Single-center Prospective Study Research Articles

Comparative diagnostic efficacy of two-dimensional shear wave and transient elastography in predicting the risk of esophagogastric varices and histological staging in patients with primary biliary cholangitis

BackgroundThis study aimed to compare the diagnostic efficacy of Two-dimensional shear wave elastography (2D-SWE) with that of transient elastography (TE) in predicting the risk of esophagogastric varices and histological staging in patients with primary biliary cholangitis (PBC).MethodsThis single-center prospective study enrolled the patients with PBC diagnosed by liver biopsy following 2D-SWE and TE. Receiver operating characteristic (ROC) curves were constructed for SWE-liver stiffness measurement (LSM) and TE-LSM to assess their diagnostic efficacy for histological staging ≥ stage 2, ≥ stage 3, and = stage 4. The diagnostic efficacy and accuracy of SWE-LSM were compared with those of the Baveno VI criteria for detecting esophagogastric varices. Additionally, the impact of different laboratory parameters on SWE-LSM was analyzed.ResultsWe evaluated 77 patients (median age, 52 years (range: 16 − 75 years), 66 females). ROC curves constructed using TE-LSM and SWE-LSM demonstrated similar diagnostic efficacy for histological staging ≥ stage 2 (area under the curve [AUC]: 0.824 vs. 0.823 for TE-LSM and SWE-LSM, respectively, p = 0.9764), ≥ stage 3 (AUC: 0.918 vs. 0.907 for TE-LSM and SWE-LSM, respectively, p = 0.6443), and = stage 4 (AUC: 0.907 vs. 0.902 for TE-LSM and SWE-LSM, respectively, p = 0.8763). Additionally, while there was no significant difference in the diagnostic efficacy between the two methods for detecting esophagogastric varices (Z = 1.516, p = 0.1296), 2D-SWE had a slightly higher diagnostic accuracy than TE (61.8% vs. 76.4%). Transaminases and bilirubin levels had little influence on SWE-LSM.Conclusion2D-SWE exhibited comparable performance to TE in predicting the risk of esophagogastric varices and histological staging.

The Effect of the 2023 Turkey-Syria Earthquakes on the Sixth-Month Breastfeeding Rate of Infants: A Single-Centre Cohort Study

Background: We investigated the effect of earthquakes on the six-month breast milk intake rate in infants. Methods: In this single-centre prospective cohort study, 35 mother-baby dyads who were in the earthquake zone during the February 6, 2023, Turkey-Syria earthquakes were included as the study group, while 29 mother-baby dyads who were not in the earthquake zone were included as the control group. The physical, environmental, and social characteristics of the settlements after the earthquake, along with the nutritional characteristics of the infants, were evaluated through questionnaires during interviews and online assessments. The Breastfeeding Self-Efficacy Form and the Edinburgh Postnatal Depression Scale were administered to the mothers, and their scores were calculated. Results: No significant difference was found between the exclusive breastfeeding rates at six months in the study and control groups [18 (62.9%) vs. 22 (61.9%), n (%), P = 0.95]. The breastfeeding self-efficacy score was significantly higher in the study group [64 (33 - 70) vs. 54 (31 - 70), median (min-max), P = 0.02]. Although the Edinburgh Postpartum Depression Scale (EPDS) score was higher in the control group [10 (0 - 21) vs. 7 (0 - 26), median (min-max)], this difference was not statistically significant. Conclusions: In general, earthquakes do not affect breastfeeding rates in infants at six months. The continuation of breastfeeding, supported by increased resilience in difficult conditions, enhances breastfeeding self-efficacy and provides protection for the mother-baby dyad. Breastfeeding should be continued and supported during natural disasters.

Repeatability of quantitative MR fingerprinting for T1 and T2 measurements of metastatic bone in prostate cancer patients.

MR fingerprinting (MRF) has the potential to quantify treatment response. This study evaluated the repeatability of MRF-derived T1 and T2 relaxation times in bone metastasis, bone, and muscle in patients with metastatic prostate cancer. This prospective single-centre study included same-day repeated MRF acquisitions from 20 patients (August 2019-October 2020). Phantom and human data were acquired on a 1.5-T MR scanner using a research MRF sequence outputting T1 and T2 maps. Regions of interest (ROIs) across three tissue types (bone metastasis, bone, muscle) were drawn on two separate acquisitions. Repeatability of T1 and T2 was assessed using Bland-Altman plots, together with repeatability (r) and intraclass correlation (ICC) coefficients. Mean T1 and T2 were reported per tissue type. Twenty patients with metastatic prostate cancer (mean age, 70 years ± 8 (standard deviation)) were evaluated and bone metastasis (n = 44), normal-appearing bone (n = 14), and muscle (n = 20) ROIs were delineated. Relative repeatability of T1 measurements was 6.9% (bone metastasis), 32.6% (bone), 5.8% (muscle) and 21.8%, 32.2%, 16.1% for T2 measurements. The ICC of T1 was 0.97 (bone metastasis), 0.94 (bone), 0.96 (muscle); ICC of T2 was 0.94 (bone metastasis), 0.94 (bone), 0.91 (muscle). T1 values in bone metastasis were higher than in bone (p < 0.001). T2 values showed no difference between bone metastasis and bone (p = 0.5), but could separate active versus treated metastasis (p < 0.001). MRF allows repeatable T1 and T2 measurements in bone metastasis, bone, and muscle in patients with primary prostate cancer. Such measurements may help quantify the treatment response of bone metastasis. Question MR fingerprinting has the potential to characterise bone metastasis and its response to treatment. Findings Repeatability of MRF-based T1 measurements in bone metastasis and muscle was better than for T2. Clinical relevance MR fingerprinting allows repeatable T1 and T2 quantitative measurements in bone metastasis, bone, and muscle in patients with primary prostate cancer, which makes it potentially applicable for disease characterisation and assessment of treatment response.

Clinical mechanism of muscle mass loss during neoadjuvant chemotherapy in older patients with esophageal cancer: a prospective cohort study.

In older patients with locally advanced esophageal cancer (LAEC), loss of skeletal muscle mass during neoadjuvant chemotherapy (NAC) is associated with poor clinical outcomes. This study aimed to investigate factors associated with loss of skeletal muscle mass during NAC in older patients with LAEC. This was a single-center exploratory prospective cohort study. Consecutive patients aged ≥65years with LAEC scheduled for curative esophagectomy after NAC were enrolled between October 2021 and December 2023. As a primary endpoint, loss of skeletal muscle mass index (ΔSMI: pre-NAC minus post-NAC value) was calculated from computed tomography images before and after NAC. Significant pre-NAC and during-NAC factors with ΔSMI were detected with a multivariate regression model. Statistical significance was considered as two-tailed P <0.05. A total of 69 patients were analyzed. The mean age was 72.9years, and 53 (77%) were male. Mean SMI before and after NAC was 43.1 and 40.9cm2/m2, and mean ΔSMI was 2.2cm2/m2. In multivariate analysis, ΔSMI was associated with increased sitting time during NAC (per 1min/day, adjusted coefficient 0.007, 95% confidence interval [CI] 0.001 to 0.013, P = 0.016), decreased Geriatric Nutritional Risk Index during NAC (per 1 score, adjusted coefficient -0.146, 95% CI -0.213 to -0.013, P = 0.002), and worsening decreased appetite during NAC (vs. no worsening, adjusted coefficient 1.571, 95% CI 0.279 to 2.862, P = 0.018). It was hypothesized that the inactivity-related mechanism and malnutrition-related mechanism are important for skeletal muscle mass loss during NAC in older patients with LAEC.

Patient-reported outcome was close to the Danish background population 6 months after non-surgical treatment of Neer 2-part surgical neck fractures: a prospective cohort study in patients aged 60 or above.

Neer 2-part surgical neck fractures are the most common displaced proximal humerus fractures. We aimed to evaluate patient-reported outcome in a consecutive series of older people receiving nonoperative treatment. This is a single-center prospective cohort study. We included patients aged 60 or above referred to a Danish university hospital. The preregistered protocol followed the recommendations from randomized trials. Patients were followed at the outpatient clinic at 2, 6, and 24 weeks. After 24 weeks, they were evaluated with Oxford Shoulder Score (OSS, 0-48, 48 best) and EuroQoL 5 dimensions, 3 levels (EQ-5D-3L, -0.624 to 1, 1 best). Clinical failure was defined as conversion to surgery or OSS ≤ 24. Population norms were reported to interpret the cohort data, but no formal statistical comparisons between historical cohorts were planned. We used descriptive statistics to report rates and proportions. For 36 months, 268 patients (mean age 76, 79% female) with Neer 2-part surgical neck fractures received non-surgical treatment. After excluding patients with concomitant fractures, dementia, or death, complete follow-up was available for 167 patients. 8 patients (3.0%) had surgery. The mean OSS was 37.2 (SD 8.1), which equals 78% of maximum shoulder function. The norm for the population of the same age and gender was 82%. The mean EQ-5D-3L score was 0.79 (SD 0.16), while the norm for the same-age population was 0.82. 16 (10%) had an OSS score of 24 or below. Non-surgical treatment in older people with Neer 2-part surgical neck fractures resulted after 6 months in patient-reported shoulder function and quality of life close to that of the Danish background population.

Environmental Surveillance of SARS-CoV-2 for Outbreak Detection in Hospital: A Single Centre Prospective Study

Environmental Surveillance of SARS-CoV-2 for Outbreak Detection in Hospital: A Single Centre Prospective Study

The Association between Home Health Nursing and 30-Day Hospital Readmission after Tracheostomy in Children: A Single-Center Prospective Cohort Study.

To identify the association between home health nursing (HHN) and hospital readmissions for patients discharged after tracheostomy placement, we conducted a single-center prospective cohort study of children ages 0 to 21 years who underwent tracheostomy placement at Children's Hospital Los Angeles between 12/2016 and 2/2023 and were discharged to home. We collected demographic, clinical, and discharge variables for the index hospitalization to test the association between our primary exposure, HHN after discharge, and 30-day same-hospital all-cause, adjusting for potential confounders. Our population of 130 children was primarily male, of Hispanic/Latino ethnicity, and on public insurance. The majority of patients (57%) received HHN on discharge and the 30-day readmission rate was 14.6%. On multivariable analysis, HHN was not associated with readmission for children discharged on home mechanical ventilation [HMV; adjusted OR (aOR = 1.11; 95% CI: 0.30-4.02)] but was associated with lower odds of all-cause 30-day readmission in children discharged without HMV (aOR = 0.12; 95% CI: 0.02-0.81). Our findings support consideration for HHN as a hospital-to-home bridge for children after tracheostomy placement to decrease hospital readmissions and support parents and caregivers during this transition period.

Quality of Life in Symptomatic Septal Perforation.

The aim of this study is to investigate the impact of septal perforation (SP) on quality of life (QoL). SP is compared to the general population and patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) using the Sino-Nasal Outcome Test 22 (SNOT-22). Prospective single-center study in a referral Rhinology Unit from January 2014 to March 2023. A total of 392 patients were included in three groups: controls (n = 141), CRSwNP (n = 118), and SP (n = 133). The mean score of the SNOT-22 was significantly higher in the CRSwNP group (42.4, SD = 24.4) and SP (46.5, SD = 22) compared to the control group (6.2, SD = 8.4). Scores by either items or domains were significantly higher in the CRSwNP and SP groups compared to the control group. There were no significant differences in the mean SNOT-22 between the CRSwNP and SP groups (p = 0.26; 95% CI -1.68-9.99). Domain-specific analysis of overall SNOT-22 scores revealed that patients with SP experienced higher levels of disturbances in sleep, function, and psychological domains (p ≤ 0.001). SP produces a negative impact on QoL similar to CRSwNP. Moreover, sleep, psychological, and function domains are significantly worse in SP. Etiology and area of SP influence nasal and emotion domain, though more studies on SP using SNOT-22 and specific questionnaires are needed. 3 Laryngoscope, 134:4480-4487, 2024.

A Prevalence-Based Study to Estimate Cost of Illness of Rheumatoid Arthritis in a Tertiary Care Hospital in India

Background: Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition with high cost of management and significant impact on the patient and healthcare system. Hence, there is a need to estimate and analyze the economic impact of RA. Materials and Methods: It was a cross-sectional prospective follow-up single-center study at a tertiary care hospital conducted over a period of 02 years and 06 months from September 2019 to February 2022 after ethical committee clearance. Results: A total of 189 RA patients were included after excluding 15 patients. The male-to-female ratio was 0.687. The mean age of the study population was 44.74 ± 5.2 years. The mean yearly average cost of management of RA was Rs 29155.1 ± 18234.1, of which 49.6% was direct medical, 19.4% was direct non-medical, and 31% was indirect costs. Of average direct medical costs, cost toward non-steroidal anti-inflammatory drugs (NSAIDs) was 3.1%; conventional disease-modifying antirheumatic drugs (DMARDs) was 36.3%; and laboratory, radiology investigations, and consultations was 6.4%, 1.48%, and 12.3%, respectively. Factors, such as longer duration of treatment, use of biologic DMARDs, loss of productive workdays, extraarticular manifestations, and management of complications, were associated with higher cost of treatment of RA. Conclusions: This study quantifies the economic burden of the RA by measuring costs incurred toward all aspects of the patient’s life including the indirect costs due to loss of workdays. The knowledge of cost will help in financial management by patients and healthcare providers.

Features of the oropharyngeal microbiota of healthy children and those with acute respiratory infections. A prospective single-center randomized study

Background. The oropharyngeal microbiota is involved in the development of colonization resistance, affecting viral adhesion and metabolism. Any deviations in the stability of the environmental microbial niches of the oropharynx alter the local immune response and can trigger severe chronic somatic disorders. Aim. To compare the composition of the microbiota of children during an episode of respiratory infection and healthy volunteers examined in different periods of convalescence. The obtained data can be used to predict the course of the disease, analyze the risk of complications, and assess the frequency of the diseases in the future. Materials and methods. From 20.01.2022 to 23.12.2022, an open-label prospective single-center randomized comparative study was conducted, which included 120 children aged 5-10 who presented with symptoms of acute respiratory infection. The control group consisted of 15 asymptomatic children examined at different periods of convalescence. The study compared changes in the oral microbiota composition of patients and healthy children. The evaluation was performed using complete 16S rRNA gene sequencing on the Oxford Nanopore platform. Taxonometric analysis at the species and genera level was performed using the Knomics-Biota platform. The R programming language was used for statistical processing. In addition, the parameters of α- and β-diversity of the microbiota were assessed. The Chao1 and Shannon indices were calculated to assess α-diversity (diversity within one community). The Chao1 index is based on the number of species found in the sample and also rare species that are found only 1 or 2 times, thus preventing underestimation of diversity. The Shannon index includes both the number of species and their uniformity in the community. A change in the index indicates the dominance of one or more species. The following indicators were used to assess the β-diversity describing the differences between two microbiota samples at the species and genera level: Bray–Curtis dissimilarity (characterizing the ratios of common and different microorganisms between the samples) and the Aitchison distance (reflecting the differences in the proportions of microorganisms). In addition, the balance between the two groups of microorganisms was evaluated using the NearesBalance method, which characterizes the differences between the microbiota of the main and control groups. Results. The results of our study show that during respiratory infection, the state of the oropharyngeal microbiota is characterized by an increase in α-diversity, which is associated with an increase in the proportion of species of Streptococcus salivarius, Streptococcus pneumoniae, Streptococcus pseudopneumoniae, Streptococcus pyogenes, Streptococcus thermophilus and A12 versus the proportion of Streptococcus mitis, Streptococcus oralis, Streptococcus gwangjuense, Streptococcus sanguinis, Streptococcus gordonii and FDAARGOS_192. In the control group, the oropharyngeal microbiota was divided into two clusters. The dominance of streptococci was observed in the first group (control), while the second group had a more uniform representation. Analysis of the changes in microbial communities in the main and control groups can show the stages of oral microbiota recovery after an acute respiratory infection episode. Conclusion. More research is needed in the field of the oropharyngeal microbiome on a larger sample of healthy children, to standardize the communities of the oropharyngeal microbiota, to study the interaction within communities and with the body as a whole. Analysis of the impact of the microbiota on the frequency and course of respiratory infections and the rate of complications opens up new prospects in treating, rehabilitating, and preventing diseases. These research areas can contribute to improving children's health and quality of life and introducing new approaches into clinical practice.

Is Floppy Eyelid Syndrome predictive of Intraoperative Floppy Iris Syndrome? A prospective and translational study

Intraoperative floppy iris syndrome (IFIS) is defined as an excessive billowing of the iris during cataract surgery. Floppy eyelid syndrome is defined as an excessive hyperlaxity of the eyelids. Based in our daily experience, we suspected FES to be associated with IFIS. This association has been investigated. The goal of the study was to explore whether FES was predictive of IFIS. We conducted a prospective observational single-center study at the University Hospital of Nice. IFIS and FES were investigated in patients undergoing cataract surgery from November 2019 to May 2021. In addition, tarsus and iris samples were harvested in 2 fresh cadavers, and Verhoeff staining was used to identify elastin fibers. We included 452 eyes (n=312 patients, 50.9% male) with a mean age of 71.7years (±11.4). IFIS was diagnosed in 88 (19.5%) patients, including 20 (4.4%) grade 1, 34 (7.5%) grade 2, and 33 (7.3%) grade 3. FES was diagnosed in 35 (7.7%) patients. PEX was found in 23 (5.1%) patients. On multivariate analysis, FES (P<0.001), pseudo exfoliation (P=0.017), intracameral dilatation (P<0.004), senior surgeons (P=0.009) and α1-ARA (P<0.001) were associated with IFIS. Elastin fibers were identified in small amounts in the tarsus samples but not in the iris samples. FES is predictive of IFIS. Surgeons should be aware of this association to prevent intraoperative complications.

Aerobic bacteria study, clinical spectrum, and outcome of patients with community-acquired multidrug-resistant pathogens

ABSTRACT Context: Infectious diseases are the leading cause of death in developing countries like India. Hence, even small relative increases in the mortality rate for infections due to multidrug-resistant pathogens would lead to substantial increases in the number of deaths as a result of infections worldwide. Aims: The aim of the study was to study the microbiological data of community-acquired pathogens and the corresponding outcomes due to antibiotic-resistant versus antibiotic-susceptible bacterial microorganisms. Settings and Design: A single-center prospective cohort study for two years undertaken during the study period of March 2022 to 31 October 2023. Materials and Methods: All clinical samples of 402 patients diagnosed microbiologically as community-acquired infections were included. Culture samples were collected and processed according to standard operating procedures and clinical details were recorded. Statistical Analysis Used: Categorical variables were expressed as counts and percentages. Fisher’s exact test was used for testing differences in proportions. Two-sided distribution P values of &lt;0.05 were considered significant. Results: Among Gram-positive organisms, Staphylococcus aureus and Streptococcus pyogenes were predominant isolates. Escherichia coli and Klebsiella species were the majority of the pathogens among Gram-negative isolates. Mortality rates observed in community-acquired respiratory tract infections (CA-RTIs), community-acquired urinary tract infections (CA-UTIs), community-acquired skin and soft tissue infections (CA-SSTIs), and community-acquired bloodstream infections (CA-BSIs) were 13.6%, 6.56%, 4.5%, and 31.5%, respectively. The length of hospital stay of more than three days was found as 56.06%, 36.2%, 40.9%, and 73.6% in CA-RTIs, CA-UTIs, CA-SSTIs, and CA-BSIs, respectively. Conclusions: Performing cultures earlier during hospitalization and determining the timing of colonization can allow more targeted choices and reduce morbidity and mortality rates among infected patients.

A Prospective Observational Study Analyzing the Diversity and Specific Composition of the Oral and Gut Microbiota in Lung Cancer Patients.

Host microbiota dysbiosis has been recognized as a key factor in lung cancer. However, the specific diversity and composition of microbiota in lung cancer patients remain unknown. This single-center prospective observational study analyzed both saliva and fecal samples from 74 participants [lung cancer (LC) patients: n=53; lung inflammation (LI) patients: n=11; healthy control (HC): n=10]. We performed 16S ribosomal RNA gene sequencing and analyzed the associations between oral and gut microbiota diversity and composition across the three groups. Alpha diversity of the oral microbiota was significantly lower in the LC group than in the HC group (Chao 1, p=0.004; Simpson, p=0.018; Shannon, p=0.009). Beta diversity of both oral and gut microbiota showed significant differences among the three groups (PERMANOVA, oral: p=0.005; gut: p=0.002). Compositional differences in the oral microbiota were observed between the HC and LC or LI groups; in particular, Bacilli class, Streptococcaceae family, Streptococcus genus, Firmicutes phylum, and Lactobacillales order were more abundant in the LC group. Additionally, six oral-related microbiota showed significant abundance in the gut of the LC group (p=0.00182). The oral microbiota in lung cancer patients is significantly different from that in healthy individuals. Specific changes in oral microbiota and oral-related gut microbiota compositions were evident in lung cancer patients. These findings might be useful for identifying novel biomarkers to predict the risk of lung cancer and prevent the disease.

Changes in portal pulsatility index induced by a fluid challenge in patients with haemodynamic instability and systemic venous congestion: a prospective cohort study

BackgroundIt is uncertain whether fluid administration can improve patients with systemic venous congestion and haemodynamic instability. This study aimed to describe the changes in systemic venous congestion and peripheral perfusion parameters induced by a fluid challenge in these patients, and to analyse the influence of the fluid responsiveness status on these changes.MethodsThe study is a single-centre prospective cohort study of 36 critically ill ICU patients with haemodynamic instability and a maximum vena cava diameter ≥ 20 mm. Changes in cardiac index during a fluid challenge (4 mL/kg of lactated Ringer’s solution during 5 min) assessed by pulse contour analysis, central venous pressure, ultrasound systemic congestion parameters (portal venous flow pulsatility index, supra hepatic and intrarenal venous Doppler), and peripheral perfusion parameters (capillary refill time and peripheral perfusion index) were assessed in the overall population. All these data were compared between patients presenting a cardiac index increase > 10% during the fluid challenge (fluid responders) and the others (fluid non-responders).ResultsTwenty-eight (78%) patients were admitted for postoperative care following cardiac surgery; their mean ± SD left ventricular ejection fraction was 42 ± 9% and right ventricular dysfunction was found in at least 61% of the patients. The mean ± SD SOFA score was 9 ± 3. Thirteen (36%) patients were fluid responders. The fluid challenge administration induced a significant increase in portal pulsatility index, VExUS score, and central venous pressure without significant difference of these changes between fluid responders and non-responders. No significant change in perfusion parameters was observed.ConclusionFluid administration in patients with haemodynamic instability and systemic venous congestion worsens venous congestion regardless of the fluid responsiveness status, without improving perfusion parameters.

The Association between Home Health Nursing and 30-Day Hospital Readmission after Tracheotomy in Children: A Single-Center Prospective Cohort Study.

The Association between Home Health Nursing and 30-Day Hospital Readmission after Tracheotomy in Children: A Single-Center Prospective Cohort Study.

A single-center prospective study of vitamin D levels and its supplementary effect in the first trimester

Objective: To investigate vitamin D levels and the effect of exogenous vitamin D supplementation in the first trimester among pregnant women in our center. Methods: This was a prospective cohort study. A total of 98 women in the first trimester who were followed-up regularly in Peking Union Medical College Hospital from December 1st 2020 to December 1st 2021 were enrolled. Subjects who had medical conditions that affect vitamin D absorption or metabolism were excluded. Questionnaires were administered, and 25-hydroxyvitamin D [25(OH)D] levels were detected using liquid chromatography tandem mass spectrometry (LC/MS/MS) method. According to the basic 25(OH)D level, different dosages of exogenous vitamin D were supplemented. After 4 weeks, 25(OH)D levels were detected again to evaluate the effect of supplementation. T test, analysis of variance, χ2 test, and multiple linear regression analysis were used for analysis. Results: The mean age of enrolled subjects was (33.5±4.0) years. The baseline 25(OH)D level was (41.2±20.0) nmol/L. Briefly, 70.4% (69/98) subjects were deficient in vitamin D, and 42.9% (42/98) patients were using vitamin D supplementation at the time of 25(OH)D testing. Single-factor analysis showed that vitamin D supplementation (t=-4.21, P<0.001), season (t=2.59, P=0.011), and nut-eating frequency (t=2.67, P=0.009) were related to 25(OH)D levels. Multiple linear regression analysis showed that only vitamin D supplementation had a relationship with 25(OH)D level (B=13.84, P=0.006). According to the baseline 25(OH)D level, 400-5 000 U/d vitamin D3 was supplemented regularly for (4.1±2.5) weeks, and 25(OH)D levels significantly increased after supplementation [(64.1±18.1) vs (37.3±16.6) nmol/L, t=-9.36, P<0.001]. The ascending range was negatively associated with basic 25(OH)D level (B=-0.66, P<0.001) and positively associated with supplementary dosage (B=0.51, P<0.001). 25(OH)D levels increased by 0.51 nmol/L on average per 1 μg (40 U) of vitamin D supplementation daily. Conclusions: The proportion of vitamin D deficiency was high in the first trimester among pregnant women in our center. Exogenous vitamin D supplementation could significantly increase 25(OH)D levels, and the effect was negatively associated with basic 25(OH)D level but positively associated with supplementary dosage.

The Potential of Sound Analysis to Reveal Hemodynamic Conditions of Arteriovenous Fistulae for Hemodialysis.

Arteriovenous fistula (AVF), the preferred vascular access for hemodialysis, is associated with high failure rate. The aim of this study was to investigate the potential of AVF sound auscultation in providing quantitative information on AVF hemodynamic conditions. This single-center prospective study involved six patients with native radio-cephalic AVFs who underwent multiple follow-up visits. Doppler Ultrasound blood flow volume (BFV) assessment and electronic stethoscope-based sound recordings were performed during each visit, whereas MRIs were acquired 3days, 3weeks and 1year after surgery. Computational fluid dynamic (CFD) simulations were performed on patient-specific MRI-derived geometrical models. Higher values of median peak amplitudes ratios (high-low peak ratio-HLPR) were found to be associated with complex blood flow and velocity streamlines recirculation at systolic peak, and corresponding extended regions of high oscillatory shear index (OSI). On the contrary, lower values of HLPR were associated with laminar flow pattern and low values of OSI. Significant differences were observed in HLPR between subgroups with extended or limited areas with OSI > 0.1 (0.67 vs 0.31, respectively). Significant relationships were found between AVF sound intensity and brachial BFV (slope = 0.103, p < 0.01) as well as between longitudinal changes in brachial BFV and HLPR (slope = - 0.001, p < 0.01). Our results show that AVF sound can be exploited to extract fundamental information on AVF hemodynamic conditions, providing indication of the presence of complex hemodynamic and adequate BFV to perform hemodialysis. Sound analysis has therefore the potential to improve clinical AVF surveillanceand to ameliorate outcome.

30-day Spirometry Holter method design and prospective observational study

Asthma underdiagnosis and overdiagnosis remain significant problems for healthcare systems worldwide and indicate considerable pain points with current guidelines and diagnostic methods; therefore, new, targeted approaches seem crucial. This study introduces a novel spirometry-based approach using digital tools for objective asthma diagnosis support. This was a single-centre (Warsaw Medical University, Poland) prospective cohort study. It included adults with suspected asthma per GINA 2020, without confirmed obstruction in ambulatory spirometry. Patients were equipped and trained with a portable spirometer with built-in manoeuvre quality features AioCare® (HealthUp, Poland). The protocol included twice-daily spirometry examinations over four weeks and symptom reporting in the mobile app. The number of obstructions detected, probability of finding obstruction over time, spirometry values’ variability, technical correctness, and reported symptoms were evaluated. 26 patients enrolled (14 females, mean age 37.6 years old, BMI 24.7 kg/m^2), with a primary outcome of observed obstruction in 42% of participants (3.08 per patient, 95%CI: 0.78–5.37). The detection probability of obstruction plateaued at 100% within the first 21 days of monitoring. Diurnal PEF and FEV1 variability were exceeded (≥ 10%) in 73% and 66% of patients, respectively. 88% of participants performed over half of their tests correctly. 85% of patients reported symptoms at least once. The Spirometry Holter is a novel and feasible tool for monitoring airway limitation variability in line with GINA guidelines. It shows promise in objectively supporting asthma diagnoses in treatment-naive patients lacking documented prior obstruction.

Predictors of New-Onset Atrial Fibrillation in Patients With Chronic Coronary Artery Disease After Coronary Artery Bypass Grafting: a Prospective, Observational, Single-Centre, Non-Randomized Study

To study the factors that influence the occurrence of postoperative atrial fibrillation (POAF) in patients with chronic ischemic heart disease (IHD) after coronary artery bypass grafting (CABG). This single-center prospective observational non-randomized study included 152 patients with chronic IHD. Mean age of patients was 64.4±5.9 years. All patients after CABG were divided into two groups based on the occurrence of atrial fibrillation (AF) in the early postoperative period: group 1, with POAF (n=43; 28.3%) and group 2, without POAF (n=109; 71.7%). The primary study endpoint was new-onset POAF in the early postoperative (hospital) period after CABG. The secondary study endpoint was in-hospital postoperative complications (non-fatal/fatal acute coronary syndrome (ACS), non-fatal/fatal stroke, major bleeding, death). Patients with POAF had significantly more pronounced structural and functional changes in the heart than patients with preserved sinus rhythm after CABG: larger left ventricular (LV) volume, greater LV myocardial mass, lower LV systolic function parameters and impaired diastolic function, and an enlarged left atrial (LA) cavity. Analysis of in-hospital complications did not show any differences between the groups associated with the development of POAF. The following risk factors for POAF were identified: age older than 65 years (p=0.022), body mass index ≥30.5 kg/m2 (p=0.020), epicardial adipose tissue thickness &gt;10.5 mm (p=0.015), indexed LA volume &gt;33 ml/m2 (p&lt;0.001), LV myocardial mass index &gt;115 g/m2 (p=0.042), left main coronary artery disease &gt;50% (p=0.043), duration of cardiopulmonary bypass during CABG &gt;60 min (p=0.019), blood potassium concentration in the early postoperative period after CABG (on the first day) &lt;3.6 mmol/l (p&lt;0.001), and pericardial effusion volume in the early postoperative period &gt;88 ml (p&lt;0.001). Determining the risk of developing POAF is important and necessary for the closest monitoring of a patient with chronic IHD in the postoperative period.

Infiltrations of plasma cells in synovium predict inadequate response to Adalimumab in Rheumatoid Arthritis patients

ObjectiveRheumatoid arthritis (RA) is a clinically heterogeneous and complex autoimmune disease, making the prediction of therapeutic responses a significant challenge. This study aims to assess the role of clinical and synovial biomarkers in predicting poor response to adalimumab treatment in RA patients.MethodsThis single-center prospective study included 56 RA patients who had an inadequate response to methotrexate (MTX). At baseline, comprehensive assessments including complete blood count, liver and kidney function tests, blood glucose levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA), as well as counts of swollen and tender joints, Health Assessment Questionnaire (HAQ) score, pain visual analogue scale (VAS) scores, and DAS28-CRP scores were conducted. Synovial biopsies were performed, followed by an efficacy evaluation at 12 weeks of adalimumab treatment. Patients not meeting the ACR20 criteria were classified into the non-responder group, with the remainder categorized as the responder group.ResultsOut of the participants, 24 (42.9%) failed to achieve ACR20 with adalimumab treatment. Non-responders exhibited higher infiltration of plasma cells in the synovium. Multivariate logistic regression analysis identified the presence of plasma cells as an independent risk factor for inadequate response to adalimumab.ConclusionInadequate responses to adalimumab in RA patients were associated with increased plasma cell infiltrations in the synovium. These findings suggest a promising target for tailored therapies in rheumatoid arthritis.