Single-center Case-control Study Research Articles

Risk Factors for Ectropion After Lower Eyelid and Cheek Reconstruction Following Mohs Micrographic Surgery.

Development of ectropion is a frequently reported complication after reconstruction of infraorbital Mohs defects. This study aimed to characterize preoperative and surgical factors contributing to ectropion development in patients undergoing reconstruction after Mohs micrographic surgery. We conducted a retrospective single-center case-control study on patients undergoing reconstruction of Mohs micrographic surgery defects involving the nonmarginal lower eyelid and upper cheek from 2011 to 2023. Pre- and postoperative photographs were reviewed to confirm defect location and postreconstructive eyelid malposition. Ectropion risk factors were determined with uni- and multivariate odds ratio analyses. A total of 202 patients were included, 45 cases in the ectropion group and 157 in the control group. Negative orbital vector (P = 0.02), recurrent disease (P = 0.01), and greater defects size (P = 0.007) were associated with postreconstructive ectropion. Ectropion was more likely after multidisciplinary reconstruction (13.3% versus 1.4%, P < 0.001) and reconstruction with cervicofacial flaps (28.9% versus 4.2%, P < 0.0005); and less likely after primary closure (8.9% versus 28.5%, P < 0.001). Multivariate assessment (odds ratio [95% confidence interval], P value) revealed that combined cheek and eyelid defect involvement (4.32 [1.36-13.6], P = 0.01), larger size (1.07 [1.03-1.13], P < 0.001), and negative orbital vector (12.11 [2.65-65.42], P = 0.002) were independent risk factors for ectropion development. Combined cheek/lower eyelid defects and negative orbital vector increase the risk of postreconstructive ectropion. These findings can be used to optimize surgical technique and counsel patients on increased likelihood of this complication with possible need for revision surgery.

Using left atrial strain values and correlating changes in left atrium area and volume size as an early predictor of atrial fibrillation: a prospective, single-centre case-control study

Abstract Background Atrial fibrillation (AF) is the most common type of arrhythmia and is characterised by chaotic, fast, and irregular electrical activity. AF detection is often incidental as patients may be asymptomatic. Turbulent blood flow and poor atrial contraction increase the likelihood of thrombus formation, and ultimately, increase stroke risk. New techniques focussing on LA strain analysis may be able to detect subtle changes within the LA, before gross cardiac structural and electrical remodelling has occurred. Aim Differences in LA strain values between three groups: normal sinus rhythm (NSR) and normotensive, NSR and hypertensive, and chronic AF. Correlations between LA strain to LA area and volume size were also investigated as well as the use of LA strain as an early predictor of AF. Methods A total of 72 participants were successfully recruited and allocated into one of three groups. 24 participants in the control group, 28 in the disease-control group; and 20 in the disease group. LA strain analysis was performed using the AFI LA atrial strain tool to obtain reservoir (LASr), conduit (LAScd) and contractile (LASct) strain from apical 4- and 2-chamber images. Area and volume (LAVMax) measurements were also obtained, allowing for Pearson’s Correlation Coefficient analysis comparing LA strain values to LA area and volume size. Linear regression was also performed to determine whether a reduction in LA strain may increase the risk of AF development. Results All data was found to have normal distribution. A One-Way ANOVA demonstrated that there were statistically significant differences in LA area, LASr (A4C, A2C and Biplane), and LAVMax (A4C, A2C and Biplane). When comparing mean LA area, volume and LASr between the control and disease groups, all p values &amp;lt; 0.001. Average Biplane LASr values are as follows: NSR and normotensive = 25.2% (±6.22%); NSR and hypertensive = 23.3% (± 618%); and AF group = 11.3% (±7.24%). This creates a scale demonstrating the significant reduction in LA strain in AF patients. Pearson’s Correlation indicated that there was a significantly moderate, negative correlation between Biplane LASr and LA area (r = -0.454, p &amp;lt; 0.001, N = 57), and between Biplane LASr and Biplane LAVMax (r = -0.580, p &amp;lt; 0.001, N = 72). Furthermore, a simple bivariate linear regression indicated that an increase in one point in research group type, would correspond, on average, with a decrease in Biplane LASr value by around 0.38 to 0.72 points. Suggesting that as LASr values decrease, the likelihood of AF increases. Conclusion LASr values are significantly different between patients in NSR and AF and LASr values correlate negatively with LA area and volume. It is possible to suggest that decreased LASr values, in patients with or without hypertension, can be used as a novel and alternative measure of atrial dysfunction in patients with risk factors for AF; LASr may be able to predict risk of AF development and subsequent progression.

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

P0491 Cumulative Inflammatory Burden and Structural Bowel Changes as Independent Risk Factors for Colonic Dysplasia in Ulcerative Colitis: A Case-Control Study

Abstract Background Long-standing inflammation has been implicated in the development of colonic dysplasia in ulcerative colitis (UC). However, the relationship between varying degrees of inflammatory exposure and dysplasia risk remains poorly understood. We aimed to identify risk factors for colonic dysplasia in UC patients, with particular focus on quantifying long-term inflammatory exposure. Methods In this retrospective single-center case-control study, we reviewed 55 UC patients diagnosed with colonic dysplasia (low-grade, high-grade, or cancer) between 2013 and 2022, and 110 randomly selected UC patients without dysplasia as controls. Endoscopic inflammation was scored using the Mayo endoscopic subscore (0-3), and cumulative inflammatory exposure was calculated by multiplying these scores with the duration of each endoscopic follow-up period. Clinical factors and endoscopic findings were compared between groups, and logistic regression analysis was performed to identify independent predictors of dysplasia. Results Univariate analysis showed that the dysplasia group had significantly higher frequencies of anemia (hemoglobin &amp;lt;10 g/dL), elevated ESR (&amp;gt;18 mm/hr at diagnosis), steroid and biologics use, tubular or shortened colon, and high cumulative endoscopic inflammation scores (&amp;gt;10). In multivariate analysis, after adjusting for age, gender, and disease duration, both tubular or shortened colon (OR 3.172, 95% CI: 1.029-9.780) and high cumulative endoscopic inflammation score(&amp;gt;10) (OR 4.205, 95% CI: 1.065-16.600) were independently associated with increased dysplasia risk. Conclusion High cumulative inflammatory burden, as indicated by elevated endoscopic inflammation scores and structural bowel changes, significantly increases the risk of colonic dysplasia in UC patients. More intensive surveillance strategies may be warranted for patients with these objective risk indicators to enable early detection of colitis-associated dysplasia.

Impact of Earthquakes During COVID-19 Lockdown on the Pediatric Injury Pattern in the Zagreb Urban Area.

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, like an earthquake, that influences the number of injured children's referrals. Therefore, this study aimed to investigate the influence of earthquakes during the COVID-19 lockdown on pediatric injury pattern referrals at a tertiary care hospital in a urban setting. Methods: A retrospective single-center case-control study comprised a time interval at the time of the COVID-19 lockdown, starting with a day when the biggest earthquake happened and finishing at the end of the confinement period in Zagreb, Croatia (22 March-27 April 2020). The control group comprised the identical time interval in 2019. We identified all successive pediatric trauma patients referred to the Pediatric Emergency Department. Demographics and leading injury characteristics were analyzed. Results: We analyzed data from 1166 patients. In the case group, the median age was lower than in the control group but without gender differences. We detected a decrease in Pediatric Emergency Department referrals and a reduced proportion of pediatric trauma patients in the case group. Additionally, the proportion of shoulder/elbow injuries and head injuries was higher, and the proportion of foot/ankle injuries was lower in the case period than in the control period. Conclusions: Earthquakes during the COVID-19 lockdown changed the pattern of pediatric injuries. These data can be used to restructure health resources during similar conditions to provide optimal health care to children.

Risk of comorbidity of autoimmune liver disease in patients with inflammatory bowel disease: A single-center case-control study in China.

To investigate the prevalence of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), and the impact of comorbidity of AIH, PBC, and PSC on hospitalization burden in patients with inflammatory bowel disease (IBD). Inpatients admitted to Peking Union Medical College Hospital from January 1, 1998 to December 31, 2021 were included. Odds ratio (OR) and the corresponding 95% confidence interval (CI) were calculated to compare the risk of AIH, PBC, and PSC between IBD and non-IBD patients. Medical cost and length of hospitalization were compared between IBD patients with and without AIH, PBC, or PSC. Among the included 858 967 inpatients, there were 3059 patients with IBD. Additionally, there were 117 patients with AIH, 879 patients with PBC, and 35 patients with PSC, regardless of having IBD or not. Patients with IBD had a significantly higher risk of AIH (OR 4.87, 95% CI 1.20-19.71, p = 0.03) and PSC (OR 112.28, 95% CI 53.88-233.98, p < 0.01) than those without IBD. While there was no significant difference in the risk of PBC between patients with and without IBD (OR 1.60, 95% CI 0.67-3.86, p = 0.29). The medical cost of each hospitalization did not differ between IBD patients with and without AIH, PBC, or PSC. IBD patients had a higher risk of AIH and PSC. Comorbidity of AIH, PBC, or PSC has no significant effect on the average cost of each hospitalization in IBD patients.

The impact of the COVID-19 pandemic on hospital presentations in adults with gastrointestinal infections at a tertiary centre in Australia.

The COVID-19 pandemic resulted in the enactment of substantial public health measures aimed at reducing the transmission of respiratory viruses. The impact of these measures on gastrointestinal (GI) infections remains unexplored. To determine whether there was a change in the number of patients presenting to The Royal Melbourne Hospital with GI infections during the COVID-19 pandemic compared to the year prior. We conducted a retrospective, single-centre case-control study comparing the incidence and characteristics of hospitalisations with GI infections from March to August 2019 and across the same months in 2020, corresponding to periods immediately prior to and during the COVID pandemic. Of 430 presentations with GI infections across both time periods, there was a 51.9% decrease in hospitalisations with GI infections during the pandemic. Patients admitted during the pandemic were more likely to be admitted to the intensive care unit (0.71% vs 3.4%, P < 0.04) and to be prescribed antibiotics (21.9% vs 36.1%, P < 0.01). Length of stay and mortality were unchanged. There was a decline in the number and proportion of patients with positive faecal cultures in 2020, primarily attributed to a significant reduction in Norovirus cases (28% vs 4%) (odds ratio (OR) = 0.093, P < 0.01). Conversely, the proportion of patients presenting with Clostridioides difficile was higher in 2020 (22% vs 44%) (OR = 2.4, P = 0.01). There was a substantial decrease in hospital admissions with GI infections, particularly Norovirus, during the COVID-19 pandemic. Admissions because of Clostridioides increased. Stringent public health measures reducing interpersonal contact and increased antibiotic prescribing respectively may explain these changes, while an increased reluctance to seek medical care may also have contributed to the sharp overall decrease in hospitalisations.

Transesophageal 3-dimensional echocardiographic guidance for pacemaker lead placement improves lead position accuracy and reduces fluoroscopy.

Pacemaker and implantable cardioverter-defibrillator (ICD) lead placement traditionally uses fluoroscopy, often with inaccurate lead placement on the free wall rather than on the ventricular septum, with associated longer QRS duration and pacemaker-induced cardiomyopathy while exposing staff and patients to radiation. We sought to determine whether transesophageal 3-dimensional echocardiography (3DE) guidance improves lead placement accuracy in the ventricular septum, results in shorter paced QRS durations, and reduces fluoroscopy exposure. In a single-center case-control study, 3DE guided right ventricular or atrial pacemaker and ICD leads to the desired location, with fluoroscopy used per operator preference. Ventricular lead location, paced QRS duration, and fluoroscopy times were recorded and compared with historical controls that used only fluoroscopy during procedures. In 59 patients, 3DE guidance substantially improved ventricular lead placement in the septum (78.4% vs 29.8%; P < .001) rather than in the free wall (3.9% vs 57.4%; P < .001) compared with 72 historical controls; this difference was more pronounced when only pacemaker leads were considered (90.2% vs 39.4% [P < .001] for septal and 2.4% vs 45.5% [P < .001] for free wall locations). Compared with controls, 3DE guidance reduced fluoroscopy times (6.6 vs 11.2 minutes for all leads [P = .005] and 4.7 vs 9.5 minutes for right ventricular leads [P = .014]) and trended toward shorter paced QRS durations (133 ms vs 141.5 ms; P = .084). For pacemaker and ICD lead placement, 3DE guidance substantially improves the accuracy of lead placement in the septum, with a shorter QRS duration, while reducing fluoroscopy exposure.

Pain and small fiber pathology in men with fibromyalgia syndrome.

Small fiber pathology may be involved in the pathophysiology of pain in women with fibromyalgia syndrome (FMS). This prospective single-center case-control study provides detailed pain phenotyping and small fiber pathology data in a cohort of men with FMS on a morphological and functional level. Forty-two men with FMS underwent a comprehensive pain-related interview and neurological examination, a questionnaire and neurophysiological assessment, and specialized small fiber tests: skin punch biopsy, quantitative sensory testing including C-tactile afferents, and corneal confocal microscopy. Data were compared with those of healthy male controls. Men with FMS reported generalized and permanent pain with additional pain attacks and a mostly pressing pain character. Intraepidermal nerve fiber density was reduced at ≥1 biopsy site in 35 of 42 (83%) men with FMS (controls: 32/65, 49%). Compared with male controls, men with FMS had elevated cold (P < 0.05) and warm detection thresholds (P < 0.001) and an increased mechanical pain threshold (P < 0.05) as well as an impairment of C-tactile afferents (P < 0.05). Corneal nerve fiber density was lower in male patients with FMS vs healthy men (P < 0.01). Male FMS patients with pathological skin innervation at ≥1 biopsy site compared with those with normal skin innervation had a higher clinical Widespread Pain Index (P < 0.05) indicating an association between the severity of cutaneous denervation and symptom load. We show a distinct pain phenotype and small nerve fiber dysfunction and pathology in male patients with FMS. These findings may have implications for the diagnosis and management of men with FMS.

Abstract 4144528: The Polygenic Mechanisms of Dilated Cardiomyopathy Contribute to The Development of Tachycardia-Associated Cardiomyopathy in Patients With Atrial Tachyarrhythmias

Background Longstanding tachycardia can lead to reversible left ventricular (LV) systolic dysfunction called tachycardia-associated cardiomyopathy (TAC). It is unknown if there is a genetic predisposition to the development of TAC or whether there is overlap between the genetic pathways of TAC and dilated cardiomyopathy (DCM). Research Questions Is there a genetic predisposition towards the development of TAC in individuals with arrhythmia? If so, do these genetic pathways overlap with those of DCM? Methods/Approach The study is a single-center case control study performed at the Montreal Heart Institute (MHI). Inclusion criteria for TAC cases are shown in Table 1. All cases underwent array genotyping and exome sequencing. Previously genotyped controls with arrhythmia but no documented LV dysfunction were included from the MHI Biobank. Following imputation using the TOPMed imputation server, a polygenic score for DCM (PGS DCM ; PGS000666) was calculated for cases and controls. The rate of (likely) pathogenic variants in known cardiomyopathy genes was reported in cases. Results/Data (descriptive and inferential statistics) The study included 107 cases and 878 controls. Case characteristics are shown in Table 1. The average PGS DCM for cases was significantly higher than that of controls (p-value &lt;10 -10 ; Figure 1). Logistic regression with correction for age, sex, and ancestry (principal components) showed a strong association of PGS DCM with TAC (OR 1.99, 95% CI 1.54-2.58; p-value &lt;10 -6 ). Notably, among patients with atrial tachyarrhythmias, those with a PGS DCM above the 95 th percentile had a 3.53-fold increased risk of TAC (p-value 4.5 -4 ). Exome sequencing in TAC cases identified only 2/107 (2%) carriers of (likely) pathogenic variants (in cardiomyopathy genes TNNT2 and MYH7 ). Conclusions Pathogenic variants account for a small minority of TAC cases. In contrast, a significant association between PGS DCM and TAC is suggestive of a shared polygenic pathway between TAC and DCM.

MRI findings of newly present benign focal hepatic observations following chemotherapy: distinct features in early- and late-term follow-up.

To evaluate gadoxetic acid-enhanced (Gd-EOB-DTPA) MRI features of newly detected benign focal hepatic observations after chemotherapy. In this retrospective single-center case-control study, we enrolled a cohort of 43 cancer patients with 93 newly detected benign focal hepatic observations after chemotherapy between January 2010 and December 2020. We evaluated several parameters including the delay of occurrence after chemotherapy, imaging features, and imaging follow-up. These parameters were compared with those observed in a control group comprising 34 patients with 93 hepatic metastases. For focal hepatic observations occurring at early-term follow-up (delay of occurrence after chemotherapy, median 3 months, range 1-6 months) with 22 patients encompassing 45 lesions, most lesions exhibited an ill-defined margin on HBP images (64.4%), negative on diffusion-weighted images (84.4%), mottled hypo-intensity on hepatobiliary phase images (88.9%), and undistorted vessels traversing the lesions (80.0%). Follow-up imaging indicated that 91.9% of these lesions resolved within 4-20 months. For focal hepatic observations occurring at late-term follow-up (delay of occurrence after chemotherapy, median 34 months, range 12-60 months) with 21 patients encompassing 48 lesions, which were diagnosed as focal nodular hyperplasia (FNH)-like lesions based on MRI features. A hepatobiliary ring enhancement was observed in 56.3% of lesions, and 66.7% of patients showed an increase in lesion size and/or number during follow-up imaging. Focal hepatic observations occurring at early-term and late-term follow-ups after chemotherapy have distinctive imaging features at Gd-EOB-DTPA-MRI. Early-term focal observations tend to resolve spontaneously, whereas FNH-like lesions can increase in size and number during follow-up. Question Focal benign liver lesions related to chemotherapy-induced hepatic injury were reported in recent years, often leading to confusion with metastasis and resulting in misdiagnosis. Findings Chemotherapy-induced focal hepatic observations identified during early- and late-term follow-up exhibit distinct imaging characteristics on Gd-EOB-DTPA-MRI and demonstrate varying temporal changes. Clinical relevance Chemotherapy-induced hepatic observations can be differentiated from metastasis based on Gd-EOB-DTPA MRI findings and their temporal changes. A deeper understanding of their findings can avoid unnecessary biopsies or surgical resections.

Predicting new-onset persistent conduction disturbance following transcatheter aortic valve replacement: the usefulness of FEOPS finite element analysis

BackgroundDespite the frequency of persistent new-onset conduction disturbances after transcatheter aortic valve replacement (TAVR), few preoperative methods of prediction exist.MethodsPatients who underwent TAVR in the Department of Cardiology of the Second Affiliated Hospital of the Army Medical University from December 2020 to September 2021 and postoperative aortic root modeling via the FEOPS finite element analysis were included in this single-center case–control study, divided into persistent conduction disturbances (PCD) and non-PCD groups according to their pre- and postoperative electrocardiograms in the first month. Risk factors affecting PCD were identified by comparing the baseline data of these two groups, including echocardiograms, computed tomography angiography of the aortic root, surgical decision-making, and FEOPS data. Independent risk factors were screened using logistic regression modeling, and the receiver operating characteristic (ROC) curve was used to test the predictive ability.ResultsA total of 56 patients were included in this study, 37 with bicuspid aortic valve (BAV) and 19 with trileaflet aortic valve (TAV), with 17 cases of PCD. The contact pressure index (CPI) of FEOPS, valve oversize ratio, differences between membranous interventricular septum length and implantation depth (ΔMSID) and valve implantation depth were statistically different (P < 0.05). CPI could be used as an independent risk factor for PCD (P < 0.05), and the ROC curve comparison showed that the CPI was more predictive (AUC = 0.806, 95% CI: 0.684–0.928, P = 0.001).ConclusionsThe CPI of FEOPS has better predictive value for new-onset conduction disturbance after TAVR compared to other known predictors.

Impact of Pemphigus on Sleep Quality: A Prospective Observational Single-Center Case-Control Study.

Pemphigus, an autoimmune disorder, significantly impacts the quality of life for those affected. This study examined the sleep quality in patients with pemphigus, a domain for which the existing literature provides limited data without a focused analysis. A total of 156 individuals, 52 in the case and 104 in the control group, completed several questionnaires (Pittsburgh Sleep Quality Index [PSQI], General Health Questionnaire-12 [GHQ-12], and ABQOL [Autoimmune Bullous Disease Quality of Life]). Disease severity was evaluated using the Pemphigus disease area index (PDAI index). The case group exhibited significantly higher levels of psychological distress, reflected in GHQ-12 scores (P = 0.00), and notably poorer sleep quality compared to controls across various parameters (sleep latency [SL], disturbances [SDi], medication [SM], daytime sleep dysfunction [DSD]), and the global PSQI score (GS)] (P = 0.00)). Significant correlations were observed between PDAI scores and sleep duration (SDu) (P = 0.01), SM (P=0.03), SL (P =0.03), and GS (P=0.00). An association was found between the equivalent steroid intake and SDu (P=0.00) as well as GS (P=0.02). No statistically significant correlation emerged between disease duration and PSQI scores. Our findings indicated a correlation between poor sleep quality and cutaneous rather than mucosal manifestations (p=0.01). Pemphigus affects sleep quality. Severe disease showed heightened SDi, correlating with higher steroid doses, and in the chronic phase, the impact seems to have been more influenced by the pro-inflammatory stage of the disease. Patients with cutaneous pemphigus exhibited reduced sleep quality compared to those with oral pemphigus. Understanding that pemphigus worsens sleep quality can be beneficial for the holistic management of individuals with this condition.

Characteristics of the fundus and optical coherence tomography angiography metrics in myopic patients with myelinated retinal nerve fibers

AimsTo investigate the fundus characteristics and macular optical coherence tomography angiography (OCTA) metrics in patients with myelinated retinal nerve fibers (MRNF) and to identify the associations among myopic parameters, fundus metrics, and OCTA metrics.MethodsThe single-center case-control study included 15 patients with monocular MRNF and 15 patients without MRNF, matched for age, affected eyes’ spherical equivalent error (SER), and axial length (AL) between May 2021 and December 2021. Fundus features, including the entire MRNF area (Area1), the denser MRNF area (Area2), and the shortest distance from the fovea to the MRNF border (Df−m), along with ocular parameters, including SER, AL, best corrected visual acuity (BCVA), and OCTA metrics at the fovea, including choroidal (ChT) and retinal (ReT) thicknesses at the fovea, the foveal avascular zone area (FAZ), foveal avascular zone perimeter (FAZP), FAZ-circularity index (FAZ-CI), and foveal vessel density in a 300-µm wide region (FD-300), were assessed.ResultsThe SER, AL, and BCVA were significantly different, and the ChT was thinner in the affected eyes than in the contralateral eyes. Compared with matched eyes, affected eyes had reduced BCVA and thinner ReT. In the affected eyes, both Area1 and Area2 were negatively correlated with SER (r1 = -0.84, r2 = -0.65), △SER (r1 = -0.86, r2 = -0.61), ReT at the vertical superior 3 mm (VS) (r1 = -0.78, r2 = -0.67), and ChT_VS (r1 = -0.64, r2 = -0.62), and positively correlated with AL (r1 = 0.82, r2 = 0.52) and BCVA (r1 = 0.54, r2 = 0.59). Df−m was negatively correlated with BCVA (r = -0.57).ConclusionThe presence of MRNF affects BCVA and ReT at the fovea. The area of the MRNF, as well as the distance from the MRNF to the fovea, are closely associated with the affected eyes’ BCVA, SER, AL, and the degree of anisometropia.

Pediatric orthopedic surgeons may perform better in terms of surgical outcomes in type 3 supracondylar humerus fractures: a comparative analysis.

Supracondylar fractures of the humerus represent the most common surgical fractures in pediatric patients. There is a discourse regarding the influence of the surgeon training on treatment. Different studies show equivocal effect of subspecialty training. We conducted a single center case control study to evaluate the outcomes of type 3 fractures (fully displaced) comparing pediatric-trained orthopedic surgeons (PTOS) and non-pediatric trained orthopedic surgeons (NTOS). In this retrospective study, we investigated the surgical outcomes of type 3 supracondylar fractures of the humerus in children treated between the years 2012 and 2019, divided by surgeon type. During the research, a policy reform at our department was established and PTOS became the only surgeons for those injuries starting from September 2017. Patients' demographics, perioperative details, and postoperative course were recorded. Primary outcome was reoperations, and secondary outcomes were open reductions, infections, length of surgery, and neurological deficits. 1175 patients were diagnosed with supracondylar fractures at our Level I trauma center, and 346 cases were diagnosed with radiologically confirmed type 3. Overall, 312 cases were analyzed; 113 cases were diagnosed before 1 September 2017 and treated by NTOS, and 199 cases were treated by PTOS until 31 December 2019; 7.1% (8) of the patients treated by NTOS had to be reoperated compared to 1.5% (3) of the patients treated by PTOS (P = 0.014). There was significant difference looking at postsurgical complications and surgery length. This study's findings suggest that PTOS achieve superior outcomes when treating patients with type 3 supracondylar humerus fractures. Level of evidence: Level III.

Analysis of characteristics of peripheral blood lymphocytes in endometrial carcinoma: a single-center study based on five-year clinical data

IntroductionThis study analyzed and discussed the characteristics of peripheral blood lymphocytes (PBLs) in patients with endometrial carcinoma (EC) to explore the PBLs’ clinical application value.MethodsThis single-center case‒control study analyzed the clinical data of patients with EC and uterine fibroids who underwent surgery at the First Affiliated Hospital of Chongqing Medical University between October 2018 and October 2023 retrospectively. The Center for Clinical Molecular Medical Detection of our hospital performed PBLs detection using flow cytometry, and recorded the detection results in the electronic medical records system. Between-group and subgroup comparisons of PBLs in patients with EC were analyzed using t-test or Mann–Whitney U test. The effect of surgery on PBLs in patients with EC was assessed using a paired t-test or the Wilcoxon signed rank test.ResultsThe immune function of patients with EC was significantly lower than that of healthy people (P < 0.05) and those with benign uterine diseases (P < 0.05) and was related to body mass index (BMI), hypertension, diabetes, and blood lipids (P < 0.05). In patients with EC, the PBLs counts decreased significantly after surgery (P < 0.05) and more kinds of lymphocytes were affected in the laparoscopic surgery group than in the open surgery group.ConclusionsWith the decrease of PBLs counts, the immune status of patients with EC is impaired. Metabolic syndrome (Mets), including obesity, hypertension, diabetes, and high blood lipids, also affects the immune function of patients with EC. And for EC patients, the effect of laparoscopic surgery is greater than that of open surgery. PBLs has the potential to be one of indicator during the diagnosis and treatment of EC.Trial registrationThis study was retrospectively registered by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (approval number K2023-578).

Acute kidney injury and mortality in patients with critical COVID-19 in Mexico: case-control study.

We aimed to test the association between acute kidney injury (AKI) and mortality in critically ill patients with Coronavirus disease 2019 (COVID-19). We conducted a single-center case-control study at the intensive care unit (ICU) of a second-level hospital in Mexico. We included 100 patients with critical COVID-19 from January to December 2021, and collected demographic characteristics, comorbidities, APACHE II, SOFA, NEWS2, and CO-RADS scores at admission, incidence of intrahospital complications, length of hospital and ICU stay, and duration of mechanical ventilation, among others. The median survival of deceased patients was 20 days. After multivariable logistic regression, the following variables were significantly associated to mortality: AKI (adjusted odds ratio [AOR] 6.64, 95% confidence intervals [CI] = 2.1-20.6, p = 0.001), age > 55 years (AOR 5.3, 95% CI = 1.5-18.1, p = 0.007), and arrhythmias (AOR 5.15, 95% CI = 1.3-19.2, p = 0.015). Median survival was shorter in patients with AKI (15 vs. 22 days, p = 0.043), as well as in patients with overweight/obesity (15 vs. 25 days, p = 0.026). Our findings show that the development of AKI was the main risk factor associated with mortality in critical COVID-19 patients, while other factors such as older age and cardiac arrhythmias were also associated with this outcome. The management of patients with COVID-19 should include renal function screening and staging on admission to the Emergency Department.

Effect of postoperative normothermic intraperitoneal chemotherapy on the prognosis of MPM patients receiving CRS+HIPEC: A single-center case-control study

BackgroundThe comprehensive treatment strategy, mainly cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), combined with systemic and intraperitoneal chemotherapy, is the standard treatment for malignant peritoneal mesothelioma (MPM), which can significantly prolong the survival of patients. The aim of this study is to investigate the clinical significance of postoperative normothermic intraperitoneal chemotherapy (NIPEC) in MPM patients. MethodsData of 152 MPM patients who underwent CRS + HIPEC and postoperative intravenous chemotherapy were retrospectively analyzed. Patients were divided into the Non-NIPEC group and the NIPEC group according to whether they received NIPEC after surgery. The baseline characteristics of the two groups were compared, and the survival outcome was analyzed in subgroups according to completeness of cytoreduction (CC) score. Multivariate survival analysis was used to determine the independent prognostic factors. ResultsIn CC 0–1 and CC 2–3 subgroups, there was no significant difference in baseline characteristics between Non-NIPEC and NIPEC groups. Survival analysis showed that for CC 0–1 patients, there was no significant difference in overall survival (OS) between Non-NIPEC and NIPEC groups (P = 0.503). However, for CC 2–3 patients, the median OS of the NIPEC group was significantly longer than that of the Non-NIPEC group (24.5 vs. 10.3 months, P = 0.005). Pathological type, preoperative thrombosis and postoperative NIPEC (HR = 0.423, 95%CI: 0.228–0.786, P = 0.006) were independent prognostic factors for CC 2–3 patients. ConclusionsFor MPM patients receiving CRS + HIPEC, postoperative intraperitoneal combined with intravenous chemotherapy may improve the survival of CC 2–3 patients, but CC 0–1 patients do not seem to derive the same benefit.

Unveiling molecular clues: Exploring IFNγ, IL-10, and MMP7 blood levels in gastric carcinoma patients

Objective: Gastric carcinoma is a leading cause of morbidity and mortality worldwide. Early detection can help reduce mortality rates. Biomarkers are being investigated globally for their potential in disease screening, monitoring, and follow-up in various cancers. However, currently, there is insufficient data on the role of biomarkers in gastric carcinoma. Material and Methods: This single center case control study was conducted from June 2018 to March 2021 from South India. Blood samples were collected from 85 patients diagnosed with gastric carcinoma and 85 apparently healthy individuals serving as the control group. The samples were collected in a fasting state. The serum levels of biomarkers interferon gamma (IFNγ), interleukin 10 (IL-10), and matrix metalloproteinase 7 (MMP7) were measured using enzyme-linked immunosorbent assay (ELISA) and compared between the two groups. Additionally, the levels of biomarkers were compared within the gastric cancer group based on disease location, stage, and histotype. Results: The serum levels of IFNγ and IL-10 were found to be significantly elevated in gastric carcinoma patients compared to the healthy control group. Both biomarkers exhibited high sensitivity and specificity in detecting carcinoma of the stomach. However, there was no significant difference in the serum level of MMP7 between gastric cancer patients and control group. Conclusion: IFNγ and IL-10 show promise as potential molecular biomarkers for the detection of gastric carcinoma. Further, well designed studies, involving larger and more diverse populations matched for stage and histological types, are necessary to establish the screening and monitoring utility of these biomarkers in gastric carcinoma.