Student's T-test Research Articles

The relationships among family function, psychological resilience, and social network of patients with chronic disease in the community

This study aimed to examine the relationships among family function, psychological resilience, and social network of patients with chronic disease in the community and to further identify whether psychological resilience played a mediating role in the relationship between family function and social network. A cross-sectional survey including 460 convenient samples of patients with chronic disease in four Chinese communities was conducted using a general characteristics questionnaire, the Family APGAR Index, the Connor-Davidson Resilience Scale, and the Lubben Social Network Scale 6. Data were analyzed using descriptive analysis, Student's t-test, one-way ANOVA, Pearson/Spearman correlation, hierarchical multiple regression analysis, and mediation analysis using the PROCESS macro. Family function, psychological resilience, and social network were significantly related. Psychological resilience partially mediated the relationship between family function and social network. Interventions designed to enhance family function and psychological resilience may improve social network among patients with chronic disease in the community.

Valoración fisiológica y manejo de pacientes post-COVID con pruebas funcionales cardiopulmonares y de imagen normales

ObjectiveContributing to elucidate the pathophysiology of dyspnoea and exertion intolerance in post-COVID syndrome patients with normal cardiopulmonary imaging and functional tests at rest, while determining their fitness and level of endurance in order to individualize working parameters for physical rehabilitation. Material and methodsAfter an anamnesis and clinical examination at rest, 27 subjects (50±11.9 years) (14 women) with post-COVID syndrome of more than 6 months of evolution performed a continuous maximal-incremental graded cardiopulmonary exercise test (CPET) with breath-by-breath gas-exchange monitoring and continuous ECG registration, on an electromagnetically braked cycle ergometer. The values obtained were compared with those of reference, gender or controls, using the Chi-square, t-Student or ANOVA test. ResultsThe clinical examination at rest and the CPET were clinically normal and without adverse events. Reasons for stopping exercise were leg discomfort. It is only worth noting a BMI=29.9±5.8kg/m2 and a basal lactate concentration of 2.1±0.7mmol/L. The physiological assessment of endurance showed the following results relative to predicted VO2máx: 1)peakVO2=80.5±18.6%; 2)VO2 at ventilatory threshold1 (VO2VT1): 46.0±12.9%; 3)VO2VT2: 57.2±16.4%; 4)working time in acidosis: 5.6±3,0minutes; and 5)maximum lactate concentration: 5.1±2.2mmol/L. ConclusionsThe CPET identified limited aerobic metabolism and early increase in glycolytic metabolism as causes of dyspnoea and exercise intolerance, determined fitness for physical rehabilitation, and individualized it based on the level of endurance.

Myocardial perfusion SPECT radiomic features reproducibility assessment: Impact of image reconstruction and harmonization.

Coronary artery disease (CAD) has one of the highest mortality rates in humans worldwide. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) provides clinicians with myocardial metabolic information non-invasively. However, there are some limitations to interpreting SPECT images performed by physicians or automatic quantitative approaches. Radiomics analyzes images objectively by extracting quantitative features and can potentially reveal biological characteristics that the human eye cannot detect. However, the reproducibility and repeatability of some radiomic features can be highly susceptible to segmentation and imaging conditions. We aimed to assess the reproducibility of radiomic features extracted from uncorrected MPI-SPECT images reconstructed with 15 different settings before and after ComBat harmonization, along with evaluating the effectiveness of ComBat in realigning feature distributions. A total of 200 patients (50% normal and 50% abnormal) including rest and stress (without attenuation and scatter corrections) MPI-SPECT images were included. Images were reconstructed using 15 combinations of filter cut-off frequencies, filter orders, filter types, reconstruction algorithms, number of iterations and subsets resulting in 6000 images. Image segmentation was performed on the left ventricle in the first reconstruction for each patient and applied to 14 others. A total of 93 radiomic features were extracted from the segmented area, and ComBat was used to harmonize them. The intraclass correlation coefficient (ICC) and overall concordance correlation coefficient (OCCC) tests were performed before and after ComBat to examine the impact of each parameter on feature robustness and to assess harmonization efficiency. The ANOVA and the Kruskal-Wallis tests were performed to evaluate the effectiveness of ComBat in correcting feature distributions. In addition, the Student's t-test, Wilcoxon rank-sum, and signed-rank tests were implemented to assess the significance level of the impacts made by each parameter of different batches and patient groups (normal vs. abnormal) on radiomic features. Before applying ComBat, the majority of features (ICC: 82, OCCC: 61) achieved high reproducibility (ICC/OCCC ≥ 0.900) under every batch except Reconstruction. The largest and smallest number of poor features (ICC/OCCC<0.500) were obtained by IterationSubset and Order batches, respectively. The most reliable features were from the first-order (FO) and gray-level co-occurrence matrix (GLCM) families. Following harmonization, the minimum number of robust features increased (ICC: 84, OCCC: 78). Applying ComBat showed that Order and Reconstruction were the least and the most responsive batches, respectively. The most robust families, in a descending order, were found to be FO, neighborhood gray-tone difference matrix (NGTDM), GLCM, gray-level run length matrix (GLRLM), gray-level size zone matrix (GLSZM), and gray-level dependence matrix (GLDM) under Cut-off, Filter, and Order batches. The Wilcoxon rank-sum test showed that the number of robust features significantly differed under most batches in the Normal and Abnormal groups. The majority of radiomic features show high levels of robustness across different OSEM reconstruction parameters in uncorrected MPI-SPECT. ComBat is effective in realigning feature distributions and enhancing radiomic features reproducibility.

Efficacy of specific drug class therapy in pulmonary arterial hypertension associated with HIV, portal hypertension or both: a single Center experience

Abstract Background Pulmonary arterial hypertension (PAH) is a rare complication of both HIV infection (HIV-PAH) and portal hypertension (Po-PAH); it can occur in patients with both diseases (HIV/Po-PAH). The use of the PAH-specific drug classes (prostanoids, endothelin-1 receptor antagonists [ERA] and phosphodiesterase-5 inhibitors [PDE5-i]) is largely justified by retrospective and observational case reports since, to date, there are no randomized clinical trials except for the PORTICO trial which demonstrated the efficacy of macitentan in Po-PAH. Purpose the aim of the study was to evaluate the efficacy of PAH-specific drugs, both monotherapy and dual oral upfront therapy (ERA + PDE5i started within 1 month apart), in patients with Po-PAH, HIV/Po-PAH and HIV-PAH. Methods Between 1998 and 2023 we enrolled patients with Po-PAH, HIV-PAH and HIV/Po-PAH referred to our Center and undergoing monotherapy with prostanoid, ERA and PDE5-I or dual upfront oral therapy. The efficacy of the drugs was assessed by comparing clinical parameters (NYHA functional class), exercise capacity (six-minute walking test) and hemodynamic parameters at baseline and after a treatment period of 3-6 months. The data are expressed as mean and standard deviation and were compared with Student's t-test for paired data. Results 128 patients were enrolled (83 Po-PAH, 23 HIV/Po-PAH and 22 HIV-PAH). 20 were treated with ERA monotherapy, 90 with PDE5-I, 13 with prostanoids and 5 treated with dual oral upfront therapy. Conclusions Prostanoids, ERAs and PDE5-Is, both in monotherapy and as dual upfront oral therapy, are associated with a significant improvement in functional class, exercise capacity and hemodynamic parameters. The effect of such drugs is similar to patients suffering from other forms of PAH.

Cardiac remodeling in rheumatoid arthritis: assessing the influence of anti-CCP and rheumatoid factor

Abstract Background Anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF), markers of Rheumatoid Arthritis (RA) activity, are associated with adverse cardiovascular outcomes, suggesting a potential link between RA and cardiac remodeling. Purpose Our study aimed to explore the correlation between antibody levels (anti-CCP and RF) and left ventricular (LV) remodeling in RA patients without known heart disease. Additionally, it sought to identify other disease-related factors that correlate with LV remodeling. Methods A cross-sectional study of 124 RA patients aged ≥ 18 years, classified per the 2010 ACR/EULAR criteria, collected blood samples for CRP, and antibody levels (RF ≥ 20 IU/ml and anti-CCP ≥ 5 IU/ml via ELISA). Transthoracic echocardiography (TTE) was conducted using a linear method in a long-axis parasternal 2D window. Sixty-two patients exhibited LV remodeling and were matched with 62 patients without it. Echocardiographic variables included were those to calculate the relative wall thickness (RWT, cut-off value 0.42) and left ventricular mass index (LVMI, cut-off values of 43-95 g/m2 in women and 49-115 g/m2 in men) along with left ventricular end diastolic (LVIDd), and systolic volumes (LVIDs), and left ventricular ejection fraction (LVEF). Statistical analyses employed the Chi-square test, Student's t-test, or Mann-Whitney U test as applicable, with correlations assessed using Spearman's rho, an analysis was conducted on the area under the curve (AUC) and a significance level of p ≤ 0.05. Results The most common type of LV alteration in our study was concentric remodeling (74.2%). A statistically significant difference was observed in the levels of Anti-CCP titers 193.85 IU/ml (p &amp;lt; .001), RF IgM 200.00 IU/ml (p &amp;lt; .001) and IgA 185.5 IU/ml (p &amp;lt; .001) in patients with LV remodeling. Anti-CCP and RF IgA antibody levels exhibited a moderate correlation with the presence of LV remodeling, with rho 0.387 (p &amp;lt; .001) and rho 0.344 (p &amp;lt; .001), respectively. The RWT showed a moderate correlation with anti-CCP titers with rho 0.298 (p .001). AUC analysis anti-CCP titers demonstrated better diagnostic performance for the existence of cardiac remodeling (0.722, 95% CI 0.628-0.816, p &amp;lt; .001), RF IgA (0.696, 95% CI 0.602-790, p &amp;lt; .001) and IgM (0.650, 95% CI 0.563-755, p .002). Conclusion In summary, among RA patients without heart failure (HF), LV remodeling and elevated RWT correlate with antibody levels independently of traditional cardiovascular risk factors. Patients with altered LV geometry exhibit higher antibody titers, highlighting the need for RA-related biomarkers that correlate with changes in LV structure and function Recognizing association between autoimmunity and HF development holds significant implications for both prevention and treatment strategies in RA patients.

Sinus rhythm restoration as an independent predictor of left ventricular ejection fraction improvement in patients with the first hospitalization for heart failure and reduced ejection fraction

Abstract Background and Purpose Tachycardiomyopathy (TCM) is prevalent in heart failure with reduced ejection fraction (HFrEF). Despite its significance, a comprehensive understanding of its evolutionary trajectory and prognosis remains limited. This study aims to investigate the prognosis and left ventricular ejection fraction (LVEF) trajectory in patients with TCM compared to other etiologies within a cohort initially admitted for "de novo" HFrEF (LVEF &amp;lt; 40%). Methods A prospective registry was conducted across two University Hospitals, incorporating patients hospitalized with a diagnosis of HFrEF. The study encompassed 370 patients admitted between March 2021 and October 2023, with a median follow-up of 15 months (IQR 7-22). Two distinct groups were delineated based on etiology (TCM vs other etiologies). Within the TCM cohort, subgroups were established concerning LVEF improvement, following the criteria outlined in the "Universal Definition and Classification of Heart Failure" report. Categorical variables were presented as absolute frequencies and percentages, analyzed using the chi-square test. Continuous variables were expressed as mean +/- SD and compared through Student's t-test or Mann-Whitney U test. Hazard functions were estimated using the Kaplan-Meier method. Data analysis was executed using SPSS Statistics. Results In our cohort, both TCM and other etiologies groups exhibited improved LVEF post-neurohumoral blockage titration. Nonetheless, the TCM cohort demonstrated notably higher LVEF (49.1% vs. 43.5%, p = 0.005) [Figure 1]. Moreover, overall mortality, cardiovascular mortality, and the composite of CV mortality and hospitalizations for CV causes were notably lower in the TCM group compared to other etiologies [Figure 2]. Among TCM patients, those with improved LVEF during follow-up were younger (66 vs. 72), with no differences in treatment at discharge or after neurohumoral blockage titration. While achieving sinus rhythm before discharge did not correlate with LVEF improvement, attaining sinus rhythm during follow-up (at titration completion) significantly correlated with LVEF improvement [Table 1]. Multivariate analysis revealed that sinus rhythm restoration after up-titration emerged as an independent predictor of LVEF improvement, irrespective of sinus rhythm restoration at discharge or the attainment of quadruple therapy during follow-up, among other variables (Table 2). Conclusions Among patients initially admitted for "de novo" HFrEF, TCM presents a potentially more favorable clinical trajectory compared to other HF causes, showcasing reduced total and cardiovascular mortality, as well as combined cardiovascular mortality and hospitalizations for cardiovascular causes. Notably, in this patient subset, sinus rhythm restoration during follow-up emerged as an independent predictor of improved LVEF, irrespective of pre-discharge sinus rhythm restoration or adherence to comprehensive four-pillar HF management.

Comparison of direct and indirect admission to a cardiac arrest centre for intubated out-of-hospital cardiac arrest patients in the Northwest England: an audit

Abstract Background Despite concerted global efforts to enhance cardio-pulmonary resuscitation (CPR) and post-resuscitation care, out-of-hospital cardiac arrest (OHCA) remains a significant cause of mortality. Current guidelines promote the concept of Cardiac Arrest Center (CAC), offering advanced post-resuscitation management with the aim of improving survival rates. However, it remains uncertain whether directly transporting OHCA patients from the scene to these centers would enhance their prognosis. Purpose This study aimed to assess whether direct transport of intubated OHCA patients to a higher-level cardiac arrest center in the Northwest of England yielded better outcomes compared to initial resuscitation in smaller local emergency departments followed by transfer. Methods Conducted as a retrospective analysis, the audit examined OHCA patients presenting at a single cardiac arrest center between October 2018 and April 2022. Only intubated patients were included. The study compared two groups based on the route of admission: direct admission to the cardiac arrest center from the field by emergency medical service providers versus indirect admission via inter-hospital transfer to the center. The primary outcomes assessed were inpatient survival and 30-day survival. Statistical analysis employed Student's T-test and Chi-square test for clinical significance. Results The audit included 214 patients, with 112 (52.34%) in the direct group and 102 (47.66%) in the indirect group. Baseline characteristics between the groups were similar, including age, gender, downtime, bystander CPR, haemodynamic status, initial presenting rhythm (VT/VF), post-arrest ECG (STEMI), comorbidities, and procedural outcomes (Table 1). However, the direct group exhibited significantly shorter average arrival times at the cardiac arrest center (72 minutes vs. 190 minutes, p=0.017), along with improved in-hospital survival (52.68% vs. 41.18%, p=0.009) and 30-day survival rates (52.68% vs. 37.25%, p=0.002). Conclusion The direct admission of intubated OHCA patients to a cardiac arrest center, as observed in this audit, was associated with improved outcomes attributed to expedited admission times. The study’s design limitations, including its non-randomized nature and single-center approach, underscore the need for further research.

Impact of neonatal hyperoxia on the development of the coronary vascular bed: an experimental model for the study of cardiomyopathy associated with premature birth

Abstract Introduction Very preterm birth (PT; &amp;lt;32 weeks of gestation), nearly 2% of all births, leads to short-term complications such as bronchopulmonary dysplasia and retinopathy of prematurity that are driven by compromised organ vascular development. Adults born preterm display an increased risk of ischaemic cardiomyopathy and heart failure. Our group has shown that neonatal rats exposed to hyperoxia, simulating the PT neonatal conditions, develop cardiomyocytes hypertrophy, fibrosis and cardiac dysfunction, or Oxygen-Induced Cardiomyopathy (OIC). Whether cardiac changes also associate with alterations in vascular development in the left ventricle (LV) remains unknown. Purpose We hypothesized that neonatal exposure to hyperoxia impact the development of the LV vascular network. Methods Male pups were exposed to 80% O2 (OIC) or room air (CTRL) from day 3 (P3) to P10 of life. Hearts were collected at P10, 4- and 16 weeks. Arteriolar length and capillary density per cardiomyocyte were measured using stereology (elastin) and immunofluorescence (WGA, α-SMA, CD31). High-resolution 3D reconstruction of the vascular network was achieved by combining fluorescent labelling of coronaries (anti-α-SMA) and capillaries (anti-CD31) with a tissue-cleaning protocol (iDisco+), allowing detailed morphometric characterization of the vascular network. The expression of vascular endothelial growth factors and receptors (VEGFA, VEGFB, VEGFR 1 and 2, NRP1, and PIGF) were quantified by RT-qPCR and Western blots. Differences between groups were analyzed with Student's t-test (P &amp;lt; 0.05) (N = 6 per group). Results At P10, we observed a notable rise in the number of capillaries per cardiomyocyte (0.88 ± 0.05 vs. 0.62 ± 0.02 mm2) and a significant increase in VEGFA (+76%) and NRP1 (+38%) expression in the LV from OIC vs. CTRL rats. By 4 weeks, the OIC group showed a significant reduction in arteriolar length vs. CTRL (6.51 ± 0.76 vs. 9.77 ± 1.12 m/cm3), coupled with an increase in the number of capillaries per cardiomyocyte (1.11 ± 0.05 vs. 0.85 ± 0.03 mm2). VEGFA was decreased (-14%) and PLGF increased (+24%) in the LV of OIC rats. At 16 weeks, the OIC condition displayed a significant increase in the number of capillaries per cardiomyocyte (1.37 ± 0.03 vs. 0.98 ± 0.07 mm2) and a decrease in VEGFA (-23%), along with reduction in its receptors VEGFR1 (-27%), VEGFR2 (-20%) and NRP1 (-17%). Conclusion OIC resulting from neonatal hyperoxia exposure associates with vascular changes in the LV that persist to adulthood. These changes are characterized by a reduction in arteriolar length and an increase in the number of capillaries, accompanied by modulation of the expression of pro-angiogenic VEGFA and receptors. The impact of these vascular alterations on the susceptibility of the LV to ischemic or hypertension-related damage is to be explored. These findings suggest a crucial mechanistic pathway for understanding the risk of cardiac pathologies associated with preterm birth.

Self-Care of Older Patients Affected by at Least Two Chronic Conditions Between Heart Failure, Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: A Comparative Study.

This study aims to describe disease-specific self-care behaviours in patients with heart failure (HF), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) in various combinations; to compare these self-care behaviours within patient groups; and to evaluate differences across these groups. Cross-sectional study. A total sample of 1079 older patients was recruited from outpatient clinics and home settings. Eligible patients were aged ≥ 65 years and had a diagnosis of HF and/or DM, and/or COPD, along with at least one additional chronic condition. Data were collected using validated tools: the Self-Care of Heart Failure Index, Self-Care of Diabetes Inventory and Self-Care of Chronic Obstructive Pulmonary Disease Inventory. Descriptive statistics were used to analyse disease-specific self-care behaviours. Group comparisons were performed using Student's t-test and univariate, followed by multivariate analyses of variance. The analysis focused on a subset of 223 patients who had a combination of at least two chronic conditions between HF, DM and/or COPD. The mean age of participants was 77.3 (SD 7.5) years, with a majority being female (53.4%). Self-care maintenance, monitoring and management for HF and COPD were found to be inadequate across all patient groups. Adequate self-care was only observed in DM management among those with HF and DM and in DM maintenance for those with DM and COPD treated with insulin. Significant differences in all self-care dimensions were observed across groups, particularly in patients managing all three conditions (HF, DM and COPD). The findings provide valuable insights into the complexities of self-care in patients with multiple chronic conditions, underscoring the need for tailored, integrated and patient-centred interventions. Healthcare strategies should focus on enhancing patient education and developing personalised approaches to improve health outcomes and quality of life in this population. All the authors have adhered to the EQUATOR guidelines STROBE Statement. A convenience sample of patients was recruited in outpatient clinics and their homes. Data were collected between March 2017 and August 2022, by face-to-face during routine outpatient visits or directly at the patient's home.

Left atrial strain differences between hypertensive and sarcomeric left ventricular hypertrophy: a sign of sarcomeric auricular myopathy?

Abstract Introduction In clinical practice, left ventricular (LV) hypertrophy is a common finding that can be caused by physiologic or pathologic conditions. An etiologic diagnosis is extremely important because it may change the prognosis and management of the patient and his family. Left atrial (LA) dysfunction is common due to diastolic dysfunction but, in patients with sarcomeric LV hypertrophy, primary cardiomyopathy disease could also be present. Purpose To evaluate if there are differences in LA function between arterial hypertension (HT) and hypertrophic cardiomyopathy (HCM) patients. Methods 73 patients with HCM (according to ESC guidelines criteria) and 82 patients with HT (under treatment with ≥1 hypertensive drug for ≥3 months) and ≥13mm of LV hypertrophy underwent an echocardiography to assess LA function with strain analysis and LV diastolic function. Continuous normally distributed variables were compared with T-student test and categoric variables with square-chi or exact Fisher test if required, accepting as significant a p-value &amp;lt;0.05. Results Globally, HCM patients showed thicker LV walls and larger LA indexed volumes (18.7±4.7 vs. 13.3±0,8 mm and 44.9±20.7 vs. 30.7±8.8 ml/m2, p&amp;lt;0.000 for both). Also, HCM patients presented diastolic dysfunction and atrial fibrillation history in a higher frequency (31 vs. 7.6% and 16.4% vs. 0%, p&amp;lt;0.000 for both). LA strain was significantly lower in HCM patients as compared to the HT group (LA contractile 11.5±5.8 vs. 17.2±4.4, p&amp;lt;0.000; LA conduit 12.2±5.4 vs. 13.3±3.8, p=0.041; and LA reservoir 23.9±8.7 vs. 31.1±5.9, p&amp;lt;0.000). In the subgroup of patients with moderate-severe LV hypertrophy (&amp;lt;17mm) and no significant mitral regurgitation (n=103; HCM=21, HT=82), LA contractile strain remained lower in HCM as compared to HT patients (13.2±4.8% vs. 17.2±4.4%, p&amp;lt;0.000) (figure 1); without differences in diastolic dysfunction, LA volumes, significant mitral regurgitation or atrial fibrillation history. Conclusions Our results show that LA strain is more impaired in HCM patients as compared to HT patients. Specifically, contractile LA strain remained lower even in those patients with moderate-severe LV hypertrophy, despite having similar LV diastolic function, LA indexed volumes, significant mitral regurgitation, or atrial fibrillation history. These findings could be caused by HCM involvement of the LA myocytes. In the context of moderate-severe hypertrophy of unknown origin with non-significant mitral regurgitation, the detection of abnormally reduced LA strain could indicate the presence of an HCM.Figure 1

Impact of fractional flow reserve measurement on angina frequency in the invasive arm of the ISCHEMIA trial

Abstract Introduction Fractional flow reserve (FFR) is an invasive, lesion-specific surrogate for myocardial ischemia. The use of FFR to guide lesion selection for revascularization is believed to improve outcomes compared to an angiographic approach because it allows categorization of lesions based on hemodynamic significance. Lesions that are not hemodynamically significant can be safely deferred while the revascularization of significant lesions has been reported to improve quality of life compared to medical therapy alone. Purpose To compare the outcomes of patients randomized to the invasive (INV) arm of the ISCHEMIA trial who underwent FFR during initial angiography with those whose treatment was guided by angiography alone. Methods The ISCHEMIA data set was obtained from the National Heart, Lung, and Blood Institute under a data use agreement. Subjects randomized to the INV arm who underwent FFR were compared to those who underwent angiography alone. Categorial variables were compared using the chi-squared or Fisher’s exact test. Continuous variables were compared using the student T-test or Wilcoxon rank sum test. Multivariable linear mixed effects regression was used to evaluate the association of FFR use on SAQ7 AF score as well as assess changes across five years of follow-up. Covariates included in the model were based on their univariate and clinical significance. All tests were two-sided and P&amp;lt;0.05 was considered statistically significant. Results Of the 5,179 patients with chronic coronary syndromes and at least moderate ischemia on stress testing, 2588 were assigned to the INV strategy and 2210 had data available for analysis. Of these individuals, 410 (19%) had FFR performed during their diagnostic angiogram. Females comprised 24% of FFR patients and 24% of non-FFR patients (P=0.85). FFR patients were older than non-FFR patients (65.7 [8.7] years vs. 64.3 [9.6] years, P=0.006). The incidence of hypertension, diabetes, smoking, or prior MI at baseline did not differ between groups. Mean ejection fraction did not differ between groups. Fewer FFR patients had severe ischemia at baseline (45% vs. 52%) and more had mild or moderate ischemia (54% vs. 48%) (P=0.009). FFR patients had fewer native vessels with &amp;gt;70% stenosis than non-FFR patients (1.0[0.9] vs. 1.5[1.0], P&amp;lt;0.001), and less complex disease as assessed by the Duke jeopardy score (P&amp;lt;0.001). On multivariable linear mixed effects regression, FFR was not associated with a significant change in the SAQ AF score (0.56 (-0.85 – 1.97; P=0.44)), after adjusting for other covariates. However, the SAQ7 AF score was 0.22 units less in those that underwent FFR compared to those that did not (95%CI=-0.44 – -0.01; P=0.043) when assessed over follow-up time. Conclusion ISCHEMIA patients randomized to an INV strategy who underwent physiologic assessment with FFR had no improvement in angina frequency compared to those who underwent angiography alone.

Prognostic impact of the presence and absence of angina on mortality and cardiovascular outcomes in the ISCHEMIA trial

Abstract Introduction Patients with chronic coronary syndromes (CCS) manifested by myocardial ischemia may present with typical angina or with no anginal symptoms. It is unclear whether symptom status affects prognosis in these patients. Purpose To assess whether the risk of all-cause mortality and other cardiovascular (CV) outcomes varied according to the presence or absence of angina in patients with CCS and moderate to severe myocardial ischemia in the ISCHEMIA trial. Methods The ISCHEMIA data set was obtained from the National Heart, Lung, and Blood Institute under a data use agreement. Subjects were divided into quartiles by baseline Seattle Angina Questionnaire Angina Frequency (SAQ AF) score. Quartile (Q)1 included patients with SAQ AF scores from 1-70 whereas all patients in Q4 had SAQ AF scores of 100, indicating no angina at baseline. Categorical variables were compared using the chi-squared or Fisher’s exact test. Continuous variables were compared using the student T-test or Wilcoxon rank sum test. The cumulative incidence rate of outcomes up to five years was estimated with the Kaplan-Meier method and the rate curves were compared using the log-rank test. Multivariable Cox regression models were used to estimate hazard ratios (HRs) with potential confounders from baseline characteristics, clinical history, and angiographic characteristics included. All tests were two-sided and P&amp;lt;0.05 was considered statistically significant. Results Of the 5,179 patients with CCS and at least moderate ischemia on stress testing, 1,434 were in Q1 and 1,635 were in Q4. Compared to Q1, patients in Q4 were older (66.4 (9.0) vs. 62.8 (9.6); P&amp;lt;0.001), more often male (82% vs. 73%; P&amp;lt;0.001), more often diabetic (43% vs. 38%; P=0.006) and less often current smokers (12% vs. 15%; P=0.001). The estimated glomerular filtration rate was lower in Q4 (82(22) vs. 86 (38); P=0.002). Fewer patients in Q4 had NYHA class II heart failure (37% vs. 62%) and more had Class I symptoms (63% vs. 38%) (P&amp;lt;0.001). Q4 patients had a lower ejection fraction (59% vs. 60%; P=0.002), a lower Duke jeopardy score (4.9(3.5) vs. 5.5 (3.3); P&amp;lt;0.001), less often had severe ischemia (47% vs. 56%), and more often had moderate ischemia (40% vs. 32 %) (P&amp;lt;0.001). The cumulative 5-year event rates for Q4 vs. Q1 were: all-cause death, 10.6% and 6.4% (P=0.002); CV death/MI, 16.3% vs. 13.7% (P=0.97); CV death, 7% vs. 3.7% (P=0.009); MI, 11.4% vs. 11.4% (P=0.2). On multivariable Cox regression, angina quartile (Q4 vs. Q1) was not independently associated with all-cause death (HR 1.34, 95% CI: 0.76-2.31; P=0.33), CV death/MI (HR 0.77, 95% CI: 0.52-1.14; P=0.19), CV death (HR 1.10, 95% CI: 0.50-2.43; P=0.82), or MI (HR 0.70; 95% CI: 0.45-1.08; P=0.11). Conclusion In the ISCHEMIA trial, patients with CCS and moderate to severe myocardial ischemia are at elevated risk for all-cause mortality and other major CV outcomes. This risk is not modified by the presence or absence of angina.

Treatment Outcome of Surgery Followed By Corticosteroid Therapy For Idiopathic Granulomatous Mastitis

Introduction: Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic inflammatory breast condition that has been shown to have radiological and clinical similarities to breast cancer. In spite of the fact that the cause of IGM is unknown, various contributing variables have been identified, such as a reaction to chemical substances like OCP, viral disorders, autoimmune diseases, and an immunological response to milk leakage from the breast lobule. Although various methods have been used for IGM treatment (such as surgical excision, steroids, methotrexate, etc), no consensus currently exists regarding the ideal method of treatment. Due to its positive response to steroid treatment, it is hypothesized that IGM is an autoimmune disease and is well responds to corticosteroid therapy. The aim of this study is to observe the treatment outcomes of surgery and corticosteroid therapy in IGM. Materials and Methods: This quasi experimental study was conducted in Department of Surgery, Khulna Medical College Hospital from 8th August 2018 to 8th August 2019. Total 30 patients were enrolled and allocated in two groups a ratio of 1:1. In group-A there were 15 patients, received surgical treatment with corticosteroid therapy and group-B, 15 patients received only surgical treatment. A wide local excision (WLE) was done in surgical procedure to remove area of diseased unhealthy tissue with a margin of normal tissue. Corticosteroid therapy was given orally in the following regimen: 8 weeks of steroid therapy with prednisolone at 0.5mg/kg/day for 4 weeks and then tapered down slowly for 4 weeks. Then subsequent follow up conducted after 2 months and after 4 months of primary treatment to observe the treatment outcomes. Statistical analysis was carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). A descriptive analysis was performed for all data. The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages. Unpaired student t-test was used to compare continuous variables. Chi-square test used to compare categorical data. A “p” value of &lt;0.05 was considered as significant. Result was presented by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram &amp; charts etc. Result: Maximum numbers of patients (50.0%) were between 31-40 years age group, mean±SD age was 29.7±10.2 years. The left breast was affected in 16(53.3%) patients, right breast in 12(40.0%) patients and bilateral in 2(6.7%) patients. Included 30 patients were allocated in two groups. Among them in group-A there were 15 patients (Surgical treatment with corticosteroid therapy) and group-B, 15 patients (Surgical treatment alone). Wide local excision was performed in all patients. Concomitant corticosteroids therapy was used in selective group (group-A). Study shows that 22(73.3%) of the patients recovered completely (80.0% versus 66.7% in group-A and group-B respectively). There was a statistically significant difference (pd”0.05). Present study revealed that incidence of complications and recurrence rate was 8(26.7%) patients, among them 3(20.0%) were of group-A, while 5(33.3%) patients were group-B. Conclusions: Present study concluded that treatment outcomes of surgery, followed by corticosteroid therapy can be preferred at Idiopathic granulomatous mastitis (IGM) in the means of less early or late postoperative complication, resolution of symptoms with high accuracy rate to relief symptoms. J Dhaka Med Coll. 2023; 32(1) : 71-76

Eight Year Follow-Up After Gastric Bypass and Sleeve Gastrectomy in a Brazilian Cohort: Weight Trajectory and Health Outcomes.

Despite Sleeve Gastrectomy (SG) being the most commonly performed bariatric surgery today, studies with over 5years of follow-up show that patients undergoing SG have inferior weight loss compared to those undergoing Roux-en-Y gastric bypass (RYGB). The aim of this study was to examine differences in weight loss and the prevalence of weight regain between SG and RYGB up to 8years after surgery. Retrospective study including adult patients undergoing SG or RYGB between 2015 and 2018 at a tertiary center in Brazil. We evaluate the weight trajectory and pre- and postoperative behavior of type 2 diabetes (T2D), hypertension, and dyslipidemia. Differences betwen variables were tested using Student t-test, Mann-Whitney U, Pearson's chi-square or Fisher's exact test as appropriate. The level of significance adopted was p < 0,005. Among 591 patients (40 ± 10years; baseline body mass index 41.7 [IQR 39.1-45]; 83% women), 327 underwent RYGB (55%) and 264 SG (45%). Preoperatively, 14% had T2D, 40% hypertension, and 53% dyslipidemia. The mean total percentage of weight loss was higher in the RYGB group after 8years: 32% compared to 19% after SG (difference 13%, p < 0.004). At 8years, weight regain was also lower in RYGB (23%) compared to SG (39%) (p < 0.001). At 5years postoperatively, the remission rates for T2D, hypertension, and dyslipidemia were 63%, 42%, and 51%, respectively, among the patients who remained in follow-up. Patients undergoing RYGB showed greater weight loss and less weight regain 8years after bariatric surgery compared to those undergoing SG.

The prognostic significance of twist in pancreatic cancer and its role in cancer promotion through the regulation of the immune microenvironment and EMT mechanisms

ObjectivePancreatic cancer has a poor prognosis due to its high malignancy and rapid progression. The limited immunogenicity of pancreatic cancer (PAAD) contributes to its low responsiveness to immunotherapy, yet its underlying mechanism remains poorly understood. As a cancer promoting gene, Twist participates in EMT in various tumors and promotes tumor progression. The interplay between EMT and the tumor microenvironment (TME) emerges as a pivotal factor influencing tumor immunity and response to immunotherapy. Twist therefore has potential as a biomarker for gauging the outcome of tumour immunotherapy.This research aimed to assess the Twist's prognostic significance in PAAD and its relationship to immunotherapy response.MethodsIn this research, transcriptional data and epigenetic alterations of Twist in pancreatic cancer, along with their impact on the prognosis of PAAD patients, were analyzed using databases. Functional enrichment analysis elucidated the biological role of Twist in PAAD. Subsequently, databases including CIBERSORT and TIDE were employed to investigate the association between Twist expression and immune cell infiltration, immune checkpoint genes, and immunotherapy sensitivity within the pancreatic cancer immune microenvironment.Paraffinized specimens from patients with pancreatic ductal adenocarcinoma confirmed by postoperative pathology were selected for Twist expression verification, and the difference was analyzed by Chi-square test; uncontaminated pancreatic cancer cell lines were used for Twist expression verification, and the differences were analyzed by Student t-test.ResultsTwist mRNA expression was notably upregulated in PAAD, positively correlating with gene methylation levels. Analyses of Kaplan–Meier and Cox regression showed a correlation between better overall survival and lower Twist expression. Functional annotation indicated that Twist-associated differentially expressed genes (DEGs) were involved in EMT regulation and acute inflammation. High expression of Twist leads to a significant reduction in the infiltration of anti-tumor immune cells such as Monocytes, NKcellsactivated, and TcellsCD8, further supporting its creation of a typical immunosuppressive microenvironment in pancreatic cancer. Twist expression is positively correlated with the expression of HARVCR2, LAIR1, LGALS3 and other genes, which may be related to the treatment response to immune checkpoint inhibitors (ICIs). TIDE analysis predicts that patients with high expression of Twist will be insensitive to immunotherapy. Twist is significantly over-expressed in pancreatic cancer cell lines and tissues, and is negatively correlated with E-cadhrin expression, but positively correlated with N-cadherin,Snail, and ZEB1.ConclusionHigh Twist expression in PAAD signifies a grim prognosis. Its elevated levels not only contribute to tumor progression through EMT induction but also exert regulatory control over the immune microenvironment, leading to immunosuppression and diminished effectiveness of immunotherapy.

Optimizing venous anastomosis for forearm loop arteriovenous grafts: A comparative analysis of elbow veins and upper arm basilic veins in end-stage kidney disease patients.

Optimizing vascular access for hemodialysis in end-stage kidney disease is crucial. While arteriovenous fistulas (AVFs) are preferred for better patency and fewer complications, many patients require alternatives options like arteriovenous grafts (AVGs) due to anatomical constraints. This study compares outcomes between elbow and upper arm (UA) basilic veins for forearm loop AVGs, highlighting the potential benefits of the UA basilic vein to improve patency and feasibility in patients with poor elbow veins through retrospective analysis. This retrospective study analyzed 59 limbs of patients who underwent forearm loop AVG formation from January 2018 to June 2022. Elbow veins (basilic, median cubital, brachial) and UA basilic veins were evaluated for suitability using duplex ultrasonography. AVG decisions were based on patient age, health, and vein diameter (⩾2.3 mm). Statistical analyses compared baseline characteristics and evaluated primary and secondary patency rates at 12 and 18 months using Pearson's chi-square, Student's t-test, Kaplan-Meier survival analysis, and the Log-rank test. Thirty-six patients had elbow anastomosis, while 23 had UA anastomosis for forearm loop AVG. The elbow group had a higher male proportion (72.7% vs 34.7% in UA, p = 0.005) and larger elbow vein diameters (2.52 ± 0.19 mm vs 2.16 ± 0.21 mm in UA, p < 0.001). Primary patency rates at 12 months were 72.7% for elbow and 56.2% for UA; at 18 months, 59.4% and 25.5%, respectively (p = 0.376). Secondary patency rates at 12 months were 75.7% for elbow and 62.2% for UA; at 18 months, 67.8% and 33.9%, respectively (p = 0.238). The primary and secondary patency rates of forearm loop AVG with UA basilic vein anastomosis were not inferior to those with elbow veins anastomosis. UA basilic vein can be a feasible alternative for creating forearm loop AVG when elbow veins are not suitable.

Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl transdermal patch in the management of postoperative pain after lower limb surgery

Background: Postoperative pain represents a significant medical issue that needs immediate attention. Despite advancements in pain management, managing postoperative pain remains challenging. Transdermal drug delivery systems (TDDS) offers a straightforward, reliable, non-invasive, and patient-friendly approach for alleviating post-surgical pain. Hence, this study was planned to evaluate the analgesic efficacy of buprenorphine and fentanyl transdermal patch in the management of post-operative pain after lower limb surgery. Methods: In this prospective, randomised study, 82 adult patients of either sex undergoing elective lower limb surgery were randomly allocated into two groups- Group A (Transdermal Buprenorphine 20 mg patch) and Group B (Transdermal Fentanyl 50 mcg patch). Postoperative pain was assessed by 10-point Visual Analogue Scale (VAS) every 6 hours following surgery on the first day and then daily for next 4 days. All patients were also monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status. Statistical analysis was carried out using student t-test and Chi-square test. A p-value &lt;0.05 was considered significant. Results: The mean pain intensity scores were found to be significantly different (p&lt;0.0001) between the two groups, with VAS scores consistently lower in Buprenorphine group as compared to Fentanyl group. Also, Buprenorphine group had the lowest demand for rescue analgesic, with 58.5% of patients requiring two administrations and 36.6% needing only one. Patients belonging to Fentanyl group exhibited higher occurrence of nausea (46.3%), vomiting (46.3%) and pruritus (31.7%). Conclusions: Our study concludes that transdermal patch of buprenorphine demonstrates superior efficacy and safety profile as compared to fentanyl patch for post-operative pain management in lower limb surgeries.

Accuracy of Zygomatic Implant Placement Using Task-Autonomous Robotic System or Dynamic Navigation: An InVitro Study.

To evaluate and compare the accuracy of task-autonomous robot-assisted implant surgery (RAIS) and dynamic computer-assisted implant surgery (dCAIS) for zygomatic implant placement. Ten atrophic edentulous maxilla models requiring zygomatic implant (ZI) placement were randomly divided into the RAIS and dCAIS groups. Osteotomies and implant placement were performed under the guidance of a task-autonomous robotic system or dynamic navigation system. A total of 20 ZIs were analyzed. The angular, coronal, lateral coronal, coronal depth, apical, lateral apical, and apical depth deviations were measured and analyzed between the two groups. The primary outcome parameters were the angular deviations between the planned and the placed ZIs. Data was subjected to descriptive and comparative statistical analysis. The significance of inter-group differences for continuous variables was assessed with Student's two-sample t-tests, Welch two-sample t-tests, and Mann-Whitney U tests according to the distribution normality and variance homogeneity. ZI placement deviations were compared between the RAIS and dCAIS groups, showing a mean angular deviation of 0.92 ± 0.40° versus 2.03 ± 0.53° (p < 0.001), a mean (±SD) coronal deviation of 0.48 ± 0.25 mm versus 1.29 ± 0.46 mm (p < 0.001), and a mean apical deviation of 0.88 ± 0.28 mm versus 1.96 ± 0.46 mm (p < 0.001). For computer-guided ZI placement, task-autonomous RAIS was superior to dCAIS in terms of accuracy.

Deep learning super-resolution reconstruction for fast and high-quality cine cardiovascular magnetic resonance.

To compare standard-resolution balanced steady-state free precession (bSSFP) cine images with cine images acquired at low resolution but reconstructed with a deep learning (DL) super-resolution algorithm. Cine cardiovascular magnetic resonance (CMR) datasets (short-axis and 4-chamber views) were prospectively acquired in healthy volunteers and patients at normal (cineNR: 1.89 × 1.96 mm2, reconstructed at 1.04 × 1.04 mm2) and at a low-resolution (2.98 × 3.00 mm2, reconstructed at 1.04 × 1.04 mm2). Low-resolution images were reconstructed using compressed sensing DL denoising and resolution upscaling (cineDL). Left ventricular ejection fraction (LVEF), end-diastolic volume index (LVEDVi), and strain were assessed. Apparent signal-to-noise (aSNR) and contrast-to-noise ratios (aCNR) were calculated. Subjective image quality was assessed on a 5-point Likert scale. Student's paired t-test, Wilcoxon matched-pairs signed-rank-test, and intraclass correlation coefficient (ICC) were used for statistical analysis. Thirty participants were analyzed (37 ± 16 years; 20 healthy volunteers and 10 patients). Short-axis views whole-stack acquisition duration of cineDL was shorter than cineNR (57.5 ± 8.7 vs 98.7 ± 12.4 s; p < 0.0001). No differences were noted for: LVEF (59 ± 7 vs 59 ± 7%; ICC: 0.95 [95% confidence interval: 0.94, 0.99]; p = 0.17), LVEDVi (85.0 ± 13.5 vs 84.4 ± 13.7 mL/m2; ICC: 0.99 [0.98, 0.99]; p = 0.12), longitudinal strain (-19.5 ± 4.3 vs -19.8 ± 3.9%; ICC: 0.94 [0.88, 0.97]; p = 0.52), short-axis aSNR (81 ± 49 vs 69 ± 38; p = 0.32), aCNR (53 ± 31 vs 45 ± 27; p = 0.33), or subjective image quality (5.0 [IQR 4.9, 5.0] vs 5.0 [IQR 4.7, 5.0]; p = 0.99). Deep-learning reconstruction of cine images acquired at a lower spatial resolution led to a decrease in acquisition times of 42% with shorter breath-holds without affecting volumetric results or image quality. Question Cine CMR acquisitions are time-intensive and vulnerable to artifacts. Findings Low-resolution upscaled reconstructions using DL super-resolution decreased acquisition times by 35-42% without a significant difference in volumetric results or subjective image quality. Clinical relevance DL super-resolution reconstructions of bSSFP cine images acquired at a lower spatial resolution reduce acquisition times while preserving diagnostic accuracy, improving the clinical feasibility of cine imaging by decreasing breath hold duration.

Habitual water intake impacted the body composition of young male athletes in free-living conditions: a cross-sectional study

The study aimed to explore the associations between water intake and body composition and differences of body composition in different water itake and hydration statuses among young male athletes. A cross-sectional study was conducted among 111 young male athletes in Beijing, China. Total drinking fluids (TDF) and water from food were assessed using a 7-day, 24-h fluid intake record questionnaire and the duplicate portion method, respectively. The osmolality of 24-hour urine and blood samples was tested. Body composition was measured using a bioelectrical impedance analyzer twice at 5-min intervals. Participants were divided into two groups based on the recommendations of total water intake (TWI) and TDF in China, as well as into three groups based on 24-h urine osmolality. Pearson's correlation coefficients were calculated to determine the relationship between water intake and body composition. Chi-square tests and Student's t-tests were used to compare differences. A total of 109 participants completed the study. TDF (r = 0.230, p = 0.016; r = 0.234, p = 0.014; r = 0.242, p = 0.011) and TWI (r = 0.275, p = 0.004; r = 0.243, p = 0.011; r = 0.243, p = 0.011) were positively correlated with total body water (TBW), intracellular water (ICW), and extracellular water (ECW). TBW/body weight (BW) was positively associated with TDF percentage of BW (TDF/BW) (r = 0.267, p = 0.005), water from food percentage of BW (r = 0.217, p = 0.024), and TWI percentage of BW (TWI/BW) (r = 0.316, p = 0.001). Participants who met the TDF recommendation of China had 1.3 kg higher skeletal muscle mass (SMM), 0.9 kg higher ICW, and 0.5% higher TBW/BW than those who did not (all p &amp;lt; 0.05), with fat-free mass (FFM) and TBW being higher (p = 0.051; p = 0.050). Those who met the TWI recommendation of China had 1.3 kg higher SMM, 2.4 kg higher FFM, 1.1 kg higher ICW, 0.6 kg higher ECW, and 1.7 kg higher TBW than their counterparts (all p &amp;lt; 0.05). Moderate associations were found between water intake and body composition. No significant differences were observed among participants in three hydration statuses (all p &amp;gt; 0.05). Participants who met the TWI or TDF recommendations had better body composition distribution than their counterparts. Thus, habitual water intake, not hydration status, affects body composition among athletes in free-living conditions.