Uncertain Etiology Research Articles

Orally biomimetic metal-phenolic nanozyme with quadruple safeguards for intestinal homeostasis to ameliorate ulcerative colitis

BackgroundUlcerative colitis (UC) is defined by persistent inflammatory processes within the gastrointestinal tract of uncertain etiology. Current therapeutic approaches are limited in their ability to address oxidative stress, inflammation, barrier function restoration, and modulation of gut microbiota in a coordinated manner to maintain intestinal homeostasis.ResultsThis study involves the construction of a metal-phenolic nanozyme (Cur-Fe) through a ferric ion-mediated oxidative coupling of curcumin. Cur-Fe nanozyme exhibits superoxide dismutase (SOD)-like and •OH scavenging activities, demonstrating significant anti-inflammatory and anti-oxidant properties for maintaining intracellular redox balance in vitro. Drawing inspiration from Escherichia coli Nissle 1917 (EcN), a biomimetic Cur-Fe nanozyme (CF@EM) is subsequently developed by integrating Cur-Fe into the EcN membrane (EM) to improve the in vivo targeting ability and therapeutic effectiveness of the Cur-Fe nanozyme. When orally administered, CF@EM demonstrates a strong ability to colonize the inflamed colon and restore intestinal redox balance and barrier function in DSS-induced colitis models. Importantly, CF@EM influences the gut microbiome towards a beneficial state by enhancing bacterial diversity and shifting the compositional structure toward an anti-inflammatory phenotype. Furthermore, analysis of intestinal microbial metabolites supports the notion that the therapeutic efficacy of CF@EM is closely associated with bile acid metabolism.ConclusionInspired by gut microbes, we have successfully synthesized a biomimetic Cur-Fe nanozyme with the ability to inhibit inflammation and restore intestinal homeostasis. Collectively, without appreciable systemic toxicity, this work provides an unprecedented opportunity for targeted oral nanomedicine in the treatment of ulcerative colitis.

Pyogenic Granuloma Diagnosis and Management: A Practical Review.

Pyogenic granuloma (PG), or lobular capillary hemangioma, poses a clinical challenge with its uncertain etiology and treatment options. Although the clinical features and prevalence of PGs are well established, definitive evidence-based treatments remain elusive. This practical review aims to illuminate the complexities of PG management by analyzing surgical interventions based on literature analysis. A PubMed/Medline search of "pyogenic granuloma" and "surgery" yielded 1171 studies. Inclusion criteria targeted intervention-associated PG complications over 5% and treatment modalities, excluding nonclinical studies and topics unrelated to plastic and reconstructive surgery. Screening involved Oxford level of evidence, patient data extraction, complications, intervention types, success rates, sessions, follow-ups, and treatments. Thirty-one studies met inclusion criteria. Most studies were retrospective (67.7%). Ten studies satisfied intervention-linked eruptions, primarily oculoplastic, whereas 21 investigated both surgical and nonsurgical treatment modalities. Across interventions, 3579 patients (age: 34.2-85.7 years) were involved. Postsurgical PG complications averaged 15.1% and were treated predominantly with surgical excision, achieving nearly complete resolution. Surgical and nonsurgical treatment studies included 1233 patients (age: 3-46.5 years), demonstrating a 68.2% average resolution after a single session, with surgical excision exhibiting the highest success rate (96.2%) and minimal complications. This practical review highlights the complexities of managing PG, emphasizing a spectrum of effective treatments and potential postoperative complications. Ophthalmologic procedures showed PG incidences of 9%-24.4%. Surgical excision proved highly effective, surpassing methods like lasers and injectables that exhibited varied success rates requiring multiple treatment sessions. Challenges included study diversity and varying evidence levels, warranting further comparative research for PG management strategies.

Population dietary-metabolic characteristics and mortality from major cardiovascular disease subtypes: the Seven Contries Study 60-year follow-up

Background and aimDuring the last few years, the Seven Countries Study of Cardiovascular Diseases (SCS) produced some new analyses dealing with the relationships of a dietary score, the pool of dietary fatty acids and serum cholesterol with major types of cardiovascular disease (CVD) mortality in 10 cohorts of 6 countries made of middle-aged men followed-up for 60 years until extinction. This sparse evidence is condensed here to provide a coherent view. Methods and resultsThe Mediterranean Adequacy Index (MAI, a dietary score whose high levels depict the characteristics of the Mediterranean Diet), was highly and significantly associated in an inverse way, at country levels, with the Atherogenicity (ATI) and the Thrombogenicity (THI) indexes that included a series of dietary fatty acids. These indexes were highly and significantly associated in a direct way with country baseline serum cholesterol levels. Countries with high serum cholesterol had largely higher death rates from coronary heart disease (CHD) and lower rates from other heart diseases of uncertain etiology and stroke. The reverse was observed in countries with low serum cholesterol. ConclusionThe chain of diet, dietary fatty acids and serum cholesterol seems to be responsible in various ways for the different distribution of major CVD mortality subtypes in extincted cohorts.

Atypical dermatofibroma simulating hansenoma

Introduction: dermatofibroma is a benign mesenchymal lesion of uncertain etiology, centered in the dermis, with fibroblastic and histiocytic differentiation. The atypical variant can mimic superficial sarcoma histologically. Objective: to describe the clinical and histopathological findings of atypical dermatofibroma in a patient undergoing treatment for leprosy with multiple therapeutic failures. Case Description: the report concerns a 39-year-old woman with multiple therapeutic failures for Virchowian leprosy, who developed an atypical dermatofibroma on the upper limb, which clinically resembled a leproma. Discussion: molecular analyses suggest dermatofibroma may be associated with a neoplastic process. However, several studies correlate it to trauma, insect bites, folliculitis, immunological changes, and treated or reactive leprosy. The association of dermatofibroma and leprosy, especially in the Virchowian pole, is documented in the literature. However, there are no reports of atypical dermatofibroma associated with leprosy. Final Considerations: this case adds to other studies regarding a possible association between the pathogenesis of dermatofibroma and the immunological aspects present in leprosy.

Eosinophilic cystitis-an obscure case of obstructive uropathy in infancy.

We report on an infant with features of intermittent obstructive uropathy, acute kidney injury, hypertension and type 4 renal tubular acidosis (RTA) despite urethral catheterisation and fluid resuscitation. Radiological findings showed upper tract dilatation, likely bilateral vesicoureteric junction obstruction and bladder base thickening which was concerning for possible malignancy. Renal biopsy demonstrated eosinophilic infiltrate, suggestive of kidney involvement. Bladder biopsy was diagnostic for eosinophilic cystitis (EC) showing mature degranulating eosinophils. EC is a rare, easily treatable and important differential of bladder mass in children which may present with an atypical obstructive uropathy. This report adds to the limited literature of this condition within the paediatric population. EC should be considered early in children presenting with eosinophilia, urinary tract obstruction and kidney dysfunction, with uncertain aetiology. This case also highlights the need for detailed imaging, including visualisation of the bladder base, in cases of likely obstructive uropathy.

Persistent Symptoms After Lyme Disease: Clinical Characteristics, Predictors, and Classification.

Persistent symptoms after an infection have been described for a number of infectious diseases, including Lyme disease. Studies have confirmed a moderate but consistent increase in the prevalence of such symptoms after Lyme disease, though the risk increase varies dependent on study design and the definition of persistent symptoms. Various possible predictors have been proposed, including a dysregulation of the immune system, metabolic changes, increased sensitization to pain signals, cognitive-behavioral factors, or-controversially-the persistence of the causative Borrelia bacteria or remnants thereof. Research on the precise roles of any of these factors is still ongoing. The lack of biological underpinning also makes it difficult to assess with certainty which patients' (generally nonspecific) persistent symptoms are etiologically related to the previous Lyme disease episode and which are not, particularly as these symptoms occur in the general population relatively frequently. The diagnostic criteria for posttreatment Lyme disease syndrome have shown their usefulness in both clinical and research settings but leave out a number of patients whose symptoms may fall just outside said criteria. Though the relationship between these symptoms and the previous Lyme disease episode may be very uncertain, we would argue that a uniform description and classification of these patients will aid in future research and patient management, regardless of the eventual underlying cause. Thus, we argue for an inclusive classification system for all persistent symptoms attributed to Lyme disease in order to promote validation of patient experiences and perspectives, while also maintaining scientific nuance regarding the very uncertain etiology of these patients' symptoms.

Idiopathic hyalinizing fibrosclerosis: A systemic steroid-resistant condition distinct from IgG4-related disease

Since the concept of IgG4-related disease (IgG4-RD) was proposed, that diagnosis has been considered in idiopathic fibroinflammatory diseases in various organs, particularly in cases with multi-organ involvement. We have recently encountered three cases of fibrosing disease of uncertain etiology with shared microscopic appearances. Case 1 (56-year-old man) had an irregular mass at the base of mesentery. Case 2 (29-year-old woman) presented with obstructive jaundice due to an ill-defined mass at the hepatic hilum and two lung nodules. Case 3 (53-year-old man) had multiple solid nodules in the mediastinum, peritoneum, retroperitoneum, and mesentery; he also had diffuse irregular narrowing of the intra- and extra-hepatic bile ducts in keeping with sclerosing cholangitis. Serum IgG4 concentrations were not elevated. Biopsies from the nodular lesions showed extensive hyalinizing fibrosis with an only focal lymphoplasmacytic infiltrate. Thick collagenous bundles are arranged in an irregular or partly whorl pattern. Typical storiform fibrosis or obliterative phlebitis was not observed. The number of IgG4-positive plasma cells was <10 cells/high-power field; the ratio of IgG4/IgG-positive plasma cells was <30%. After the histological diagnosis of sclerosing mesenteritis, pulmonary hyalinizing granuloma, and mediastinal fibrosis was made, they were treated with a trial of steroids, but none showed a significant response. In conclusion, a hyalinizing fibrotic condition can occur at various anatomical sites. They have shared microscopic findings, and are steroid-resistant. Although the clinical presentation may mimic IgG4-RD, the two conditions are likely distinct. We would propose a diagnostic term of ‘idiopathic hyalinizing fibrosclerosis’ for this under-recognized, rare, systemic condition.

Patient with cryptogenic cirrhosis

Cryptogenic cirrhosis is cirrhosis of uncertain etiology, with no definitive clinical and histological criteria for a specific disease. More than half of such patients are women, the average age is about 60, and patients generally have only mild liver enzyme abnormalities. Cryptogenic cirrhosis's pathophysiology is unknown; therefore, further research is required to elucidate the underlying etiology. The problem of liver cirrhosis is extremely important since this pathology occurs mainly in young and healthy people. In patients with cryptogenic cirrhosis, aminotransferase (AST and ALT) levels are usually only mildly elevated or normal. In our case report, a 41-year-old male patient was approved to the emergency department due to migraine pain. Liver enzymes were high in the blood analysis taken from the patient. As a result of the liver ultrasound carried out on the patient, it was reported to have decreased liver size and irregular boundaries and compatible with chronic liver disease. The patient used various analgesics due to migraine in his 20s. However, no cause could be identified for the patient's liver failure.

Lower abdominal cyst complicated with suspected infection following INFIX internal fixation for pelvic fracture: a report of two rare cases

BackgroundThe Internal Fixator (INFIX) is a popular method, known for its minimal invasiveness and short operation time, for treating anterior pelvic ring fractures. Studies have shown that postoperative complications may occur, including anterolateral femoral cutaneous nerve injury, the femoral nerve paralysis, and delayed fracture healing. These complications are believed to be related to surgical stimulation, an excessively long lateral end of the connecting rod, a small distance between the screw and bone surface, insufficient pre-bending of the connecting rod, and difficulties in fracture reduction.Case presentationWe report two unique cases of lower abdominal pseudocyst complicated with suspected infection after INFIX treatment of pelvic fractures at our trauma center. Following surgical removal of the internal fixation, resolution of the cysts was observed in both patients, and subsequent postoperative follow-up revealed the absence of any residual sequelae. These cases have not been reported in previous literature reviews.DiscussionThe lower abdominal cysts, potentially arising from the dead space created during intraoperative placement of the INFIX rod, may increase infection risk. The etiology remains uncertain, despite the presence of abnormal inflammation markers in both cases, and staphylococcus aureus found in one. These cysts were confined to the lower abdomen, not involving the internal fixation, and hence, only the INFIX was removed. Postoperative oral cefazolin treatment was successful, with resolved pseudocysts and no subsequent discomfort.ConclusionWe report two unprecedented cases of post-INFIX abdominal cysts, with a suspected link to intraoperative dead space. Despite uncertain etiology, successful management involved INFIX removal and oral cefixime therapy. These findings necessitate further exploration into the causes and management of such complications.

The Unseen Side of Feline Hypertrophic Cardiomyopathy: Diagnostic and Prognostic Utility of Electrocardiography and Holter Monitoring.

Hypertrophic cardiomyopathy (HCM) is a common heart disease in cats, characterized by regional or diffuse hypertrophy of the left ventricular walls, with an uncertain etiology and heterogenous natural history. Several types of rhythm disturbances are often associated with the disease. This study conducts a comprehensive review of the current literature, in order to evaluate the diagnostic and prognostic effectiveness of electrocardiography and Holter monitoring in the management of feline hypertrophic cardiomyopathy. The main subjects of discussion will include general information about HCM and its connection to arrhythmias. We will explore the rhythm disturbances documented in the current literature on Holter monitoring, as well as the techniques used for Holter monitoring. Additionally, the review will cover classical electrocardiography (ECG) and its diagnostic utility. Prognostic indicators and anti-arrhythmic therapy will also be discussed in detail. The findings highlight the importance of understanding arrhythmias in feline HCM for accurate diagnosis, risk assessment, and therapeutic intervention. ECG and Holter monitoring may offer valuable insights into managing feline HCM.

Detecting outliers in case-control cohorts for improving deep learning networks on Schizophrenia prediction.

This study delves into the intricate genetic and clinical aspects of Schizophrenia, a complex mental disorder with uncertain etiology. Deep Learning (DL) holds promise for analyzing large genomic datasets to uncover new risk factors. However, based on reports of non-negligible misdiagnosis rates for SCZ, case-control cohorts may contain outlying genetic profiles, hindering compelling performances of classification models. The research employed a case-control dataset sourced from the Swedish populace. A gene-annotation-based DL architecture was developed and employed in two stages. First, the model was trained on the entire dataset to highlight differences between cases and controls. Then, samples likely to be misclassified were excluded, and the model was retrained on the refined dataset for performance evaluation. The results indicate that SCZ prevalence and misdiagnosis rates can affect case-control cohorts, potentially compromising future studies reliant on such datasets. However, by detecting and filtering outliers, the study demonstrates the feasibility of adapting DL methodologies to large-scale biological problems, producing results more aligned with existing heritability estimates for SCZ. This approach not only advances the comprehension of the genetic background of SCZ but also opens doors for adapting DL techniques in complex research for precision medicine in mental health.

Suppression of OGN in lung myofibroblasts attenuates pulmonary fibrosis by inhibiting integrin αv-mediated TGF-β/Smad pathway activation

BackgroundIdiopathic pulmonary fibrosis (IPF) represents a severe and progressive manifestation of idiopathic interstitial pneumonia marked by an uncertain etiology along with an unfavorable prognosis. Osteoglycin (OGN), belonging to the small leucine-rich proteoglycans family, assumes pivotal functions in both tissue formation and damage response. However, the roles and potential mechanisms of OGN in the context of lung fibrosis remain unexplored. MethodsThe assessment of OGN expression levels in fibrotic lungs was conducted across various experimental lung fibrosis mouse models. To elucidate the effects of OGN on the differentiation of lung myofibroblasts, both OGN knockdown and OGN overexpression were employed in vitro. The expression of integrin αv, along with its colocalization with lysosomes and latency-associated peptide (LAP), was monitored in OGN-knockdown lung myofibroblasts. Furthermore, the role of OGN in lung fibrosis was investigated through OGN knockdown utilizing adeno-related virus serotype 6 (AAV6)-mediated delivery. ResultsOGN exhibited upregulation in both lungs and myofibroblasts across diverse lung fibrosis mouse models. And laboratory experiments in vitro demonstrated that OGN knockdown inhibited the TGF-β/Smad signaling pathway in lung myofibroblasts. Conversely, OGN overexpression promoted TGF-β/Smad pathway in these cells. Mechanistic insights revealed that OGN knockdown facilitated lysosome-mediated degradation of integrin αv while inhibiting its binding to latency-associated peptide (LAP). Remarkably, AAV6-targeted OGN knockdown ameliorated the extent of lung fibrosis in experimental mouse models. ConclusionOur results indicate that inhibiting OGN signaling could serve as a promising therapeutic way for lung fibrosis.

Occupational Physical Activity and Fitness in Predicting Cardiovascular Mortality among European Cohorts of Middle-Aged Men: A 60-Year Follow-Up in the Seven Countries Study

Aim and Background: To determine whether occupational physical activity (OPA) and physical fitness (Fitscore) predict cardiovascular disease (CVD) mortality and its components. Methods: Among middle-aged men (N = 5482) of seven cohorts of the Seven Countries Study (SCS), several baseline risk factors were measured, and there was a follow-up for 60 years until virtual extinction. OPA was estimated from the type of work while Fitscore was derived from linear combinations of levels of arm circumference, heart rate and vital capacity computed as a factor score by principal component analysis. The predictive adjusted power of these characteristics was obtained by Cox models for coronary heart disease (CHD), heart diseases of uncertain etiology (HDUE), stroke and CVD outcomes. Results: Single levels of the three indicators of fitness were highly related to the three levels of OPA and Fitscore. High levels of both OPA and Fitscore forced into the same models were associated with lower CVD, CHD, HDUE and stroke mortality. When assessed concomitantly in the same models, hazard ratios (high versus low) for 60-year CVD mortality were 0.88 (OPA: 95% CI: 0.78–0.99) and 0.68 (Fitscore 95% CI: 0.61–0.75), and the predictive power of Fitscore outperformed that of OPA for CHD, HDUE and stroke outcomes. Similar results were obtained in individual outcome models in the presence of risk factors. Segregating the first 30 from the second 30 years of follow-up indicated that people dying earlier had lower arm circumference and vital capacity, whereas heart rate was higher for CVD and most of its major components (all p &lt; 0.0001). Conclusions: OPA was well related to the indicators of fitness involving muscular mass, cardio-circulatory and respiratory functions, thus adding predictive power for CVD events. The Fitscore derived from the above indicators represents another powerful long-term predictor of CHD, HDUE and stroke mortality.

Assessment of interleukin-18 gene polymorphism and serum levels in cutaneous lichen planus

BackgroundLichen planus (LP) is a chronic inflammatory disease with uncertain etiology. Interleukin-18 (IL-18) is an interferon gamma (INFγ) inducing agent. It is a pro-inflammatory cytokine that was found to play a role in the pathogenesis of some autoimmune disorders.Material and methodsThis study included 50 patients with classic cutaneous lichen planus (CLP) and 50 healthy volunteers serving as controls. Venous blood samples were withdrawn from the study subjects under complete aseptic precautions. Blood samples were examined for single nucleotide polymorphisms (SNPs) of IL-18 gene at promoter -137(G/C) and -656 (G/T) using polymerase chain reaction (PCR) and IL-18 level was assessed using enzyme linked immunosorbent assay (ELISA).ResultsThe mean level of IL-18 was significantly higher in CLP patients (31.63 ± 4.90) compared to control subjects (13.95 ± 6.82). Significantly high levels of IL-18 were found among patients with diabetes, hypertension (p < 0.01 in both). HCV positive patients and patients with both OLP and CLP also expressed higher levels of IL-18. Genotypic and allelic distribution at position -137(G/C) showed that the genotype GG was present at significantly higher frequency in cases (58%) compared to controls (28.0%). On the other hand the CC genotype at position -137 was significantly higher in the controls (28%) as compared to CLP cases (6%). Polymorphism of IL-18 at position -656(G/T) showed no significant difference between cases and controls. No significant difference could be detected in IL-18 level between different genotypic variants at position -137(G/C) and -656(G/T).ConclusionIL-18 may play important role in pathogenesis of LP. Elevated IL-18 levels could be part of the pro-inflammatory autoimmune process in LP. The presence of OLP, HCV, diabetes and hypertension is associated with higher production of IL-18. IL-18 promotor region -137(G/C) polymorphism might be a factor that increase the risk of development of lichen planus in Egyptian patients.

The Palliative Care in Patients with Oncological Diseases - a New Medical and Therapeutic Approach

The life epectancy increase in patients with cancer requires more attention to the quality of life and mental health status of this population. The aim of the current research is to change the perspective on the evolution of oncological disorders, regardless of their localization, stage, or complications, in terms of survival chances, by eploring the essential role of psychiatric medication on the core physical and mental health-related outcomes. This is a prospective, naturalistic study, that enrolled 284 oncological patients, distributed in three groups, diagnosed with lung cancer, metastatic lung cancer or other types of cancer, who received psychotropic medication for their mood symptoms, and changes in the primary outcomes (i.e., patients’ mood and pain, and quality of the mental status of the caregivers) were monitored for si months. The results reflected the efficacy of psychopharmacological intervention initiated early after the diagnosis of cancer was formulated, according to the scores on the Integrated Palliative Care Outcome Scale (IPOS). The severity of pain, the intensity of depression, and aniety in family members decreased significantly during si months of the standard-of-care psychotropic medication administered for depressive disorders. In the long term, the objective is to change the oncological protocols to accommodate an early introduction of psychiatric medication in the evolution of oncological disease, even in the contet of moderate physical symptoms with uncertain etiology, which causes a deterioration in overall functionality and quality of life. A new notion, created by the first author, is supported by this research, i.e., “long-term oncological survivorship care,” which will replace the former concept of palliative care, which refers to “end-of-life care,” or “comfort care,” in relation to the oncological contet.

Pharmacological treatment in Idiopathic Pulmonary Fibrosis: current issues and future perspectives

Idiopathic pulmonary fibrosis (IPF) represents a fibrotic interstitial lung disease characterized by uncertain etiology and poor prognosis. Over the years, the path to effective treatments has been marked by a series of advances and setbacks. The introduction of approved antifibrotic drugs, pirfenidone and nintedanib, marked a pivotal moment in the management of IPF. However, despite these advances, these drugs are not curative, although they can slow the natural progression of the disease. The history of drug therapy for IPF goes together with the increased understanding of the pathogenic mechanisms underlying the disease. Based on that, current research efforts continue to explore new therapies, possible personalized treatment strategies, drug combinations, and potential biomarkers for diagnosis and prognosis. In this review, we outline the route that led to the discover of the first effective therapies, ongoing clinical trials, and future directions in the search for more effective treatments.

#2722 Hemodialysis vascular access flow assessment by ultrasound dilution method (NephroFlow™) and ultrafiltration method with NIKKISO DBB-EXA™

Abstract Background and Aims A functioning vascular access (VA) is needed to ensure optimal dialysis. Reduced or falling levels of VA flow volume (Qa) indicate VA dysfunction and predict thrombosis. Qa can be measured by a number of different techniques, most of all using dilution techniques such as ultrasound dilution to measure the amount of recirculation induced by reversal of blood lines. The NephroFlow™ hemodialysis monitor estimates Qa using ultrasound velocity measurements of flowing blood and their dilution with 0.9% NaCl. Nikisso DBB-EXATM dialysis machine has the capacity to measure the VA recirculation rate by photometry performing a controlled rise on ultrafiltration rate; Qa is subsequently estimated using the Krivitski formula. There is little literature on the comparison of the different methodologies, but it was described that the DBB-EXATM method underestimates Qa compared to others techniques [1]. Our study aims to compare the Qa between the NephroFlow™ ultrasound dilution technique and the Nikisso DBB-EXATM ultrafiltration method. Method We performed an observational study that included 45 hemodialysis patients followed at our unit. Measurements of VA flow using the NephroFlow® device and the Nikisso-EXATM Ultrafiltration method were performed in patients with a native arteriovenous fistula or a graft. They were hemodynamically stable without acute clinical conditions. Both studies were undertaken during the first 90 minutes of a mid-week dialysis session, under a constant dialysis blood pump flow with the ultrafiltration interrupted during the procedure after having reversed the dialysis lines. For each patient we calculated the average of two Qa evaluations conducted at Nikisso-EXATM, spaced 15 days apart, with an additional evaluation using NephroFlow® conducted between these assessments. Results Forty-five patients (male: 71.1%) with a mean age of 73.2 ± 8 years were selected. The main CKD causes were diabetic kidney disease (n = 13, 28.9%) and uncertain etiology (n = 13, 28.9%). The dialysis vintage of these patients was 142.6 months (minimum 19, maximum 168). An arteriovenous fistula was present in 38 patients (84.4%) and an arteriovenous graft in 7 patients (15.6%). In the entire group, the mean flow with NephroFlow™ was 986.9 ± 515 ml/min and with DBB-EXATM 859.7 ± 522 ml/min. The measured values of the two methods presented a significant positive correlation (by Pearson) (R = 0.822, P &amp;lt; 0.01) (Fig. 1). In the group of patients with arteriovenous fistula (n = 38, 84.4%), the mean flow with NephroFlow™ was 961.8 ± 395 ml/min and with DBB-EXATM 839.1 ± 577 ml/min. The measured values of the two methods presented a significant positive correlation (by Pearson) (R = 0.844, P &amp;lt; 0.01). In the group of patients with arteriovenous graft (n = 7, 15.6%), the mean flow with NephroFlow™ was 1017.3 ± 401 ml/min and with DBB-EXATM 909.2 ± 604 ml/min. The measured values of the two methods presented a significant positive correlation (by Pearson) (R = 0.906, P &amp;lt; 0.01). Conclusion We found a significantly positive correlation between the Qa measurements obtained using both methods. The measurement of Qa using the ultrafiltration method on Nikisso DBB-EXATM seems to be a valuable and easily implementable tool for VA surveillance in both arteriovenous fistula and grafts. However, a bigger number of studies are required in this field in order to clarify this correlation with an additional comparative analysis to assess the reproducibility of measurements.

#2614 Extramedullary hematopoiesis resembling an asymptomatic renal mass: an unusual presentation

Abstract Background and Aims Extramedullary hematopoiesis (EMH) is the body's compensatory response to deficient erythropoiesis by the bone marrow or accelerated destruction of erythrocytes. The term refers to deposits of erythroid precursors in organs outside the bone marrow, most frequently occurring in the liver, spleen and lymph nodes. We report a case of perirenal EMH revealed by ultrasound (US) integrated with magnetic resonance imaging (MRI) in a patient with primary myelofibrosis. This case reveals the importance of point-of-care US (POCUS) to complete the nephrological examination and better direct the diagnostic process. Method A 68 yo man with a myeloproliferative disease was referred to nephrologists due to the discovery of altered creatinine and urea values in the blood tests (1.6 and 65 mg/dl, respectively, eGFR 43 ml/min EPI-CKD), reduction of hemoglobin value (6,4 g/dl) despite erythropoietin (EPO) and iron supplements, and for renal cysts follow-up. The standard urinalysis showed no abnormalities and negative fecal occult blood tests. Physical examination and US were performed during outpatient visit. Results On US abdominal evaluation, an already known severe splenic enlargement was found (LD 18 cm, Fig. 2), with the presence of two peri centimetric accessory spleens at the hilum. In the prone position, a bilobed, isoechoic structure was noticed emerging from the posterior profile of the upper pole of the left kidney: it measured 3.7 cm and didn't show a clear solution of continuity with the renal parenchyma. The color evaluation did not reveal hypervascularization. The uncertain nature of the lesion led us to perform an MRI, which showed bilaterally, along the posterior capsular margin, an isointense tissue thickening on T1 and slightly hyperintense and inhomogeneous on T2 with signs of diffusivity restriction, compatible in the first hypothesis with perirenal EMH (Fig. 1).These findings were absent in the annual US performed in hematology; they entered into the differential diagnosis with cysts or renal lesions. US first and then MRI made it possible to diagnose EMH and clinically justify the anemia and the low recent response to EPO. Conclusion Primary myelofibrosis is characterized by bone marrow fibrosis and the proliferation of megakaryocytes and granulocytes in the bone marrow and may result in progressive pancytopenia and EMH. Foci of EMH may develop or enlarge significantly after splenectomy, perhaps due to the loss of filtering function of the spleen. The kidney is an unusual site for EMH and it can be asymptomatic clinically. There have been few previous reports of EMH renal involvement, that can be parenchymal, intrapelvic or perirenal. In our patient, EMH diagnosis was coincidental but allowed us to place differential diagnosis with other diseases such as tumors, lymphomas, lipomatosis, renal inflammatory or infectious tissue, which generally present as a perirenal or parapelvic mass of uncertain etiology. In this case, POCUS allowed us to locate the mass and characterize it, excluding obstructive renal failure, and to establish a differential diagnosis with complex cysts or lymph node packages or others. Despite the reduced eGFR, renal function was stable in the previous and following months. According to the literature, we decided to perform only radiological exams because of the kidney biopsy risk of significant bleeding. In patients with hematologic disorders, it is important to investigate the presence of renal structural changes that require radiological follow-up and that could affect long-term prognosis.

Inflammatory fibroid polyp– a rare aetiology for adult ileocolic intussusception

We report a case of an adult ileocolic intussusception secondary to an inflammatory fibroid polyp (IFP), a rare and unexpected association between a surgical condition, and an underlying histopathological process. Intussusception is an uncommon surgical diagnosis in adults, and an IFP is rare mesenchymal tumour. Surgical intervention of the intussusception in an adult patient, given the uncertain aetiology of the lead point, is recommended as gold standard.

Exploring biomarkers as predictors of left ventricular recovery in a national registry of takotsubo syndrome patients (RETAKO)

Abstract Funding Acknowledgements None. Introduction Tako-Tsubo Syndrome (TTS) is characterized by transient dysfunction of the left ventricle (LV) of uncertain etiology, although considered a benign entity, TTS has a mortality rate and complications similar to STEMI patients (1). Late LV recovery (&amp;gt;10 days) has been associated with a worse prognosis. Currently, there is no data on biomarkers that can predict the disease's progression. Purpose We aim to correlate different biomarkers with LV recovery in TTS patients. Method We used data from the National Multicenter Registry on Tako-Tsubo Syndrome (RETAKO). Information on biomarkers, including NT-proBNP, C-reactive protein (CRP), leukocytes, and platelets, was collected both upon admission and at peak values. Early recovery was considered when it occurred within the first 10 days after the index event. A non-parametric correlation analysis was conducted to assess the predictive capacity of different biomarkers on LV recovery. Results Out of a total of 1,463 patients, 373 (25.5%) experienced late LV recovery. The average age was around 73 years, with the majority of the sample being women (86%). Significant differences were observed between the groups in NT-proBNP, CRP, and peak values of leukocytes and platelets, with higher levels in the late recovery group. In the linear correlation analysis, a significant association was found between late recovery and higher levels of NT-proBNP, peak leukocytes and platelets, however it was not statistically significant for the levels of CRP. Conclusions In a large national cohort of TTS patients, higher levels of NT-proBNP, peak of leukocytes and platelets during the hospital stay were significantly associated with late LV recovery. This recovery appears to depend on the degree of LV dysfunction and the inflammatory response.Biomarkers table 1