Single-center Retrospective Case Control Research Articles

Diagnosis of perimenopausal coronary heart disease patients using radiomics signature of pericoronary adipose tissue based on coronary computed tomography angiography

To assess whether the radiomics signature of pericoronary adipose tissue (PCAT) from coronary computed tomography angiography (CCTA) can distinguish between perimenopausal women with coronary heart disease (CHD) and those without coronary artery disease (CAD). This single-center retrospective case–control study comprised 140 perimenopausal women with CHD presenting with chest pain who underwent CCTA within 48 h of admission. They were matched with 140 control patients presenting with chest pain but without CAD, based on age, risk factors, radiation dose and CT tube voltage. For all participants, PCAT around the proximal right coronary artery was segmented, from which radiomics features and the fat attenuation index (FAI) were extracted and analyzed. Subsequently, corresponding models were developed and internally validated using Bootstrap methods. Model performance was assessed through measures of identification, calibration, and clinical utility. Using logistic regression analysis, an integrated model that combines clinical features, fat attenuation index and radiomics parameters demonstrated enhanced discrimination ability for perimenopausal CHD (area under the curve [AUC]: 0.80, 95% confidence interval [CI]:0.740–0.845). This model outperformed both the combination of clinical features and PCAT attenuation (AUC 0.67, 95% CI 0.602–0.727) and the use of clinical features alone (AUC 0.66, 95% CI 0.603–0.732). Calibration curves for the three predictive models indicated satisfactory fit (all p > 0.05). Moreover, decision curve analysis demonstrated that the integrated model offered greater clinical benefit compared to the other two models. The CCTA-based radiomics signature derived from the PCAT model outperforms the FAI model in differentiating perimenopausal CHD patients from non-CAD individuals. Integrating PCAT radiomics with the FAI could enhance the diagnostic accuracy for perimenopausal CHD.

Chest CT scan predictors of intensive care unit admission in hospitalized pregnant women with COVID-19: a case–control study

Purpose To investigate the role of chest computed tomography (CT) scan in the prediction of admission of pregnant women with COVID-19 into intensive care unit (ICU). Methods This was a single-center retrospective case–control study. We included pregnant women diagnosed with COVID-19 by reverse transcriptase polymerase chain reaction between February 2020 and July 2021, requiring hospital admission due to symptoms, who also had a CT chest scan at presentation. Patients admitted to the ICU (case group) were compared with patients who did not require ICU admission (control group). The CT scans were reported by an experienced radiologist, blinded to the patient’s course and outcome, aided by an artificial intelligence software. Total CT scan score, chest CT severity score (CT-SS), total lung volume (TLV), infected lung volume (ILV), and infected-to-total lung volume ratio (ILV/TLV) were calculated. Receiver operating characteristic curves were constructed to test the sensitivity and specificity of each parameter. Results 8/28 patients (28.6%) required ICU admission. These also had lower TLV, higher ILV, and ILV/TLV. The area under the curve (AUC) for these three parameters was 0.789, 0.775, and 0.763, respectively. TLV, ILV, and ILV/TLV had good sensitivity (62.5%, 87.5%, and 87.5%, respectively) and specificity (84.2%, 70%, and 73.7%, respectively) for predicting ICU admission at the following selected thresholds: 2255 mL, 319 mL, and 14%, respectively. The performance of CT-SS, CT scan score, and ILV/TLV in predicting ICU admission was comparable. Conclusion TLV, ILV, and ILV/TLV as measured by an artificial intelligence software on chest CT, may predict ICU admission in hospitalized pregnant women, symptomatic for COVID-19.

Characteristics and outcomes in adult patients with Staphylococcus lugdunensis bacteremia compared to patients with Staphylococcus epidermidis and Staphylococcus aureus bacteremia: a retrospective study in a 16-year period at the university hospital, Japan

BackgroundStaphyococcus lugudnensis (S. lugdunensis) is one of coagulase-negative Staphylococcus species with a potential to cause invasive infections. Few studies have evaluated the characteristics and outcomes of patients with S. lugdunensis bacteremia (SLB) compared with those of patients with Staphylococcus epidermidis (S. epidermidis) and Staphylococcus aureus (S. aureus) bacteremia.MethodsWe performed a single-center retrospective case–control study of patients aged ≥ 18 who had SLB with at least two sets of positive blood cultures at the Kyoto University Hospital, Japan, from January 2005 to June 2022. Patients who had S. epidermidis bacteremia (SEB) with at least two sets of positive blood cultures and those who had S. aureus bacteremia (SAB) with at least one set of positive blood cultures were randomly selected in a 1:5:5 (SLB:SEB:SAB) ratio.ResultsA total of 22 patients with SLB, 110 patients with SEB, and 110 patients with SAB were included. The proportions of infective endocarditis (IE) and metastatic infections were statistically higher in the SLB group than in the SEB group (14% vs. 2%, p < 0.01 and 18% vs. 5%, p 0.02, respectively) and were not significantly different between the SLB and SAB groups (14% vs. 5%, p 0.16 and 18% vs. 16%, p 0.78, respectively). The seven-day mortality was higher in the SLB group than in the SEB group (9% vs. 1%, p 0.02) and similar between the SLB and SAB groups (9% vs. 7%, p 0.77).ConclusionsThe clinical course and outcome of SLB were worse than those of SEB and similar to those of SAB. Appropriate evaluation and treatment for SAB may be warranted in patients with SLB.

845: TRANSITION FROM DIRECT TO VIDEO LARYNGOSCOPY IN A PEDIATRIC ICU

Introduction: As an infection control measure for COVID-19, our PICU transitioned to near universal video laryngoscopy (VL). In 2019, 24% of intubations used VL; this increased to 96% in 2021. Comparing these two cohorts elucidates the effect of transitioning from direct laryngoscopy (DL) to VL on first time success rate (FTSR), Cormack-Lehane (C-L) grade view and successful trainee intubation. First time intubation success is associated with fewer complications and is therefore an important marker of intubation safety. Methods: Single Center retrospective case control. Data for 2019 were identified via chart review. Data from 2021 were obtained through a dedicated form introduced in the Fall of 2020. Each comparison group was limited to a full calendar year (Jan-Dec) to account for progression in trainee skill. A comparison was made between all patients in cohort groups with additional stratification of patients above and below the age of one. Included intubations were those in the PICU as well as those in the pediatric floor or ED performed by PICU staff. Statistics via Fischer Exact test. Results: 75 patients met criteria for 2019 and 73 in 2021. The age range in both groups was 2 days to 23 years. C-L view was documented in 72 of 75 patients in 2019 and all patients in 2021. 2019 had a 69.4% grade 1 C-L view rate, while 2021 had a 79.5% grade 1 C-L view rate (p=0.19). The overall FTSR in 2019 was 57.3% vs 65.7% in 2021 (p=0.31). 26 children under the age of one were intubated in both years, with a FTSR of 53.8% and 50% respectively. The FTSR in children above one year was 59.2% and 74.5% respectively (p=0.13). Additionally, an airway provider was documented in all but two cases in 2019. Of these, 75.3% were managed successfully by pediatric subspecialty fellows (PICU or rotating PEM). In 2021 this number increased to 84.9% (p=0.21). Conclusions: FTSR did not improve with transition to VL. In the 2021 cohort, children above age one had a 15.3% increased FTSR and trainees had a 9.6% increase in completed intubations. While not significant, these findings would benefit from reanalysis with a larger sample. First time success is an important marker for safe intubation practice, however there may be other benefits to either approach such as set up time and assistance from a second viewer.

SARS-CoV-2 in Pregnancy-A Retrospective Analysis of Selected Maternal and Fetal Laboratory Parameters.

Pregnant women and their neonates belong to the group of individuals with elevated risk for COVID-19 infection. Data on the course of the disease and how it affects the pregnancy and neonatal wellbeing remain conflicting. The aim of the study was to evaluate the effect of SARS CoV-2 infection on the mode of delivery, neonatal condition and selected maternal and fetal laboratory parameters. This was a single-center retrospective case-control study. This dataset was generated using electronic medical records collected by medical personnel. Two groups of patients, hospitalized between April, 2020 and February, 2021, were included in the study: study group (304)-pregnant women with SARS-CoV-2 and control group (N = 329)-healthy pregnant women or parturients. Mothers with a severe course of COVID-19 had higher activated partial thromboplastin-APTT (p = 0.02), C-Reactive Protein-CRP (p = 0.00) and procalcitonin (p = 0.032) levels as compared to pregnant women with mild or moderate course of the disease. Neonates born to SARS-CoV-2-infected mothers presented with worse condition at 1 and 5 minutes of life (p = 0.000 and 0.00, respectively) and lower Arterial Blood Gas-ABG pH scores (p = 0.016). Elective cesarean section is the most common mode of delivery for SARS-CoV2-infected mothers. Emergency cesarean sections are performed at earlier gestational age as compared to vaginal delivery and elective cesarean section. Lower Apgar scores were observed in neonates born to SARS-CoV-2-infected mothers who required oxygen therapy and whose procalcitonin levels were elevated. There is a relationship between more severe course of COVID-19 and APTT, as well as CRP and procalcitonin levels.

Association between patient with muscle-invasive bladder cancer with the incidence of urinary tract infection in Karawang Regional Hospital: a single center study

Background: Several studies link urinary tract infection (UTI) and bladder cancer. However, the association between bladder cancer muscle invasiveness and the incidence of UTI is not known Objective: This study aimed to study the association between the occurrence of UTI in bladder cancer and the severity of the bladder cancer, specifically in a patient admitted to Karawang regional hospital, Indonesia. Material and Methods: This is a single-center retrospective case control. Data were obtained through medical records of the patient admitted with bladder cancer in Karawang Regional Hospital from 2019-2021. Diagnosis of Non-muscle invasive Bladder cancer (NMIBC)/Muscle-invasive Bladder Cancer (MIBC) and UTI were all obtained through medical records. Binary logistic regression analysis was used to determine the odds ratio between these variables and the incidence of UTI Result: A total of 59 samples were obtained. 57.7% were males, and 42.3% were females, with a mean age of 59 years and distributed into two groups, NMIBC/MIBC. There are also no significant gender and age difference between groups. Our data showed no significant association between bladder cancer muscle invasiveness and the incidence of UTI (OR=1.67; 95%CI 0.218-12.7; p=0.622). Subgroup analysis with different gender also yields no significant result. Conclusion: UTI incidence increased in MIBC patients compared to NMIBC, but it is not statistically significant.

Case–control study exploring the short-term association of bronchiolitis with high blood pressure and hypertension in hospitalized children

BackgroundUnlike in adults, there are limited pediatric data exploring the association between acute respiratory illnesses and blood pressure abnormalities. The aim of our study was to explore the association of bronchiolitis, a common respiratory illness, with elevated blood pressure in hospitalized children.MethodsIn this single center retrospective case–control study, we evaluated the association between bronchiolitis and elevated blood pressure and hypertension in hospitalized children, compared to a control group admitted with nonrespiratory conditions, using multivariate regression analyses. Standard published normative data on pediatric blood pressure were used to classify children in various blood pressure categories.ResultsA high prevalence of elevated blood pressure (16%) and hypertension (60%) was noted among children with bronchiolitis; this was not statistically different from the control group (18% for elevated blood pressure; 57% for hypertension; P-values, 0.71 and 0.53, respectively). On multivariate regression analyses, only length of stay was associated with hypertension. No patient with blood pressure abnormalities received antihypertensives nor were any nephrology consults documented.ConclusionsA high prevalence of blood pressure abnormalities, without documentation of their recognition, was noted in hospitalized children regardless of diagnosis, pointing to the need for more data on outcomes-driven significance of pediatric inpatient blood pressure measurements.

Real time wire localization by ultrasound during central line insertion improves accurate positioning in all upper torso sites.

To investigate whether point of care ultrasound can improve central venous catheter tip positioning. A single center retrospective case control study. We compared the precision of central venous catheter tip positioning between two intensive care units while in only one of the units, we used point of care ultrasound for guidewire identification. 207 cases in which central venous catheter was inserted using point of care ultrasound guided method, compared to 192 controls. The primary outcome of correct placement of the central venous catheter tip was significantly higher in the point of care ultrasound guided group (97.6% vs 88.0% p=0.001). Central venous catheter tip was located too low among 12% of patients in the control group while in only 2.4% of patients in the point of care ultrasound group (p=0.001). Logistics regression analysis revealed that the correct placement of central venous catheter tip in the point of care ultrasound group versus the control group had an odds ratio of 4.9 (CI 1.6-14.5 P=0.004). Point of care ultrasound for guidewire identification and localization, while inserting central venous catheter from all upper torso sites, improves precision positioning.

P589 Total thiopurine exposure and impact on the development of keratinocyte carcinomas in Inflammatory Bowel Disease patients; a case control study

Abstract Background Keratinocyte skin cancer (KSC) including basal-cell carcinomas (BCC) and cutaneous squamous cell carcinomas (SCC), is the most prevalent cancer-type in the Netherlands with an increasing incidence and impact on morbidity. In addition to ultraviolet radiation (UVR), thiopurines used in patients with inflammatory bowel disease (IBD), are associated with KSC development. It is unclear whether this is a dose response relationship. The aim of this study was to investigate the association between the cumulative dose of thiopurines and the development of KSCs in IBD patients. Methods A single-center retrospective case control study was conducted and we included patients with IBD on thiopurines and a history of KSC (n=50, cases) as well as without KSC (n= 150, controls). For each patient we calculated the cumulative dose of azathioprine (AZA), 6-mercaptopurine (6-MP) and tioguanine (6-TG) as primary outcome, and of methotrexate (MTX) as secondary outcome. Univariable and multivariable regression analyses were performed, the latter corrected for known risk factors and potential confounders: age and smoking. Results 200 IBD patients were included (see Table 1). There were more cases (24%) using azathioprine at time of KSC onset compared to 11.3% of controls at time of inclusion (p= 0.028). Independent variables including age at inclusion (OR 1.065, CI 1.038–1.092) and IBD disease duration (OR 1.040, CI 1.016–1.065) were significantly associated with KSC. No significant association was found between KSC development and smoking, cumulative thiopurine use, nor between KSC development and cumulative MTX use. To account for possible non-linear effects, cut-offs at the registered 1- and 3-years- cumulative doses were assessed. Here, no significant results were found for any of the distinct thiopurines or MTX, the 3-years cumulative use of AZA had the highest odds ratio of 1.085 (CI 0.795–1.482). In multivariate logistic regression analyses (see Table 2), age per 10 years remained significant associated (p=0.005) (OR 1.666, CI 1.165–2.381). Conclusion This study showed that in IBD-patients IBD duration (only in univariable regression analysis) and age (in both uni- and multivariable regression analyses) are important risk factors for KSC development while cumulative exposure of thiopurines and MTX did not show an association. The dose response association between KSC and thiopurines requires further research.

Endothelial Cell Activation and Thrombin Generation Assessment for the Risk of Severe Early Onset Preeclampsia. the ROADMAP-EOP Study

Background The ROADMAP-EOP study aimed to identify clinically relevant biomarkers of hypercoagulability for the identification of pregnant women at risk of early onset preeclampsia worsening. Methods The ROADMAP-EOP observational single center retrospective case–control study was conducted in Greece (Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece) from July 2020 to July and enrolled pregnant women diagnosed with EOP stratified in mild EOP group (n = 34) and severe EOP group (n = 15) as well as women with uncomplicated pregnancy (control group; n = 35). All women were assessed with thromboelastometry (ROTEM®), Calibrated Automated Thrombogram®, tissue factor activity (TFa), procoagulant phospholipid dependentclotting time (Procoag-PPL®), Proteins S (PS), TFPI, D-dimer, antithrombin (AT), thrombomodulin (TM), fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT). The primary study end-point was severe earlyonset preeclampsia. Principal component analysis (PCA) was performed. Results The PCA analysis showed that a score composed of the lag-time, ttPeak and Procoag-PPL accurately predicted severe EOP (sensitivity 71.4%, specificity 61.8%, and AUC of the ROC analysis 0.953). Conclusion The pilot ROADMAP-EOP shows that activation of endothelial cells and blood hypercoagulability are driven events in the worsening of EOP. Among a large panel of biomarkers and coagulation assays, thrombingeneration test and procoagulant phospholipid dependent clotting time emerged as clinically relevant for the evaluation of the risk of severe EOP. This methodology for the development of a new clinic-biological risk assessment model for prompt identification of pregnant women at risk of severe EOP must be validated in a large multi-centerprospective study.

New-onset acute ischemic stroke following COVID-19: A case-control study.

Background:Neurological manifestations of coronavirus disease 2019 (COVID-19) have been highlighted. COVID-19 potentially increases the risk of thromboembolism. We aimed to compare patients with COVID-19 with and without new-onset acute ischemic stroke (AIS).Materials and MethodsIn this single-center retrospective case–control study, demographics, clinical characteristics, laboratory findings, and clinical outcomes were compared between 51 patients with both COVID-19 and AIS (group A) and 160 patients with COVID-19 and without AIS (group B).Results:Patients in group A were significantly older, more likely to present with critical COVID-19 (P = 0.004), had higher rates of admission in the intensive care unit (P < 0.001), more duration of hospitalization (P < 0.001), and higher in-hospital mortality (P < 0.001). At the time of hospitalization, O2 saturation (P = 0.011), PH (P = 0.04), and HCO3 (P = 0.005) were lower in group A. White blood cell count (P = 0.002), neutrophil count (P < 0.001), neutrophil-lymphocyte ratio (P = 0.001), D-Dimer (P < 0.001), blood urea nitrogen (BUN) (P < 0.001), and BUN/Cr ratio (P < 0.001) were significantly higher in patients with AIS.Conclusion:Stroke in COVID-19 is multifactorial. In addition to conventional risk factors of ischemic stroke (age and cardiovascular risk factors), we found that patients with more severe COVID-19 are more prone to ischemic stroke. Furthermore, leukocyte count, neutrophil count, neutrophil-lymphocyte ratio, D-Dimer, BUN, and BUN/Cr ratio were higher in patients with AIS following COVID-19 infection.

Aberrant Hematopoiesis and Morbidity in Extremely Preterm Infants With Intrauterine Growth Restriction.

Background and Objective: Intrauterine growth restriction (IUGR) poses additional challenges in extremely low gestational age newborns (ELGANs). We assessed disturbed hematopoiesis and morbidities associated with this disorder.Methods: This single-center retrospective case–control study compared perinatal hematological profiles, major morbidities, and mortality of 49 infants (gestational age <28 weeks, birth weight ≤ 3rd percentile, and compromised placental function) and 98 infants (birth weight >10th percentile) matched for gestational age, year, and sex.Results: IUGR-ELGANs had significantly elevated nucleated red blood cells and lower neutrophil and platelet counts at birth and on the third day of life. During the first week of life, IUGR-ELGANs received more red blood cell, platelet, and plasma transfusions and were more intensively treated with antibiotics. Rates of infections acquired during the first week (59.2 vs. 17.3%, p < 0.001), severe bronchopulmonary dysplasia or death (42.9 vs. 17.3%, p < 0.01), and mortality (36.7 vs. 7.1%, p < 0.001) were markedly elevated in IUGR-ELGANs, but not of hemorrhages or other morbidities.Conclusions: IUGR-ELGANs have high rates of acquired infections during the first week of life and display severe pulmonary morbidity leading to bronchopulmonary dysplasia or death. The high rate of transfusions observed in these infants warrants further scrutiny.

Ethics of rooming-in with COVID-19 patients: Mitigating loneliness at the end of life.

To investigate whether point of care ultrasound can improve central venous catheter tip positioning.A single center retrospective case control study.We compared the precision of central venous catheter tip positioning between two intensive care units while in only one of the units, we used point of care ultrasound for guidewire identification.207 cases in which central venous catheter was inserted using point of care ultrasound guided method, compared to 192 controls. The primary outcome of correct placement of the central venous catheter tip was significantly higher in the point of care ultrasound guided group (97.6% vs 88.0% p = 0.001). Central venous catheter tip was located too low among 12% of patients in the control group while in only 2.4% of patients in the point of care ultrasound group (p = 0.001). Logistics regression analysis revealed that the correct placement of central venous catheter tip in the point of care ultrasound group versus the control group had an odds ratio of 4.9 (CI 1.6–14.5 P = 0.004).Point of care ultrasound for guidewire identification and localization, while inserting central venous catheter from all upper torso sites, improves precision positioning.

Assisted Reproductive Technology and Anorectal Malformation: A Single-Center Experience.

Background: Assisted reproductive technologies (ART) are becoming widespread, accounting for approximately 2% of all births in the western countries. Concerns exist on the potential association of ART with congenital anomalies. Few studies have addressed if a relationship exists between ART and the development of anorectal malformation (ARM). Our aim was to analyze the relationship between ARM and ART.Methods: Single-center retrospective case control study of all patients treated for ARM between 2010 and 2017. Patients with bronchiolitis treated since 2014 were used as controls. Variables analyzed include the following: prevalence of ART, gestational age, birth weight, and maternal age. Patients with ARM born after ART were also compared with those naturally conceived for disease complexity. Fisher's exact and Mann-Whitney U-tests were used as appropriate.Results: Three hundred sixty-nine patients were analyzed (143 cases and 226 controls). Prevalence of ART was significantly higher in ARM patients than in controls [7.6 vs. 3.0%; odds ratio: 2.59 (95% CI, 0.98–0.68); p = 0.05]. Among ARM patients, incidence of VACTERL association (17%) is more frequent in ART babies.Conclusion: Patients with ARM were more likely to be conceived following ART as compared with controls without congenital anomalies. Disease complexity of patients with ARM born after ART seems greater that those born after nonassisted conception.

English

BACKGROUND Mesenteric lymphadenitis (MLN) is found commonly associated with children having chronic abdominal pain, but its significance is rarely mentioned in literature. Mesenteric lymphadenitis is the inflammation of the mesenteric lymph nodes that drain the gastrointestinal tract. The present study was undertaken to assess the prevalence and significance of mesenteric lymphadenopathy among children with chronic abdominal pain (CAP). METHODS This is a single center retrospective case control study conducted in the department of paediatrics of a private medical college in Puducherry. Data was obtained from the records over a period of past 24 months. Cases were defined as 5 - 15 years aged children presenting with chronic abdominal pain. Controls were defined as 5 - 15 years aged children who were subjected to abdominal ultrasonography for reasons other than abdominal pain. Records over past 24 months were studied and for uniformity of analysis, a total of 100 children aged 5 - 15 years, were included in both the groups. Data from the case records was analysed retrospectively to calculate the prevalence of mesenteric lymphadenitis in both the groups. RESULTS Chronic abdominal pain was almost equal in both sexes with a male : female ratio of 0.9 : 1. In our study, the incidence of significant MLN among children with chronic abdominal pain was 89 % [n = 89, out of 100 cases] and was 26 % among controls [n = 26, out of 100 controls]. CONCLUSIONS This study showed that MLN is one of the most common findings in children with CAP with higher incidence among cases than controls and is statistically significant. Abdominal ultrasonography is a useful tool in the evaluation of CAP to rule out organic causes. KEYWORDS Chronic Abdominal Pain (CAP), American Academy of Paediatrics (AAP), Mesenteric Lymphadenopathy [MLN], Recurrent Abdominal Pain (RAP)

Balloon occluded TACE (B-TACE) vs DEM-TACE for HCC: a single center retrospective case control study

BackgroundTo compare oncological results and safety profile of balloon micro-catheter trans-arterial chemoembolization (b-TACE) and drug-eluting-microsphere (DEM-TACE) in patients with hepatocellular-carcinoma (HCC).MethodsThis is a case–control, retrospective, single-center study. Between January-2015/March-2019, 149 patients (131 males [87.9%]) with 226 HCC were treated, 22 patients (35 HCC; 19 [86.4%] males) with b-TACE and 127 with DEM-TACE (191 HCC, 112 [88.2%] males). Embolization protocol was standardized (sequential 100 ± 25 and 200 ± 25 μm microspheres). Results were evaluated by modified-response-evaluation-criteria-in-solid-tumor [mRECIST] at 1, 3–6 and 9–12 months and time to recurrence after complete response [TTR] at 1 years. Cox’s regression weighted with tumor dimensions was performed. Adverse events (AEs) were recorded.ResultsmRECIST oncological response at all time points (1, 3–6 and 9–12 months) for both treatments were similar, with the exception of Objective response rate at 9-12 months. Objective response at 1 and 3–6 months between b-TACE vs DEM-TACE [23/35 (65.7%) vs 119/191 (62.3%), 21/29 (72.4%) vs 78/136 (57.4%) (p > 0.05), respectively]. On the contrary, at 9–12 months, it was significantly higher in b-TACE subgroup than DEM-TACE (15/19 [78.9%] vs 48/89 [53.9%], p = 0.05). TTR for complete response at 1 year had a better trend for b-TACE vs DEM-TACE (278.0 days [196.0–342.0] vs 219.0 days [161.0–238.0], OR 0.68 [0.4–1.0], p = 0.10). The use of balloon micro-catheter reduced the relative risk of the event of recurrence by 0.63 [CI95% 0.38–1.04]; p = 0.07). No significant differences were found in AEs rate.Conclusionb-TACE showed a trend of better oncological response over DEM-TACE with and longer TTR with a similar adverse events rate, in patients presenting with larger tumors.

Methotrexate-Induced AKI: Incidence, Risk Factors and Recovery

Background: Data on short and long term renal outcomes after high dose methotrexate (HD MTX) in large adult cohorts using a standardized definition of AKI is lacking. This is a report on the incidence of AKI after HD MTX, renal outcomes when HD MTX is continued after AKI, and long term renal function in patients who survived beyond 5 years after Risk factors for AKI following HD MTX were also examined. Methods: In this single center retrospective case control study, all adult patients (>18 years) who had received HD MTX (defined as >1g/m 2 ) from 2003 – 2013 were analyzed. AKI was identified by a > 1.5x increase in baseline serum creatinine (Cr) within 4 days after HD MTX. We have collected age at first HD MTX, race, cancer, baseline and all Cr values after HD MTX, and cumulative dose (CD) of MTX. Univariable and multivariable logistic regression models were performed with AKI as the dependent variables. Overall survival for patients that had received HD MTX was presented in a Kaplan-Meier analysis. Findings: In a cohort of 865,32.1% developed AKI. Patients who developed AKI had a lower baseline Cr (0.7 ± 0.2 vs 0.9 ±0.2; p<0.001), a higher eGFR (95.1 ± 21.8 vs 90.0 ± 22.0; p<0.001) and received a higher CD (25,750 (14100 – 35000) vs 20,000 (9425 – 34,300); p<0.01). There was no statistical difference in overall survival among patients who developed AKI (p=0.13) and those who continued to receive HD MTX after AKI (p=0.32). Recovery from AKI to within 20% of baseline Cr was associated with a higher probability of survival (p<0.001). Interpretation: Despite its relatively common incidence in adult patients receiving HD MTX, AKI does not affect overall survival and should not be a barrier to further administration of chemotherapy. Funding Statement: This study was funded by NIH/NCI Cancer Center Support Grant P30 CA008748. Declaration of Interests: None to declare. Ethics Approval Statement: This study was approved by the Internal Review Board at Memorial Sloan Kettering Cancer Center, retrospective data was collected on all adult patients (>18 years) who received HD MTX from 01/01/2003 – 12/31/2013.

Open versus endovascular REBOA control of blood loss during cesarean delivery in the placenta accreta spectrum: A single-center retrospective case control study

ObjectiveThe aim of this study was to compare two vascular control options for blood loss prevention and hysterectomy during cesarean delivery (CD22Cesarean delivery.): endovascular balloon occlusion of the aorta (REBOA33Resuscitative endovascular balloon occlusion of the aorta.) and open bilateral common iliac artery occlusion (CIAO44Common iliac artery occlusion.) in women with extensive placenta accreta spectrum (PAS55Placenta accreta spectrum.). Study designThis was retrospective comparison of cases of PAS using either CIAO (October 2017 through October 2018) or REBOA (November 2018 through November 2019) to prevent pathologic hemorrhage during scheduled CD. Women with confirmed placenta increta/percreta underwent either CD then intraoperative post-delivery, pre-hysterectomy open vascular control of both CIA66Common iliac artery. (CIAO group) or pre-operative, ultrasound-guided, fluoroscopy-free REBOA followed by standard CD and balloon inflation after fetal delivery (REBOA group). Intraoperative blood loss, transfusion volumes, surgical time, blood pressure, maternal and neonatal outcomes, hospitalization length and postoperative complications were compared. ResultsThe REBOA and CIAO groups included 12 and 16 women, respectively, with similar median age of 35 years and gestational age of 34–35 weeks. All REBOA catheters were successfully placed into aortic zone three under ultrasound guidance. The quantitated median intraoperative blood loss was significantly lower for the REBOA group, (541 [IQR 300–750] mL) compared to the CIAO group (3331 [IQR 1150−4750] mL (P = 0.001). As a result, the total volume of fluid and blood replacement therapy was significantly lower in the REBOA group (P < 0.05). Median surgical time in the REBOA group was less than half as long: 76 [IQR 64−89] minutes compared to 168 [IQR 90−222] minutes in the CIAO group (P = 0.001). None of the women with REBOA required hysterectomy, while 8/16 women in the CIAO group did (P = 0.008). Furthermore, the post-anesthesia recovery and hospital discharge times in the REBOA-group were shorter (P < 0.05). One thromboembolic complication occurred in each group. The only REBOA-associated complication was non-occlusive femoral artery thrombosis, with no surgical management required. No maternal or neonatal deaths occurred in either group. ConclusionFluoroscopy-free REBOA for women with PAS is associated with improved vascular control, perioperative blood loss, the need for transfusion and hysterectomy and reduces surgical time when compared to bilateral CIAO.

Gestational Outcomes of Pregnant Women with Unilateral Congenital Renal Agenesis

Objective We evaluated if there were more adverse gestational outcomes of pregnant women with unilateral congenital renal agenesis (UCRA). Study design: This single center retrospective case–control study compared maternal complications and neonatal outcomes from 25 women with UCRA to the outcomes of 125 women with two kidneys. Results: UCRA women had lower gestational weeks at birth and higher rates of preterm delivery (p = 0.004 and <0.001; respectively). Mothers had higher rates of preeclampsia and newborns with congenital anomalies and neonatal intensive care unit (NICU) admission (p = 0.009, 0.042, and 0.039; respectively). Unadjusted odds ratios were significantly higher for preterm delivery and for any APGAR score of <7 at the first 10 min and preeclampsia [OR (95% CI):13.5 (4.66–39.05), 31 (3.44–279.32) and 5.76 (1.33–24.84), respectively]. Conclusion: Maternal UCRA is a risk factor for less optimal obstetric and neonatal outcomes.

Left Ventricular Magnetic Resonance Imaging Strain Predicts the Onset of Duchenne Muscular Dystrophy-Associated Cardiomyopathy.

Early detection of left ventricular (LV) dysfunction before the onset of overt Duchenne muscular dystrophy-associated cardiomyopathy (DMDAC) may direct clinical management to slow onset of dysfunction. We aimed to assess whether LV strain will predict those who develop DMDAC. We performed a single center retrospective case control study of patients with Duchenne muscular dystrophy who underwent serial cardiac magnetic resonance between 2006 and 2019. Patients with Duchenne muscular dystrophy with an LV ejection fraction ≥55% on ≥1 cardiac magnetic resonance were identified and grouped into age-matched +DMDAC and -DMDAC. Within 3 years, +DMDAC had a subsequent cardiac magnetic resonance with a decline in LV ejection fraction ≥10% and absolute LV ejection fraction ≤50%. -DMDAC maintained an LV ejection fraction ≥55% on serial cardiac magnetic resonances. Two-dimensional and 3-dimensional global radial strain, global circumferential strain (GCS), and global longitudinal strain were measured using tissue tracking software and their ability to predict DMDAC onset was assessed. Multivariable analysis adjusted for late gadolinium enhancement. Thirty +DMDAC and 30 age-matched -DMDAC patients were included with a total of 164 studies analyzed. Before DMDAC onset, 2-dimensional global radial strain and GCS were significantly worse in +DMDAC compared with -DMDAC (25.1±6.0 versus 29.0±6.3, P=0.011; -15.4%±2.4 versus -17.3%±2.6, P=0.003). Three-dimensional GCS and global radial strain had similar findings. Among strain measures, 3-dimensional GCS had the highest area under the curve to predict DMDAC in our cohort. These findings persisted after adjusting for the presence of late gadolinium enhancement. Reduced global radial strain and GCS may predict those at risk for developing DMDAC before onset of LV dysfunction and its clinical utility warrants further exploration.