Single-center Prospective Study Research Articles

Prevalence of post-intensive care syndrome: Observations from a tertiary care hospital in Eastern India

ABSTRACT Background: Post-intensive care syndrome (PICS) refers to physical, cognitive and psychological symptoms that occur after a patient is discharged from the intensive care unit (ICU). Aims: The present study aimed to explore the prevalence of PICS among ICU survivors of a tertiary care setup in Eastern India. Methods: A single-centre prospective cohort study was conducted amongst patients admitted to the ICU. A predefined, structured interview in 1st month, 3rd month, 6th month after ICU admission was done. Baseline characteristics were noted. Physical and cognitive impairment, psychological distress and general health were assessed using the Barthel Index (BI), mini-mental state examination (MMSE) tool, Hospital Anxiety and Depression Scale (HADS) and EuroQoL Visual Analogue Scale. Results: Of the 150 patients included in the study, the mean Acute Physiology and Chronic Health Evaluation II score was 20.87. The leading cause of ICU admission was sepsis (40.7%), followed by acute exacerbation of chronic obstructive pulmonary disease and pneumonia (14%). The median stay in the ICU was 8 days. Mean BI significantly decreased from 79.20 at baseline to 60.17 and 64.33 in the 3rd and 6th months, respectively. The mean HADS-Depression score increased from 3.79 at baseline to 7.08 at 3rd and 5.92 at 6th month. Similarly, the mean HADS-Anxiety score increased from 4.37 at baseline to 7.44 at 3rd and 6.31 at 6th month. The mean MMSE score decreased from 24.61 at baseline to 22.26 at the 3rd and 6th months, respectively. Thus, PICS was recorded in 90% of cases in the 3rd month and 89.3% in the 6th month. Conclusion: The management of PICS involves a multidisciplinary approach, including physical rehabilitation, cognitive rehabilitation and psychological support.

Myeloperoxidase and N-terminal proatrial natriuretic peptide as predictors for atrial fibrillation recurrence in patients undergoing redo ablation

BackgroundAtrial fibrillation (AF) is a progressively developing arrhythmia. Electroanatomic remodeling may play an important role, both in the development of the disease as well as in the perpetuation and thus in the recurrence of AF. ObjectiveThis study aimed to investigate potential biomarkers Myeloperoxidase (MPO), N-terminal pro-atrial natriuretic peptide (NT-proANP), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloproteinase-2 (MMP-2) and their predictive value for AF recurrence in patients undergoing redo ablation. MethodsIn this single-center prospective cohort study 50 consecutive patients underwent ultra-high-density mapping and redo ablation. Biomarkers were determined before ablation and at 6 months follow-up. Seven-day Holter was conducted to check for AF recurrence (>30 seconds). ResultsEleven (22%) patients showed AF recurrence after redo ablation. ROC analysis revealed venous MPO and NT-proANP (AUC 0.755, 95% CI 0.599 – 0.912, p=0.010 and AUC 0.752, 95% CI 0.551 – 0.953, p=0.011) as acceptable predictors for intermediate AF recurrence, whereas MMP-2, ICAM-1, and established cardiovascular biomarkers such as NT-proBNP, Troponin T, and C-reactive protein were not (all AUC <0.600). MPO and NT-proANP correlated with AF burden (ρ 0.365, p=0.005 and ρ 0.362, p=0.005). While MPO was associated with atrial fibrosis in the endocardial map (ρ 0.280, p=0.024), NT-proANP correlated with left atrial volume index (ρ 0.256, p=0.037). There were no significant differences in biomarkers concentrations with regard to venous and coronary sinus samples. ConclusionMPO and NT-proANP are of predictive value for AF recurrence in patients undergoing redo ablation. While MPO correlated with endocardial fibrosis, NT-proANP was associated with left atrial volume.

Functional outcomes and clinical characteristics of children discharged from pediatric intensive care unit of a low- and middle-income countries: A single-center prospective observational cohort study from Rwand

Abstract Background: The development of pediatric intensive care units (PICUs) has contributed to the improvement in the survival of critically ill children; however, the long-term functional outcome of these children is often unknown in many low-/middle-income countries including Rwanda. This study aimed to describe incidence and type of long-term functional outcomes and associated clinical characteristics among PICU survivors during a 5 years’ period (2015–2019). Subjects and Methods: This was a single-center, prospective observational cohort study conducted in the PICU of University Teaching Hospital in Rwanda. A Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scales were used to screen for long-term functional outcomes. The results were evaluated by telephone interview and statistically analyzed using logistic regression. Results: Out of 158 children, 53.2% had overall disability while 33.6% had some level of cognitive disability after PICU discharge. Out of 41 (2`5.9%) deaths during study period, three (7.3%) occurred during the hospital stay, while 8 (19.6%) occurred after the first year of hospital discharge. Disability screened by two scales, PCPC and PCOC, was comparable for mild (13.3% vs. 23.4%), moderate (11.4% vs. 20.3%), and severe (5.1% vs. 5.7%) categories. PICU admission for patient with at least one preadmission comorbidity had significantly greater disability at discharge (P &lt; 0.05). Conclusions: Despite a high survival rate, residual functional disability is prevalent among children after discharge from the PICU in Rwanda. The presence of at least one preadmission comorbidity was independently associated with greater disability at discharge.

371. ENDOFLIP: THE FUTURE OF DYSPHAGIA DIAGNOSIS AND MANAGEMENT

Abstract Background High-resolution manometry (HRM) is the gold standard for characterizing esophageal motility disorders, but it’s frequently associated with poor patient tolerance. A newer diagnostic tool, the Endoscopic Functional Lumen Imaging Probe (EndoFLIP), has emerged to assess esophagogastric junction (EGJ) distensibility and distension-mediated peristalsis. Also, for motility disorders such as EGJ outflow obstruction (EGJOO), HRM-isolated features aren’t enough for the diagnosis. The diagnosis also requires symptom correlation and additional investigations like EndoFLIP. Methods We conducted a single-center prospective cohort study for patients with dysphagia and inconclusive or intolerant to HRM. The inclusion criteria were patients with an elevated median integrated relaxation pressure (IRP) on HRM and patients with an inconclusive or intolerant to HRM. Patients with isolated IRP on HRM were included, as this isolated finding does not allow for the definitive diagnosis of EGJOO. These patients underwent EndoFLIP testing from January 2022 to February 2024 at a tertiary center. Results We performed EndoFLIP on 42 patients (50% male; 50% female), 23,8% with EGJOO diagnosis on HRM, 21,4% with inconclusive HRM, and 54,8% patients intolerant to HRM. Twenty-three patients intolerant to HRM underwent EndoFLIP, enabling diagnosis in all cases. Four patients were diagnosed with EGJOO, 6 with achalasia, and 4 with ineffective esophageal motility (IEM). On 88% of patients, the EndoFLIP allowed a correct diagnosis and treatment, with 29% undergoing endoscopic treatment during the same procedure. 9 patients with inconclusive HRM were diagnosed after EndoFLIP: 3 were diagnosed with EGJOO, 4 with IEM, and 3 with achalasia. We report a significant discordance between EGJOO diagnosis on HRM and EndoFLIP results. 50% of patients diagnosed with EGJOO on HRM showed normal EndoFLIP results, with only 20% confirming the diagnosis, while 20% raised the possibility of the diagnosis being achalasia. 43,8% of patients diagnosed with EGJOO confirmed by EndoFLIP underwent endoscopic therapy with botulinum toxin or balloon dilation during the same procedure, resulting in clinical improvement for all patients. Discussion The discordance between HRM and EndoFLIP may arise from HRM's tendency to overdiagnose EJGOO, leading to unnecessary testing and treatments for EGJOO. Many EGJOO HRM diagnoses don't require therapy, as symptoms often resolve spontaneously or with dietary education, casting doubt on the isolated HRM finding's clinical significance. It's particularly beneficial for patients with inconclusive/intolerance to HRM, allowing correct diagnosis and treatment in cases of obstructive symptoms. These results support EndoFLIP as a screening tool for patients undergoing endoscopy, enabling better selection of those benefiting from subsequent HRM.

Timing of ultra-portable ultrasound (UPUS) Examinations in detecting clinically concerning recurrent pneumothorax

BackgroundRecurrent pneumothorax (rPTX) is a common complication following thoracostomy tube (TT) removal in chest trauma patients. While chest X-ray (CXR) is most commonly used to detect a rPTX, bedside ultraportable ultrasound (UPUS) is a feasible, low cost, and radiation free alternative. No consensus exists with regards to the optimal timing of diagnostic imaging to assess for rPTX post-TT removal. Accordingly, we sought to identify an ideal UPUS timing to detect a rPTX MethodsWe conducted a single center prospective study of adult (≥18years) patients admitted with a chest trauma. UPUS examinations were performed using the Butterfly iQ+™ ultrasound. Three intercostal spaces (ICS) were evaluated (2nd through 4th). Post-TT UPUS examinations were performed at different timepoints following tube removal (1–6 h). A rPTX on UPUS was defined as the absence of lung-sliding in one or more intercostal spaces, and was considered a clinically concerning rPTX if lung-sliding was absent in ≥2 ICS. UPUS findings were compared to CXR. ResultsNinety-two patients (97 hemi-thoraces) were included in the analysis. A total of 58 patients had a post-TT removal rPTX of which 11 were either clinically concerning or expanding. Comparing UPUS findings to CXR, the 3-hour post-TT removal ultrasound examinations were associated with the highest sensitivity. By hour 4, no rPTX showed expansion in size. Three patients required an intervention for a clinically concerning rPTX, all of whom were detected on UPUS 3-hour post-TT removal. ConclusionBedside UPUS performed at 3-hour post-TT removal has the highest sensitivity in detecting clinically concerning rPTX. Size of rPTX appears to stabilize by hour 4. In the absence of clinical symptoms, repeat imaging or observation of non-significant rPTX beyond 4 h may not provide added clinical benefit. Level of EvidenceLevel II, Diagnostic Tests or Criteria

Is there any difference in Lactobacillus abundance between age groups during ovarian stimulation in fresh in vitro fertilization (IVF) cycles?

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To investigate an influence of age and body mass index (BMI) as determinants of infertility treatment success in vitro fertilization (IVF) procedures confirmed so far, on the amount of &amp;lt;em&amp;gt;Lactobacillus&amp;lt;/em&amp;gt; spp. (LS) and &amp;lt;em&amp;gt;Gardnerella vaginalis&amp;lt;/em&amp;gt; (GV) in the endometrium in fresh IVF cycles at the time of embryo transfer.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; This a prospective single-centre study included patients who underwent fresh embryo transfer (ET) in a private IVF Centre. A catheter tip for embryo transfer was used for collecting samples from the endometrial cavity. Real time polymerase chain reaction (RT PCR) was used to determine LS and GV quantity. Patients were divided into two age groups: &amp;amp;lt;35 years and &amp;amp;ge;35 years. Normal BMI group included patients with 18.-24.9 kg/m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;, and the in-creased BMI group patients with BMI &amp;amp;ge; 25kg/m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; Tips for embryo transfer catheters were positive on LS in 55 (96.4%) patients. The median of quantification cycle of RT-PCR (Cq RT-PCR) for LS was 33, and 31 for the younger and older groups, respectively. Twenty-one (36.8%) patients tested positive for GV. The median of Cq RT-PCR for GV was 33 and 34 for the younger and older groups, respectively. There were 36 patients with normal and 18 with increased BMI. BMI showed no correlation with LS amount in the endometrial cavity.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; Aging affects the endome-trial microbiome resulting in an increase of &amp;lt;em&amp;gt;Lactobacillus&amp;lt;/em&amp;gt; number, but not the number of GV.&amp;lt;/p&amp;gt;

Development and Validation of a Contrast-Enhanced US VI-RADS for Evaluating Muscle Invasion in Bladder Cancer.

Background Contrast-enhanced US (CEUS) can be used preoperatively for evaluating muscle invasion in bladder cancer, which is important for determining appropriate treatment. However, diagnostic criteria for assessing this at CEUS have not been standardized. Purpose To develop and validate a CEUS Vesical Imaging Reporting and Data System (VI-RADS) for evaluating muscle invasion in bladder cancer. Materials and Methods This single-center prospective study consecutively enrolled patients with suspected bladder cancer. Participants underwent transabdominal or intracavity CEUS between July 2021 and May 2023. Participants were divided into a training set and a validation set at a 2:1 ratio based on the chronologic order of enrollment. The training set was used to identify major imaging features to include in CEUS VI-RADS, and the likelihood of muscle invasion per category was determined using a pathologic reference standard. The optimal VI-RADS category cutoff for muscle invasion was determined with use of the maximum Youden index. The validation set was assessed by novice and expert readers and used to validate the diagnostic performance and interreader agreement of the developed system. Results Overall, 126 participants (median age, 64 years [IQR, 57-71 years]; 107 male) and 67 participants (median age, 64 years [IQR, 56-69 years]; 49 male) were included in the training and validation set, respectively. In the training set, the optimal CEUS VI-RADS category cutoff for muscle invasion was VI-RADS 4 or higher (Youden index, 0.77). In the validation set, CEUS VI-RADS achieved good performance for both novice and expert readers (area under the receiver operating characteristic curve, 0.80 [95% CI: 0.70, 0.90] vs 0.88 [95% CI: 0.80, 0.97]; P = .09). The interreader agreement regarding the evaluation of CEUS VI-RADS category was 0.77 (95% CI: 0.65, 0.85) for novice readers, 0.87 (95% CI: 0.79, 0.92) for expert readers, and 0.78 (95% CI: 0.70, 0.84) for all readers. Conclusion The developed CEUS VI-RADS showed good performance and interreader agreement for the assessment of muscle invasion in bladder cancer. Chinese Clinical Trial Registry no. ChiCTR2100049435 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Morrell in this issue.

Reduction of peritoneal dialysis associated infections using a novel exit-site care practice.

Peritoneal dialysis (PD) related infections are a significant obstacle leading to PD discontinuation. Since catheter related infections (CRI), defined as exit site infections and/or tunnel infection, can progress to peritonitis, vigorous efforts are implemented in CRI prevention. Following an increased CRI rate in our institution, partially related to environmental organisms found in water distribution systems, we hypothesized that exit site care that includes prevention of water exposure-related pathogens may reduce CRI. In this prospective single center study, we compared a contemporary cohort consisting of PD patients who implemented the modified exit-site care protocol, mainly including water avoidance during shower with stoma bag usage and local Mupirocin ointment against a historical control group before the protocol implementation. The historical cohort was allowed water exposure and used local gentamicin ointment. The primary outcome was the development of a CRI. Secondary outcomes were PD associated peritonitis and infection related outcomes. There were 55 patients in contemporary cohort and 58 in historical group. The CRI rate was significantly lower in study group (0.11/episodes per patient year [EPP]) compared to control group (0.71 EPP), p < 0.001. A multivariate Cox regression analysis demonstrated a protective effect of being in the contemporary cohort compared to historical group (HR for first CRI = 12.0 95%CI: 4.0-35.7, p < 0.001). Peritonitis rate was significantly lower in contemporary cohort (0.19/EPP) compared to the historical group (0.40/EPP), p = 0.011. Transfer to hemodialysis was significantly lower in contemporary cohort than historical group (7.3% vs 31.0% in contemporary and historical group respectively, HR = 0.2, 95%CI; 0.05-0.6, p = 0.001). An exit site care protocol that includes water avoidance and local Mupirocin use reduced substantially both CRI and peritonitis rate in patients treated with PD.

Efficacy and safety of serrapeptase on ankle sprain cases: A single center prospective comparative study

BackgroundNon-steroid anti-inflammatory drugs (NSAIDs) rank among the frequently prescribed medications for addressing pain and inflammation. Although they are powerful pain relievers, their side effects are indisputable. Serrapeptase, a serine protease, exhibits anti-inflammatory and anti-oedemic activity without the side effects of NSAIDs. We aim to assess the efficacy and safety of serrapeptase in the treatment of pain and edema in ankle sprains. MethodsIn a single-centre prospective comparative study, 76 patients aged 18–53 with Grade II ankle sprains were assigned to either a serrapeptase intervention group (n = 38) receiving 5 mg serrapeptase (two tablets, three times per day) for ten days, or a control group (n = 38) receiving 500 mg paracetamol (three times per day) for the same duration. Ankle joint edema was assessed using both Figure-of-Eight and water-displacement methods. Pain was assessed with Visual Analogue Scale (V.A.S.). Within-groups and between-groups analyses were performed in the 3rd and 10th day. ResultsBoth groups exhibited reduced edema and pain over time. Serrapeptase demonstrated a superior reduction in ankle joint edema on the third and tenth day compared to paracetamol, while pain management did not differ significantly. ConclusionSerrapeptase exhibited better efficacy than paracetamol in reducing ankle joint edema, highlighting its potential as an alternative treatment. Level of evidenceLevel II, prospective comparative trial without randomization.

Development of a new scale for self-reported procedural patient comfort during endovascular therapy for acute stroke.

In stroke patients with acute large vessel occlusion, endovascular therapy (EVT) may be performed with or without sedation. Our aim is to describe self-reported intraprocedural comfort in patients undergoing EVT depending on sedation type. We performed a prospective observational single-center study of patients undergoing EVT. Patients were systematically interviewed on the day following intervention using a structured questionnaire addressing five domains (nausea/vomiting, pain of any kind, physical discomfort, emotional discomfort, and medical team interaction). Each domain scored 0 to 2 points for a maximum total of 10 points (a higher score indicating greater discomfort). In addition, satisfaction with procedural comfort was rated on a visual analog scale (VAS), and patients reported whether they would have preferred more, less, or the same amount of sedation. Patients who underwent EVT without sedation (local anesthesia, LA) were compared to those who received procedural sedation (conscious sedation, CS). Seventy-seven questionnaires were completed: 37 (48%) patients underwent EVT with CS while 40 (52%) were treated under LA. Median scores on the self-reported discomfort scale (1[0-2] vs 1[0-2], p = 0.70) and mean scores on VAS (76 ± 25 vs 81 ± 24, p = 0.37) were similar between the CS and the LA group. The proportion of patients who were satisfied with the adopted sedation strategy was similar between groups. EVT without prior sedation seems to be well tolerated. Systematic self-evaluation of patient comfort appears feasible and may become integrated into routine clinical care. Patient-oriented outcomes should be included in future trials of sedation during thrombectomy.

Cardiac biomarker profiles in dogs with naturally occurring precapillary pulmonary hypertension

Introduction/ObjectivesThis study evaluated circulating amino-terminal pro-B-type natriuretic peptide (NT-proBNP), amino-terminal pro-A-type natriuretic peptide (NT-proANP), and cardiac troponin I (cTnI) concentrations in dogs with precapillary pulmonary hypertension (Pre-PH) and control dogs with respiratory clinical signs but no Pre-PH. AnimalsTwenty-six dogs (17 affected, and 9 controls) were involved in the study. Materials and MethodsThis was a sub-study of a large prospective single-center observational study. Dogs underwent blood sample collection, physical examination, and echocardiographic evaluation. Pre-PH was diagnosed when a calculated right ventricular-to-right atrial pressure gradient (RV:RA PG) measuring ≥40 mmHg was identified echocardiographically, barring right ventricular outflow obstruction and/or left-sided cardiac disease. ResultsTwo, nine, and six dogs had mild, moderate, and severe Pre-PH, respectively. Plasma concentrations of NT-proBNP, NT-proANP, and cTnI were significantly higher in the affected group than in the control group (P=0.020, P=0.009, P=0.011, respectively). There was a positive correlation between RV:RA PG and NT-proBNP (r = 0.52), NT-proANP (r = 0.54), and cTnI (r = 0.67) concentrations. DiscussionPre-PH should be included in the differential diagnosis list of elevated cardiac biomarker concentrations in dogs with respiratory signs. Study LimitationsStrict selection criteria reduced group sizes. There were rare missing data points. The diagnosis of Pre-PH was obtained from Doppler echocardiographic RV:RA PG. The disease process causing Pre-PH was not evaluated histopathologically. ConclusionsCirculating cardiac biomarker concentrations are increased in dogs with Pre-PH and there is a positive correlation between RV:RA PG and NT-proBNP, NT-proANP, and cTnI concentrations.

Loss of Heterozygosity and Mutations in the RAS-ERK Pathway Genes in Tumor Cells of Various Loci in Multiple Myeloma.

Multiple myeloma (MM) is a disease characterized by spatiotemporal heterogeneity of tumor clones. Different genetic aberrations can be observed simultaneously in tumor cells from different loci, and as the disease progresses, new subclones may appear. The role of liquid biopsy, which is based on the analysis of tumor DNA circulating in the blood plasma, continues to be explored in MM. Here, we present an analysis of the STR profiles and mutation status of the KRAS, NRAS, and BRAF genes, evaluated in plasma free circulating tumor DNA (ctDNA), CD138+ bone marrow cells, and plasmacytomas. The prospective single-center study included 97 patients, with a median age of 55 years. Of these, 94 had newly diagnosed symptomatic MM, and three had primary plasma cell leukemia. It should be noted that if mutations were detected only in ctDNA, "non-classical" codons were more often affected. A variety of adverse laboratory and clinical factors have been associated with the detection of rare KRAS or NRAS gene mutations in bone marrow or ctDNA, suggesting that these mutations may be factors of an unfavorable prognosis for MM. Liquid biopsy studies provide undeniable fundamental information about tumor heterogeneity and clonal evolution in MM. Moreover, we focus on using liquid biopsy to identify new high-risk factors for MM.

Circulating circular RNAs as novel biomarkers and functional prediction for the early diagnosis in post-stroke cognitive impairment: A single-center prospective study in China

BackgroundEarly evaluation and intervention for post-stroke cognitive impairment are crucial for improving the prognosis of acute ischemic stroke. The search for specific diagnostic markers and feasible therapeutic targets is extremely urgent.The characteristics of circular RNAs make them promising candidates. AimsTo screen circular RNAs as novel biomarkers and therapeutic targets for post-stroke cognitive impairment in large-artery atherosclerosis anterior circulation cerebral infarction patients. MethodsIn this prospective observational study, patients with first-ever large-artery atherosclerosis anterior circulation cerebral infarction were recruited. The Montreal Cognitive Assessment was used to assess the cognitive statuses of patients. Venous blood samples were collected on the seventh day after stroke onset. A circRNA microarray was used to identify differentially expressed circular RNAs in the discovery cohort (four patients with post-stroke cognitive impairment and four patients with post-stroke cognitive normal characteristics), and validation was performed in the validation cohorts (45 patients with post-stroke cognitive impairment and 30 patients with post-stroke cognitive normal characteristics) using quantitative real-time polymerase chain reaction. Receiver operating characteristic curves of the validated circular RNAs and the NIHSS score were constructed, and the area under the curve, sensitivity, and specificity were calculated. Correlation analysis was performed to explore the relationship between the copy number of circular RNAs and the cognitive status. The functions of the differentially expressed circular RNAs were predicted using bioinformatics analysis. ResultsCircRNA microarray analysis revealed 189 human circular RNAs (152 upregulated and 37 downregulated) that were differentially expressed in the plasma samples of patients with post-stroke cognitive impairment and PSCN characteristics. The expression of hsa_circ_0089763, hsa_circ_0064644, and hsa_circ_0089762 was validated using quantitative real-time polymerase chain reaction. The area under the curve, sensitivity, and specificity of hsa_circ_0089762 in post-stroke cognitive impairment diagnosis were 0.993, 97.8%, and 96.7%, respectively, and the correlation coefficient between hsa_circ_0089762 expression and the Montreal Cognitive Assessment score was -0.693 (p < 0.001), which made it an ideal biomarker. Bioinformatic analysis revealed that the targeted mRNAs of the three circular RNAs were enriched in pathologically related signaling pathways of post-stroke cognitive impairment, such as the MAPK and PI3K-Akt signaling pathways. Based on the circRNA-miRNA-mRNA network, the three circular RNAs play a crucial role in numerous pathological processes of acute ischemic stroke and post-stroke cognitive impairment by sponging miRNAs such as MiR-335, MiR-424, and MiR-670. By building the protein-protein interaction network, we identified cluster 1 according to the MCODE score; cluster 1 was composed of ERBB4, FGFR1, CACNA2D1, NRG1, PPP2R5E, CACNB4, CACNB2, CCND1, NTRK2, and PTCH. ConclusionHsa_circ_0089762, hsa_circ_0064644, and hsa_circ_0089763 are potential novel biomarkers and focal points for exploring intervention targets in post-stroke cognitive impairment of large-artery atherosclerosis anterior circulation cerebral infarction patients. Registration numberChiCTR2000035074

Insights into Iron Metabolism Parameters in Ischemic Stroke: A Single-Center Prospective Cohort Study.

The hemojuvelin-hepcidin regulatory axis may play a key role in the iron metabolism both systemically and locally. There is a pressing need to evaluate this tightly regulated network of iron parameters and their potential impact on the development of ischemic stroke (IS). We aimed to assess iron metabolism biomarkers in patients after IS, evaluating changes over time and considering their clinical features. We studied 45 patients diagnosed with IS. We assessed major iron metabolism parameters, such as hepcidin, soluble hemojuvelin (sHJV), soluble transferrin receptor (sTfR), and ferritin, using immunoenzymathic methods at two time points: on admission and on the 7th day post IS. We found increased ferritin levels on the 7th day post IS compared to admission, and this was observed in the entire study group (p = 0.03) and in the subgroup treated with thrombolysis (p = 0.02). The hepcidin levels, on the other hand, showed a significant decrease on the 7th day, though this difference was only evident in the entire study group (p = 0.04). We also discovered significantly elevated sHJV levels in patients with PACI stroke compared to other stroke locations, both on admission and on the 7th day post IS (p < 0.05). Significantly higher sHJV levels were observed in patients treated with thrombolysis compared to those receiving conventional treatment, regardless of the time point (p < 0.0001 and p = 0.0002, respectively). Our study revealed changes in the iron metabolism parameters during stroke. The patients with anterior cerebral infarction and those treated with thrombolysis presented significantly elevated sHJV levels.

Side Shift of Attacks in Cluster Headache: A Prospective Single-center Study

Purpose: Although strict unilaterality is a characteristic of cluster headache (CH), side shift of attacks has been reported. We aimed to assess the prevalence and patterns of side shifts, as well as their correlations with clinical characteristics and treatment response in CH patients. Methods: We prospectively recruited and followed up CH patients at a university hospital. Patients with two or more lifetime CH bouts were interviewed about their side shift history using a structured questionnaire. The demographics and disease characteristics were collected at baseline, and the treatment response at 2- to 4-week follow-up examinations was compared between patients with versus without side shifts. Results: Out of 124 CH patients, 26 (21.0%) experienced side shifts. Sixteen (61.5%) experienced shifts between bouts, 13 (50.0%) within a bout, and four (15.4%) within an attack, with none (0%) reporting bilateral pain during an attack. Among patients who experienced shifts between bouts, six (37.5%) reported a single shift during the entire disease course, while 10 (62.5%) reported multiple shifts between bouts. The demographics, characteristics, and treatment response did not significantly differ according to the history of side shift. Conclusion: In our study, the prevalence and pattern of side shifts were comparable to the results from earlier studies. The presence of side shifts did not show significant association with a specific clinical profile and their incidence did not impact the treatment response. These findings suggest that side-shifting CH is not a distinct entity or migraine variant, but rather within the spectrum of CH.

Dexmedetomidine Improves Microcirculatory Alterations in Patients With Initial Resuscitated Septic Shock.

The study was to investigate the effects of dexmedetomidine on microcirculation in patients with early septic shock despite initial resuscitation. This was a single-center prospective study. Patients with early septic shock despite initial fluid resuscitation who still required norepinephrine to maintain target arterial pressure were enrolled. Hemodynamic and gas analysis variables, sublingual microcirculatory parameters were measured at baseline, and during the infusion of dexmedetomidine for 1 h (0.7mcg/kg/h). To elucidate the possible mechanisms of the effect of dexmedetomidine on microcirculation, after interim analysis, the dose-effect relationship of dexmedetomidine on microcirculation and catecholamine level were investigated at baseline, 1h after stabilization at different doses of dexmedetomidine (0.7 and 0.3 mcg/kg/h), and 2h after dexmedetomidine cessation. Forty-four patients with septic shock were enrolled after initial resuscitation. Compared with baseline, total and perfused vascular densities were statistically increased after infusion of dexmedetomidine, which was correlated with the dose of dexmedetomidine. During dexmedetomidine infusion, plasma norepinephrine, and dopamine level were significantly decreased. Changes in plasma norepinephrine level contributed to dexmedetomidine infusion were well correlated with changes in total and perfused vascular densities. In adult patients with resuscitated septic shock, dexmedetomidine improved microcirculation, which might be associated with plasma catecholamine level. However, double-blinded large sample studies should be performed to verify the results.

Association of Lipopolysaccharide-Type Endotoxins with Retinal Neurodegeneration: The Alienor Study

PurposeLipopolysaccharide (LPS) -type endotoxins are naturally found in the gut microbiota and there is emerging evidence linking gut microbiota and neuroinflammation leading to retinal neurodegeneration. Thinning of the retinal nerve fiber layer (RNFL) is a biomarker of retinal neurodegeneration, and a hallmark of glaucoma, the second leading cause of blindness worldwide. We assessed the association of a blood biomarker of LPS with peripapillary RNFL thickness (RNFLT) and its longitudinal evolution up to 11 years. DesignThe Alienor study is a single center prospective population-based cohort study. SubjectsThe studied sample of this study includes 1062 eyes of 548 participants receiving at least one gradable RNFL measurement. MethodsPlasma esterified 3-hydroxy fatty acids (3-OH FAs) were measured as a proxy of LPS burden. RNFLT was acquired using spectral domain optical coherence tomography imaging every two years from 2009 to 2020 (up to 5 visits). Main Outcome MeasureAssociations of plasma esterified 3-OH FAs with RNFLT were assessed using linear mixed models. ResultsMean age of the included 548 participants was 82.4 ± 4.3 years and 62.6 % were women. Higher plasma esterified 3-OH FAs was significantly associated with thinner RNFLT at baseline (Coefficient Beta (ß)= -1.42 microns for 1 SD-increase in 3-OH FAs, 95% confidence interval [-2.56; -0.28], p = 0.02). This association remained stable after multivariate adjustment for potential confounders. No statistically significant association was found between 3-OH FAs and longitudinal RNFLT change. ConclusionsHigher plasma esterified 3-OH FAs were associated with thinner RNFLT at baseline, indicating an involvement of LPS in the early processes of optic nerve neurodegeneration and highlighting the potential importance of the human microbiota in preserving retinal health.

Prevalence of pre-operative anxiety among adult patients undergoing elective surgery: A prospective observational single-centre study

Prevalence of pre-operative anxiety among adult patients undergoing elective surgery: A prospective observational single-centre study

Does patient activation matter? An examination of the relationships between patient activation and healthcare use in older adults with mild frailty after discharge from an emergency department.

ObjectivePatient engagement, as measured by the Patient Activation Measure (PAM®), has been used to assess patients' ability to manage their own care. This study aimed to determine whether the PAM® could predict healthcare use in older adults aged >70years, living independently in the community with mild frailty, within 30days after emergency department (ED) discharge.MethodsA prospective single-centre observational cohort study was completed including older adults who presented to an ED. The 13-item PAM® and selected International Consortium for Health Outcomes Measures were completed prior to ED discharge.ResultsTwo hundred patients were recruited with a mean age of 84.8years (s.d. 6.9). The mean PAM® score was 58.6 (s.d. 13.3), with 12.5% at Level 1 (n=25), 40% at Level 2 (n=80), 34.5% at Level 3 (n=69) and 13.0% at Level 4 (n=26). The PAM® level was significantly associated with ED presentations in the past 6months (P=0.030). The PAM® level did not predict healthcare use within 30days of discharge consisting of time until ED representation (P=0.557), number of ED representations (P=0.560), number of hospital admissions (P=0.499), length of stay in hospital (P=0.254) and number of post-discharge contacts (P=0.667).ConclusionsOverall, the PAM® did not predict prospective short-term healthcare use. However, the PAM® was significantly associated with 6-month previous ED use. With more than 50% of patients at Level 1 or 2, indicating lower capacity for self-management, tailored interventions are required to assist mildly frail patients to manage discharge care plans and engage in preventative strategies.

The FLARE Score and Circulating Neutrophils in Patients with Cancer and COVID-19 Disease.

Inflammation and neutrophils play a central role in both COVID-19 disease and cancer. We aimed to assess the impact of pre-existing tumor-related inflammation on COVID-19 outcomes in patients with cancer and to elucidate the role of circulating neutrophil subpopulations. We conducted a multicenter retrospective analysis of 524 patients with cancer and SARS-CoV-2 infection, assessing the relationship between clinical outcomes and circulating inflammatory biomarkers collected before and during COVID-19 infection. Additionally, a single-center prospective cohort study provided data for an exploratory analysis, assessing the immunophenotype of circulating neutrophils and inflammatory cytokines. The primary endpoints were 30-day mortality and the severity of COVID-19 disease. Prior to COVID-19, 25% of patients with cancer exhibited elevated dNLR, which increased to 55% at the time of COVID-19 diagnosis. We developed the FLARE score, incorporating both tumor- and infection-induced inflammation, which categorized patients into four prognostic groups. The poor prognostic group had a 30-day mortality rate of 68%, significantly higher than the 23% in the favorable group (p < 0.0001). This score proved to be an independent predictor of early mortality. This prospective analysis revealed a shift towards immature forms of neutrophils and higher IL-6 levels in patients with cancer and severe COVID-19 infection. A pre-existing tumor-induced pro-inflammatory state significantly impacts COVID-19 outcomes in patients with cancer. The FLARE score, derived from circulating inflammatory markers, emerges as an easy-to-use, globally accessible, effective tool for clinicians to identify patients with cancer at heightened risk of severe COVID-19 complications and early mortality who might benefit most from immediate and intensive treatment strategies. Furthermore, our findings underscore the significance of immature neutrophils in the progression of COVID-19 in patients with cancer, advocating for further investigation into how these cells contribute to both cancer and COVID-19 disease.