Single-center Observational Study Research Articles

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.

Clinical features and outcomes of pseudolithiasis induced by ceftriaxone in Chinese children: a single-center observational study

Clinical features and outcomes of pseudolithiasis induced by ceftriaxone in Chinese children: a single-center observational study

Effectiveness of a co-management program with internal medicine on hip fracture patients at a regional hospital in northwest Spain. Co-inter-Monf study.

Hip fractures represent a serious public health problem with a high burden of mortality, morbidity, and resource use. Co-management has proven to enhance the clinical outcomes of hip fracture patients hospitalized in various settings. This study aims to evaluate whether the previously observed benefits of co-management can be achieved when such a program is implemented in a rural-based district hospital. A prospective, single-center observational study was conducted on hip fracture patients hospitalized for hip fracture. Patients were either co-managed by an internal medicine specialist with part-time dedication or not co-managed. The study was conducted in a rural hospital located in Galicia, Northwestern Spain, which serves a population of 45,000. A total of 207 patients were included in the study, of whom 97 received co-management. The majority of the patients who were co-managed were female (69.1%) and had a median age of 88years (interquartile range 83-92). The study showed a high burden of comorbidity with a median Charlson index of 6 points, along with high prevalence rates of dementia (46%), functional disability (50%), and chronic anticoagulant therapy (25%). Despite no differences in age, sex, or preadmission cognitive or functional status, the study found lower 30-day postdischarge mortality in co-managed patients (9.3%) compared with the 110 controls (20.0%, p = 0.049). The prevalence of osteoporosis treatment, both calcium/vitamin D (87.8% vs. 60.7%, p < 0.001) and bisphosphonates/denosumab/teriparatide (42.4% vs. 15.7%, p < 0.001), was higher in the co-managed patients at 30days after discharge. No differences were observed between the two groups in terms of in-hospital mortality and length of stay. The implementation of internal medicine co-management for hip fracture patients resulted in enhanced outcomes, particularly in the reduction of mortality within 30days of discharge as well as in the prevalence of osteoporosis treatment.

Clinical SANTI classification of arthrogenic muscle inhibition has an excellent inter-rater and intra-rater reliability in preoperative and post-operative anterior cruciate ligament rupture.

Arthrogenic muscle inhibition (AMI) is a reflexive shutdown of the quadriceps muscles following a knee injury or surgery that presents with or without hamstring contracture. This complication can be classified according to the SANTI classification, but the reproducibility of this clinical classification has not yet been demonstrated. This single-centre longitudinal observational study included 140 patients who were within 6 weeks of an ACL rupture. The presence of AMI was assessed separately and blindly during the preoperative consultation and at 3 weeks post-operative by an Orthopaedic Surgeon, an Orthopaedic Resident, a Sports Medicine Physician and a Physiotherapist. AMI was also assessed a second time by the physiotherapist, 10 days after the first assessment, before and after reconstruction surgery, in order to measure intra-rater reliability. The inter-rater and intra-rater reliability of the AMI classification was determined by calculating the intraclass correlation coefficient (ICC). Agreement for the AMI classification between different examiners was excellent pre-operatively (ICC = 0.99 [95% confidence interval, CI: 0.99-0.99]) and post-operatively (ICC = 0.98 [95% CI: 0.98-0.99]). Agreement in the AMI classification, when determined repeatedly by the same assessor (physiotherapist), was excellent pre-operatively (ICC = 0.92 [95% CI: 0.89-0.94]) and post-operatively (ICC = 0.98 [95% CI: 0.97-0.99]). Excellent intra-rater and inter-rater reliability of the AMI classification system was found in patients with recent ACL rupture and post-operatively. Level II, diagnostic study prospective cohort study.

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.

Delirium at the intensive care unit and long-term survival: a retrospective study

BackgroundDelirium is a common complication in patients at the intensive care unit (ICU) and is associated with prolonged ICU-stay and hospitalization and with increased morbidity. The impact of ICU-delirium on long-term survival is not clearly understood.MethodsThis retrospective single center observational study was conducted at the Institute of Intensive Care Medicine at the University Hospital Zurich, Switzerland. All adult ICU-survivors over a four-year period were screened for eligibility. ICU-delirium was defined based on the Intensive Care Delirium Screening Checklist (ICDSC), together with the coded diagnosis F05 in the International Classification of Diseases (ICD-2019). ICU-survivors who developed delirium during their ICU stay (group D) were compared with ICU-survivors who did not (group ND). Survival was evaluated according to data from hospital electronic health records up to four years from ICU-discharge. The survival analysis was reported using Kaplan-Meier curves and absolute risk differences (ARD). A multivariable logistic regression model was fitted with long-term survival at four years after ICU-discharge as outcome of interest, including several clinical conditions and interventions associated with long-term survival for ICU patients. For subgroup analysis, ICU-survivors were grouped based on age at the time of admission (45–54, 55–64, ≥ 65 years), and on relevant clinical conditions.ResultsA total of 9’604 patients fulfilled the inclusion criteria, of them 22.6% (n = 2’171) developed ICU-delirium. Overall, patients in the group D had a significantly lower probability of survival than patients in the group ND (p < 0.0001, ARD = 11.8%). In the multivariable analysis, ICU-delirium was confirmed as independently associated with long-term survival. After grouping for age categories, patients between 55 and 64 years of age in the group D were less likely to survive than patients in the group ND at every time point analyzed, up to four years after ICU discharge (p < 0.001, ARD = 7.3%). This difference was even more significant in the comparison between patients over 65 years (p < 0.0001, ARD 11.1%). No significant difference was observed in the other age groups.ConclusionsIn the study population, ICU-delirium was independently associated with a reduced long-term survival. Patients who developed ICU-delirium had a reduced survival up to four years after ICU discharge and this association was particularly evident in patients above 55 years of age.

MicroRNAs in Plasma-Derived Extracellular Vesicles as Non-Invasive Biomarkers for Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic inflammatory esophageal disorder. The lack of non-invasive biomarkers currently results in dependency on endoscopy with biopsies for its diagnosis and monitoring. We aimed to identify potential non-invasive biomarkers using microRNAs (miRNAs) in plasma-derived extracellular vesicles (pEVs). This was a prospective single-center observational study of a discovery cohort of EoE patients (n = 26) with active disease (EoE.Basal) and after anti-inflammatory treatment (EoE.Post.tx) and control subjects (n = 16). Small-RNA-seq was performed to identify differentially regulated small RNAs (sRNAs). Candidate miRNAs were validated in an independent cohort (EoE patients, n = 33; controls, n = 14). The pEVs-sRNA cargo differed among conditions. Compared with controls, Ser_Comb_22, Leu_Comb_5, miR-10b-5p, and miR-125a-5p were upregulated in EoE.Basal, and miR-224-5p, miR-221-3p, let-7d-5p, and miR-191-5p were downregulated. The combination of miR-221-3p and miR-10b-5p showed the best diagnostic performance. Comparing paired EoE samples, miR-374a-5p and miR-30a-3p were upregulated in EoE.Basal, while miR-15a-5p and let-7d-5p were downregulated. Combined miR-30a-3p and miR-15a-5p showed the best AUC values, and miR-30a-3p alone was best as a monitoring biomarker (p = 0.001). In conclusion, pEVs-sRNA changed upon inflammation in EoE patients, and miR-30a-3p was proposed as a potential biomarker for monitoring the treatment. This study was the first to explore the use of pEVs as a non-invasive biomarker for EoE.

Quantitative Contribution of Clinical Attacks to Residual Disability in Patients With AQP4-Antibody Neuromyelitis Optica Spectrum Disorder.

Disease-related disability in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) is solely attributed to clinical attacks. However, few studies have assessed the relationship between attacks and residual disability in NMOSD. Thus, we aimed to quantify the contribution of clinical attacks to the residual disability in patients with AQP4-NMOSD. This retrospective observational single-center study enrolled patients from the Oxford National NMO Service, with the inclusion criteria as (1) AQP4-NMOSD diagnosis and (2) availability of at least 1 disability score (Expanded Disability Status Scale [EDSS] or logarithm of the minimum angle of resolution [LogMAR] score) recorded ≥6 months after attack (defined as residual disability). The outcome measures were EDSS and LogMAR scores. Univariable and multivariable linear mixed-effect models were used to quantify the effect of clinical relapses on the outcomes. A total of 165 patients with AQP4-NMOSD (median onset age, 43 years, range 2-84; women, 140 [84.8%]; White European patients, 92 [55.8%]; African or African British patients, 40 [24.2%]; Asian or Asian British patients, 20 [12.1%]; multiracial or unknown racial patients, 13 [7.9%]) were included, with the median time of disability measurement since the last attack being 32 months (range 6-197). The mean increase in the EDSS score per relapse was 0.304 (95% CI 0.074-0.553, p < 0.001), with individual relapse phenotypes showing different effects: the transverse myelitis (TM) + optic neuritis (ON) phenotype contributed most, with an increase of 1.290 (95% CI 0.233-2.207, p = 0.017) per relapse, followed by brain plus other phenotypes (β = 0.782, 95% CI 0.029-1.03, p < 0.001) and isolated TM (β = 0.295, 95% CI 0.074-0.549, p < 0.001), while neither brain nor optic nerve relapse alone was associated with a residual change in the EDSS score. Older onset age was correlated with more severe motor disability where this mainly occurred early in the disease course while younger patients exhibited mild initial disability that worsened more significantly with relapses. Each ON attack led to a mean increase of 0.464 (95% CI 0.199-0.741, p < 0.001) in the LogMAR score. Race, sex, and timing of acute treatment did not significantly affect these disability outcomes (EDSS and LogMAR scores). The quantitative contribution of relapse to the residual disability in patients with AQP4-NMOSD varies across phenotypes, and this relapse-related disability progression may also vary by the onset age. Although this retrospective single-center study may need validation in other data sets, these findings may help predict disability and provide a modeling tool for longer term disability in the cost-effective analysis of newer interventions.

Unexpected Clinically Relevant Findings Detected via Computed Tomography in Patients with Severe Aortic Stenosis Who Are Candidates for Transcatheter Aortic Valve Replacement

Background: The detection of unexpected findings (UF) during CT scans of patients undergoing TAVR is frequent; however, it is unclear whether such findings have a clinical impact on the TAVR pathway. Methods: We conducted a retrospective, single-center observational study enrolling patients who were candidates for TAVR. All enrolled patients underwent a CT scan before valve implantation. The primary outcome of this study was all-cause mortality, while the secondary outcome was to determine whether the diagnosis of clinically relevant UF on CT scans results in a significant delay in the TAVR procedure. Results: A total of 284 patients were enrolled. Clinically relevant UF were identified in 15% of the patients, with the most common types being pulmonary masses or nodules. During the follow-up period, 83 patients (29.2%) died. The prognosis was worsened by chronic kidney disease (HR 1.76, p = 0.03) and left ventricular dilatation (HR 1.74, p = 0.04), while the diagnosis of clinically relevant UF did not impact all-cause mortality (p = 0.38). No statistically significant differences were found in the delay from the diagnosis of severe aortic stenosis to TAVR between patients with and without clinically relevant UF (p = 0.07), although patients with clinically relevant UF experienced a median delay of approximately 37 days in the TAVR procedure. Conclusions: The presence of clinically relevant UF on preoperative CT scans does not affect all-cause mortality but shows a trend toward increasing the time from diagnosis to the procedure in patients with severe aortic stenosis undergoing TAVR. Further studies are required to confirm these findings in larger patient cohorts.

Clinical characteristics of immunocompromised patients infected with COVID-19

Objective: To analyze the clinical features of COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Methods: A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023. They were divided into an immunocompromised group (102 patients, 47.9%) and an immunocompetent group(111 patients, 52.1%), and clinical data were compared between the two groups. The immunocompromised group was further divided into death group (18 cases, 17.6%) and non-death group (84 cases, 82.4%). The differences in laboratory examination findings were compared. Further analysis was performed on the lymphocyte subset differences between the death group(10 patients, 9.8%) and the non-death group (36 patients, 35.3%) with complete data. Results: The proportion of severe and critical cases and the mortality rate, were significantly higher in the immunocompromised group than the immunocompetent group (47.1% vs. 40.5%, 18.6% vs. 9.0%, 17.6% vs. 9.0%,P<0.05). The immunocompromised group had lower vaccination rate (26.5% vs. 44.1%, P<0.05). Hypertension, kidney disease and infections were more common in the immunocompromised group (63.7% vs. 48.6%, 30.4% vs. 9.0%, 49.0% vs. 19.8%, all P<0.05). CT findings of consolidation (40.2% vs. 18.9%), rate of antiviral treatment (48.0% vs. 30.6%) and the positive duration of viral nucleic acid [median 14(7.0, 19.3) days vs. 9(7.0, 18.0) days] were higher in the immunocomprised group (all P<0.05). Lactate dehydrogenase (LDH), procalcitonin (PCT), interleukin-6 (IL-6) and ferritin were higher in the immunocompromised group than those in the immunocompetent group (all P<0.05). In the death group, neutrophils (NEU), C-reactive protein (CRP), PCT, IL-6, ferritin and D-dimer were higher, while lymphocytes (LY), CD4+T-cells, CD8+T-cells, B-cell counts and hemoglobin (HGB) were significantly lower than those in the non-death group (all P<0.05). Conclusions: More than 60% of patients in the immunocompromised group were classified as severe or critical type, with a higher mortality rate and decreased ability to clear severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Decreases in total lymphocytes, CD4+T lymphocytes, CD8+T lymphocytes, and B lymphocytes, along with elevated levels of procalcitonin, ferritin, and D-dimer, indicated poor prognosis.

Efficacy of serum lactate/albumin ratio as a prognostic biomarker in patients with ventilator-associated pneumonia

Aims: This study aims to evaluate the efficacy of the serum lactate/albumin ratio (LAR) as a prognostic marker in patients with ventilator-associated pneumonia (VAP) who are hospitalized in the intensive care unit (ICU). Methods: This single-center retrospective observational clinical study was conducted between January 1, 2022, and October 1, 2024. The study group comprised 58 patients admitted to the ICUs of Malatya Training and Research Hospital, Turkiye, with intubation but without a diagnosis of pneumonia at the time of admission. These patients were diagnosed with VAP 48 hours after intubation. The serum LAR was calculated within the first 24 hours after admission to the ICU and correlated with mortality and morbidity. Results: The mean age of the patients was 68 years, with the majority being over 65 years of age. Of the 58 patients included in the study, 43 (74.1%) ultimately succumbed to their illness. The LAR of those who died in the study was significantly higher than that of those who survived. The LAR was identified as a reliable predictor, exhibiting a sensitivity of 83.7% and a specificity of 60% when a cutoff value of 1.13 was applied. The survival time of patients with a LAR of ≤1.13 was significantly longer than that of patients with a ratio of &gt;1.13. Conclusion: In our study, the mortality prediction performance of the LAR in patients with VAP was superior to that of the serum lactate level or serum albumin level alone. Therefore, the LAR may be a useful and readily available prognostic factor for early risk stratification of VAP patients.

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...

Early urea-to-creatinine ratio to predict rapid muscle loss in critically ill patients with sepsis: a single-center retrospective observational study

BackgroundPatients with sepsis in the intensive care unit (ICU) often experience rapid muscle loss. The urea-to-creatinine ratio (UCR) is thought to reflect muscle breakdown (creatinine) and catabolism (urea) and is commonly used to assess nutritional and metabolic status. This study aimed to investigate whether changes in UCR (ΔUCR) can predict the development of rapid muscle loss in patients with sepsis.MethodsThis retrospective observational study was conducted in a university ICU between 2014 and 2021, involving adult patients (≥ 18 years) diagnosed with sepsis. The primary outcome was the incidence of rapid muscle loss during ICU hospitalization. Changes in the cross-sectional muscle area at the third lumbar vertebra (L3SMA) were measured using CT images to evaluate muscle loss. Rapid muscle loss was defined as a change in ΔL3SMA greater than 2% per day. Multivariable logistic regression was used to examine the association between UCR or ΔUCR and rapid muscle loss. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive performance of UCR or ΔUCR for rapid muscle loss.ResultsOf the 482 patients, 141 (29.2%) experienced rapid muscle loss during their ICU stay. Multivariable logistic regression analysis revealed that ΔUCR was significantly associated with an increased risk of rapid muscle loss, with an odds ratio (OR) of 1.02 [95% CI: 1.01, 1.02]. The AUC for ΔUCR in predicting rapid muscle loss was 0.76 [95% CI: 0.68–0.83], with a threshold value of 19.4 µmol urea/µmol creatinine for ΔUCR.ConclusionThe results demonstrate that ΔUCR is independently associated with rapid muscle loss in patients with sepsis and the AUC of the ROC curve for the ability of ΔUCR to predict rapid muscle loss was 0.76. Though additional prospective data are needed, our results suggest that ΔUCR may be useful in the early identification of critically ill patients with sepsis at risk of rapid muscle loss.

Les enjeux des nouvelles technologies numériques sur le système de santé marocain : Cas du service de cardiologie -B- du Centre Hospitalier Universitaire Ibn Sina (CHUIS) Rabat

We live in the era of information technology (IT) innovations in the health sector, this has led to the appropriation of new organizational models which are profoundly changing the practice of medicine. Our study aims to determine the challenges of new digital technologies in the Moroccan health system, the case of the cardiology department - B - of the Ibn Sina University Hospital Center. This is a single-center observational descriptive-analytical study carried out at the level of the cardiology department - B- for 6 months, from September 1, 2022. Questionnaires were distributed in paper form to staff-affiliated medical doctor or carrying out their internships, using a digital device within the service. Thirty-one (31) responses were collected, with a participation rate of 78%; the age of the respondents varies between 21 to 55 years with an average of 30.3± 8.71 years with a female predominance of 67.7% and almost half of the health professionals in our sample 42% were residents. The most deployed digital device is the Hospital Information System (HIS) in 80.6%; 93.5% of respondents noted that saving of time is one of the advantages of telemedicine and 71% of respondents who affirmed that the better monitoring of patients located in isolated areas in order to avoid forgoing care. 74.2% of respondents considered that technical problems constituted an obstacle to the deployment of remote procedures; compared to 22.2% for a weak diagnosis; 64.5% of respondents noted that training would be a major lever for integrating more remote activities into their practices and 54.5% of respondents are in favor of adapted time slots. The benefits perceived by respondents of these digital tools are numerous, although there are obstacles preventing digital transformation from reaching its full potential. The use of new digital technologies in this health sector responds to positive challenges in terms of organizational and educational efficiency; this requires the coordination of all stakeholders. The cardiology department -B - is a space conducive to the implementation of new digital technologies.

Tofersen treatment leads to sustained stabilization of disease in SOD1 ALS in a "real-world" setting.

Patients with amyotrophic lateral sclerosis (ALS) caused by superoxide dismutase 1 (SOD1) gene mutations (SOD1 ALS) treated with tofersen have shown slowing of disease progression, and disease stabilization with recovery of function in some patients. We report our clinical experience with treating patients with SOD1 ALS and the effects of tofersen on outcome measures. This was a single-center observational study of patients with SOD1 ALS receiving treatment with tofersen. The effects of tofersen treatment on neurofilament levels, muscle strength, and clinical outcome measures were assessed. Several patients had outpatient neuromuscular rehabilitation in addition to tofersen treatment and we report changes in functional outcomes. Seven SOD1 ALS patients received treatment at our institution. All patients showed robust and sustained declines in serum NfL and CSF pNFH (mean change serum NfL: -57.9%; mean change CSF pNFH: -67.6%). There was apparent disease stabilization as assessed by the ALSFRS-R total score, mean change 1.1 (SD = 0.7). There was notable improvement in functional independence measured by the FIM motor score, mean change 5.13 points (SD = 3.85). This study provides evidence that tofersen treatment in SOD1 ALS can lead to meaningful preservation of function and suggestions of sustained improvement in neurologic function in some patients, and strongly supports the role of neurofilaments as therapeutic biomarkers.

Optimizing Care for Primary Glomerulonephritis: The Role of Thyroid Evaluation.

The coexistence of primary glomerulonephritis and autoimmune thyroid disease has not been investigated. This study aimed to assess thyroid morphology using sonography, determine the prevalence of autoimmune thyroid disorders, and evaluate thyroid function status in patients diagnosed with primary glomerulonephritis. This single-center cross-sectional and observational study included 58 consecutive patients with primary glomerulonephritis and 58 healthy controls (HC). All participants underwent thyroid examination through laboratory tests and thyroid ultrasonography. The findings were subsequently compared between the two groups. Among the patients, 17.2% (n = 10) exhibited subclinical hypothyroidism, while 8.6% (n = 5) had overt hypothyroidism. None of the HCs showed overt hypothyroidism, whereas 3.4% (n = 2) of them exhibited subclinical hypothyroidism. Patients displayed significantly lower free triiodothyronine (FT3) levels than HCs (p < 0.001). A linear correlation was observed between patients' thyroid-stimulating hormone (TSH) levels and the degree of proteinuria (p = 0.044). Furthermore, thyroid volume (p < 0.001), hypoechogenicity (p < 0.001), heterogeneous structure (p < 0.001), pseudonodular hypoechoic infiltration (p = 0.05), and the presence of nodules (p < 0.001) were notably higher in patients compared to HCs. The prevalence of both overt and subclinical hypothyroidism, along with the frequency of nodular goiter, was found to be elevated in patients with primary glomerulonephritis. Considering that primary glomerulonephritis predominantly afflicts young individuals, and these patients bear the lifelong burden of chronic kidney disease, we underscore the significance of routine thyroid function tests and sonographic examinations for the early detection of thyroid disorders.

A modified technique for radial artery access: how interventional radiologists can optimise the cardiologists’ technique to suite their procedures

BackgroundThis is a single-centre prospective observational study examining radial access in 62 Prostatic Artery Embolisation (PAE) procedures. Evaluation of left radial artery diameter using high frequency ultrasound before and after administration of sublingual glycerl trinitrate (GTN). Pre-procedure questionnaires calculating symptom severity score compared with post-procedure.ResultsSublingual GTN resulted in a statistically significant increase in radial artery diameter (p < .00001). There was a statistically significant reduction in both average International Prostate Symptom Score (IPSS) and Quality of Life (QoL) from pre-procedure to post-PAE. The radial sheath was successfully inserted in 100% of cases. Crossover rate to femoral access was low (4%). Radial artery access had a low complication rate (2%). Radial artery variant anatomy was reasonably common (7%).ConclusionsSublingual GTN significantly increase radial artery diameter. PAE from radial access is associated with a symptomatic improvement at 2-month follow-up.

Assessment of the MANTA closure device in real-life transfemoral transcatheter aortic valve replacement: A single-centre observational study

Assessment of the MANTA closure device in real-life transfemoral transcatheter aortic valve replacement: A single-centre observational study

Therapeutic regimens against Helicobacter pylori infection without proton pump inhibitors in patients with corpus atrophic gastritis: a real-life single-centre longitudinal observational study.

Efficacy of eradication regimens in Helicobacter pylori (Hp) infection is commonly reported with proton pump inhibitors (PPIs). In patients with corpus atrophic gastritis, characterized by impaired acid secretion, PPI treatment is questionable. The current study aimed to assess in clinical practice the tolerability and eradication rate of modified eradication regimens without PPI as first-line treatment in patients with histologically Hp-positive corpus atrophic gastritis. Real-life longitudinal observational study. Overall, 76 patients (77.6% females, age 58.5 (26-88) years) with histologically Hp-positive corpus atrophic gastritis were consecutively diagnosed (2001-2022). First-line eradication treatment was prescribed without PPIs: concomitant or sequential amoxicillin-based therapy (ABT) until 2016 (n = 30), then single-pill bismuth treatment (SPBT; n = 46). Treatment adherence and adverse events were clinically evaluated and treatment efficacy was assessed by histopathology (updated Sydney system) at 6 ± 3 months after treatment. Only mild adverse events not requiring medical treatment were observed in four patients treated with SPBT without PPIs (vomiting, self-limiting diarrhoea, nausea, abdominal discomfort) and in two treated with ABT without PPIs (vomiting and abdominal discomfort). Overall, 71/76 (93.4%) corpus atrophic gastritis patients completed the treatment: 43/46 (93.5%) SPBT without PPIs and 28/30 (93.3%) ABT without PPIs. Successful cure of Hp was observed in 64/71 patients: overall eradication rate 90.1%, 95%CI 69.4%-115.1%. 42/43 corpus atrophic gastritis patients treated with SPBT without PPIs were successfully cured against 22/28 of those treated with ABT without PPIs. The eradication rate was higher for SPBT than ABT: 97.7%, 95%CI 70.4%-132.0% vs 78.6%, 95%CI 49.2%-118.9%, p = 0.013. In clinical practice, Hp cure can be achieved without PPIs as first-line treatment in about 90% of patients with corpus atrophic gastritis.

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.