Significant Predictors Of Outcome Research Articles

Predictors of Neurological Outcomes in Patients with Poor Glasgow Coma Scale Scores 1 Week After Aneurysmal Subarachnoid Hemorrhage

This study assessed neurological outcomes and variables associated with favorable outcomes in aSAH patients with low functional status (Glasgow Coma Scale [GCS] score ≤8) on postbleed day 7 (PBD7). A retrospective analysis was conducted of all patients in the Barrow Ruptured Aneurysm Trial (January 1, 2014-July 31, 2019) treated for a ruptured aneurysm and who had a GCS score ≤8 on PBD7. The primary outcome was a favorable neurological outcome (modified Rankin Scale score ≤2) at last follow-up. Of 312 patients, 63 had low GCS scores at PBD7. These patients had a significantly greater proportion of poor Hunt and Hess scale grades (≥4) (44/63 [70%] vs 49/249 [19.7%], P < 0.001) and poor Fisher grades (grade=4) (58/63 [92%] vs 174/249 [69.9%], P < 0.001) compared to patients who did not have low GCS scores on PBD7, but no differences were found in age, sex, anterior location, aneurysm size, or type of treatment. Of the 63 patients, 7 (11%) experienced a favorable neurological outcome. On univariate analysis, none of the physical examination reflexes predicted a favorable neurological outcome. The middle cerebral artery aneurysm territory was the only significant predictor of a favorable neurological outcome by multivariate analysis (odds ratio, 10.8; 95% confidence interval, 1.16-100], P = 0.04). This study yielded no significant physical examination findings that predict a favorable outcome in patients with GCS score ≤8 on PBD7. This finding may inform the decision of whether to prolong hospital management or arrange for end-of-life care.

Association between mitochondrial DNA copy number and neurodevelopmental outcomes among black and white preterm infants up to two years of age.

Mitochondrial DNA copy number (mtDNAcn) is associated with mitochondrial function, with abnormal copy numbers having been linked to various disease states. Our study aims to understand the association between infant mtDNAcn and infant neurodevelopment, as well as the association with racial disparities. A longitudinal study was conducted with 55 preterm infants from whom a single blood sample was collected during their Neonatal intensive care unit (NICU) stay and used to analyze mtDNAcn. In addition, the NICU Network Neurobehavioral Scale at 36-38 postmenstrual age (PMA) and the Bayley Scale of Infant and Toddler Development (Bayley) Edition III at 1 and 2 years of corrected age were both conducted. Linear regression models were performed to investigate the relationship between infant clinical characteristics, infant neurobehavioral outcomes, and mtDNAcn. The majority of infants studied were white (72.73%), non-Hispanic (70.91%), males (54.55%), delivered through C-section (72.73%), and without preterm premature rupture of membrane (76.36%). Increased mtDNAcn was associated with younger birth gestational age (<30.57 wk, P < 0.001). In addition, the opposite associations between mtDNAcn and neurodevelopmental outcomes were observed between white and black infants up to 1 year of gestational age. Increased mtDNAcn in white infants, and decreased mtDNAcn in black infants may be considered significant predictors of poor early-life neurodevelopmental outcomes in infants. A better understanding of the underlying mechanisms contributing to infant disparity in mtDNAcn and how low or high copy number impacts infant outcomes is essential.

Effectiveness of Extracorporeal Cardiopulmonary Resuscitation for Non-Shockable Out-of-Hospital Cardiac Arrest: An Analysis From the SOS-KANTO 2017 Study.

Extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has the potential as a viable treatment for refractory out-of-hospital cardiac arrest (OHCA). While mechanical circulatory support devices, such as Impella® and left ventricular assist devices, are being increasingly used, initial ECPR often relies on V-A ECMO. Previous studies, including randomized controlled trials, reported the prognostic benefits of ECPR for shockable OHCA (SOHCA); however, its effectiveness for non-SOHCA (NSOHCA) remains unclear, with poorer neurological outcomes and the lower return of spontaneous circulation rates than for SOHCA being reported. The present study utilized data from the SOS-KANTO 2017 study to examine the impact of ECPR on the neurological outcomes of NSOHCA. Data from 2,502 OHCA cases were analyzed, with a focus on the relationship between ECPR and 90-day neurological outcomes. The results obtained showed significantly higher survival rates at 30 and 90 days and significantly better 90-day neurological outcomes in the ECMO attempt group than in the non-ECMO attempt group. A multivariate analysis identified ECPR as one of the significant independent predictors of favorable neurological outcomes. The prognosis of NSOHCA cases with CA was improved by ECPR using V-A ECMO, particularly in those where CPR was initiated within one minute of onset and the patient arrived at the hospital within 45 minutes. Factors associated with a favorable prognosis included a shorter time from onset to hospital arrival and the likelihood of acute coronary syndrome being the cause of CA. The present results suggest the potential of ECPR to improve the survival and the 90-day prognosis of NSOHCA, particularly when bystander CPR is initiated quickly and hospital arrival is prompt.

Laparoscopic Sacrohysteropexy for the Management of Uterovaginal Prolapse: a Pilot, Single-Center Experience from Saudi Arabia.

Laparoscopic sacrohysteropexy is an emerging uterine-preserving strategy for management of uterovaginal prolapse (UVP). The literature on laparoscopic sacrohysteropexy for management of UVP is very scarce from Saudi Arabia. This research examined the feasibility, clinical utility, and safety of laparoscopic sacrohysteropexy in a Saudi setting. A retrospective study was conducted, including all patients who met the inclusion criteria. The laparoscopic sacrohysteropexy technique was adapted with modifications from the "Oxford hysteropexy". The primary endpoint was overall success, defined as anatomical success in all vaginal compartments (UVP grade 0 or 1 postoperatively). The secondary endpoint was the mean change in point C. Descriptive data were summarized with numbers and percentages, while numerical data used means ± standard deviations. Fisher's exact and Student's t tests were used for univariate analyses. Significant surgical outcome predictors were identified via logistic regression, with p <0.05 considered statistically significant. Overall, 21 patients met the inclusion criteria. The most frequent indication for laparoscopic sacrohysteropexy was UVP without anterior or posterior wall prolapse (n = 15, 71.4%), whereas the most frequent grade of UVP was grade III (n = 13, 61.9%). One patient (4.8%) required switch to laparotomy due to severe adhesions. No perioperative complications were recorded. The mean change in point C and hospital stay were 5.8 ± 2.1 (range: 0-8) and 1.4 ± 0.6 days (range: 1-3), respectively. Surgical success was achieved in 18 patients (85.7%). Only three patients experienced recurrences (one, two, and six months postoperatively). The mean change in point C was significantly higher in successful cases contrasted with the failed cases (6.5 versus 1.3). Laparoscopic sacrohysteropexy for management of uterovaginal prolapse revealed technical feasibility, safety, and beneficial utility of the procedure. Further large-sized and multicentric investigations are important to gather additional pertinent information on laparoscopic sacrohysteropexy.

Neighborhood resources are associated with neuropsychological outcomes among pediatric brain tumor survivors

Background: Cancer-related cognitive impairment in survivors of pediatric brain tumors is a public health concern, yet studies seldom explore the role of social determinants of health beyond treatment effects. We investigated the influence of neighborhood resources using the Child Opportunity Index (COI) on neuropsychological functioning in survivors. Methods: Intelligence (IQ) and untimed reading and math proficiency were assessed retrospectively in 190 survivors. Multiple regression analyses explored associations among the COI composite and indices (Education, Health-Environment, Social-Economic) and neuropsychological outcomes, controlling for cumulative neurological risk and treatment exposures (Neurological Predictor Scale; NPS) and parental education. Results: Performance was on average within normal limits: IQ (M = 94.08, SD = 15.85, d=.37) with 13.4% of scores below impairment thresholds; reading (M = 95.08, SD = 17.36, d=.28) and math calculation (M = 91.84, SD = 18.82, d=.43) with 16.92% and 20.63% of scores below impairment thresholds, respectively. Each COI domain predicted reading and IQ after controlling for NPS, parental education, and age at diagnosis; however, the Education domain was the only significant predictor of math outcomes. Conclusion: The COI domains significantly predicted IQ and untimed academic skills in survivors, revealing the critical role of neighborhood resources on cognition above and beyond parental education and treatment factors. This is among the first studies to illuminate the influence of neighborhood resources on cognition in survivors. Future research should examine neighborhood context, an understudied construct, with importance in the move toward precision medicine.

Comparative Analysis of Refractive Outcomes Following Cataract Surgery Using IOL Master 500 and IOL Master 700 Biometry Devices: A Retrospective Analysis.

Background: This study aims to compare the refractive outcomes of cataract surgery using two different biometry devices, the IOL Master 500 and IOL Master 700, and to investigate the influence of patient-related factors on these outcomes. Methods: In this retrospective study, we analyzed data from 2994 eyes that underwent cataract surgery. Multiple linear regression analyses were performed to examine the impact of the biometry device (IOL Master 500 or IOL Master 700), patient age, time elapsed between biometry and surgery, gender, and insurance status, as well as biometric parameters (anterior chamber depth, axial length, and corneal curvature), on postoperative refractive outcomes, specifically the deviation from target refraction. Results: The choice of the IOL Master device did not result in a statistically significant difference between the two devices (p = 0.205). Age (p = 0.006) and gender (p = 0.001) were identified as significant predictors of refractive outcomes, with older patients and males experiencing slightly more hyperopic outcomes compared to younger patients and females, respectively. The time elapsed between biometry and surgery and insurance status did not significantly influence the refractive outcomes. Conclusions: Our study, supported by a large cohort and a diverse group of patients representing typical anatomical variants seen in cataract surgery, supports the thesis that the IOL Master 500 and IOL Master 700 can be regarded as equivalent and effective for biometry in cataract surgery. The differences between the devices were negligible. Therefore, switching between the devices is safe for bilateral patients.

Potential of Nutritional Markers as Predictors After Immunotherapy in Advanced Head and Neck Squamous Cell Carcinoma.

Immune checkpoint inhibitors (ICIs) are the standard treatment for advanced head and neck squamous cell carcinoma (HNSCC). Programmed death-ligand 1 (PD-L1) is clinically assessed before initiating ICIs; however, there are no established biomarkers for predicting the response to immunotherapy. In this study, inflammatory and nutritional parameters were examined to determine the therapeutic outcomes of ICIs for HNSCC. Sixty-five patients with metastatic or recurrent HNSCC who received programmed death-1 (PD-1) blockade were enrolled. Inflammatory and nutritional indices were correlated with patient outcomes, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI). Patients aged <70 years were significantly associated with a high NLR, whereas those with a performance status of 2 or 3 were closely related to a high NLR, high SII, and low PNI. Although all patients achieved an objective response rate of 24.6% and a disease control rate of 36.9%, the NLR, PLR, SII, and PNI values were not significantly different between responders and non-responders. Univariate analysis showed that the NLR, PLR, SII, and PNI were significant predictors of progression-free survival (PFS) and overall survival (OS). Multivariate analysis identified PNI as an independent predictor of PFS and OS. PNI, as a nutritional marker, was identified as a significant predictor of outcomes following PD-1 blockade administration in patients with advanced HNSCC, compared to inflammatory markers, such as NLR, PLR, and SII.

Comparing clinical and genomic features based on the tumor location in patients with resected pancreatic cancer

BackgroundPancreatic cancer is anatomically divided into pancreatic head and body/tail cancers, and some studies have reported differences in prognosis. However, whether this discrepancy is induced from the difference of tumor biology is hotly debated. Therefore, we aimed to evaluate the differences in clinical outcomes and tumor biology depending on the tumor location.MethodsIn this retrospective cohort study, we identified 800 patients with pancreatic ductal adenocarcinoma who had undergone upfront curative-intent surgery. Cox regression analysis was performed to explore the prognostic impact of the tumor location. Among them, 153 patients with sufficient tumor tissue and blood samples who provided informed consent for next-generation sequencing were selected as the cohort for genomic analysis.ResultsOut of the 800 patients, 500 (62.5%) had pancreatic head cancer, and 300 (37.5%) had body/tail cancer. Tumor location in the body/tail of the pancreas was not identified as a significant predictor of survival outcomes compared to that in the head in multivariate analysis (hazard ratio, 0.94; 95% confidence interval, 0.77–1.14; P = 0.511). Additionally, in the genomic analyses of 153 patients, there were no significant differences in mutational landscapes, distribution of subtypes based on transcriptomic profiling, and estimated infiltration levels of various immune cells between pancreatic head and body/tail cancers.ConclusionsWe could not find differences in prognosis and tumor biology depending on tumor location in pancreatic ductal adenocarcinoma. Discrepancies in prognosis may represent a combination of lead time, selection bias, and clinical differences, including the surgical burden between tumor sites.

The association between klotho and kidney and cardiovascular outcomes: a comprehensive systematic review and meta-analysis.

Chronic kidney disease (CKD) and end-stage renal disease (ESKD) are significant global health challenges associated with progressive kidney dysfunction and numerous complications, including cardiovascular disease and mortality. This study aims to explore the potential association between plasma klotho levels and various prognostic outcomes in CKD and ESKD, including all-cause mortality, cardiovascular events, metabolic syndrome development and adverse renal events necessitating renal replacement therapies. A literature search was conducted through 3 June 2024 using the electronic databases Cochrane Library, Ovid MEDLINE, CINAHL, Web of Science, SCOPUS and PubMed. This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fourteen studies were included. For all-cause mortality, comparing CKD patients with low versus high klotho levels showed a significant association {odds ratio [OR] 1.81 [95% confidence interval (CI) 1.34-2.44], P=.0001}, with substantial heterogeneity (I 2=69%). Excluding one study reduced heterogeneity (I 2=43%) while maintaining significance [OR 1.97 (95% CI 1.45-2.66), P<.0001]. Cardiovascular mortality was higher in patients with low klotho levels [OR 2.11 (95% CI 1.61-2.76), P<.00001], with low heterogeneity (I 2=25%). Excluding one study eliminated heterogeneity (I 2=0%) while maintaining significance [OR 2.39 (95% CI 1.83-3.12), P<.00001]. Composite cardiovascular events did not differ significantly between low and high klotho groups [OR 1.51 (95% CI 0.82-2.77), P=.18], but with high heterogeneity (I 2=72%). Patients with low klotho levels had a higher risk of adverse renal events [OR 2.36 (95% CI 1.37-4.08), P=.002], with moderate heterogeneity (I 2=61%). Sensitivity analysis reduced heterogeneity (I 2=0%) while maintaining significance [OR 3.08 (95% CI 1.96-4.85), P<.00001]. Specifically, for ESKD or kidney replacement therapy risk, low klotho levels were associated with an increased risk [OR 2.30 (95% CI 1.26-4.21), P=.007]. Similarly, CKD progression risk was higher in patients with lower klotho levels [OR 2.48 (95% CI 1.45-4.23), P=.0009]. Lower serum klotho levels serve as a significant predictor of adverse outcomes, including increased risks of all-cause mortality, cardiovascular mortality and progression to end-stage kidney disease among CKD patients.

Central pathology review and its prognostic value in upper tract urothelial carcinoma patients: a nationwide multi-institutional study

The prognostic value of central pathology review in upper urinary tract cancer (UTUC) remains inadequately addressed in existing literature. In this study, we conducted an extensive central pathology review and presented its influence on multi-center UTUC studies. We conducted a retrospective review of patients who underwent radical nephroureterectomy or segmental resection for UTUC to determine eligibility for central pathology review. In the Taiwan UTUC Collaboration cohort, 377 cases met the criteria for pathology review. We assessed agreement between pathologists using both the total percentage of agreement and simple kappa statistics. The prognostic implications of original and review pathology for various parameters were examined using the Cox regression model. This study included 209 female and 168 male participants. Pathology review revealed substantial interobserver variability in pT staging, with a particularly high rate of pT2 cases being upgraded to pT3 upon central review (17/70 pT2 stage made by local pathologists were finally confirmed as pT3 disease by the review pathologist). The local pathologist cohort identified fewer significant histological predictors in survival models compared to the review pathology cohort. Advanced pT stage, perineural invasion (PNI), and positive surgical margin were independent predictors of poorer overall survival and cancer-specific survival. PNI, lymphatic vascular invasion, and positive surgical margin were independent predictors of disease recurrence. Substantial interobserver variability in histological assessment underscores the importance of centralized pathology review for both multi-center studies and accurate post-operative management of UTUC patients. Advanced stage, perineural invasion, and margin status were significant histological predictors of oncological outcomes.

Flow Diversion for Cerebral Aneurysms: A Decade-Long Experience with Improved Outcomes and Predictors of Success.

Flow diversion has significantly improved the management of cerebral aneurysms. Technological advancements and increased clinical experience over the past decade have led to better outcomes and fewer complications. This study provides updated results and examines the factors that influence the success of flow diversion. We reviewed records of 115 patients with 121 intracranial aneurysms treated from July 2014 to August 2023. All patients had unruptured aneurysms in the anterior and posterior circulation. Complete aneurysm occlusion was achieved in 72.7% of cases, with a complication rate of 9.1%. Significant predictors of complete occlusion included aneurysm diameter (OR = 0.89, 95% CI 0.82-0.97, p = 0.009) and the presence of incorporated branches (OR = 0.22, 95% CI 0.08-0.59, p = 0.003). Cox analysis identified neck diameter (HR = 0.92, 95% CI 0.87-0.98, p = 0.009) and incorporated branch (HR = 0.40, 95% CI 0.24-0.69, p = 0.001) as significant for occlusion. Multivariable analysis identified aneurysm diameter (OR = 1.21, 95% CI 1.09-1.37, p = 0.001) as significant for safety outcomes. Improved outcomes were observed in recent treatments, with higher occlusion rates (79.7% vs. 61.7%, p = 0.050) and lower complication rates (4.1% vs. 14.9%, p = 0.011). Enhanced technical proficiency, better devices, and refined patient selection have significantly improved the efficacy and safety of flow diversion for cerebral aneurysms. Identifying significant predictors for treatment success and safety outcomes can inform clinical practice, aiding in patient selection.

Evaluation of treatment outcome in extrapulmonary tuberculosis: A mixed method study from Puducherry

BackgroundExtrapulmonary tuberculosis (EPTB) is also a public health problem and involves other parts of the body other than lung. During the quarterly review meeting of State Task Force (STF), Puducherry the members raised concern about the outcome of patients referred from the medical colleges. Even though we receive 60 % feedback of initiation of treatment from the PHI but the treatment outcome of EPTB is not clear. Hence primary agenda of this research was to identify the gap in adherence to diagnostic criteria and treatment. AimTo assess the methods adopted for diagnosis of EPTB and to find out the compliance and outcome of the treatment and to identify the patient and health providers related factors that contribute to the outcome of the treatment. Material and methodStudy design: An explanatory mixed method study. Data collection: The information on methods adopted for diagnosis and category of treatment followed in EPTB was extracted from TB register and patient record sheets from the Medical College. House visits was made to trace the patients and the information related to duration of treatment and the outcome of treatment was found. Free listing was conducted to explore the reasons (facilitating and barriers) contributed to the outcome of the EPTB patients. Data analysis: Using EpiData (version 3.1, EpiData Association, Odense, Denmark), data was entered and analysed. The qualitative data was entered and analysed using Visual Anthropac (Ver_1.0.1.36; Analytic Technologies, Inc., USA) software package. ResultsMore than three-fourth (83.6%) of the patients completed extrapulmonary tuberculosis treatment. The site of EPTB emerged as significant predictor for disease outcome. The most salient facilitating factors and barriers contributed to the outcome of treatment were “periodic reminders and care by the family members” and Side effects such as giddiness, loss of sleep and appetite, discolouration of urine, gastritis, difficulty in breathing and walking, swelling of legs, weight and hair loss and myalgia” respectively. ConclusionThe study found that there is good compliance and outcome in treatment outcome. Efforts should be made to overcome the barriers to the outcome of treatment.

Heart Rate Variability and Functional Outcomes of Patients with Spontaneous Intracerebral Hemorrhage.

The relationship between heart rate variability (HRV) changes potentially indicating autonomic dysregulation following spontaneous intracerebral hemorrhage (ICH) and functional outcome has not yet been fully elucidated. This study investigated the effects of HRV during the initial 96 h after admission on 90-day functional outcome in ICH patients. We included patients with spontaneous ICH in a prospective cohort single-center study. Continuous HR data were retrieved from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) and analyzed within the following time intervals: 0-2, 0-8, 0-12, 0-24, 0-48, 0-72, and 8-16, 16-24, 24-48, 48-72, 72-96 h after admission. HRV was determined from all available HR values by calculating the successive variability (SV), standard deviation (SD), and coefficient of variation (CV). Low HRV was set as SD ≤ 11.4 ms, and high HRV as SD > 11.4 ms. The clinical severity of ICH was assessed using the National Institutes of Health Stroke Scale (NIHSS) and functional outcome using the modified Rankin Scale (mRS). Good functional outcome was defined as mRS 0-2. The cohort included 261 ICH patients (mean age ± SD 69.6 ± 16.5 years, 48.7% female, median NIHSS 6 (2, 12), median ICH score 1 (0, 2), of whom 106 (40.6%) had good functional outcome. All patients had the lowest HRV at admission, which increased during the first two days. Comparing ICH patients with low HRV (n = 141) and high HRV (n = 118), those with good outcome showed significantly lower HRV during the first three days (0-72 h: HRV SD good outcome 10.6 ± 3.5 ms vs. poor outcome 12.0 ± 4.0 ms; p = 0.004). Logistic regression revealed that advanced age, high premorbid mRS, and high NIHSS at admission were significant predictors of poor functional outcome, while reduced SD of HRV showed a non-significant trend towards good functional outcome (0-72 h: OR 0.898; CI 0.800-1.008; p = 0.067). Our results indicate autonomic dysfunction with sympathetic hyperactivity after spontaneous ICH, as reflected by the evidence of the lower HRV in the first days. Initially increased sympathetic tone appears to have a protective effect, as suggested by the comparatively lower HRV in patients with good functional outcome at the first days.

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Dysphagia Severity and Quality of Life in Nasopharyngeal Cancer Patients after Intensity Modulated Radiotherapy (IMRT).

Background: Patients treated with definitive radiotherapy for nasopharyngeal carcinoma (NPC) develop severe dysphagia, affecting their quality of life. Traditional prognosis biomarkers are insufficient, leading to a search for new predictors like neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Methods: We retrospectively enrolled 44 NPC patients who underwent definitive radiotherapy between 2010 and 2018. EQUATOR and STROBE network guidelines were adopted. Pre-treatment evaluations were conducted, and post-treatment oropharyngeal dysphagia was assessed using the Sydney Swallow Questionnaire (SSQ) and FEES, then assigning a Dysphagia Outcome and Severity Scale (DOSS) level. Patients were divided based on NLR and PLR cut-offs, comparing subjective dysphagia (SSQ) scores and DOSS results at baseline and after a 5-year follow-up. Multiple linear regression was used for analysis. Results: At baseline, the mean NLR was 2.52 ± 1.10, and the PLR was 208.40 ± 94.35. Multivariate analysis indicated NLR and PLR as significant predictors of DOSS outcomes (p < 0.001). Conclusions: Baseline inflammation markers, such as NLR and PLR, may be used to predict dysphagia severity in NPC patients undergoing definitive radiotherapy. These markers could help identify patients at higher risk for severe dysphagia and implement tailored therapeutic and rehabilitative strategies to improve their quality of life. Further studies with larger cohorts are needed to confirm these findings and explore additional prognostic factors for dysphagia outcomes in NPC patients.

Association of Systemic Inflammatory Response Index and Neutrophil-to-Lymphocyte Ratio on Unfavorable Functional Outcomes in Acute Ischemic Stroke Patients After Endovascular Therapy

BACKGROUNDInflammatory markers for the prognosis of acute ischemic stroke (AIS) with endovascular therapy remain unclear. The purpose of this study was to investigate the association between the Systemic Inflammatory Response Index (SIRI) and Neutrophil-to-Lymphocyte Ratio (NLR) with unfavorable functional outcomes at 90-day in individuals of AIS who underwent endovascular therapy. METHODS128 AIS patients who had endovascular therapy were enrolled from the Nanjing Stroke Registry between September 2019 and November 2022. Peripheral venous blood was collected from patients within 24 h of admission for information on the following parameters: neutrophil count, lymphocyte count, monocyte count. Then, the SIRI and NLR values were calculated, and the association among SIRI, NLR, and modified Rankin Scale (mRS) scores 90 days after endovascular therapy was examined via univariate and multivariate logistic analyses. ROC curves were utilized to determine the best threshold for SIRI and NLR in predicting negative neurological outcomes following endovascular treatment for patients with AIS. RESULTS128 participants were evaluated, among which 50% had unfavorable outcomes. Linear regression analysis showed that the best threshold for SIRI was >1.407 (OR = 1.265; 95% CI, 1.071-1.493; P = 0.006), and for NLR it was >5.347 (odds ratio; OR = 1.088; 95% confidence interval [CI], 1.007-1.175; P = 0.033). These results revealed NLR and SIRI as significant predictors of unfavorable outcomes at 90 days. The AUC for SIRI and NLR in predicting 90-day adverse outcomes was 0.643 and 0.609, respectively. CONCLUSIONSHigher SIRI and NLR levels at admission may lead to unfavorable outcomes at 90 days for AIS patients with endovascular therapy.

Personalized Management of Patients with Proliferative Diabetic Vitreoretinopathy.

Purpose: To evaluate prognostic factors for visual outcome in patients with diabetes who have undergone vitrectomy (PPV) for severe proliferative diabetic vitreoretinopathy (PDVR) in at least one eye in the past 15 years. Methods: Medical records of 132 eyes of 66 patients were analyzed (median age 52 years 21-80; patients with type 1/2 diabetes 40/26; median follow-up 38 months 9-125). Correlations between final favorable visual outcome defined as 0.5≤ best-corrected visual acuity (BCVA) and prognostic factors (age, sex, type and duration of diabetes, metabolic status, BCVA, diabetic retinopathy status, data of preoperative management, data of vitrectomy, and postoperative complications) were analyzed. Results: BCVA improved significantly in the entire study cohort (from median 0.05 min-max 0.001-1 to 0.32, 0.001-1, p < 0.001). Visual stabilization was achieved in the majority of patients, and good visual acuity (0.5 ≤ BCVA) was maintained in more than one-third of the eyes. Multivariable GEE statistics showed that in addition to the duration of diabetes and stable HbA1c values, only preoperative tractional macular detachment proved to be an independent significant predictor of visual outcome. Conclusions: Pars plana vitrectomy is a useful tool when performed early before tractional macular detachment. However, long-term visual stability can only be achieved with good metabolic control.

REVIVED BCIS-2: update and key learnings.

This review summarises the shifting paradigms in the treatment of ischemic left ventricular dysfunction, spotlighting the revascularization for ischemic ventricular dysfunction-British cardiovascular intervention society-2 (REVIVED-BCIS2) trial results and its impact on key therapeutic goals: survival, left ventricular function, arrhythmia prevention, quality of life and viability testing. The REVIVED-BCIS2 trial, and its subsequent sub studies highlighted that (PCI) does not provide additional benefits to optimal medical therapy in terms of improving survival, left ventricular (LV) function, arrhythmic risk or quality of life. Additionally, viability testing did not differentiate patients who could benefit from PCI, although scar burden was found to be a significant predictor of outcome in these patients. The outcomes of REVIVED have challenged multiple existing beliefs in the field of ischaemic left ventricular dysfunction management, emphasising the importance of investigating evidence free areas in our practice. Future work, including the STICH3 international consortium of trials, aims to answer some of the remaining unanswered questions.

Does concordance between preoperatively measured prostate volume and enucleated weight predict outcomes in endoscopic enucleation of the prostate? Results from the REAP database.

We aimed to determine if preoperative prostate volume-enucleated weight concordance predicts short-term anatomical endoscopic enucleation of the prostate (AEEP) outcomes using the REAP international database. 649 patients with data on both preoperative ultrasound-derived prostate volume and enucleated specimen weight were analyzed. Linear regression was used to investigate the effect of volume-weight concordance on postoperative outcomes. Model residuals were used to divide the cohort into 3 centiles: (1) less-than-expected enucleated specimen weight; (2) appropriate concordance between prostate volume and specimen weight; (3) more-than-expected specimen weight. Outcomes were also analyzed with only enucleated weight as a predictor (comparing ≤ 80g and > 80g). There was a trend towards more-than-expected enucleated specimen weight with increased age (p = 0.006). There was an increasing trend of operation time (p = 0.012) and enucleation time (p = 0.015) as specimen weight increased, and a decreasing trend of postoperative acute urinary retention (p = 0.005). Laser type, enucleation method, and early apical release were similar. In correlation analysis, greater-than-expected prostate weight was associated with greater Qmax improvement at 3 months. Prostate weight alone did not appear to be a significant predictor of outcomes. If enucleated specimen weight is more than expected according to preoperative ultrasound volume measurement, greater Qmax improvement and less postoperative acute urinary retention is expected. Although precision may be limited by ultrasound approximation and inexact specimen weight measurements, these shortcomings are similar in real-world clinical practice. Overall, preoperative prostate volume and actual enucleated specimen weight should be interpreted in the context of each other to predict clinical outcomes.

Usefulness of serum transthyretin for prediction of the 1-year outcome in idiopathic pulmonary fibrosis: An evaluation of sarcopenic and nutritional indicators

BackgroundPatients with idiopathic pulmonary fibrosis (IPF) often experience sarcopenia and malnutrition. However, this has not been fully examined through longitudinal surveys. This study investigated whether sarcopenia and malnutrition were associated with 1-year outcomes in IPF. MethodsWe evaluated sarcopenia and nutritional status in 64 outpatients with IPF. We assessed the time-to-event for respiratory-related hospitalizations or deaths 12 months after enrollment. Sarcopenia was diagnosed by the criteria of the Asian Working Group for Sarcopenia, 2019. Nutritional status was assessed by serum transthyretin and the Geriatric Nutritional Risk Index (GNRI). ResultsThe average age was 73.6 ± 7.9 years, and the percent predicted forced vital capacity (FVC) was 81.9 ± 15.7%. Of the 64 patients, 24 (37.5%) had sarcopenia. The median serum transthyretin level and mean GNRI were 23.8 mg/dL and 102, respectively. Eleven patients (17.2%) experienced respiratory-related hospitalization or death within the first year. Cox regression analysis showed that the % predicted diffusion capacity for carbon monoxide, lowest oxygen saturation in the 6-min walk test, serum transthyretin level, and GNRI were significant predictors of 1-year outcomes. The Kaplan–Meier method, which divided the patients into two groups based on a transthyretin level of 22.6 mg/dL, showed a significant difference (P < 0.001, log-rank test). Sarcopenia and the percent predicted FVC did not predict the 1-year outcomes. ConclusionsThis pilot study represents the first longitudinal survey assessing patients with IPF for sarcopenia and malnutrition. Serum transthyretin levels may predict respiratory-related hospitalization or death within 1 year in patients with IPF.

Comparative Analysis of Diabetic Neuropathy Examination Scores and Nerve Conduction Velocity in Patients with Diabetic Neuropathy

Background: Diabetic neuropathy is a prevalent consequence of diabetes, resulting in substantial morbidity. Precise evaluation is essential for prompt intervention and control. The study assessed the correlation and effectiveness of the Diabetic Neuropathy Examination (DNE) scores and Nerve Conduction Velocity (NCV) as diagnostic tools in individuals with diabetic neuropathy. Methods: An observational research was done, comprising 200 diabetic patients who were diagnosed with diabetic sensory-motor polyneuropathy. Participants completed Dynamic Neuromuscular Examination (DNE) grading and Nerve Conduction Velocity (NCV) testing. The data were analysed using SPSS version 20.0. Results: The study found a considerable negative correlation (r = -0.68, p &lt; 0.001) between DNE scores and NCV results. Higher DNE scores were associated with lower NCV values. Specifically, 20% of participants had mild neuropathy, 40% had moderate neuropathy, and 40% had severe neuropathy according to DNE scores. NCV testing revealed that 65% of participants had abnormal nerve conduction, with 25% showing mild reduction, 25% moderate reduction, and 15% severe reduction. Multivariate regression confirmed that DNE scores are significant predictors of NCV outcomes (Beta = -0.52, p &lt; 0.001), even after adjusting for confounding variables such as gender, age, diabetes duration, and HbA1C levels. Conclusion: DNE scoring is a reliable tool for assessing neuropathy severity in diabetic patients, correlating well with NCV results. Integrating DNE scoring in routine clinical practice can enhance the early detection and management of diabetic neuropathy. Recommendations: Routine use of DNE scoring along with NCV testing is recommended for comprehensive evaluation of diabetic neuropathy. Further research should explore additional diagnostic tools to improve early detection and intervention. Keywords: Diabetic Neuropathy, Diabetic Neuropathy Examination Score, Nerve Conduction Velocity Testing, Diabetic Polyneuropathy, Neuropathy Assessment..