in group 2B by 29.0%, in group 3A by 14.9%, in the 3B group by 14.6%, in the 4A group by 28.2%, in the 4B group by 28.2%, which was accompanied by a more pronounced decrease in the severity of wrinkles according to profilometry. The use of laser therapy (an erbium or neodymium laser) and microneedle RF therapy contributes to a more significant restoration of the epidermal-dermal structure of the skin, which is confirmed by ultrasound data: the microrelief has improved by more than 3 times compared with monotherapy, the thickness of the dermis is 2.2 times and acoustic density 1.7 times.&#x0D; Conclusions. Combined methods, to a greater extent than mono-laser therapy, contribute to improving the quality of life of patients according to the dynamics of the LHC index, which decreased in groups 1 and 3 by an average of 47.1% and 44.4% versus 57.8% and 64.3% in 2 and 4 groups, while there was a significant difference in the values of the index of HSCI in groups A and B (p 0.01). In accordance with the VAS and GAIS indicators, the optimal effect after a course of therapy with preservation of the results after 1 year was achieved in 25/12.5% of patients in group 1A, in 46.7/33.3% in group 1B, 7/37.5% of patients of group 2A, 78.6/71.4% of patients of group 2B, 33.3/20.0% of patients of group 3A, 50.0/25% of patients 3B groups, 58.8/58.8% and 75.0/75.0% in patients 4A and 4B of the group, respectively, which indicates the high efficiency of the combined methods and the persistence of the results.