Vascular Score Research Articles

Use of an Artificial Intelligence-Generated Vascular Severity Score Improved Plus Disease Diagnosis in Retinopathy of Prematurity

To evaluate whether providing clinicians with an artificial intelligence (AI)-based vascular severity score (VSS) improves consistency in the diagnosis of plus disease in retinopathy of prematurity (ROP). Multireader diagnostic accuracy imaging study. Eleven ROP experts, 9 of whom had been in practice for 10 years or more. RetCam (Natus Medical Incorporated) fundus images were obtained from premature infants during routine ROP screening as part of the Imaging and Informatics in ROP study between January 2012 and July 2020. From all available examinations, a subset of 150 eye examinations from 110 infants were selected for grading. An AI-based VSS was assigned to each set of images using the i-ROP DL system (Siloam Vision). The clinicians were asked to diagnose plus disease for each examination and to assign an estimated VSS (range, 1-9) at baseline, and then again 1 month later with AI-based VSS assistance. A reference standard diagnosis (RSD) was assigned to each eye examination from the Imaging and Informatics in ROP study based on 3 masked expert labels and the ophthalmoscopic diagnosis. Mean linearly weighted κ value for plus disease diagnosis compared with RSD. Area under the receiver operating characteristic curve (AUC) and area under the precision-recall curve (AUPR) for labels 1 through 9 compared with RSD for plus disease. Expert agreement improved significantly, from substantial (κ value, 0.69 [0.59, 0.75]) to near perfect (κ value, 0.81 [0.71, 0.86]), when AI-based VSS was integrated. Additionally, a significant improvement in plus disease discrimination was achieved as measured by mean AUC (from 0.94 [95% confidence interval (CI), 0.92-0.96] to 0.98 [95% CI, 0.96-0.99]; difference, 0.04 [95% CI, 0.01-0.06]) and AUPR (from 0.86 [95% CI, 0.81-0.90] to 0.95 [95% CI, 0.91-0.97]; difference, 0.09 [95% CI, 0.03-0.14]). Providing ROP clinicians with an AI-based measurement of vascular severity in ROP was associated with both improved plus disease diagnosis and improved continuous severity labeling as compared with an RSD for plus disease. If implemented in practice, AI-based VSS could reduce interobserver variability and could standardize treatment for infants with ROP. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A Prospective Study of Patients Presenting With Pre-sternal Keloids.

Keloid represents a pathological form of scarring. They are very common in the anterior chest area; nearly 50% of all keloids occur in this location. One of the reasons for this is that folliculitis and acne, known for triggering the development of keloids, are common on the anterior chest. The other reason is the tension load in this area due to the frequent movements of the upper limbs and the respiratory movements. These movements stretch the skin of the anterior chest horizontally. When this cyclical tension is imposed on the anterior chest wounds, there is an exacerbation and prolongation of the inflammation in the reticular dermis of the wound. These stresses induce the growth of keloids along the prevailing lines of skin tension. We performed a prospective study in which patients were recruited over a period of one year. Patients presenting with symptomatic pre-sternal keloids and requesting treatment but were unwilling to undergo surgical intervention were included in this study. Patients with a history of previous thoracic surgery were excluded. Baseline assessment and documentation of the lesion were performed. The study patients received three sessions of intralesional injections of a combination of triamcinolone acetonide and hyaluronidase at four weekly intervals. The final assessment was performed four weeks after the third session. The study included 47 lesions in 47 patients with ages of the patients ranging from 16 to 70 years. Pre-sternal keloids were found to be more common among males than females, with a male-to-female ratio of 2.35:1. Patients presented with pre-sternal keloids that had been present for varying periods ranging from three to 81 months. All of our 47 patients completed the three sessions of the treatment. Following the treatment, there was an improvement in the patient's symptoms, as evidenced by the reduction in the mean pruritis scores and pain scores. There was an overall reduction in the size of the lesion. The decrease in the height of the lesions was more evident than the reduction in the craniocaudal or transverse dimensions of the lesions. There were improvements in Vancouver Scar Scale(VSS) vascularity scores and pliability scores following the treatment. We conclude that pre-sternal keloids should be considered as a distinct clinico-pathological entity. There are differences with regard to pathogenesis, clinical presentation, and management when compared to keloids elsewhere. Treatment with intralesional injections of a combination of triamcinolone acetonide and hyaluronidase effectively relieves the symptoms and may be considered in patients not willing to undergo surgical intervention. Recurrences can occur and need further treatments.

Construction and application of a three-dimensional vascular variation-based nephrometry scoring system for completely endophytic renal tumors

BackgroundCompletely endophytic renal tumors (CERT) pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location. A facile scoring model based on three-dimensional (3D) reconstructed images will assist in better assessing tumor location and vascular variations. MethodsIn this retrospective study, 80 patients diagnosed with CERT were included. Forty cases underwent preoperative assessment using 3D reconstructed imaging (3D-Cohort), while the remaining 40 cases were assessed using two-dimensional imaging (2D-Cohort). Vascular variations were evaluated by ascertaining the presence of renal arteries > 1, prehilar branching arteries, and arteries anterior to veins. The proposed scoring system, termed RAL, encompassed three critical components: (R)adius (maximal tumor diameter in cm), (A)rtery (occurrence of arterial variations), and (L)ocation relative to the polar line. Comparison of the RAL scoring system was made with established nephrometry scoring systems. ResultsA total of 48 (60 %) patients exhibited at least one vascular variation. In the 2D-Cohort, patients with vascular variations experienced significantly prolonged operation time, increased bleeding volume, and extended warm ischemia time compared with those without vascular variations. Conversely, the presence of vascular variations did not significantly affect operative parameters in the 3D-Cohort. Furthermore, the 2D-Cohort demonstrated a notable decline in both short- and long-term estimated glomerular filtration rate (eGFR) changes compared with the 3D-Cohort, a trend consistent across patients with warm ischemia time ≥ 25 min and those with vascular variations. Notably, the 2D-Cohort exhibited a larger margin of normal renal tissue compared with the 3D-Cohort. Elevated RAL scores correlated with larger tumor size, prolonged operation time, extended warm ischemia time, and substantial postoperative eGFR decrease. The RAL scoring system displayed superior predictive capabilities in assessing postoperative eGFR changes compared with conventional nephrometry scoring systems. ConclusionsOur proposed 3D vascular variation-based nephrometry scoring system offers heightened proficiency in preoperative assessment, precise prediction of surgical complexity, and more accurate evaluation of postoperative renal function in CERT patients.

#2559 “Remote software technology to assist clinical decision in vascular access surveillance: single UK centre experience”

Abstract Background and Aims Optimal arteriovenous access monitoring and surveillance aims for early detection of dysfunctional access, enabling pre-emptive referral for angioplasty or surgery to prevent access loss or thrombosis. Here we compared the addition of remote software surveillance to standard clinical care in our units. Method From January–December 2023 we conducted a 12-month prospective study of maintenance hemodialysis (HD) patients. We used Vasc-Alert software technology to assist clinical decision making for vascular access (VA) surveillance in 2 out of 5 HD units. In these units, vascular access risk score was calculated using Vasc-Alert software platform from routinely collected data from the dialysis procedure as previously described [1]. Patients with high Vasc-Alert access risk score (≥7) underwent clinical assessment and were referred for fistulogram if they met the relevant KDOQI criteria [2]. The following variables were collected from all 5 HD units: baseline permanent VA prevalence, subsequent VA events (stenosis or thrombosis), access abandonment (i.e. unsalvageable access loss), complication free days (CFD)-extended over one year (defined as days without serious vascular access events, radiological or surgical intervention, VA infection, hospitalisation or use of central venous catheter). Data was collected on patients who were pre-emptively referred for diagnostic fistulogram ± angioplasty but thrombosed while awaiting intervention. Median time interval from the date of fistulogram request till the date of confirmed thrombosed access was calculated. Comparison between HD units with Vasc-Alert use (Group 1) or without (Group 2) was performed using appropriate statistical tests depending on the type and distribution of the data. Survival analysis of post-intervention primary patency rate was conducted at 3 and 6 months defined as the time from the index procedure until the next access thrombosis or reintervention [3]. Results There were 81 (53.6%) patients with permanent VA in group 1and 201 (59.3%) patients in group 2at the start of the study. We recorded 23 (28.4%) episodes of stenosis and 6 (7.4%) episodes of thrombosis in Group 1 and 40 (19.9%) episodes of stenosis and 21 (10.4%) episodes of thrombosis in Group 2 (p value 0.121 and 0.432, respectively). In Group 2, 11 patients (5.5%) developed repeated stenosis and 2 patients (1%) repeated thrombosis. In Group 1, 5 /6 (83%) cases preemptively referred for diagnostic fistulogram ± angioplasty developed thrombosis whilst awaiting elective intervention, compared with 4/21 (19%) in group 2 (p value = 0.008) (Fig. 1). The median time interval from the date of fistulogram request till date of thrombosed VA was 26 days with Interquartile range (IQR 25-75%) of 21-34 days. Group 1 had better post-intervention primary patency rate of VA (Fig. 2) and longer CFD-extended compared to group 2 (p values < 0.001 and 0.002 respectively) (Table 1). Conclusion Our study shows that integrating Vasc-Alert technology into the VA surveillance program was associated with improved early detection of high-risk access, higher primary patency rates and CFD-extended. Additionally, our data emphasizes the need to enhance interventional radiology capacity for timely access intervention, to realise the true potential of Vasc-Alert technology in prevent access thrombosis.

Efficacy of Fractional Micro-plasma Radio Frequency Technology in Treating Hypertrophic Burn Scars in Asian Patients Under General Anesthesia: A Retrospective Study of 104 Cases.

Laser and other energy devices have been widely used in the minimally invasive treatment of scars. Among various technologies, Fractional Micro-Plasma Radio Frequency Technology (FMRT) has gained extensive consensus in the treatment of various types of scars and skin disorders, such as wrinkles, skin laxity, and pigmentation. This study is a retrospective clinical trial aimed at assessing the effectiveness and safety of FMRT for hypertrophic burn scars treatment in the Asian population under different anesthesia methods. A total of 104 patients with hypertrophic burn scars treated in our department from May 2018 to May 2022 were selected. Scar assessment scales were applied to observe changes in scars before and after FMRT treatment. A prospective study of 104 patients found that female patients were more likely to undergo laser treatment under general anesthesia (P < 0.05). Postoperative VSS total score, VSS total score difference, and immediate postoperative pain score were all better with general anesthesia compared to local anesthesia (P < 0.05). There were more significant improvements in scar color, vascular distribution, and flexibility (P < 0.05). When comparing the treatment outcomes between females and males, it was found that general anesthesia patients were superior to local anesthesia patients in terms of color score, vascular distribution score, flexibility score, and postoperative VSS total score 6 months after the final treatment. General anesthesia patients had a shorter hospital stay. Overall treatment evaluation was better for female general anesthesia patients than male patients. General anesthesia combined with FMRT is an effective, safe, and more acceptable treatment method for hypertrophic burn scars in the Asian population. In the Asian population, the combined use of general anesthesia and Fractional Micro-Plasma Radio Frequency Technology (FMRT) is an effective, safe, and accepted method for treating skin scars. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Impact of long-term white matter hyperintensity changes on mobility and dexterity.

White matter hyperintensities (WMH), a common feature of cerebral small vessel disease, are related to worse clinical outcomes after stroke. We assessed the impact of white matter hyperintensity changes over 1 year after minor stroke on change in mobility and dexterity, including differences between the dominant and non-dominant hands and objective in-person assessment versus patient-reported experience. We recruited participants with lacunar or minor cortical ischaemic stroke, performed medical and cognitive assessments and brain MRI at presentation and at 1 year. At both time points, we used the timed-up and go test and the 9-hole peg test to assess mobility and dexterity. At 1 year, participants completed the Stroke Impact Scale. We ran two linear mixed models to assess change in timed-up and go and 9-hole peg test, adjusted for age, sex, stroke severity (National Institutes of Health Stroke Scale), dependency (modified Rankin Score), vascular risk factor score, white matter hyperintensity volume (as % intracranial volume) and additionally for 9-hole peg test: Montreal cognitive assessment, hand (dominant/non-dominant), National Adult Reading Test (premorbid IQ), index lesion side. We performed ordinal logistic regression, corrected for age and sex, to assess relations between timed-up and go and Stroke Impact Scale mobility, and 9-hole peg test and Stroke Impact Scale hand function. We included 229 participants, mean age 65.9 (standard deviation = 11.13); 66% male. 215/229 attended 1-year follow-up. Over 1 year, timed-up and go time increased with aging (standardized β [standardized 95% Confidence Interval]: 0.124[0.011, 0.238]), increasing National Institutes of Health Stroke Scale (0.106[0.032, 0.180]), increasing modified Rankin Score (0.152[0.073, 0.231]) and increasing white matter hyperintensity volume (0.176[0.061, 0.291]). Men were faster than women (-0.306[0.011, 0.238]). Over 1 year, slower 9-hole peg test was related to use of non-dominant hand (0.290[0.155, 0.424]), aging (0.102[0.012, 0.192]), male sex (0.182[0.008, 0.356]), increasing National Institutes of Health Stroke Scale (0.160 [0.094, 0.226]), increasing modified Rankin Score (0.100[0.032, 0.169]), decreasing Montreal cognitive assessment score (-0.090[-0.167, -0.014]) and increasing white matter hyperintensity volume (0.104[0.015, 0.193]). One year post-stroke, Stroke Impact Scale mobility worsened per second increase on timed-up and go, odds ratio 0.67 [95% confidence interval 0.60, 0.75]. Stroke Impact Scale hand function worsened per second increase on the 9-hole peg test for the dominant hand (odds ratio 0.79 [0.71, 0.86]) and for the non-dominant hand (odds ratio 0.88 [0.83, 0.93]). Decline in mobility and dexterity is associated with white matter hyperintensity volume increase, independently of stroke severity. Mobility and dexterity declined more gradually for stable and regressing white matter hyperintensity volume. Dominant and non-dominant hands might be affected differently. In-person measures of dexterity and mobility are associated with self-reported experience 1-year post-stroke.

25(OH)D level and vascular lesion scores in kidney histopathology as risk-stratification tool for predicting renal progression in people with type 2 diabetes

AimTo evaluate the potential of the combined individual vascular histopathological lesion and serum 25-hydroxy vitamin D [25(OH)D] level as predictors of outcomes in patients with diabetes and chronic kidney disease. MethodsA total of 190 patients with type 2 diabetes and kidney disease stages 1–4 were retrospectively included. Kaplan-Meier analysis and the log-rank test were performed to assess renal survival differences. And the time-dependent receiver operating characteristic analyses were used to characterize the predictive accuracy. Hazard ratios for vascular lesion scores and 25(OH)D levels with renal outcomes were estimated using Cox proportional hazards regression models with follow-up time. ResultsOver a median follow-up of 23.78 (12.61, 37.14) months, 71 patients (37.4 %) experienced the renal outcomes. Enrolled patients with more severe vascular lesions had worse kidney function, heavier proteinuria, lower serum 25(OH)D levels, and higher prevalence of composite kidney outcomes. Baseline serum 25(OH)D was a significant independent risk factor for vascular lesion scores. The effect of serum 25(OH)D level on kidney prognosis was more pronounced in males and those with more exacerbated vascular lesions (score 2). The severity of vascular lesions and serum 25(OH)D levels were associated with unfavorable kidney outcomes. Accordingly, further time-dependent receiver operating characteristic curves confirmed that combined 25(OH)D level and vascular lesion score had a stable and reliable performance in renal outcomes prediction at short and long-term follow-up times. Conclusions25(OH)D level and vascular lesion scores in kidney histopathology could serve as a useful risk-stratification tool for predicting renal progression in patients with type 2 diabetes.

ANTIPLATELET THERAPY IN PRIMARY PREVENTION. OBSERVATIONAL STUDY AND SURVIVAL ANALYSIS IN HIGH CARDIOVASCULAR RISK PATIENTS.

Objective: Cardiovascular diseases are the leading cause of morbidity and mortality in industrialized countries. This was a retrospective observational study, evaluating clinical outcomes, metabolic consequences and survival rate resulting from prolonged antiplatelet therapy for primary prevention in patients with high CVR. Design and method: Overall, 516 patients were randomly selected from cardiovascular risk and metabolism consultations in a single center in Porto (Portugal). Sociodemographic, lifestyle and clinical characteristics were collected at baseline, including biochemical parameters, vascular risk scores and tests for heart and cardiovascular evaluation. In this follow-up with a median of 11 years, 287 patients received adjuvant antiplatelet therapy in primary prevention. Association between sex, observation time and treatments with LDLc and HDLc variations were assessed. Multiple linear regression was performed to evaluate which factors could explain the differences in HDLc and LDLc levels. Kaplan-Meier survival analysis was also conducted. Results: Therapy with statins was initiated early for metabolic compensation of dyslipidemia, according to clinical practice. Statistically significant reductions were found for almost all biochemical parameters, mean carotid intima-media thickness and lipid metabolism parameters, including triglycerides, total cholesterol and the respective fractions. Patients taking statins showed greater increased HDLc values and reduced LDLc values than those who were not. Additionally, women showed a more favorable evolution regarding HDLc increase compared to men. Survival rate was estimated at 77.5% with 22 years as the maximum observed time. The median time of survival was not computed, since more than half of the patients (77.5%) were alive after 22 years. No bleeding episodes were recorded during this long period of observation.In fact, 99.0% of patients were alive after 10 years and the percentage of patients alive remained over 90% at 17 years. After 18 years of observation, 88.6% of patients were alive, and at 20 years 77.5% were alive without major cardiovascular events (MACE). Conclusions: Antiplatelet therapy should always be considered in primary prevention in patients with high CVR. There were no cases of hemorrhage or MACE. The survival rate estimated for the study population was 77.5% over 22 years.

Isolated Retinal Neovascularization in Retinopathy of Prematurity: Clinical Associations and Prognostic Implications

Isolated retinal neovascularization (IRNV) is a common finding in patients with stage 2 and 3 retinopathy of prematurity (ROP). This study aimed to further classify the clinical course and significance of these lesions (previously described as "popcorn" based on clinical appearance) in patients with ROP as visualized with ultrawidefield OCT (UWF-OCT). Single center, retrospective case series. Images were collected from 136 babies in the Oregon Health and Science University neonatal intensive care unit. A prototype UWF-OCT device captured en face scans (>140°), which were reviewed for the presence of IRNV along with standard zone, stage, and plus classification. In a cross-sectional analysis we compared demographics and the clinical course of eyes with and without IRNV. Longitudinally, we compared ROP severity using a clinician-assigned vascular severity score (VSS) and compared the risk of progression among eyes with and without IRNV using multivariable logistic regression. Differences in clinical demographics and disease progression between patients with and without IRNV. Of the 136 patients, 60 developed stage 2 or worse ROP during their disease course, 22 of whom had IRNV visualized on UWF-OCT (37%). On average, patients with IRNV had lower birth weights (BWs) (660.1 vs. 916.8 g, P= 0.001), gestational age (GA) (24.9 vs. 26.1 weeks, P= 0.01), and were more likely to present with ROP in zone I (63.4% vs. 15.8%, P < 0.001). They were also more likely to progress to stage 3 (68.2% vs. 13.2%, P < 0.001) and receive treatment (54.5% vs. 15.8%, P= 0.002). Eyes with IRNV had a higher peak VSS (5.61 vs. 3.73, P < 0.001) and averaged a higher VSS throughout their disease course. On multivariable logistic regression, IRNV was independently associated with progression to stage 3 (P= 0.02) and requiring treatment (P= 0.03), controlling for GA, BW, and initial zone 1 disease. In this single center study, we found that IRNV occurs in higher risk babies and was an independent risk factor for ROP progression and treatment. These findings may have implications for OCT-based ROP classifications in the future. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Remote Surveillance Technology of Dialysis Arteriovenous Access: Retrospective Evaluation in a UK Renal Centre

Background: Early identification of dysfunctional arteriovenous haemodialysis (HD) vascular access (VA) is important for timely referral and intervention. Method: We retrospectively calculated VA risk score using Vasc-Alert surveillance software technology from HD treatment sessions in 2 satellite HD units over 18 months. We included in the analysis HD patients dialysing with arteriovenous fistula or graft (AVF/G) with available Vasc-Alert data for≥ 2 months. For group one (eventful) that included patients who developed vascular access thrombosis or stenosis over the study period, we collected Vasc-Alert risk score 2 months prior to the event and, for group two (uneventful), over 5 consecutive months. Vasc-Alert technology utilises routinely collected data during HD to calculate VA risk score and triggers an alert if the score is ≥7 in 3 consecutive dialysis sessions. Patients with >2 alerts (vascular access score ≥7) per month were considered to have positive alerts. Results: From 140 HD patients, 81 patients dialysed via AVF/G. 77/81 had available Vasc-Alert data and were included in the final analysis. Out of 17 eventful patients, 11 (64.7%) had positive alerts 2 months prior to the vascular event. Out of the 60 patients without vascular events, 20 patients (33.3%) had positive alert. Vasc-Alert’s sensitivity and specificity for vascular events were 64.7% and 66.6%, respectively. Within the 6 patients with thrombosed access, 2 patients (33.3%) detected by Vasc-Alert were not detected with clinical monitoring. Conclusion: Vascular access risk score can be a useful non-invasive vascular access surveillance method to assist clinical decision making.

Spectrum of chronic lung allograft dysfunction pathology in human lung transplantation

BackgroundLong-term survival after lung transplantation (LTx) remains limited by Chronic Lung Allograft Dysfunction (CLAD), which includes two main phenotypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), with possible overlap. We aimed to detail and quantify pathological features of these CLAD sub-types. MethodsPeripheral and central paraffin-embedded explanted lung samples were obtained from 20 consecutive patients undergoing a second LTx for CLAD, from 3 lobes. Thirteen lung samples, collected from non-transplant lobectomies or donor lungs, were used as controls. Blinded semi-quantitative grading was performed to assess airway fibrotic changes, parenchymal and pleural fibrosis, as well as epithelial and vascular abnormalities. ResultsCLAD lung samples had higher scores for all airway- and lung-related parameters compared to controls. There was a notable overlap in pathological scores between BOS and RAS, with a wide range of scores in both conditions. Parenchymal and vascular fibrosis scores were significantly higher in RAS compared to BOS (p=0.003 for both). We observed a significant positive correlation between the degree of inflammation around each airway, the severity of epithelial changes and airway fibrosis. Immunofluorescence staining demonstrated a trend towards a lower frequency of club cells in CLAD, and a higher frequency of apoptotic club cells in BOS samples (p=0.01). ConclusionsCLAD is a spectrum of airway, parenchymal, and pleural fibrosis, as well as epithelial, vascular, and inflammatory pathological changes, where BOS and RAS overlap significantly. Our semi-quantitative grading score showed a generally high inter-reader reliability and may be useful for future CLAD pathological assessments.

Implications and late outcomes of type II endoleaks after endovascular aneurysm repair

ObjectiveType II endoleaks (T2ELs) are the most common cause of reintervention after endovascular aneurysm repair (EVAR). Although most resolve spontaneously, the long-term implications of T2ELs remain elusive. We aim to evaluate the impact of persistent and late T2ELs on clinical outcomes after EVAR. MethodsThis was a single-institution retrospective review of patients who underwent EVAR for degenerative infrarenal abdominal aortic aneurysm between January 2010 and June 2022 with no type I (T1EL) or III (T3EL) endoleak seen at EVAR completion. Patients were categorized based on T2EL status. Group 1 included patients with never detected or transient T2ELs (detected at EVAR completion but not after). Group 2 encompassed persistent T2ELs (seen at EVAR completion and again during follow-up) and late T2ELs (detected for the first time at any point during follow-up). Time-to-event analysis was conducted using a time-dependent approach to T2EL status. Primary outcomes included freedom from sac enlargement (SE), aneurysm-related reinterventions, and overall survival. ResultsA total of 803 patients met inclusion criteria. Group 1 included 418 patients (52%), of which 85% had no T2ELs and 15% had transient T2ELs. Group 2 had 385 patients; 23% had persistent T2ELs, and 77% developed a new T2EL. Patients in group 1 had a higher prevalence of smoking (88% vs 83%; P < .001), chronic obstructive pulmonary disease (33% vs 25%; P = .008), chronic kidney disease (13% vs 8%; P = .021), and a higher mean Society for Vascular Surgery score (7 vs 6 points; P = .049). No differences were found in aneurysm diameter or morphology. Mean follow-up was 5 years for the entire cohort. In Group 2, 58 patients (15%) underwent T2EL treatment, most commonly transarterial embolization. At 10 years after EVAR, Group 2 was associated with lower freedom from SE (P < .001) and abdominal aortic aneurysm-related reinterventions (P < .001) and comparable overall survival (P = .42). More T1ELs were detected during follow-up in Group 2 (6 [1%] vs 20 [5%]; P = .004), with 15 (75%) of these detected at a median of 3 years after the T2EL. No difference between groups was observed in explant (0.7% vs 2.1%; P = .130) or aneurysm rupture (0.5% vs 1.3%; P = .269) rates. ConclusionsOne-half of patients treated with infrarenal EVAR developed persistent/late T2ELs, which are associated with a higher risk of SE and reinterventions. No difference in overall survival or aneurysm rupture risk was seen at 10 years, based on T2EL status or T2EL intervention. A conservative approach to T2ELs may be appropriate for most patients with absent T1ELs or T3ELs.

Prognostic value of 18 FDG-PET at diagnosis and follow-up in giant cell arteritis: An observational restrospective study

ObjectivesTo evaluate the ability of 18FDG PET/CT, at diagnosis of giant cell arteritis (GCA) and during follow-up, to predict occurrence of relapse in large-vessel GCA (LV-GCA). MethodsWe conducted a retrospective study using the French Study Group for Large-Vessel Vasculitis (GEFA) network. Data from patients with LV-GCA diagnosed by PET/CT and who had PET/CT in the following year were collected. For each PET/CT, PET vascular activity score (PETVAS) and total vascular score (TVS) were assessed, and their ability to predict the occurrence of subsequent relapse was assessed. ResultsA total of 65 LV-GCA patients were included, of whom 55 had undergone a follow-up PET/CT 3 to 12 months after the diagnosis of GCA. Patients for whom the second PET/CT (PET2) was performed during active GCA were excluded. PETVAS and TVS decreased between PET1 and PET2 in all patients (p < 0.001). There was no correlation between vascular activity scores in PET2 and time to prednisone taper. For relapse prediction, at PET1, the AUC of the TVS and PETVAS were respectively 51.9 and 41.9 at 6 months, 55.3 and 49.7 at 1 year, 55 and 55.7 at 2 years. For PET2, the AUC were respectively 46.1 and 46.7 at 6 months, 52.1 and 48.9 at 1 year, 58.4 and 52.3 at 2 years. ConclusionPET vascular activity scores at diagnosis and at follow-up PET/CT performed outside a period of GCA activity do not display high performance to predict the occurrence of subsequent relapse in LV-GCA patients.

543 The link between preexisting hypertension and COVID-19 severity in a hamster model

OBJECTIVES/GOALS: Hypertension is a major risk factor for coronavirus disease 2019 (COVID-19) severity. Our goal was to determine if hypertension worsens lung pathology induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in hamsters. METHODS/STUDY POPULATION: Male hamsters (7-8 weeks old) were infused with angiotensin II (AII; 200 ng/kg/min via osmotic minipump) for 4 weeks to induce hypertension. During the last week of the infusion, the hamsters were inoculated intranasally with vehicle (V) or SARS-CoV-2 (S; 1 x 105 plaque forming units/ml). Half of the hamsters were sacrificed 1 day post-inoculation (dpi-1) and the other half on dpi-6. Two scoring systems were applied to lung tissue sections stained with hematoxylin and eosin to determine the degree and severity of lung pathology: the first system assessed all pertinent alterations in the lungs, while the second system only assessed the pathology related to the pulmonary vasculature. Lung histopathology scores were calculated as the sum of the airway and lung alveolar scores in arbitrary units (AU). RESULTS/ANTICIPATED RESULTS: Studies revealed that the SARS-CoV-2-infected hamsters exhibited a 76-fold higher total airway score compared to vehicle controls [(AU): V, 0.25 ± 0.1; S, 19.00 ±1.35; p&lt;0.05; n=4]. Total lung alveolar scores (27-fold) [(AU): V, 0.30 ± 0.11; S, 8.0 ± 4.1; p&lt;0.05; n=4] and total vascular scores (17-fold) [(AU): V, 0.35 ± 0.2; S, 6.0 ±1.4; p&lt;0.05; n=4] were also markedly higher compared to controls on dpi-1. AII increased blood pressure, which was sustained through the 4-week infusion period. Under these conditions, body weight slightly dropped by 4.5%. Ongoing studies are assessing the effect of hypertension on the % of airway, alveoli and vessels affected, airway and alveolar severity, and bronchiolar epithelial and type II pneumocyte hyperplasia. DISCUSSION/SIGNIFICANCE: Establishing the hypertensive hamster as a small animal model of COVID-19 will facilitate investigations into why preexisting hypertension is a risk factor for disease severity. These studies could lead to the development of novel therapeuticsfor treating COVID-19 patients with hypertension.

Circulatory endostatin level and risk of cardiovascular events in patients with end-stage renal disease on hemodialysis.

Endostatin is released during extracellular matrix remodeling and is involved in the development of vascular pathology and cardiovascular (CV) disease. However, the role of circulating endostatin as a biomarker of vascular calcification and CV events in patients undergoing hemodialysis (HD) remains unclear. A total of 372 patients undergoing HD were prospectively recruited. Plasma endostatin levels were measured at baseline, and their associations with circulating mineral bone disease (MBD) biomarkers and abdominal aortic vascular calcification scores were analyzed. The primary endpoint was defined as a composite of CV and cardiac events. Plasma levels of patients in endostatin tertile 3 were significantly associated with low-density lipoprotein cholesterol levels and predialysis systolic blood pressure in multivariate analysis. However, endostatin levels did not correlate with circulating MBD biomarkers or vascular calcification scores. Patients in endostatin tertile 3 had a significantly higher cumulative event rate for the composite of CV events (p = 0.006). Endostatin tertile 3 was also associated with an increased cumulative rate of cardiac events (p = 0.04). In multivariate Cox regression analyses, endostatin tertile 3 was associated with a 4.37-fold risk for composite CV events and a 3.88-fold risk for cardiac events after adjusting for multiple variables. Higher circulating endostatin levels were independently associated with atherosclerotic risk factors but did not correlate with MBD markers or vascular calcification. Higher circulating endostatin levels were associated with a greater risk of composite CV events in patients undergoing HD, and endostatin is a biomarker that helps to determine the high risk of CV events.

The risk factors for arteriovenous fistula dysfunction in maintenance hemodialysis patients: A cross-sectional study.

Arteriovenous fistula (AVF) dysfunction is a prevalent complication among maintenance hemodialysis patients. However, the factors influencing AVF patency remain unclear. To address this, we conducted a study aimed at identifying factors contributing to AVF dysfunction in this patient population. The study compared clinical data, vascular calcification score, and laboratory data focusing on blood cell composition and coagulation in 100 maintenance hemodialysis patients in whom an AVF had been inserted from January through September of 2022. The patients were divided into a group in which the AVF functioned without issues and a group in which the AVF was dysfunctional, defined as not able to provide a blood flow of greater than 200 mL/min. Patients in the 2 groups (56 in the dysfunctional AVF group and 44 in the group with satisfactory AVF function) were similar demographically. Compared with the normally functioning AVF group, the AVF dysfunction group exhibited significantly higher Agatston calcium scores (20.5 [1.28, 298] median [Q1, Q3] vs. 1.14 [0.00, 11.6]; p = 0.01), elevated triglyceride levels (1.1 [0.6, 1.2] mmol/L vs. 0.5 [0.3, 0.8]; p < 0.01), increased prothrombin activity (113 ± 22.1% vs. 99.4 ± 23.1; p < 0.01), lower prothrombin time (10.4 [9.8, 10.8] s vs. 11.0 [10.3, 11.5]; p < 0.01), higher red blood cell (RBC) counts (3.5 ± 0.7 · 1012/L vs. 3.0 ± 0.7; p < 0.01), and elevated hemoglobin levels (98.0 ± 21.8 g/L vs. 84.9 ± 24.2; p < 0.01). Higher C-reactive protein (20.2 [3.3, 20.2] mg/L vs. 17.8 [6.2, 17.8]; p = 0.01) and procalcitonin levels (0.9 [0.4, 0.9] ng/mL vs. 0.5 [0.2, 0.7]; p < 0.01) were also noted. Logistic regression analysis indicated that platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and RBC count were factors associated with AVF dysfunction. Increased monocyte/lymphocyte ratio and RBC count correlated with higher risk, while a higher platelet/lymphocyte ratio was associated with lower risk. Arteriovenous fistula dysfunction in maintenance hemodialysis patients is associated with higher proportions of specific hematological parameters, particularly elevated RBC count, and altered platelet/lymphocyte and monocyte/lymphocyte ratios.

A Phase IIa Multicenter, Randomized, Vehicle-Controlled, Dose Escalating Study to Evaluate the Safety, Efficacy, and Pharmacokinetics of CBT-001 Ophthalmic Solution in Patients With Primary or Recurrent Pterygium

PurposeTo evaluate the safety and efficacy of CBT-001, a multi-target tyrosine kinase inhibitor (MKI) eyedrop, for pterygia. DesignPhase 2 clinical trial. Stage 1 was a single center, open-labeled, vehicle-controlled study. Stage 2 was a multicenter, randomized, double-masked, vehicle-controlled trial. ParticipantsPatients with primary or recurrent pterygia. Main Outcome MeasuresThe primary efficacy endpoint was lesion vascularity based on masked grading of photographs by an independent reading center. Other endpoints included dimensions of pterygia and safety. MethodsIn Stage 1, 24 eyes of 24 patients received one drop of CBT-001 in a dose escalation fashion (0.02%, 0.05%, and 0.2%) to determine the maximally tolerated dose based on adverse events and blood drug levels. In Stage 2, subjects were randomly assigned to receive the maximally tolerated dose of CBT-001 or vehicle dosed three times a day (TID) for 4 weeks with a 20-week follow up. ResultsIn Stage 1, the plasma maximum concentration (Cmax) values for all doses of CBT-001 were at or below the limit of detection (0.01 ng/mL). The most commonly reported adverse events were mild foreign body sensation and irritation. CBT-001 0.2% was evaluated in Stage 2. Baseline demographic characteristics were similar between patients receiving CBT-001 (n = 25) and vehicle (n = 23). After 4 weeks of dosing, mean change from baseline in pterygium vascularity scores was –0.8 ± 0.7 (mean ± standard deviation) in subjects receiving CBT-001 0.2% and 0.0 ± 0.5 in subjects receiving vehicle (P < 0.001; 95% confidence interval [CI]: -1.12, -0.40). Pterygium vascularity scores remained significantly decreased, after the 4-week dosing period, at weeks 8 and 16, but not at week 24. Mean changes from baseline in the length of the pterygia were also significantly lower in subjects receiving CBT-001 compared to vehicle at weeks 2, 4, and 8 (P≤0.014). The most commonly reported adverse events were ocular, mild in severity, resolved after therapy, and did not result in discontinuation. ConclusionsCBT-001 0.2% decreased pterygia vascularity and lesion length after 4 weeks of dosing with a prolonged effect after dosing. The drug was well tolerated with minimal detected systemic drug levels.

Framingham risk score based vascular outcomes in acute versus chronic HIV cohorts after 6 years of ART.

Immune dysregulation persists in people with HIV (PWH) on antiretroviral therapy (ART) and may lead to accelerated vascular ageing and cardiovascular disease (CVD). While delayed time to initiation of ART has been linked to worse cardiovascular outcomes, the effect of ART initiation during acute infection on these outcomes is not well understood. Participants were enrolled from the SEARCH010/RV254 acute HIV (AHI) and HIV-NAT chronic HIV (CHI) cohorts in Thailand. Participants with 6-year follow-up and viral suppression (viral load < 50 copies/μL) at follow-up were included. Both unmatched cohorts and age and gender-matched cohorts were analysed. Demographics, HIV laboratories, and cardiovascular risk factors from enrolment and 6-year follow-up were obtained from electronic records. Framingham Risk Score (FRS), vascular age (VA), vascular age deviation (VAD), and 10-year atherosclerotic cardiovascular disease (ASCVD) risk were calculated from previously published equations. Vascular outcomes in AHI and CHI cohorts were compared, and univariable and multivariable linear regression analyses were used to investigate risk factors associated with worse vascular scores. In all, 373 AHI participants and 608 CHI participants were identified. AHI participants were of younger age, had a higher prevalence of syphilis and a lower prevalence of prior hepatitis B, tuberculosis, diabetes, and hypertension. Higher CD4 T-cell and lower CD8 T-cell counts were seen in the AHI cohort at enrolment and 6-year follow-up. In all participants, the AHI cohort had a lower median FRS (p < 0.001) and VA (p < 0.001), but higher VAD (p < 0.001). However, in matched cohorts, no differences were found in FRS-based outcomes. In all participants, higher VAD after 6 years of ART was associated with higher body mass index (p < 0.001) and higher CD4 count (p < 0.001), which persisted in multivariable analysis. When FRS components were analysed individually, CD4 count was associated only with male sex and cholesterol. We did not identify differences in FRS-based vascular outcomes at 6 years in matched cohorts of participants who started ART during AHI versus CHI. We identified a correlation between higher CD4 count and worse FRS-based vascular outcomes, which may be driven by underlying metabolic risk factors. Further study is needed to confirm these findings and evaluate underlying mechanisms.

Review of Māori equity in surgical trainee selection.

The Royal Australasian College of Surgeons (RACS) aims to achieve Māori health equity and cultural safety within the surgical workforce. The RACS Māori Health Strategy and Action Plans encourage Surgical Education and Training (SET) selection criteria that recognizes and credit applicants who identify as Māori or demonstrate competence in Māori health issues. This study investigates the current SET selection criteria for Māori entering surgical specialties. The selection criteria for each surgical speciality for the proposed 2024 intake were examined through a documentary analysis. Criteria were reviewed for applicability to Māori identification and/or cultural competency. Criteria related to Māori identification and/or cultural competency make up 6%, 2%, and 1.5% of Otolaryngology and Head and Neck, General, and Vascular Surgery total SET selection score respectively. Criteria related to Māori identification and/or cultural competency make up 9% and 0.1% of Orthopaedic and Plastics and Reconstructive Surgery ranking scores for interview eligibility respectively. Cardiothoracic Surgery, Paediatric Surgery, Neurosurgery and Urology specialties do not incorporate any criteria appertaining to Māori. Allocation of research-related points determined by authorship may disincentivize Māori trainees. Some surgical specialties fail to recognize or credit Māori identification and cultural competency in SET selection criteria. There is a need for regular auditing to ensure SET criteria align with the RACS aspirations for Māori health equity and cultural safety within the surgical workforce.

Using a combination of superb microvascular imaging and other auxiliary ultrasound techniques to increase the accuracy of gray-scale ultrasound for breast masses

BackgroundBreast ultrasound is highly sensitive, but its specificity is not as high for detecting malignant lesions. Auxiliary modalities like elastography, Color and Power Doppler ultrasound are used as adjuncts to yield both a high sensitivity and specificity. Superb microvascular imaging (SMI) is a newer modality with more accuracy for detecting breast lesions. In this study, our goal was to investigate the role of SMI as an adjunct to ultrasound and find a suitable combination model for the evaluation of breast masses.MethodsIn this cross-sectional study, 132 women with 172 breast masses who underwent ultrasound-guided biopsy were included.. The ultrasound features of the lesion, the strain ratio in strain elastography, the number of vessels for each lesion, their morphology and distribution in Doppler and Power Doppler ultrasound and SMI were recorded for each lesion. A vascular score and a vascular ratio were defined.ResultsIn the histologic examination, 31 lesions (18%) were malignant and 141 lesions (82%) were benign. The vascular score was more accurate than the vascular ratio in all three modalities. The predictive ability of strain ratio was higher than Doppler and Power Doppler ultrasound and SMI. Adding SMI alone to ultrasound increased the specificity from 46.10% to 61.2% and the accuracy from 55.80% to 70.11%. In the combination of ultrasound with other modalities, the best was the combination of ultrasound, strain elastography, and SMI; which yielded a specificity and sensitivity of 100% and 74.4%, respectively.ConclusionAdding SMI and STE modalities as adjuncts to ultrasound lowers the chance of missing malignant lesions and reduces unnecessary biopsies of breast lesions. A study with a larger sample size using this combination model to evaluate the accuracy with greater precision is recommended.