Single-center Observational Cohort Study Research Articles

P0798 Forty-eight months outcomes of Teduglutide in adult stable patients with short bowel syndrome and home parental nutrition dependence: a real-world italian single center observational cohort study

Abstract Background This real-life study is designed to investigate the short and long-term efficacy and safety of teduglutide (TED) and its effects on quality of life (QoL) in a cohort of adult, stable patients with short bowel syndrome and chronic intestinal failure (SBS-CIF) receiving a long term parenteral support (PS). Methods A prospective, single-center study was conducted for individuals who began using TED between March 2017 and August 2023. Results Ten patients were included in the analysis, among which the median duration of teduglutide administration was 48 (range, 12- 71) months. Data relative to short-term clinical outcomes demonstrate that 4 of 10 (40%) patients were early responders to teduglutide therapy, defined as a ≥20% reduction in PS requirement at 3 months. Six of 10 (60%) were no-responders. Data relative to 48 months long-term clinical outcomes demonstrated the absence of late responder patients and underline that all of 4 early TED responder patients continued to mantein a sustained reductions in PS. Two of the 4 patients (50%) responding to TED discontinued PS while the other 2 patients (50%) reduced the number of weekly PS infusions by approximately 50%. The physical and mental components of QoL improved significantly (p<0.05) in responsive patients while they did not change in non-responsive ones. Predictibility of response to TED therapy in this study seems to be linked to: i) SBS type 3 that is completely absent in the no-responder patients (p<0.0001), ii the residual small bowel length significantly (p<0.02) higher in the responder (102=18 cm) compared to no-responder patients (67=27 cm), and i11) SBS type 1 and 2, enterostomy, surgical complications are significantly predictive of no response. Crohn's disease is equally present in both responder and non-responder patients. The number of side effects observed in our experience is extremely rare both at the 3th (0.01 n°/day/patients) and at the 48th months (0.001 I°/day/patients). No endoscopic neoplastic lesions were observed up to the 48th month of TED therapy. Conclusion This real-world experience allows us to state that, after 48 months of treatment, TED: a) is a safe therapy with minimal side effects: b) produces a rapid reduction in PS volumes in 40% of treated patients; c) consents to weaned off PS in 20% of enrolled patients; d) maintains a stable nutritional state and, finally, e) significantly improves Qol.

Effects of Spinal Cord Stimulation in Patients with Small Fiber and Associated Comorbidities from Neuropathy After Multiple Etiologies.

Objectives: The aim of this study was to evaluate the effects of spinal cord stimulation (SCS) on pain, neuropathic symptoms, and other health-related metrics in patients with chronic painful peripheral neuropathy (PN) from multiple etiologies. Methods: A prospective single center observational longitudinal cohort study assessed SCS efficacy from April 2023 to May 2024, with follow-ups at 2, 4, 6, and 12 months in 19 patients suffering from the painful polyneuropathy of diverse etiologies: diabetic (DPN), idiopathic (CIAP), chemotherapy-induced (CIPN), and others. Patients were implanted with a neurostimulator (WaveWriter AlphaTM, Boston Scientific Corporation, Valencia, CA, USA) and percutaneous leads targeting the lower limbs (T10-T11) and, if necessary, the upper limbs (C4-C7). Stimulation programming was individualized based on patient preference and best response. Assessments were performed before and after implantation and included pain intensity (VAS and DN4), neuropathic pain symptoms (NPSI and SF-MPQ-2), autonomic symptoms (SFN-SIQ and SAS), sensory and small fiber nerve injury (UENS), functionality (GAF), sleep (CPSI), global impression of change (CGI and PGI), and quality of life (EQ-VAS and EQ-5D). Intra-epidermal nerve fiber density (IENFD) via skin biopsy was also performed at baseline (diagnostic) and after 12 months to assess potential small fiber re-growth. Statistical analyses were conducted to determine the evolution of treatment success. Results: To date, 19 patients have undergone implantation and completed follow-up. SCS produced a significant consistent and sustained improvement in pain intensity by 49% in DN4 and 76% in VAS, in neuropathic pain symptoms by 73%, in autonomic symptoms by 26-30%, in the sensorimotor physical exam by 8%, in functionality by 44%, in sleep by 74%, and in quality of life (69% for EQ-VAS and 134% EQ-5D). Both clinicians and patients had a meaningful global impression of change, at 1.1 and 1.3, respectively. Distal intra-epidermal nerve fiber density improved by 22% at 12 months while proximal intra-epidermal nerve fiber density decreased by 18%. Conclusions: SCS is an effective therapy for managing various types of PN.

Quantitative Pupillometry Predicts Neurologic Deterioration in Patients with Large Middle Cerebral Artery Stroke.

This study assesses whether longitudinal quantitative pupillometry predicts neurological deterioration after large middle cerebral artery (MCA) stroke and determines how early changes are detectable. This prospective, single-center observational cohort study included patients with large MCA stroke admitted to Boston Medical Center's intensive care unit (2019-2024). Associations between time-to-neurologic deterioration and quantitative pupillometry, including Neurological Pupil Index (NPi), were assessed using Cox proportional hazards models with time-dependent covariates adjusted for age, sex, and Alberta Stroke Program Early CT Score. Models using dilation velocity were compared with partial likelihood ratio tests. Pupillometric changes over 2-h intervals in the 12 h preceding deterioration were analyzed with linear mixed-effects modeling and Tukey's test. Matched referents (age, sex, stroke side, follow-up duration) were used for comparison. Optimal thresholds were identified using the Youden Index. Among 71 patients (mean age 66.5 years; 59.2% women), 32 (45.1%) experienced deterioration. A 1-unit decrease in NPi was associated with a higher hazard of deterioration (hazard ratio 2.46; 95% confidence interval 1.68-3.61). Dilation velocity improved model performance compared to NPi alone. NPi was significantly lower at 0-2 h (3.81 vs. 4.38, p = 0.001) and 2-4 h (3.71 vs. 4.38, p < 0.001) before deterioration compared to 10-12 h prior. Optimal thresholds were 4.01 for NPi, 0.49 mm/s for dilation velocity, and -0.15 change in NPi over 12 h. Quantitative pupillometry predicts neurological deterioration in MCA stroke, with declines detectable up to 12 h prior. Dilation velocity shows promise as a novel biomarker. ANN NEUROL 2025.

10-year clinical outcomes in Atypical Spitz Tumours: a prospective, single-centre observational cohort study.

Atypical Spitz Tumours are an uncommon group of lesions which demonstrate features of both benign spitz naevi and malignant spitzoid melanoma. Risk stratification of atypical Spitz tumours can be difficult, thus creating uncertainty surrounding their management. We aimed to determine the long-term clinical outcomes of atypical spitz tumours over a 10-year follow-up period, including disease recurrence and incidence of metastasis.

Accuracy of the National Early Warning Score version 2 (NEWS2) in predicting need for time-critical treatment: retrospective observational cohort study

BackgroundInitial ED assessment can use early warning scores to identify and prioritise patients who need time-critical treatment. We aimed to determine the accuracy of the National Early Warning Score version...

The Global RAdical Cystectomy Evaluation and Management (GRACEM) pathway: single-centre prospective observational cohort study protocol.

Despite guideline recommendations, few institutions have implemented clinical pathways that incorporate frailty into routine decision-making for patients undergoing radical cystectomy (RC). This paper presents an integrated clinical pathway designed to address the needs of frail patients undergoing RC. The purpose of the study is to determine whether a multifaceted prevention programme that tailors interventions to the syndromic components of frailty can improve postoperative morbidity and recovery time for patients. New insights will be gained into how to optimize the physical and mental status and quality of life of patients before and after surgery, up to 1 year later. The Global RAdical Cystectomy Evaluation and Management (GRACEM) study is a prospective, observational, single-centre, 2-year cohort study. Patient enrolment began on 27 April 2023, and results are pending. The primary endpoints are postoperative morbidity and the in-hospital postoperative care burden. Postoperative morbidity is measured by the number of early (up to 1month) and late (over 1month and up to 12 months) complications, graded by severity according to the Clavien-Dindo classification. In-hospital postoperative care burden is measured by the number and duration of key care processes as recorded by the Care Process Monitoring Chart, a tool developed for this study. Secondary endpoints are changes in frailty and health-related quality of life (HRQoL) from pre-intervention to planned follow-up up to 1year. Frailty is assessed with the Functional Limitations and Geriatric Syndromes Frailty Questionnaire (FLIGS-FQ), another ad hoc tool. HRQoL is assessed using the EQ-5D-5L questionnaire combined with the cystectomy-specific FACT-Bl-cys index from the first month of follow-up. The GRACEM study includes patients with non-metastatic, histologically confirmed, muscle-infiltrating bladder cancer who underwent RC surgery with curative intent. This study is unique in that the GRACEM Core Team shares decision-making throughout the pathway, from before the intervention to the end of the patient's follow-up. The pathway involves the patient, family members and community services.

Acellular Dermal Matrices in Reconstructive Pediatric Complex Lower Limb Trauma: An Observational Study.

Contemporary research has shown that acellular dermal matrices can benefit adult lower extremity traumatic injuries; however, its use in children has not been explored. This study aims to explore the use of acellular dermal matrices in pediatric complex lower extremity trauma. This single-center retrospective observational cohort study of children with complex lower extremity trauma treated with Pelnac™, commercial acellular dermal matrices, was conducted at a tertiary hospital in South Africa from 2010 to 2017. Demographic and clinical data were collected from medical records. The primary outcome was the rate and type of acellular dermal matrices-related complications. Secondary outcomes included the usage of negative pressure wound therapy. A total of 54 children were studied; 30 (55%) were male, and the median age was six. Forty-five children healed without complications, while nine experienced complications - four acute and five chronic. Four patients had complete loss of acellular dermal matrices, and three developed acute infections. More than 30days post-acellular dermal matrices application, five patients had hypertrophic scarring, four had joint contractures, and two had non-healing wounds. All patients who healed without complication received negative pressure wound therapy (n =45), while those who did not (n =5) developed complications. Three of the five patients without negative pressure wound therapy had acute acellular dermal matrices loss, compared to only one of the 49 patients who received negative pressure wound therapy. Our findings suggest that acellular dermal matrices may be an effective and safe reconstructive adjunct or alternative when used with negative pressure wound therapy.

Syndecan-1 in the Serum of Deceased Kidney Donors as a Potential Biomarker of Kidney Function.

The process of kidney transplantation remains the optimal treatment for end-stage renal disease, offering improved quality of life and increased survival rates compared to long-term dialysis. However, despite advances in surgical techniques, immunosuppression regimens, and post-operative care, there are still significant challenges in predicting the organ's status and long-term outcomes of transplantation. Among the many factors that influence graft survival, the quality of the donated organ plays a fundamental role. There is an ongoing need for accurate and reliable biomarkers. Syndecan-1 is found in the endothelial glycocalyx and shed at a higher rate into the blood during systemic pathological conditions. The aim of this study is to evaluate the potential of serum syndecan-1 levels as a biomarker for assessing donor kidney quality and to investigate its correlation with donor characteristics and short-term outcomes in kidney recipients. We investigated serum syndecan-1 levels in 80 deceased donors and correlated them with donor characteristics and short-term outcomes (defined as delayed graft function - defined as the need for dialysis within the first week post-transplantation and renal function at 3 months post-transplantation - assessed using serum creatinine levels) in 104 corresponding kidney recipients. This single-center retrospective observational cohort study was conducted from April to December 2021. The donor pool consisted of 65% males with a median age of 53 years. Of these, 45 donors (56%) were classified as extended criteria donors. Higher syndecan-1 levels correlated with the last creatinine levels before organ procurement (R = 0.32, p = 0.01) and were marginally higher in donors with acute kidney injury (p = 0.07). However, syndecan-1 levels were not associated with short-term outcomes in kidney recipients (renal function at 3 months). The data suggests syndecan-1 could be a potential biomarker for assessing donor kidney quality, although its implications on recipient outcomes require further study. This pilot investigation underscores the importance of syndecan-1 in evaluating organ quality but highlights the necessity for more extensive research to validate these findings and explore their implications in transplant success.

Conservative Pulmonary Arteriovenous Malformation Screening in Children: Re-Evaluation of Safety.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disease and screening to detect pulmonary arteriovenous malformations (PAVMs) is important to prevent complications. In adults, transthoracic contrast echocardiogram (TTCE) is used to screen PAVMs. In children, a conservative screening method seems to be sufficient to rule out major PAVMs and prevent them from PAVM-related complications. This study reevaluates the conservative noninvasive screening method using a larger cohort of children screened for HHT. This single-center observational cohort study includes children screened between December 1998 and December 2022. The screening consisted of medical history, physical examination, pulse oximetry, and chest radiography. Data regarding screening, PAVM presence and complications (including transient ischemic attack, stroke, brain abscess and hemoptysis) were collected using the Dutch HHT-patient database. In total, 600 children, mean age 9.9 years (SD 4.3) were screened for the presence of PAVMs. None of the 600 children screened suffered any PAVM-related complications after a total of 7102 years of patient follow-up (251 children [42%] with a definite HHT-diagnosis, accounting for 3232 years of follow-up). In 32 patients (13% of children with HHT), a treatable PAVM was found during childhood. This study confirms that a conservative PAVM screening method in children is safe to prevent complications related to PAVMs. Small PAVMs will be missed using this conservative approach, but without an increased risk of complications.

Efficacy of multimodal treatment involving Baclofen, pelvic floor physiotherapy and polysomnography for sleep related painful erections (SRPE): a single centre observational cohort study

Efficacy of multimodal treatment involving Baclofen, pelvic floor physiotherapy and polysomnography for sleep related painful erections (SRPE): a single centre observational cohort study

Intraoperative Electroencephalogram Frontal Low Alpha Power for Predicting Postoperative Delirium in Elderly Patients after Orthopedic Surgery: A Prospective Cohort Study.

Postoperative delirium (POD) is a common complication with significant adverse effects in elderly patients. Electroencephalography (EEG) provides a promising approach for predicting the risk of POD. This study aims to elucidate the correlation between intraoperative EEG spectrum and the incidence of POD in elderly patients undergoing orthopedic surgery. A single-center prospective observational cohort study was conducted at Zhongda Hospital, Southeast University, from September 2022 to March 2023, registered on Chinese Clinical Trail Registry (ChiCTR2300069548). Among the 172 patients who underwent orthopedic surgery, 125 completed the study with available data. Preoperative baseline cognitive function was assessed using the mini-mental state examination (MMSE). An intraoperative 4-channel EEG was recorded. Total power spectra and power spectral density for beta, alpha, theta, and delta bands were calculated. Spectral edge frequency, burst suppression ratio, and patient state index were directly extracted from the EEG monitor. The primary outcome was POD, assessed using a 3-minute Diagnostic Interview for Confusion Assessment Method (CAM)-Defined Delirium scale or the CAM for the Intensive Care Unit. Patients were divided into POD and non-postoperative delirium (non-POD) groups. Logistic regression analysis was conducted to evaluate the independent predictive effect of intraoperative spectral distribution and other quantitative EEG data for POD. The incidence of delirium within 72 hours after surgery was 8.8%. Compared to the non-POD group, the POD group showed significantly lower absolute power in the beta [0.06 (0.03, 0.09) dB vs 0.14 (0.08, 0.26) dB, p < 0.001], alpha [0.41 (0.25, 0.71) dB vs 1.24 (0.55, 2.57) dB, p = 0.008], and theta [0.77 (0.44, 1.01) dB vs 1.19 (0.72, 2.02) dB, p = 0.035] bands. Logistic regression analysis identified several independent risk factors for POD, including lower intraoperative alpha power [odds ratio (OR) 10.210, 95% confidence interval (CI) 1.233-84.568, p = 0.031], advanced age (OR 7.713, 95% CI 1.022-58.204, p = 0.048), preoperative anemia (OR 6.636, 95% CI 1.091-40.358, p = 0.040), and preoperative depression (OR 10.089, 95% CI 1.029-98.909, p = 0.047). In contrast, higher preoperative MMSE scores appeared to be a protective factor for POD (OR 0.130, 95% CI 0.021-0.820, p = 0.030). Intraoperative EEG frontal low alpha power demonstrated a significant independent association with POD in elderly patients after orthopedic surgery. This parameter may serve as an intraoperative neurophysiological marker of cerebral vulnerability to POD. Additionally, advanced age, lower preoperative MMSE scores, preoperative anemia, and preoperative depression were independent risk factors for POD. Chinese Clinical Trial Registry (ChiCTR2300069548).

Indications, complications and outcomes of minimally-invasive lateral lumbar interbody fusion with anterior column realignment vs. standard LLIF using expandable interbody spacers

BackgroundAnterior column realignment (ACR), using a lateral lumbar or thoracic interbody fusion (LLIF) approach to release the anterior longitudinal ligament (ALL), is a powerful technique to increase segmental lordosis. We here report our experience with the use of expandible LLIF cages for ACR.MethodsRetrospective, single-center observational cohort study including consecutive patients treated by LLIF using an expandible interbody implant. Patients with ACR were compared to patients without ACR. Our outcomes include adverse events (AEs), radiological (segmental sagittal cobb angle, spinopelvic parameters) and clinical outcomes until 12 months postoperative.ResultsWe identified 503 patients, in which we performed LLIF at 732 levels. In 63 patients (12.5%) and 70 levels (9.6%) an expandable cage was used. Of those, in 30 patients (47.6%) and 30 levels, the ALL was released (42.8%). Age (mean 61.4 years), sex (57.1% female), comorbidities and further demographic features were similar, but patients in the ACR group had a higher anesthesiologic risk, were more frequently operated for degenerative deformity and had a more severely dysbalanced spine (all p &amp;lt; 0.05). ACR was most frequently done at L3/4 (36.7%) and L4/5 (23.3%), entailing multilevel fusions in 50% (3–7 levels) and long constructs in 26.7% (&amp;gt;7 levels). Intraoperative AEs occurred in 3.3% (ACR) and 3.0% (no ACR; p = 0.945). In ACR cases, mean segmental lordosis changed from −2.8° (preoperative) to 16.4° (discharge; p &amp;lt; 0.001), 15.0° (3 months; p &amp;lt; 0.001) and 16.9° (12 months; p &amp;lt; 0.001), whereas this change was less in non-ACR cases [4.3° vs. 10.5° (discharge; p &amp;lt; 0.05), 10.9 (3 months; p &amp;lt; 0.05) and 10.4 (12 months; p &amp;gt; 0.05)]. Total lumbar lordosis increased from 27.8° to 45.2° (discharge; p &amp;lt; 0.001), 45.8° (3 months; p &amp;lt; 0.001) and 41.9° (12 months; p &amp;lt; 0.001) in ACR cases and from 37.4° to 46.7° (discharge; p &amp;lt; 0.01), 44.6° (3 months; n.s.) and 44.9° (12 months; n.s.) in non-ACR cases. Rates of AEs and clinical outcomes at 3 and 12 months were similar (all p &amp;gt; 0.05) and no pseudarthrosis at the LLIF level was noted.ConclusionsACR using an expandible LLIF interbody implant was safe, promoted solid fusion and restored significantly more segmental lordosis compared to LLIF without ALL release, which was maintained during follow-up.

Effects of Biologics on Temporomandibular Joint Inflammation in Juvenile Idiopathic Arthritis.

This prospective study investigates the efficacy of biologics in combination with methotrexate or leflunomide on juvenile idiopathic arthritis (JIA)- related temporomandibular joint (TMJ) arthritis measured by magnetic resonance imaging (MRI)-based inflammation score and deformity score. A prospective single center observational cohort study of 18 consecutive patients were performed between September 2018- April 2023. Inclusion criteria were: 1) Diagnosis of JIA, 2) MRI-verified TMJ arthritis leading to treatment with tumor necrosis factor inhibitor (TNFi), 3) MRI at 6 and 24 months after treatment initiation, 4) clinical follow-up contemporary with the MRI by a pediatric rheumatologist and an orthodontist. We included 18 patients (89% females). At time of first MRI median age was 13.2 years (IQR 11.3-16.9), median disease duration was 7.8 years (IQR 3.4-11.1) and 4 received MTX/leflunomide. During the observation period, significant improvements were observed in TMJ movement pain (p=0.01), morning stiffness (p=0.004), opening capacity (p=0.03) and maximal incisal opening (p=0.006). The inflammation score decreased significantly from median 2 (IQR 1-3) at baseline to median 1(IQR 0-2) at 24 months, p=0.009. In 17 out of 36 TMJs (48%), the deformity score improved or remained stable and no significant increase in the median score was observed. This is the first prospective observational study with evidence to support that the orofacial signs, symptoms and MRI-derived inflammation score in TMJ arthritis can be reduced by treatment with TNFi.

Comparison of ROTEM® Delta and ROTEM® Sigma transfusion algorithm performance in thoracic aortic surgery: a single-centre prospective observational cohort study

BackgroundThromboelastometry plays a key role in many transfusion algorithms. ROTEM® Sigma is the fully automated successor of ROTEM® Delta. Compatibility with current ROTEM® Delta-based algorithms remains uncertain. This study compares ROTEM® Delta with ROTEM® Sigma in patients undergoing thoracic aortic surgery. MethodsThree ROTEM® measurements in duplicate (one Delta and one Sigma) per patient were performed during aortic surgery. The primary outcome was the percentage of patients who would have received a different haemostatic intervention after protamine reversal based on the institutional ROTEM®-guided transfusion algorithm (‘deviation’). A 10% deviation was deemed acceptable. Secondary outcomes were differences in numerical values assessed by Passing–Bablok regressions, Bland–Altman plots, and correlations with conventional coagulation tests. ResultsOf 111 patients, 102 had matched post-protamine ROTEM® measurements. There were 43 algorithm deviations. Most deviations (29) were attributable to conflicting advice on CT EXTEM-based plasma or prothrombin complex concentrate (PCC) administration; in 25 patients, Delta results advised the administration of plasma or PCC, whereas Sigma did not, and vice versa in four patients. Deviations on additional protamine, fibrinogen concentrate, or platelet administration were acceptable. All numerical ROTEM® variables examined passed the criteria for equivalence, except for A10 FIBTEM at baseline and A10 EXTEM in heparinised and post-protamine samples, which would not have led to clinical consequences. Correlations with conventional coagulation tests were similar or better for Sigma compared with Delta. ConclusionsROTEM® Sigma can be used with existing ROTEM-guided transfusion algorithms in cardiothoracic surgery except for the advice for administration of plasma or PCC. Clinical Trial RegistrationNetherlands trial register NL8273.

The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy.

A significant number of patients who present with mild symptoms following large-vessel occlusion acute ischemic stroke (LVO-AIS) are currently considered ineligible for EVT. However, they frequently experience neurological deterioration during hospitalization. This study aimed to investigate the association between neurological deterioration and hemodynamic impairment by assessing steal phenomenon derived from blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) in this specific patient cohort. From the database of our single-center BOLD-CVR observational cohort study (June 2015-October 2023) we retrospectively identified acute ischemic stroke patients with admission NIHSS < 6, a newly detected large vessel occlusion of the anterior circulation and ineligible for EVT. Neurological deterioration during hospitalization as well as outcome at hospital discharge were rated with NIHSS score. We analyzed the association between these two outcomes and BOLD-CVR-derived steal phenomenon volume through regression analysis. Additionally, we investigated the discriminatory accuracy of steal phenomenon volume for predicting neurological deterioration. Forty patients were included in the final analysis. Neurological deterioration occurred in 35% of patients. In the regression analysis, a strong association between steal phenomenon volume and neurological deterioration (OR 4.80, 95% CI 1.32-31.04, p = 0.04) as well as poorer NIHSS score at hospital discharge (OR 3.73, 95% CI 1.52-10.78, p = 0.007) was found. The discriminatory accuracy of steal phenomenon for neurological deterioration prediction had an AUC of 0.791 (95% CI 0.653-0.930). Based on our results we may distinguish two groups of patients with minor stroke currently ineligible for EVT, however, showing hemodynamic impairment and exhibiting neurological deterioration during hospitalization: (1) patients exhibiting steal phenomenon on BOLD-CVR imaging as well as hemodynamic impairment on resting perfusion imaging; (2) patients exhibiting steal phenomenon on BOLD-CVR imaging, however, no relevant hemodynamic impairment on resting perfusion imaging. The presence of BOLD-CVR derived steal phenomenon may aid to further study hemodynamic impairment in patients with minor LVO-AIS not eligible for EVT.

Predictive accuracy of comorbidity index models in assessing mortality risk among hemodialysis patients: A comprehensive single-center observational cohort study.

Comorbidity prediction models have been demonstrated to offer more comprehensive and accurate predictions of death risk compared to single indices. However, their application in China has been limited, particularly among maintenance hemodialysis (MHD) patients. Therefore, the objective of this study was to evaluate the utility of comorbidity index models in predicting mortality risk among Chinese MHD patients. The MHD patients in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were taken as the subjects. Claims-based disease-specific refinements matching translation to ICD-10 and flexibility (CDMF-CCI) model and Liu model were selected as the candidate models for this verification research. Univariate and multivariate Cox regression calculations were used to analyze the independent predictive effect of the models on survival rate. Annually, nearly 500 patients undergo hemodialysis treatment. From January 2019 to June 2022, a total of 199 patients succumbed, with a mean age of 65.2 years. During these 4 years, the mortality rates were 13.04%, 9.68%, 11.69%, and 6.39%, respectively. The leading causes of death were sudden demise (82 patients, 41.2%), cardiovascular disease (48 patients, 24.1%), pulmonary infection (33 patients, 16.5%), and stroke (19 patients, 9.5%). When compared to individual indices, the CDMF-CCI model displayed more accurate and predictive results, with an HR of 1.190 (P = 0.037). Conversely, the Liu model failed to identify high-risk individuals. The MHD patients face a significant risk of mortality. When compared to univariate parameters and the Liu model, the CDMF-CCI model exhibits superior predictive accuracy for mortality in MHD patients.

Galectin-3 as an independent predictor of postoperative atrial fibrillation

Objective: to evaluate the significance of preoperative plasma galectin-3 levels for predicting postoperative atrial fibrillation (AFP) in a cohort of patients who underwent elective heart surgery.Materials and methods: this prospective observational single-center cohort study was conducted at the Research Institute – Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky, Krasnodar. In the period from September 1, 2023 to February 1, 2024, all patients admitted for elective coronary artery bypass grafting and/or valve surgery (valve replacement or reconstruction) were included in this study. In the early postoperative period, POAF developed in 158 patients, who formed the main group A, and from 436 patients with sinus rhythm, a control group B was generated using a random number generator, comparable with the main group in the number of observed patients and amounted to 160 patients.Results: the onset of POAF from the beginning of the operation is 66.2±41.7 hours (on average, on the 3rd day, minimum 1 hour, maximum 166.5 hours, i.e. on the 7th day). When comparing laboratory data in patients before the operation (blood sampling was performed 12–24 hours before cardiac surgery), a statistically significant factor associated with the development of POAF was the level of galectin-3 in the blood (2.1±1.99 ng/ml in patients from group A, 1.87±1.64 ng/ml in patients from group B, p 0.01). Moreover, the blood galectin-3 level in patients with POAF significantly increased in the early postoperative period (up to 2.75±2.1 ng/ml, p &lt;0.001), which was confirmed by the ROC curve (the area under the AUC curve was 0.522 (AUC: 0.522, 95% CI: 0.457–0.588; P =0.033)).Conclusions: preoperative plasma galectin-3 levels have an independent value for predicting POAF and can serve as a useful prognostic parameter in a multimodal approach to risk assessment in the era of personalized treatment.

Right ventricular outflow tract fractional shortening: a novel diagnostic parameter for pulmonary hypertension.

Pulmonary hypertension (PH) is a progressive vascular disease characterized by elevated pulmonary arterial pressure and resistance in the pulmonary vascular bed. It is associated with high morbidity and mortality. Although right heart catheterization (RHC) is the gold standard for diagnosis, noninvasive methods, such as echocardiography, are essential for early detection and management. This study aimed to elucidate the potential of right ventricular outflow tract fractional shortening (RVOT-FS) as a noninvasive diagnostic tool for PH. This single-center observational cohort study was conducted between November 2023 and May 2024. The study included 141 patients referred to the PH clinic (75 with confirmed PH and 66 controls). Echocardiographic measurements were performed using standard protocols, and RVOT-FS was calculated. Hemodynamic parameters were obtained via RHC. RVOT-FS was significantly lower in the PH group (35.71%, IQR: 27.15-43.33) than in the control group (54.50%, IQR: 45.21-69.17) (p < 0.001). RVOT-FS showed negative correlations with mean pulmonary artery pressure (mPAP) (r = -0.664, p < 0.001), pulmonary vascular resistance (PVR) (r = -0.526, p < 0.001), and other RHC and RV echocardiographic parameters. ROC analysis demonstrated that RVOT-FS is a reliable parameter for predicting PH, with an area under the curve (AUC) of 0.866. An RVOT-FS value of 44.05% had a sensitivity of 82.7% and specificity of 83.3% for diagnosing PH. This study revealed that RVOT-FS was significantly lower in the PH group than in the control group. The correlations also observed between RVOT-FS and mPAP, PVR, and other RHC and echocardiographic parameters imply its potential clinical utility.

Association of early perioperative stroke after cardiothoracic surgery with intraoperative regional cerebral oxygenation using near-infrared spectroscopy: an observational cohort study comparing affected versus non-affected hemispheres.

Patients undergoing cardiothoracic surgery are at risk of developing perioperative stroke, but residual effects of anesthesia may hamper timely detection. This study aims to determine if there is an association between intraoperative regional cerebral oxygenation (ScO2) monitoring using near-infrared spectroscopy (NIRS) and the occurrence of early perioperative stroke within three days after cardiothoracic surgery. We performed a single-center retrospective observational cohort study including all consecutive cardiothoracic surgery patients with routinely perioperative ScO2 monitoring admitted postoperatively to the Intensive Care Unit (ICU) between 2008 and 2017. Patients with a confirmed stroke in the anterior cerebral circulation on brain imaging were included in the analysis. Intraoperative area under the curve (AUC), duration, and total ScO2 excursions below predefined thresholds (< 50% ScO2 or > 20% reduction below baseline) were calculated for each hemisphere. Stroke-affected and non-affected hemispheres were compared using logistic regression analyses to investigate a potential association between ScO2 values and stroke. Of the 2454 cardiothoracic surgery patients with perioperative ScO2 monitoring, 39 had a anterior stroke on brain imaging. ScO2 readings of 44 affected hemispheres were compared to 34 non-affected hemispheres. Only the duration of ScO2 < 50% or a > 20% drop from baseline were significantly associated with global ischemia (OR 1.30 (0.95%CI; 1.09-2.30)) when comparing affected (72 [5 to 33] min.) versus non-affected (28 [4 to 44] min.) hemispheres. The duration of ScO2 values < 50% or a drop > 20% from baseline were associated with the occurrence of early perioperative global cerebral ischemia within three days after cardiothoracic surgery.

Functional Outcome Prediction of Acute Ischemic Stroke Based on the Oral and Gut Microbiota.

Although several studies have identified a distinct gut microbiota in individuals with acute ischemic stroke (AIS), there is a limited amount of research that has simultaneously investigated alterations in the oral and intestinal microbiota in AIS patients and their correlation with clinical prognosis. This was a prospective and observational single-center cohort study in which we included 160 AIS patients who were admitted within 24h after a stroke event. We collected oral and rectal swab samples for analysis using 16S rRNA high-throughput sequencing. Our study revealed that patients with unfavorable outcomes after AIS showed early disruptions in their oral and intestinal microbiota. Rectal swabs showed increased levels of facultatively anaerobic bacteria in patients with a poor prognosis, while the oral cavity exhibited higher levels of anaerobic and opportunistic pathogenic bacteria. By employing machine learning analysis, we found that the microbiota composition at both rectal and oral sites could predict early and long-term outcomes. Moreover, patients with a poor prognosis displayed increased oral bacterial colonization in the rectal microbiota and altered interactions between the oral and gut microbiota. This study reveals distinct rectal and oral bacteria that could predict unfavorable outcomes for AIS patients. Monitoring the microbiota of various body sites during the early stages after admission may hold prognostic value and inform personalized treatment strategies. The presence of oral bacteria colonizing the intestines during the acute phase of stroke could serve as an early indication of poor outcomes for AIS patients.