Prospective Case-control Study Research Articles

Dystrophinopathy in the paravertebral muscle of adolescent idiopathic scoliosis: a prospective case-control study in China.

A prospective case-control study. This prospective case-control study aimed to analyze the paravertebral muscle changes in patients with adolescent idiopathic scoliosis (AIS) and determine paravertebral myopathological changes associated with the clinical progression of AIS. The incidence of AIS is significant globally and worsens before bone maturation, causing a serious effect. Many studies have investigated its causes-such as genetic, epigenetic, and hormonal factors-but more research remains warranted. This study enrolled 40 patients with AIS, 20 patients with congenital scoliosis (CS), and 20 patients with spinal degenerative disease (SDD). All patients underwent open posterior surgery in our hospital, and a paravertebral muscle (multifidus muscle) biopsy was performed intraoperatively. This study included many indexes that describe muscle, especially dystrophin staining. The above pathological results were compared among the AIS, CS, and SDD groups. The correlation between the Cobb angle and Nash-Moe classification and the above pathological results was analyzed in patients with AIS. Significant reductions in the dystrophin staining of dystrophin-1 (p<0.001), dystrophin-2 (p<0.001), and dystrophin-3 (p<0.001) were observed in the AIS group than in the CS and SDD groups. The higher the Nash-Moe classification in the AIS group, the more significant the loss of dystrophin-2 (p=0.042) in the convex paraspinal muscles. Additionally, a significantly positive correlation was observed between the reductions of dystrophin-2 on the concave side of the AIS group and Cobb angle (p=0.011). Dystrophin protein deficiency in the paraspinal muscles plays a crucial role in AIS formation and progression. The severity of scoliosis in patients with AIS is correlated with the extent of dystrophin loss in the paravertebral muscles. Therefore, dystrophin dysfunction may be relevant to AIS occurrence and development.

Subclinical systolic dysfunction in children with steroid-resistant nephrotic syndrome identified by speckle tracking echocardiography.

Steroid resistant nephrotic syndrome (SRNS) is a clinical phenotype of nephrotic syndrome (NS) that does not respond to steroid therapy and usually results in kidney failure. The aim of this study was to determine whether children with SRNS have subclinical left ventricular systolic dysfunction and, if so, to identify the risk factors for myocardial involvement in those children. This prospective case-control study included of 35 children with SRNS, 40 children in the healthy control group, and 40 children with NS during the initial episode as the diseased control group. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE) were performed on all the studied children. No statistically significant difference in conventional echocardiography's parameters were detected between the patient and control groups. TDI revealed that the E/E' ratio was significantly greater in the SRNS group than in both the healthy and diseased control groups (P = 0.001). The left ventricle global longitudinal strain (LV GLS) was markedly lower in children with SRNS than in healthy controls and NS patients (the diseased controls) (P = 0.001). Multiple binary regression analysis for the predictors of systolic dysfunction in SRNS patients revealed that the serum albumin is the only variable that predicts systolic dysfunction in these children. Subclinical systolic and diastolic LV dysfunction should be screened in NS especially SRNS children.

Closed Negative Pressure Wound Therapy Vs Standard Primary Closure In Emergency Laparotomies: A Prospective Case-Control Study

Closed Negative Pressure Wound Therapy Vs Standard Primary Closure In Emergency Laparotomies: A Prospective Case-Control Study

Urine Neutrophil Gelatinase-Associated Lipocalin in Non-Associative Immune Mediated Hemolytic Anemia: A Prospective Controlled Study in 22 Dogs.

Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker for the early diagnosis of AKI. To evaluate uNGAL in dogs with non-associative immune mediated hemolytic anemia (IMHA) and to evaluate whether uNGAL correlates with disease severity markers, negative prognostic indicators and outcome. Twenty-two dogs with non-associative IMHA and 14 healthy dogs. Prospective case-control study. uNGAL was measured by a commercially available ELISA-kit and corrected to urine creatinine (uNGAL to creatinine ratio [UNCR]). uNGAL and UNCR of IMHA cases were compared to that of healthy dogs and the correlation with other clinicopathological markers was evaluated. uNGAL and UNCR were also compared between dogs with a CHAOS or ASA score < 3 and ≥ 3. uNGAL and UNCR were significantly higher in dogs with IMHA when compared to healthy controls (uNGAL median 114.58 and 0.43 ng/mL, respectively, p < 0.001; UNCR median 174.87 and 0.13 ng/mg, respectively, p < 0.001). uNGAL and UNCR were moderately positively correlated with urea (p = 0.005, r = 0.58, 0.20-0.81 95% CI and p = 0.001, r = 0.64, 0.29-0.84 95% CI, respectively) and total bilirubin (p = 0.003, r = 0.60, 0.22-0.82 95% CI and p = 0.002, r = 0.62, 0.25-0.83 95% CI, respectively). These were also significantly higher in dogs with hemoglobinuria compared to those without (uNGAL: median 269 and 30.99 ng/mL, respectively, p < 0.001; UNCR: median 585.3 and 352 37.47 ng/mg, respectively, p < 0.001). There was no statistically significant difference in uNGAL or UNCR when assessing survival to discharge (p = 0.24 and p = 0.16, respectively, 95% CI). This study suggests that renal injury might be underappreciated in dogs with IMHA.

Evaluation of fetal aortic isthmus diameter and flow in pregnant women with intrahepatic cholestasis of pregnancy; may it be a marker of poor perinatal outcomes?

To evaluate the fetal aortic isthmus (AoI) diameter and flow in pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP). In this prospective case-control study, fetal AoI diameter and Doppler measurements were performed in the ICP group (n: 30) and the control group (n: 42). Clinical characteristics, fetal AoI diameter and Doppler measurements, serum bile acid levels, liver enzyme levels, and obstetric and perinatal outcomes were compared between the groups. The AoI diameter was 4.8 ± 0.95 mm in the ICP group and 4.2 ± 0.62 mm in the control group, indicating a statistically significant difference (p = 0.003). The AoI Doppler flow parameters did not significantly differ between the groups (p > 0.05). When evaluated in subgroups according to disease severity, the AoI diameter and Doppler measurements did not significantly differ between the mild and severe ICP cases (p > 0.05). The AoI diameter was significantly larger in those requiring admission to the neonatal intensive care unit (NICU) (p = 0.005). This diameter was also larger in patients with fetal distress, albeit with no statistically significant difference (p = 0.65). ICP is a pathology with known adverse fetal cardiac effects, but there is no effective method to predict adverse perinatal outcomes. The enlarged AoI diameter in the fetuses of mothers with ICP and the association of this enlargement with NICU requirements are important findings of this study. Further research with a larger number of patients is necessary to evaluate the clinical utility of fetal AoI diameter and Doppler parameters in ICP.

Association between Mediterranean diet adherence and Parkinson's disease: a systematic review and meta-analysis.

Parkinson's disease (PD) is a chronic neurodegenerative disorder, and past research suggests that adherence to the Mediterranean diet (MD) may influence the risk of PD. However, there are varying conclusions among different studies regarding the correlation between long-term adherence to the MD and the occurrence of PD. This meta-analysis aimed to investigate the association between MD adherence and PD incidence. This meta-analysis was registered on PROSPERO (CRD42024520410). We searched PubMed, Embase, Web of Science, and Cochrane databases to identify observational studies, including prospective cohorts, case-control, and cross-sectional studies, up to February 2024. Studies reported on MD adherence were included, with MD adherence categorized through a quantifying score or index. The pool odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the highest versus the lowest categories of MD score in relation to PD risk, using random-effects models. Additionally, bias assessment, heterogeneity assessment, sensitivity analysis, and subgroup analysis were performed. A total of 12 studies were included in the meta-analysis. The overall effect size of PD risk was as follows: compared to the lowest adherence to the MD, the highest adherence to MD showed a significant negative correlation with the incidence of PD, with an overall OR of 0.75 (95% CI: 0.66, 0.84). Specifically, in studies diagnosing PD, the overall OR was 0.83 (95% CI: 0.74, 0.94), while in studies diagnosing prodromal Parkinson's disease (pPD), the overall OR was 0.67 (95%CI: 0.59, 0.76). For individuals aged <60 years, the overall OR was 0.70 (95%CI: 0.62, 0.78), whereas, for those aged ≥60 years, the overall OR was 0.86 (95%CI: 0.74, 0.99). The evidence from this meta-analysis demonstrates a significant negative correlation between adherence to MD patterns and the risk of PD, suggesting that the MD may serve as a protective factor for PD. This dietary pattern may be particularly beneficial in reducing the risk of pPD.

Congenital Heart Disease Fetuses Have Decreased Mid-Gestational Placental Flow, Placental Malperfusion Defects, andImpaired Growth.

Placental health may impact the development and outcomes of congenital heart disease (CHD). CHD fetuses have been shown retrospectively to have decreased placental blood flow. The purpose of this study was to determine if CHD fetuses with decreased placental blood flow have placental pathology at birth and if there is a relationship between placental blood flow, placental pathology, and outcomes. We performed a prospective case-control study of 38 CHD fetuses, including 28 with single ventricle physiology and 36 controls. Demographic, clinical, and postnatal biometric data were collected. Umbilical venous volume flow (UVVF) was measured from 2nd trimester fetal echocardiograms. Placentas underwent standardized pathological analysis. Standard descriptive statistics and regression analyses were performed to analyze the relationship between UVVF, placental defects, and outcomes. CHD fetuses had a 15% decrease in mid-gestational UVVF indexed to fetal weight (P<0.01), and a 27% reduction in UVVF as a proportion of fetal cardiac output (P<0.01) compared to controls. CHD fetuses had increased placental maternal vascular malperfusion (MVM) lesions (44% vs 18%, P<0.05), especially high-grade MVM (39% vs 9.1%, P=0.05), and a trend toward increased placental fetal vascular malperfusion lesions (42% vs 23%, P=0.10). Placental MVM but not fetal vascular malperfusion lesions were associated with decreased birth weight in CHD fetuses (P<0.001). There was no association between UVVF and placental pathologic findings or fetal growth. CHD (particularly single ventricle) fetuses have decreased mid-gestational placental blood flow, increased placental malperfusion defects, and impaired fetal growth. Placental MVM may influence impaired fetal growth in CHD.

Fetal Cardiac Function and Remodeling in In Vitro Fertilization Pregnancies: A Tertiary Center Experience.

To investigate fetal cardiac functions and remodeling in pregnancies conceived via in vitro fertilization (IVF). This prospective case-control study included 40 singleton IVF pregnancies and 46 uncomplicated control pregnancies at 28-36weeks of gestation. The IVF group consisted of pregnancies applied to the outpatient clinic, excluding those with anatomical or chromosomal abnormalities. Fetal cardiac morphological measurements, left myocardial performance index (MPI), cardiac output, spectral, tissue Doppler, and M-mode measurements were recorded. Ventricular and great vessel size were assessed for fetal cardiac morphology, while MPI, spectral Doppler, and tissue Doppler parameters were assessed for cardiac function. The right atrial area was statistically increased and the right ventricular basal sphericity index was statistically decreased in the IVF group. The mitral and aortic valves were smaller in the IVF group, while tricuspid and pulmonary valve measurements were similar. Left ventricular ejection time was statistically lower in the IVF group, although the MPI was similar. The IVF group had a higher right fetal MPI on tissue Doppler imaging, but the difference was not statistically significant. This study suggests that IVF pregnancies may demonstrate some effects of fetal cardiac remodeling and mild systolic dysfunction.

Enhancing early detection of keratoconus suspects using interocular corneal tomography asymmetry.

To evaluate corneal tomography asymmetry of both eyes in keratoconus (KC), keratoconus suspects (KCS), and normal (NL) eyes, and to introduce an interocular asymmetry index (IAI) for early diagnosis of keratoconus. This prospective case-control study included 210 NL eyes, 140 eyes with KCS, and 40 eyes with KC. New Scheimpflug imaging scans were performed to obtain corneal tomographic parameters. Based on the high and low values of tomographic parameters, each eye was categorized as "worse" or "better." Intragroup correlation coefficients (ICC) were used to compare interocular asymmetry. Logistic regression indices were constructed using interocular differences. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity, specificity, and cutoff values of the IAI. In the KC group, 86.7% of the parameters significantly differed between the worse and better eyes. In the KCS group, 66.7% of the parameters showed significant differences between the worse and better eyes, with high consistency between the central and thinnest corneal thickness groups (ICC > 0.6). Strong intragroup correlations were observed in the NL group (ICC > 0.6). IAI effectively distinguished the NL from the KCS group (area under the ROC [AUROC] = 0.891), reaching 67.1% sensitivity and 97.1% specificity at a cutoff value of 0.494. At a cutoff value of 0.778, the IAI reached 95.0% sensitivity and 96.2% specificity in distinguishing NL from KC (AUROC = 0.954). Interocular asymmetry in keratoconus suspects can be detected in the early stages, with increased asymmetry compared to NL eyes observed as keratoconus progresses. Interocular asymmetry can complement monocular diagnostic parameters.

Association Between Periodontal Health Status and Pregnancy and Delivery Complications in Type 1 Diabetes Mellitus Pregnant Women: A Case-Control Study.

To assess the association between periodontal health and pregnancy or delivery complications in type 1 diabetic (TIDM) and non-diabetic pregnant women. 15 TIDM and 15 non-diabetic primiparous women were enrolled in the prospective case-control study. We compared periodontal status, levels of glycosylated hemoglobin (HbA1c), gestational week of birth, birth weight of a newborn and pregnancy or delivery complications between the groups. TIDM pregnant women gave birth statistically significantly earlier (2 weeks) (p = 0.034), but not before the 37th week of gestation. The odds ratio (OR) for pregnancy or delivery complications was ~ 5 times greater (95% CI: 1.1-26.4; p = 0.033) and for Caesarean section (C-section) ~ 6 times greater (95%CI: 1.2-30.7; p = 0.032) in TIDM group. The association between periodontal disease (PD) and pregnancy or delivery complications was not statistically significant in either group. The presence of TIDM (p = 0.002; R2 = 0.28), a higher bleeding-on-probing/full-mouth bleeding score (FMBS) (p = 0.043; R2 = 0.14), and a higher level of HbA1c (p = 0.026; R2 = 0.16) were statistically significantly more often associated with an earlier gestational week of birth. Higher levels of HbA1c were statistically significantly positively associated with a higher frequency of pregnancy or delivery complications (p = 0.024) and a higher frequency of C-section (p = 0.051). There are strong indications that both endocrinological and periodontal therapy should form a part of preventive prenatal care.

Objective assessment of acute pain in foals using a facial expression-based pain scale.

Pain assessment based on facial expressions has been described in foals. To extend previous pilot findings of the Equine Utrecht University Scale for Facial Assessment of Pain in Foals (EQUUS-FAP FOAL). Prospective blinded case-control study (known groups analysis). Video recordings (30-60 s) of n = 100 foals (38 patients and 62 controls) were collected. Videos were randomised and scored by two observers, blinded for the condition of the animals. Inter- and intra-observer agreement was tested by Intra Class Correlation (ICC) analysis. Differences between patients and controls were tested using Mann-Whitney U test, differences before and after analgesic treatment were tested with Wilcoxon signed rank test. Multilevel binomial logistic regression was performed for statistical weighting of each pain scale item. Receiver operating characteristic (ROC) analysis was performed to determine sensitivity, specificity and cut-off values. EQUUS-FAP FOAL showed good inter- and intra-observer reliability (ICC coefficient of 0.85 and 0.90 respectively, p < 0.001). Patients had significantly higher pain scores (median score 7, IQR 5.3-7.5) compared with controls (median score 2.5, IQR 1-3, p < 0.001) and the patient pain scores decreased after analgesic treatment (median score 6.5, IQR 5-8 vs. median score 4.5, IQR 3.5-6.5, p < 0.05). Multilevel binomial logistic regression showed the relative importance of the individual scale items. Using the original scale, sensitivity and specificity were 88.2% (95% CI 76%-96%) and 87.9% (81%-98%) respectively, with an area under the ROC curve of 94.9% (92%-98%), based on a cut-off value of ≥4. These values remained similar with the weighted scale based on logistic regression output. Videos of included patients were short and acquired by a person in front of the stable. The current study shows that EQUUS-FAP FOAL can be effectively used to assess acute pain in young foals.

A comparative study to evaluate radiation exposure in patent ductus arteriosus device closure by conventional method and echocardiography guided method- an experience from eastern India

Abstract Background PDA constitutes 5-10% of all congenital heart defects, with a prevalence of symptomatic PDA being 0.5/1000 live births. Percutaneous PDA device closure has the advantage of early discharge and less anesthesia - related complications. However, during the procedure, the operators and patients are exposed to radiation. Use of transthoracic echocardiogram (TTE) for imaging during trans-catheter PDA closure reduces the dose of radiation, complications related to femoral arterial access and procedural time. In our institution we planned to compare the radiation exposure and procedural time of PDA device closure by transthoracic echocardiography with the use of minimal fluoroscopy(case) compared to conventional method(control) in pediatric patients. Purpose i)To compare the radiation exposure and procedural time of PDA device closure by transthoracic echocardiography with the use of minimal fluoroscopy(case) to conventional technique(control) in a tertiary care hospital. ii) To compare the complications between the two groups. Methods This was a single-centre prospective randomized case control study. Children between 6 months -12 years with an indication for percutaneous PDA device closure were selected after concsent. A six month post-operative follow up was planned. 106 patients were included in the study from July 2018 to January 2020. The first patient was selected through lottery who underwent the procedure under echocardiographic guidance with minimal fluoroscopy use and thereby every alternate patient was selected as case (n=51). 51 patients underwent closure following the conventional method(control). Each group were selected with comparable age group and other characteristics. 4 patients in the case arm had to undergo aortogram, so excluded from the study. Results Patients were equally distributed in both groups. There was statistically significant difference in the procedural time, fluoroscopy time and radiation dose in terms of total kerma, dose area product and dose area product/kg among the two groups, all of them were lower in the echocardiography group compared to fluoroscopy group.The least fluoroscopy time, radiation exposure and procedural time in the echocardiography group were 43 seconds, 1mGy, 20minutes respectively. Conclusion In both the groups the patient characteristics, defect size and device used was comparable. The fluoroscopy group had a single case of groin hematoma, managed conservatively. Fluoroscopy time, procedural time and amount of radiation exposure in TTE guided group was significantly less than the control group. In echocardiography group, no contrast was used and all the possible arterial access related complications were easily prevented. Above results show that it is safe and feasible to perform PDA device closure with TTE-guided percutaneous PDA occlusion as compared to conventional method with minimal fluoroscopy exposure.

P-1779. Effect of a Transitions of Care Pharmacist Intervention on Discharge Oral Antibiotic Prescribing

Abstract Background An emerging area of focus in antibiotic stewardship programs (ASP) is appropriate antibiotic selection at hospital discharge. The purpose of this study was to assess the effect of a transitions of care (ToC) pharmacist-led review of discharge oral antibiotic therapy on antibiotic appropriateness. Methods This was a prospective single center case-control study at Mount Sinai Beth Israel that included adult patients (≥18 years old) discharged on oral antibiotics for the treatment of common infectious diseases syndromes between February 13, 2023 and May 13, 2023. Appropriateness of antibiotic regimen was based on standardized guidance developed by the ASP team. The primary outcome was the difference in percentage of inappropriate antibiotic prescriptions between the provider-only and ToC pharmacist-reviewed groups. Secondary outcomes included mean duration of therapy between the two groups, percentage of pharmacist interventions accepted, and number of fluoroquinolone prescriptions avoided. Comparisons were performed using Chi-squared or Fischer’s exact test for categorical variables and Student’s t test or the Mann-Whitney U test for continuous variables, as appropriate. P &amp;lt; .05 was considered statistically significant. Results A total of 182 patients were included in the analysis, 81 patients in the provider-only group and 101 patients in the ToC pharmacist-reviewed group. The most common diagnoses were intra-abdominal infection (37.9%), urinary tract infection (23.1%), skin and soft tissue infection (21.4%), and community acquired pneumonia (17.6%). Patients in the ToC pharmacist-reviewed group were significantly less likely to have an inappropriate antibiotic prescription at discharge when compared to the provider-only group (25.7% vs. 87.7%; p &amp;lt; .001). The mean duration of therapy was significantly lower in the ToC pharmacist-reviewed group when compared to the provider-only group (7.7 vs. 9.1 days; p =.007). In the ToC pharmacist-reviewed group, 56.9% (33/58) of pharmacist interventions were accepted and 19.3% (11/57) of fluoroquinolone prescriptions were avoided. Conclusion A ToC pharmacist’s review of oral antibiotics at discharge significantly reduced inappropriate antibiotic selection and duration of therapy. Disclosures All Authors: No reported disclosures

P-1150. Prospective case-control study to examine clinical, biochemical, and serological indicators to predict Staphylococcal scalded skin syndrome

Abstract Background Staphylococcal scalded skin syndrome (SSSS) typically affects infants &amp; children, with rare occurrences in adults. There is no rapid tool or any scoring system to diagnose SSSS, where early diagnosis is the key to successful outcome. Methods This study evaluates specific clinical &amp; serological indicators to distinguish between maculopapular eruption &amp; SSSS upon initial presentation. Additionally, we investigate the correlation between serum levels of thymus and activation-regulated chemokine (TARC) &amp; the severity of SSSS &amp; the extent of organ involvement. In this observational study conducted prospectively, 25 patients diagnosed with SSSS &amp; 25 control subjects with maculopapular rash were enrolled. Results The diagnostic efficacy of various factors, including TARC level ( &amp;gt;612.25 pg/ml), total body surface area (TBSA &amp;gt;30%), hsCRP ( &amp;gt;5mg/l), leucocytosis ( &amp;gt;12X 109 cells/L), &amp; aspartate transaminase ( &amp;gt;90 U/L), showed statistical similarity to the diagnosis of SSSS. While baseline serum TARC levels proved to be a reliable screening tool, they did not predict the severity or outcome of SSSS. However neutrophil extracellular traps (NETs) level did correlate positively with disease severity &amp; duration of hospital stay. Through multivariable regression analysis, we have formulated a novel model that integrates TBSA at baseline, neutrophil percentage in leucocytosis, &amp; hsCRP, surpassing the predictive capacity of these parameters when considered individually. The resulting equation with the highest odds for diagnosing SSSS is as follows: Odds of SSSS (present) = Antilog [-11.26 + 0.3 x Total BSA + 0.30 x hsCRP – 0.1 x neutrophil (%)]. This composite model (incorporating TBSA at baseline, neutrophil percentage, and hsCRP) achieved a sensitivity of 96% and specificity of 100% at a cutoff point of 7.8. Conclusion The equation developed from our research is straightforward to apply and suitable for use in settings with limited resources. It facilitates the identification of patients who are more likely to have SSSS, enabling the early initiation of definitive treatment. Likewise, it helps in minimizing unnecessary extensive investigations for patients unlikely to have SSSS. Neutrophil extracellular traps (NET) can be definitely used as a prognostic marker in patients with severe SSSS. Disclosures All Authors: No reported disclosures

P-2000. A Case-Control Study of the Risk of COVID-19 Infection in Underserved Persons with HIV (PWH) in Middle Tennessee

Abstract Background The COVID-19 pandemic had disproportionately affected racial and ethnic minorities. We undertook this study to examine the risk factors for COVID-19 infection and death in African Americans with HIV. Methods We conducted a prospective case-control study to assess the risk for COVID-19 infection in a clinic serving predominantly underserved African Americans in Middle Tennessee. Matched cases and controls were tested for COVID-19 by PCR around the same time. COVID-19 information, demographics, clinical and social determinants of health (SDoH) data were collected from electronic health records. Chi-square and Fisher’s exact tests were applied to evaluate the associations between outcome and predictor variables. Binary logistic regression was used to examine the effects of 18 predictors on COVID-19 infection. R/RStudio version 4.3.2 was used. The local IRB approved the study protocol. Results From 4/2020 to 11/2023, 91 PWH tested COVID-19-positive and 181 negative. We excluded 11 cases and 29 controls due to missing SDoH data; 81.0% of the patients were African American, 26.3% were female, and 46.1% fell into the 45-64-year-old age group. Among 73 symptomatic cases, the most common symptoms were cough, fever, and chills. 28/91 were admitted to the hospital, 11/28 went to ICU, and 8/28 died. All the deceased had &amp;gt;1 cardiovascular risk factor. 12/91 cases had a CD4 cell count &amp;lt; 200/mm3 and 73/91 had an HIV-1 RNA level &amp;lt; 200 copies/mL. In the bivariate analysis, incarceration (p &amp;lt; 0.001), renal failure (p &amp;lt; 0.001), smoking (p &amp;lt; 0.001), alcoholism (p = 0.003), drug use (p = 0.023), and cardiovascular risk (p = 0.023) were highly associated with COVID-19 infection. In the multivariable model, the most strongly associated risks were incarceration [OR = 18.68; 95% CI: (4.66, 74.87); p &amp;lt; 0.001], renal failure [OR = 40.62; 95% CI: (3.96, 416.83); p = 0.002], hyperlipidemia [OR = 3.94; 95% CI: (1.54, 10.06); p = 0.004], 25-44 years of age [OR = 2.48; 95% CI: (1.10, 5.58); p = 0.028], no insurance [OR = 0.36; 95% CI: (0.14, 0.92); p = 0.033], and smoking [OR = 2.20; 95% CI: (1.01, 4.82); p = 0.048]. Conclusion Incarceration, renal failure, and cardiovascular disease were very strong risk factors for COVID-19 infection in this population of PWH in Middle Tennessee. Disclosures Vladimir Berthaud, MD MPH, GILEAD SCIENCES: Grant/Research Support|GSKVIIV: Grant/Research Support|MODERNA: Grant/Research Support|NOVAVAX: Grant/Research Support

Association of Sleep Spindle Rate With Memory Consolidation in Children With Rolandic Epilepsy.

Rolandic epilepsy (RE), the most common childhood focal epilepsy syndrome, is characterized by a transient period of sleep-activated epileptiform activity in the centrotemporal regions and variable cognitive deficits. Sleep spindles are prominent thalamocortical brain oscillations during sleep that have been mechanistically linked to sleep-dependent memory consolidation in animal models and healthy controls. Sleep spindles are decreased in RE and related sleep-activated epileptic encephalopathies. To further evaluate the association between this electrographic biomarker and cognitive dysfunction in this common disease, we investigate whether children with RE have deficient sleep-dependent memory consolidation and whether impaired memory consolidation is associated with reduced sleep spindles in the centrotemporal regions. In this prospective case-control study, children were trained and tested on a validated probe of memory consolidation, the motor sequence task (MST). Sleep spindles were measured from high-density EEG during a 90-minute nap opportunity between MST training and testing using an automated sleep spindle detector validated for use in children with and without epilepsy. Twenty-three children with RE (9 with active disease, 5F, age 6.9-12.8 years; 14 with resolved disease, 8F, age 8.8-17.8 years) and 19 age-matched and sex-matched controls (8F, age 6.9-18.7 years) were enrolled. Children with active epilepsy had decreased memory consolidation compared with control children (p = 0.001, mean percentage reduction 25.7%, 95% CI 10.3%-41.2%) and compared with children with resolved epilepsy (p = 0.007, mean percentage reduction 21.9%, 95% CI 6.2%-37.6%). Children with active epilepsy had decreased sleep spindle rates in the centrotemporal region compared with controls (p = 0.008, mean decrease 2.5 spindles per minute, 95% CI 0.7-4.4 spindles per minute). Spindle rate, but not spike rate or spike-wave index, correlated with sleep-dependent memory consolidation (p = 0.004, mean MST improvement of 3.9%, 95% CI 1.3%-6.4%, for each unit increase in spindles per minute). Children with RE have impaired sleep-dependent memory consolidation during the active period of disease that correlates with a deficit in the sleep spindle rate. This finding identifies a noninvasive biomarker to aid diagnosis and a potential etiologic mechanism to guide therapeutic discovery of cognitive dysfunction in RE and related sleep-activated epilepsy syndromes.

Anterior Lumbar Interbody Fusion (ALIF) Versus Full-Endoscopic/Percutaneous TLIF With a Large-Footprint Interbody Cage: A Comparative Observational Study.

Exploratory prospective observational case-control study. Aim of this study was to compare clinical and radiologic outcome, as well as peri-operative complications, of anterior lumbar interbody fusion (ALIF) and full-endoscopic/percutaneous trans-Kambin transforaminal lumbar interbody fusion (pTLIF) with a large-footprint interbody cage. Patients that underwent elective ALIF and pTLIF with a large-footprint interbody cage were prospectively evaluated. Clinical follow-up was measured pre- and post-operatively with Visual Analogic Scale and Oswestry Disability Index scores. Radiologic outcome was assessed with a computed tomography scan and standing films at 12months. 44 patients underwent ALIF and 43 pTLIF surgery (total 87 cases). Clinical pre- and post-operative scores were comparable between both groups with 33.4months mean follow-up. Median surgical time was significantly lower for pTLIF (28minutes) compared to ALIF (72minutes). Radiologic outcome was favorable for ALIF with a significantly higher increase in segmental lordosis compared to pTLIF. Fusion rates did not significantly differ between both groups. ALIF showed significantly less cage subsidence than pTLIF. Complications included 9 (21%) cases with transitory post-operative radiculitis for ALIF and 12 (28%) for pTLIF; post-operative partial muscle weakness 3(6%) cases for ALIF and 4 (9%) for pTLIF. Two (4%) cases required revision surgery for pTLIF. ALIF and trans-Kambin pTLIF obtained comparable clinical outcome and fusion rates, while segmental lordosis restoration was favorable for ALIF. pTLIF required less surgery time and presented less intra-operative complications, while ALIF reported lower rates of post-operative subsidence, revision surgery and complications during follow-up.

Simultaneous evaluation of restless leg syndrome, neuropathic pain, disease activity, and quality of life in patients with Takayasu arteritis: a cross-sectional study

We aimed to investigate the frequency of restless legs syndrome (RLS) and neuropathic pain (NeP) in patients with Takayasu arteritis (TAK), and their relationship with disease activity, and quality of life (QoL). In this prospective case-control study, we evaluated 30 patients with TAK and 28 healthy subjects. Demographic, clinical, and current treatment-related data were also recorded. RLS diagnosis was confirmed in both groups according to the International Restless Legs Study Group criteria. The Douleur neuropathic-4 questionnaire (DN4) confirmed the frequency of neuropathic pain, and the quality of life was confirmed by the Short Form 36 (SF-36) health survey questionnaire. Univariate logistic regression analyses were performed to estimate the odds ratio (OR) for factors associated with NeP in patients with TAK. There was no statistically significant difference in the diagnosis of RLS between the TAK group and the control group (p = 0.195). The prevalence of NeP was significantly higher in TAK patients than in healthy controls (p = 0.011). The SF-36 subscale scores for physical functioning (p = 0.01) and general health (p = 0.002) were significantly lower in the TAK group than in the control group. Vasculitis Damage Index (VDI) scores were considerably higher in patients with NeP (p = 0.004). In univariate analyses, VDI decreased unbound iron-binding capacity, and SF36 mental component summary were predictors associated with NeP. This study revealed that the frequency of NeP was higher in patients with TAK than in the healthy population, and the patients with TAK were negatively affected in terms of NeP and QoL rather than RLS.

Exploring the clinical application effects of two different sources of domestic oral restoration membrane in guided bone regeneration during dental implantation in diabetic patients

Objective: To investigate the bone augmentation effects of domestic decellularized porcine small intestinal submucosa (PSIS) absorbable biomembrane and domestic bovine pericardium tissue (BPT) absorbable biomembrane in guided bone regeneration (GBR) for single-tooth implantation in diabetic patients. Methods: A prospective case-control study was conducted with 48 diabetic patients who received single-tooth implant restoration at the Department of Prosthodontics, School of Stomatology. The Fourth Military Medical University, between January 2023 and January 2024. Patients were randomly assigned to the study group (PSIS group) and the control group (BPT group) using a random number table, with 24 patients in each group. GBR was performed simultaneously with the implant surgery. Cone-beam CT was used to compare the buccal-side horizontal bone gain at 6 months post-operation between the two groups. Wound healing was evaluated at 1 and 4 weeks post-operation using wound healing scores. Results: At 6 months post-operation, the buccal-side horizontal bone gain in the study group [69.1 (55.2, 82.4) mm] and the control group [71.4 (59.8, 77.0) mm] showed no statistically significant difference (Z=-0.25, P=0.805). The wound healing scores at 1 and 4 weeks post-operation in the study group did not differ significantly from those in the control group at the same time points (1 week: Z=-0.49, P=0.627; 4 weeks: Z=-0.61, P=0.539). Conclusions: The use of two types of domestic absorbable collagen membranes for GBR in single-tooth implantation in diabetic patients showed comparable buccal-side horizontal bone gain effects at 6 months post-operation and similar clinical outcomes for wound healing at 1 and 4 weeks post-operation in both groups. The GBR effects of PSIS and BPT are similar.

Epigenome-wide DNA methylation profiling in septic and non-septic patients with similar infections: potential use as sepsis biomarkers

IntroductionSepsis is a life-threatening condition caused by a dysregulated immune response to infection, leading to organ failure. Despite its significant global burden, the underlying mechanisms of immune dysfunction in sepsis remain incompletely understood. This study explores the role of DNA methylation in white blood cells in sepsis pathogenesis.MethodsA prospective case-control study was conducted to compare DNA methylation profiles between patients with community-acquired sepsis and matched controls who had similar infections but did not develop sepsis. Whole blood samples from these patients were analyzed using the Infinium MethylationEPIC v2.0 kit, enabling genome-wide methylation analysis. Selected genes with differential methylation were validated by pyrosequencing.ResultsSignificant differential DNA methylation patterns were identified between septic and non-septic individuals uising. Our results suggest that DNA methylation changes are closely linked to the pathophysiological processes of sepsis, influencing immune cell activation, inflammation, and organ dysfunction. The most prominent findings include the hypomethylation of immune-related genes (SERPINA1, AZU1, MPO, and SLX4), which were strongly correlated with clinical severity and inflammatory markers such as SOFA scores and PCT levels. Correlation analyses demonstrated significant associations between the methylation levels of these genes and clinical severity markers, such as SOFA score and PCT levels. Notably, SLX4 hypomethylation showed the highest predictive value for poor prognosis (AUC 0.821), while SERPINA1 hypomethylation exhibited strong diagnostic potential for sepsis (AUC 0.858).DiscussionOur results underscore the potential of DNA methylation changes, particularly in immune-related genes, to enhance the early detection of sepsis and to stratify patients based on severity. Future research should explore the therapeutic implications of these epigenetic alterations in sepsis care.