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Background: Coronary physiology measured by fractional flow reserve (FFR) is superior to angiography for assessing the efficacy of percutaneous coronary intervention (PCI). Yet, the clinical adoption of post-PCI FFR is limited. Murray law-based quantitative flow ratio (μQFR) may represent a promising alternative, as it can quickly compute FFR from a single angiographic view. Objectives: The authors aimed to investigate the potential role of post-PCI μQFR in predicting clinical outcomes. Methods: This was a post hoc blinded analysis of the FLAVOUR trial. Patients with angiographically intermediate lesions randomized 1:1 to receive FFR or intravascular ultrasound-guided PCI were included. Post-PCI μQFR was assessed in successfully stented vessels, blinded to clinical outcomes. Suboptimal physiological outcome post-PCI was defined a priori as post-PCI μQFR

Background: Elevated blood pressure (BP) in childhood is associated with adult hypertension and arterial stiffness. However, the effect of long-term time in target range (TTR) for BP since childhood on the risk of arterial stiffness in midlife remains unclear. Objectives: The purpose of this study was to determine the independent association of TTR for systolic blood pressure (SBP) from childhood to midlife with arterial stiffness in adulthood. Methods: This study used data from the ongoing cohort of the Hanzhong Adolescent Hypertension Study. SBP-TTR was assessed over 36 years, with the target ranges of SBP defined as the 90th to 95th percentile of SBP for age, sex, and height in childhood, and 110 to 130 mm Hg in adulthood. Arterial stiffness was defined as brachial-ankle pulse wave velocity >1,400 cm/s. Results: Of the total 1,959 participants, 55.5% (1,088 of 1,959) were men, and the mean age was 49 years. The risk of arterial stiffness exhibited a gradual decrease with increasing SBP-TTR over the 36-year follow-up. Compared with the participants in the lowest quartile of SBP-TTR from childhood to midlife, those in the highest quartile showed significantly reduced arterial stiffness risk in midlife. This association persisted even after adjusting for mean SBP and SBP variability. Furthermore, men in the highest quartile of SBP-TTR demonstrated a markedly lower arterial stiffness risk than those in the lowest quartile, whereas this effect was not observed in women. Conclusions: Higher long-term SBP-TTR from childhood to midlife is associated with a reduced risk of arterial stiffness in midlife, regardless of the mean SBP or SBP variability.

Background: Several studies have investigated the impact of body mass index (BMI) on total shoulder arthroplasty (TSA) outcomes and reported contrasting results. Therefore, this study aims to better understand the impact of BMI on 30-day post-TSA outcomes by performing a comprehensive risk stratification based on BMI using a large national database. Methods: All patients undergoing TSA, both anatomic and reverse, between 2015 and 2019 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. The study population was stratified into 6 cohorts: BMI < 18.5 kg/m2 (underweight), BMI of 18.5-24.9 kg/m2 (reference cohort), BMI of 25.0-29.9 kg/m2 (overweight), BMI of 30.0-39.9 kg/m2 (obese), BMI of 40.0-49.9 kg/m2 (morbidly obese), and BMI ≥ 50.0 kg/m2 (super-morbidly obese). Postoperative complications within 30 days of surgery were collected. Multivariate logistic regression was conducted to investigate the association between BMI values and postoperative complications. Additionally, to facilitate a direct comparison with existing literature, and further validate our study methodology, a subgroup analysis with multivariate logistic regression was made comparing 2 groups: BMIs > 30 kg/m2 and BMIs < 30 kg/m2. Odds ratios (ORs) were reported with a 95% confidence interval. The level of statistical significance was set at P

Background: The use of closed-incision negative pressure wound therapy (ci-NPWT) has been shown to reduce postoperative wound complications and surgical site infections (SSI) after stoma closures. However, use of this approach has not been widely adopted due to high cost of the devices. We present a novel approach to stoma closure in which a self-contained mechanically powered negative pressure dressing (MP-NPD) is applied to primarily closed stoma reversal wounds. We hypothesized that SSI and wound complication rates would be improved compared to traditional stoma closure methods. Methods: This was a prospective investigator-initiated study, in which consecutive patients that underwent stoma reversal with primary stoma wound closure dressed with MP-NPD from May 2021–March 2022. 30-day outcomes from the study group, including surgical site infection, other wound complications, hospital length of stay (LOS), and readmission rates, were then reported. Results: Forty-six patients undergoing local ileostomy or colostomy closure were identified for the study group. Patient demographics and surgical variables were reported. One (2.2 %) patient in the study cohort developed superficial SSI within 30 days of their surgery. Post-op LOS in the study group versus was 4.1 days. Conclusion: Intestinal stoma reversal wounds closed primarily and dressed with the MP-NPD dressings had very low stoma site SSI rates. These results are promising as they pertain to the use of MP-NPD in stoma reversal procedures, however further large prospective RCTs with a matched control group could help better corroborate these findings.

Background: Rotator cuff tendon tears are a common cause of shoulder dysfunction in adults. Yet, impaired healing continues to result in higher failure rates after surgical repair resulting in patient dysfunction and prolonged recovery. This has spurred increased investigation of biologic augmentation to improve tendon healing. This study examines the outcome of peritendinous interleukin-17F (IL-17F) administration and oral low-dose lithium carbonate (Li) on rotator cuff healing following acute surgical repair in a rat model. Methods: Treatment group included an open supraspinatus peel and repair followed by a local injection of IL-17F at the bone–tendon interface and a 7-day course of oral Li. Control rats received no additional intervention before surgical closure. Evaluation of healing was then preformed using MRI imaging, biomechanical testing, and histological analysis at the bone–tendon interface. Results: Eighteen rats (9 control, 9 experimental) underwent complete testing. Combined treatment of peritendinous IL-17F and oral low-dose Li after rotator cuff repair improved rotator cuff healing in all outcomes when compared to controls. MRI imaging in the treatment group showed complete healing of all supraspinatus tendons across the anatomic footprint after repair. We also found significant increases in biomechanical stiffness compared to controls (P

Background: Elevated lipoprotein(a) (Lp[a]) is a risk factor for first atherosclerotic thrombosis events, but the role of elevated Lp(a) in secondary prevention is controversial. This study aimed to retrospectively investigate the influence of elevated Lp(a) levels on the prognosis of patients with coronary artery disease. Methods: The team collected and compared clinical information of patients hospitalized during percutaneous coronary intervention (PCI). This study used a multivariate logistic regression model to evaluate the relationships between Lp(a) levels, cardiovascular risk factors, and the prognosis of coronary artery disease in patients undergoing PCI. Results: There were no statistically significant differences between patients grouped according to Lp(a) level in terms of sex; age; body mass index and obesity; hyperuricemia; smoking; cardiac insufficiency; acute myocardial infarction; multivessel lesion; in-stent restenosis; secondary PCI; apolipoprotein AI level; incidence of high total cholesterol or high low-density lipoprotein cholesterol; or family history of hypertension, diabetes, or coronary artery disease. The average Lp(a) concentration did not statistically significantly decrease after 1 year of statin treatment after PCI. One year after patients began statins, there were no significant differences between Lp(a) groups in the incidence of high triglycerides (P = .13), high total cholesterol (P = .52), or high low-density lipoprotein cholesterol (P = .051). Multivariate logistic regression analysis indicated that diabetes (P = .02) was associated with in-stent restenosis, whereas diabetes (P = .02) and multivessel lesions (P < .001) were associated with secondary PCI in patients who underwent coronary angiography 1 year after PCI. Compared with normal Lp(a) levels, high Lp(a) levels did not significantly increase the incidence of in-stent restenosis or secondary PCI in patients who underwent coronary angiography 1 year after PCI. Conclusion: Sustained high concentrations of Lp(a) did not significantly increase the incidence of in-stent restenosis or secondary PCI in patients who underwent coronary angiography 1 year after PCI.

Objective: Recent advancements in chest tube technologies have gained interest for their ability to enhance postoperative recovery via reduction of retained blood syndrome after cardiothoracic surgery. The present study investigates the effect of the Centese Thoraguard automated line-clearance chest tube system on postoperative pain and recovery after cardiac surgery. Methods: This was a single-center retrospective review of 1771 adult patients undergoing nonemergency cardiac surgery between January 2021 and December 2022. Perioperative data were analyzed in 184 patients undergoing surgery with Thoraguard automated clearance chest tubes and 1587 patients with conventional chest tubes. Postoperative outcomes were compared in a propensity-matched cohort of 133 patient pairs with similar preoperative characteristics. Results: Patients undergoing cardiac surgery with automated clearance chest tubes demonstrated significant reductions in pain scores (0-10) compared with conventional chest tubes on the third postoperative day (5 vs 6, P = .02) and at hospital discharge (0 vs 3, P = .04). Automated clearance chest tubes were associated with a shorter time on the ventilator (5.3 vs 5.8 hours, P

Left ventricular-arterial coupling (VAC) is essential for understanding both cardiovascular physiology and pathophysiology. Traditionally assessed through invasive techniques, recent advancements have introduced noninvasive methods that employ imaging modalities and physiological parameters to evaluate ventricular pressure, volume, and arterial load characteristics. This review examines commonly used noninvasive VAC assessment methods, including echocardiographic single-beat method, myocardial work, wave intensity, the ratio of pulse wave velocity to global longitudinal strain, and imaging-based pressure-volume loops. These methodologies have demonstrated potential in clinical applications, such as evaluating cardiac function, personalizing treatment plans, monitoring therapeutic effects, and assessing prognosis. The incorporation of advanced imaging and computational techniques is anticipated to further enhance the accuracy and clinical relevance of VAC assessment in the management of cardiovascular diseases.

Arterial stiffness (AS) represents a pathological process characterized by reduced arterial elasticity and compliance, closely linked to aging and cardiovascular diseases, including hypertension, atherosclerosis, diabetes, and chronic kidney disease. As an important predictor of cardiovascular risk, AS evaluation plays a crucial role in early detection, disease monitoring, and therapeutic guidance. This review aims to systematically summarize current advancements in AS evaluation, focusing on non-invasive techniques such as pulse wave velocity, ultrasound-based methods, and arterial pressure waveform analysis. We discuss the advantages, limitations, and clinical applications of these methods, highlighting the recent integration of artificial intelligence and machine learning to enhance diagnostic accuracy and automation. The review also explores emerging biomarkers and novel imaging techniques, such as shear wave elastography and ultrafast ultrasound imaging, which offer promising insights for early AS detection and risk stratification. Despite significant progress, challenges remain in standardizing measurement protocols and improving sensitivity across various populations. Future research directions emphasize the development of wearable technologies, artificial intelligence-based diagnostic tools, and standardized methodologies to advance AS evaluation and improve cardiovascular outcomes.

Right ventricular-pulmonary arterial coupling refers to the interaction and functional matching between the right ventricle and the pulmonary artery. When the coupling is disrupted, it can lead to a series of cardiovascular diseases, such as pulmonary hypertension, congenital heart disease, heart failure and so on. Therefore, it is important to evaluate cardiovascular structure and function. Cardiac magnetic resonance has the advantage of multi-parameter, multi-sequence, and high-resolution imaging, which can be used to comprehensively evaluate the cardiovascular system through cardiac magnetic resonance feature tracking technology, cardiac magnetic resonance cine imaging technology, T1 mapping, and T2 mapping imaging, and so on. This review summarizes the application and research progress of cardiac magnetic resonance technology in the assessment of the right ventricle and the pulmonary artery (RV-PA) coupling.

Background: Assessing individuals’ risk of developing incident atrial fibrillation (AF) is important for making preventive and screening strategies. Objectives: The performance of the mC2HEST score for predicting incident AF has scarcely been evaluated, especially in a multi-ethnic population. Methods: Participants from the MESA (Multi-Ethnic Study of Atherosclerosis were enrolled in the present study, which involved population of different ethnicities (Caucasian, African-American, Chinese-American, and Hispanic) aged between 45 and 84 from 6 communities in the United States. The discriminative and calibration performance of the mC2HEST score was compared with other risk models. Results: A total of 4,524 subjects (mean age 60.2 ± 9.5 years; 53.0% female) were included; 565 (mean age 67.0 ± 7.9 years; 46.5% female) developed AF during 13.6 ± 2.5 years of follow-up, with an incidence of 0.93%/year. The mC2HEST score had good prediction at 10 years (C-index, 0.72; 95% CI: 0.701 to 0.753), and 15 years (0.773, 95% CI: 0.749 to 0.798). The risk of incident AF increased with higher mC2HEST score points and risk groups (log-rank P

Objective This study aimed to evaluate hepatitis B virus (HBV) reactivation and its effect on tumor response and survival outcomes in patients with HBV-related advanced hepatocellular carcinoma (HCC) undergoing lenvatinib plus camrelizumab treatment. Methods 216 patients with HBV-related advanced HCC receiving lenvatinib and camrelizumab were enrolled. Overall survival (OS), progression-free survival, and tumor response were evaluated. Univariate and multivariate analyses were performed to determine risk factors for HBV reactivation. Results HBV reactivation occurred in 24 patients (11.1%). It was associated with poor survival and tumor response in these patients. Undetectable DNA levels, the absence of antiviral therapy, and high ALT levels were identified as vital risk factors for HBV reactivation. After receiving or adjusting the antiviral strategy, tumor response improved in patients with HBV reactivation. Conclusions HBV reactivation could occur in patients with HBV-related HCC, treated with lenvatinib and camrelizumab, worsening tumor response and patient survival. Regular monitoring of the indicators of HBV infection and effective antiviral treatments are recommended for these patients to prevent severe complications.

Background: Little is known about the associations between choline metabolites (total choline, phosphatidylcholine, and glycine) and the incidence of heart failure (HF). Objectives: The purpose of this study was to assess the associations of choline metabolites with incident HF and examine the effect modification by genetic susceptibility. Methods: This prospective cohort study followed 245,072 participants from the UK Biobank from baseline (2006-2010) until March 30, 2023. Participants were free of cardiovascular diseases at baseline. Circulating choline metabolites were quantitated using nuclear magnetic resonance spectrometer. Cox proportional hazards models were fitted to assess the association of choline metabolites and genetics with incident HF. Two-sample Mendelian randomization analyses were implemented to confirm the findings in observational analysis. Results: During a median follow-up of 14.1 years, 5,468 incident HF cases were documented. Total choline and phosphatidylcholine were positively associated with HF risk (HR: 1.08 [95% CI: 1.04-1.12] and HR: 1.08 [95% CI: 1.05-1.12], per one SD increase, respectively). Compared with the lowest quartile group, the HR for the highest quartile group was 1.23 (95% CI: 1.12-1.35) for total choline and 1.23 (95% CI: 1.12-1.34) for phosphatidylcholine. Glycine was inversely associated with HF risk (HR: 0.97 [95% CI: 0.94-0.99], per one SD increase). Participants with high polygenic risk score and high total choline or phosphatidylcholine had the highest risk of HF, whereas participants with low polygenic risk score and high glycine had the lowest risk. No statistically significant interactions were observed between choline metabolites and genetic susceptibility to HF. The Mendelian randomization analysis supported the potential causal associations of total choline (OR: 1.71 [95% CI: 1.01-1.35]) and glycine (OR: 0.93 [95% CI: 0.88-0.99]) with HF. Conclusions: Circulating choline metabolites were associated with the risk of incident HF, independent of genetic susceptibility. Whether targeting the metabolic pathway of choline might be a potential strategy for improving heart health warrants further validation.

Background:. This investigation assessed patient satisfaction with a temporal incision technique using a super-high superficial musculoaponeurotic system (SMAS) flap for midface lifting in a Chinese patient cohort. Methods:. From July 2019 to July 2023, 95 patients underwent midface lifts via a temporal incision approach at our institution. The extent of SMAS flap dissection spanned 2 cm above the outer canthus, to the lower margin of the zygomatic arch inferiorly, and medially to the zygomaticus major muscle. The technique involved anchoring the elevated SMAS flap to the deep temporal fascia to elevate the malar fat pads, correct sagging tissues, and ameliorate the appearance of nasolabial folds. Results:. Among the 95 patients, 61 completed a follow-up ranging from 6 months to 2 years postsurgery, with a majority reporting satisfaction with the aesthetic results of their midface lift. No significant complications, including permanent facial nerve injury, were reported. Conclusions:. The temporal incision super-high SMAS face lift technique demonstrated high patient satisfaction and clinical effectiveness in improving the appearance of nasolabial fold and midface aesthetics. However, the success of this technique hinges on a comprehensive understanding of facial anatomy due to the confined operative field, highlighting its technical demands and the need for surgical expertise.

Cardiac electrophysiology is a highly specialized field focused on the management of cardiac arrhythmias. Therefore, rigorous training is required for advanced practice providers (APPs) to competently practice independently within the specialty. An in-depth, 12-month training curriculum was created for electrophysiology in conjunction with a previously established APP Fellowship Program for the training of other complex subspecialties at an academic medical center. The Stanford Health Care Electrophysiology APP Fellowship Program is the first in the country to provide in-depth education and training for novice APPs to deliver high level care to patients with cardiac arrhythmias. The training program has proven to be successful in transitioning novice APPs to independent practitioners within the specialty since its inception in 2021.

Spontaneous celiac artery dissection is uncommon. Abdominal pain is a common clinical presentation. Conservative medical treatments, endovascular interventions, and open surgery are used to treat spontaneous celiac artery dissection. A 49-year-old male patient visited our hospital, with back and subxiphoid pain that had persisted for 11 hours. He has been smoking 40 cigarettes a day for 20 years. The blood pressure was 180/100mmHg. Aortic computed tomography angiography (CTA) images revealed dissection of the celiac artery, common hepatic artery, left hepatic artery, right hepatic artery, and splenic artery. Urapidil hydrochloride and isosorbide dinitrate were administered to lower the blood pressure to approximately 110/70 mmHg. However, the back and subxiphoid pain persisted without relief. Angiography was performed and a vascular stent (BARD, LIFE STENT, VASCULAR, 8 × 60) was implanted into the celiac artery without involving the branches. Pain was immediately relieved after interventional therapy. The patient was discharged after 4 days. A subsequent aortic CTA after 10 months confirmed that the celiac artery dissection had still not reoccurred.

Unresectable hepatocellular carcinoma unresponsive to first-line immunotherapy has a poor prognosis with modest response to tyrosine kinase inhibitors in the second line. In these patients, the benefit of local therapy with immunotherapy rechallenge is unknown. Radioembolization is a guideline-supported locoregional therapy for HCC that has shown the potential for synergy in combination with immunotherapy. This report describes a patient with veno-invasive HCC and extrahepatic invasion of the right kidney which progressed on atezolizumab and bevacizumab and was subsequently downstaged to resection with ipilimumab and nivolumab plus radioembolization yielding a complete pathologic response. The patient is currently more than 2 years since diagnosis without evidence of disease recurrence.

Background: The purpose of this study was to investigate preoperative anemia as a risk factor for postoperative complications after arthroscopic rotator cuff repair (ARCR). Methods: Adult patients who underwent ARCR from 2015-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were grouped according to the following preoperative hematocrit levels: normal (male >39%, female >36%), mild anemia (male 33%-39%, female 33%-36%), and moderate to severe anemia (male and female ≤33%). Multivariable logistic regression analyses were performed to identify significant differences in 30-day postoperative complication rates. Results: Of the 21,836 patients identified, 19,726 (90.3%) patients had normal preoperative hematocrit, 1731 (7.9%) were mildly anemic, and 379 (1.7%) were moderate to severely anemic. After adjusting for significantly associated demographics and comorbidities, mild anemia was a significant predictor of any complication (odds ratio [OR] 1.436, P = .007), cardiac complications (OR 4.891, P = .002) sepsis-related complications (OR 4.760, P = .004), readmission (OR 1.585, P = .014), and nonhome discharge (OR 1.839, P = .006). Moderate to severe anemia was a significant predictor of any complication (OR 2.471, P < .001), readmission (OR 3.002, P < .001), and nonhome discharge (OR 3.211, P < .001). Conclusion: Preoperative anemia is a significant risk factor for postoperative complications within 30 days of ARCR.

Background: Cardiogenic shock (CS) is a complex, life-threatening condition that requires timely care of patients. The purpose of this study is to evaluate the characteristics and outcomes of patients transferred to a cardiac intensive-care unit from outside hospitals, compared to those of patients admitted directly to a CS centre. Methods: Patients admitted with CS (January 1, 2014-December 31, 2019) were analyzed. Clinical characteristics and outcomes were recorded. Results: A total of 916 patients were admitted with CS; 440 (48.0%) were transferred from outside hospitals, and 476 (52.0%) were admitted directly to our institution. Transferred patients were younger (56.5 ± 14.7 vs 63.3 ± 16.3 years, P < 0.001), required vasopressor support more often (63.6% vs 14.9%, P < 0.001), and required mechanical ventilation more often (40.6% vs 10.7%, P < 0.001) upon transfer to the cardiac intensive-care unit. Transferred patients more frequently required extracorporeal life support (8.9% vs 3.0%, P < 0.001), had a lower rate of requiring orthotopic heart transplantation (6.4% vs 14.6%, P < 0.001), and had a lower incidence of all-cause mortality during follow-up (52.3% vs 62.8%, P = 0.001). With a multivariate analysis, patients transferred from outside were found to be less likely to reach the composite endpoint of durable ventricular assist device, orthotopic heart transplantation, or death (hazard ratio 0.75, 95% confidence interval 0.62-0.90, P = 0.003). Conclusions: Marked differences are present in the characteristics and outcomes of patients transferred from outside institutions vs of those transferred from within our quaternary-care centre. Further studies are required to evaluate decision-making for transfer of CS patients and assess CS outcomes in the setting of standardized CS protocols and interventions. Résumé: Contexte: Le choc cardiogénique (CC) est une condition complexe qui met en jeu le pronostic vital et qui nécessite une prise en charge rapide des patients. L'objectif de cette étude est d'évaluer les caractéristiques et les pronostics des patients transférés dans une unité de soins intensifs cardiaques à partir d'hôpitaux extérieurs, par rapport à ceux des patients admis directement dans un centre spécialisé en CC. Méthodes: Les données des patients admis pour un CC (entre le 1er janvier 2014 et le 31 décembre 2019) ont été analysées. Les caractéristiques cliniques et les pronostics ont été enregistrés. Résultats: Au total, 916 patients ont été admis pour un CC; 440 (48,0 %) ont été transférés d'hôpitaux extérieurs et 476 (52,0 %) ont été admis directement dans notre établissement. Les patients transférés étaient plus jeunes (56,5 ± 14,7 vs 63,3 ± 16,3 ans, p < 0,001), nécessitaient plus souvent un soutien vasopresseur (63,6 % vs 14,9 %, p < 0,001) et plus souvent une ventilation mécanique (40,6 % vs 10,7 %, p < 0,001) lors de leur transfert à l'unité de soins intensifs cardiaques. Ces patients avaient aussi plus souvent besoin d'une assistance cardiorespiratoire extracorporelle (8,9 % vs 3,0 %, p < 0,001), avaient moins souvent besoin d'une transplantation cardiaque orthotopique (6,4 % vs 14,6 %, p < 0,001) et présentaient une incidence plus faible de mortalité toutes causes confondues lors du suivi (52,3 % vs 62,8 %, p = 0,001). Une analyse multivariée a montré que les patients transférés de l'extérieur étaient moins susceptibles d'atteindre le critère d'évaluation composite (dispositif d'assistance ventriculaire durable, transplantation cardiaque orthotopique ou décès) (rapport de risque 0,75, intervalle de confiance à 95 % 0,62-0,90, p = 0,003). Conclusions: Des différences marquées sont présentes dans les caractéristiques et les pronostics des patients transférés depuis des institutions extérieures par rapport à ceux admis directement dans notre centre de soins quaternaires. Des études supplémentaires sont nécessaires pour évaluer la prise de décision concernant le transfert des patients atteints de CC et évaluer les pronostics de la CC dans le cadre de protocoles et d'interventions de CC standardisés.

Background: Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time. Methods: We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression. Results: Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3—16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11). Conclusions: Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population. Résumé: Contexte: En chirurgie non cardiaque, la fibrillation auriculaire postopératoire (FAPO) d’importance clinique est une complication cardiaque fréquente. La prise en charge ponctuelle des patients présentant une FAPO est mal connue et on ne sait pas précisément si les pratiques ont évolué au fil du temps. Méthodologie: Nous avons mené une sous-étude d’observation auprès de patients ayant présenté une FAPO et dont le risque cardiovasculaire était élevé, et qui avaient participé aux études 1, 2 ou 3 du programme d’essais cliniques POISE (PeriOperative Ischemic Evaluation) entre 2002 et 2021. La FAPO était définie comme un nouvel épisode de fibrillation auriculaire (FA) d’importance clinique au cours des 30 jours suivant une intervention chirurgicale. Nous avons évalué l’utilisation d’un traitement visant à régulariser le rythme cardiaque et de l’anticoagulothérapie dans la prise en charge d’une FAPO, au moment du congé de l’hôpital, puis 30 jours après l’intervention chirurgicale. Nous avons procédé à l’évaluation des tendances temporelles par régression logistique multivariée. Résultats: Sur les 27 896 patients inclus dans l’analyse, 545 (1,9 %) ont présenté une FAPO d’importance clinique. Dans 48,6 % des cas, les patients ont reçu un traitement visant à régulariser le rythme cardiaque. Le taux d’utilisation d’un traitement visant à régulariser le rythme cardiaque a augmenté d’une étude à l’autre (étude POISE-1 vs étude POISE-2 vs étude POISE-3; 40,9 % vs 49,5 % vs 59,1 %, respectivement). Une date plus tardive de la répartition aléatoire était un facteur indépendant de l’utilisation d’un traitement visant à régulariser le rythme cardiaque (rapport de cotes = 1,05 par an; intervalle de confiance [IC] à 95 % : 1,01-1,09). Une anticoagulothérapie a été prescrite à 21 % des patients ayant présenté une FAPO. Le taux d’utilisation d’une anticoagulothérapie était plus élevé dans l’étude POISE-3, comparativement aux deux essais précédents (étude POISE-1 vs étude POISE-2 vs étude POISE-3; – 16,4 % vs 16,5 % vs 33,6 %, respectivement). Une date plus tardive de la répartition aléatoire était un facteur indépendant d’utilisation d’une anticoagulothérapie (rapport de cotes = 1,06 par an; IC à 95 % : 1,02-1,11). Conclusions: Malgré l’absence d’essais comparatifs avec répartition aléatoire, le taux d’utilisation d’un traitement visant à régulariser le rythme cardiaque ou d’une anticoagulothérapie chez les patients présentant une FAPO est en augmentation. Il existe un besoin urgent de réaliser des études cliniques de grande qualité afin de déterminer si ces interventions sont sûres et efficaces dans cette population de patients.

Objectives: The guidelines recommend fractional flow reserve-guided coronary artery bypass grafting (CABG) during primary valve surgery without evidence. Quantitative flow ratio (QFR) is a novel coronary angiography (CAG)-based fractional flow reserve measurement. We aimed to compare the early clinical outcomes between QFR-guided and CAG-guided CABG in these patients. Methods: This observational study screened all 2081 patients admitted to our institution for elective primary mitral and/or aortic valve surgery from January 2017 to September 2020. Of them, all 188 patients with comorbid coronary artery lesions (visual estimated stenosis ≥50%) were included. Sixty-nine patients with QFR analysis received bypasses only for lesions with QFR ≤0.80 (QFR-guided group). The remaining 119 patients without QFR analysis received bypasses for all stenosis ≥50% (CAG-guided group). Propensity overlap weighting was used to neutralize the intergroup imbalance. The primary end point was major adverse cardiovascular events. Results: After propensity score weighting, the baseline characteristics were comparable. Concomitant coronary artery bypass grafting was performed 58.1% versus 100% in the QFR-guided and CAG-guided groups, respectively. The mean number of grafts was significantly lower in QFR-guided group than in the CAG-guided group (0.9 ± 0.7 vs 1.6 ± 0.5 [P

Objectives: To develop computed tomography (CT)-based models to increase the prediction accuracy of spread through air spaces (STAS) in clinical-stage T1N0 lung adenocarcinoma. Methods: Three cohorts of patients with stage T1N0 lung adenocarcinoma (n = 1258) were analyzed retrospectively. Two models using radiomics and deep neural networks (DNNs) were established to predict the lung adenocarcinoma STAS status. For the radiomic models, features were extracted using PyRadiomics, and 10 features with nonzero coefficients were selected using least absolute shrinkage and selection operator regression to construct the models. For the DNN models, a 2-stage (supervised contrastive learning and fine-tuning) deep-learning model, MultiCL, was constructed using CT images and the STAS status as training data. The area under the curve (AUC) was used to verify the predictive ability of both model types for the STAS status. Results: Among the radiomic models, the linear discriminant analysis model exhibited the best performance, with AUC values of 0.8944 (95% confidence interval [CI], 0.8241-0.9502) and 0.7796 (95% CI, 0.7089-0.8448) for predicting the STAS status on the test and external validation cohorts, respectively. Among the DNN models, MultiCL exhibited the best performance, with AUC values of 0.8434 (95% CI, 0.7580-0.9154) for the test cohort and 0.7686 (95% CI, 0.6991-0.8316) for the external validation cohort. Conclusions: CT-based imaging models (radiomics and DNNs) can accurately identify the STAS status of clinical-stage T1N0 lung adenocarcinoma, potentially guiding surgical decision making and improving patient outcomes.

This case report describes a 62-year-old male with a notable medical history, including surgically treated bladder cancer and the suspicion of metastatic disease. He underwent 18F-FDG PET/CT imaging as part of the initial diagnostic workup, which identified several marginally hypodense hepatic lesions. These lesions exhibited metabolic activity that was slightly lower than the surrounding hepatic parenchyma, raising concerns for metastatic involvement. Subsequent 18F-DOTATATE PET/CT imaging significantly expanded the diagnostic perspective by identifying multiple somatostatin receptor (SSTR)-positive lesions, not only in the liver but also in lymph nodes and bones. This marked an important diagnostic advancement over the initial FDG PET/CT findings, showcasing the superior sensitivity of 18F-DOTATATE PET/CT in detecting SSTR-expressing tumors. Pathological evaluation after these imaging studies confirmed the diagnosis of a rectal neuroendocrine tumor (NET) with extensive hepatic metastasis, altering the clinical management and therapeutic approach for the patient. This case underscores the pivotal role of integrating 18F-DOTATATE and FDG PET/CT in the diagnostic and therapeutic management of neuroendocrine tumors, highlighting the complementary nature of these imaging modalities. The findings advocate for the use of 18F-DOTATATE PET/CT in cases where NETs are suspected, particularly for its enhanced sensitivity in detecting SSTR-positive lesions across various sites, thereby facilitating a more comprehensive disease assessment and informed therapeutic planning.

Background: Development of secondary esophageal cancer after hematopoietic stem cell transplantation has been described; however, there is little consensus on treatment and surveillance for these patients. The objective of this study was to describe our experience treating patients with secondary esophageal cancer. Methods: A retrospective chart review of prospectively collected data was performed to identify patients who underwent hematopoietic stem cell transplantation from 1997 to 2012 and in whom esophageal cancer developed later. Results: A total of 5066 patients underwent hematopoietic stem cell transplantation, and esophageal cancer developed in 11 (0.2%) of these patients. The median time to diagnosis of esophageal cancer after hematopoietic stem cell transplantation was 11 years (interquartile range, 8.5 to 14 years). Four patients received a diagnosis of stage III or IV disease. Seven patients underwent esophagectomy, 6 patients after neoadjuvant treatment. Three patients experienced adverse events postoperatively, all grades II and IIIa. Two surgical patients died of distant recurrence 2 years and 3 years, respectively, after their esophageal cancer diagnosis. The other 5 surgical patients have not experienced recurrence of their esophageal cancer. Conclusions: For patients with secondary esophageal cancer, esophagectomy after neoadjuvant treatment has acceptable morbidity and may be a viable option for this cohort.

Esophageal carcinoma cuniculatum is a rare histology and can be difficult to diagnose prior to resection. To date, there have been 28 cases of resected esophageal carcinoma cuniculatum reported. Herein we describe a case found in the stomach of a patient who previously underwent a Roux-en-Y gastric bypass surgery. We report the preoperative, intraoperative, and postprocedural care. We review gross and histologic pathology.

Erdheim-Chester Disease (ECD) is a rare form of histiocytosis characterized by xanthomatous infiltration of affected organs. We present a case of a 62-year-old man with ECD initially presenting with constrictive pericarditis. Comprehensive imaging revealed systemic involvement, including the skeleton, orbit, pituitary, lung, kidney, and retroperitoneum, despite the absence of related symptoms. The diagnosis of ECD was eventually confirmed through histopathological evidence from a CT-guided biopsy. The patient responded well to interferon-α2b treatment, with gradual symptom amelioration and improvement in imaging and laboratory findings over a 5-month follow-up period. This case highlights the importance of considering ECD in the differential diagnosis of constrictive pericarditis and the utility of multimodal imaging for accurate diagnosis and management of this rare disease. The patient's positive response to treatment also highlights the potential for effective management of ECD, particularly with early diagnosis and intervention.

Obesity is primarily due to excessive energy intake and lipid accumulation, leading to type 2 diabetes. Studies showed radish seed extract (RSE) can impede weight gain in mice, but the mechanism was unclear. We hypothesized that RSE inhibits obesity by stimulating adipocyte browning. Radish seeds were water-extracted, yielding a sulforaphene (SE) concentration of 1.381 ± 0.005 mg/g RSE. In 3T3-L1 adipocyte differentiation experiments, RSE and SE increased the expression of beige adipocyte markers uncoupling protein 1 (UCP1) and peroxisome proliferator-activated receptor-γ coactivator 1-α (PGC1α). In C57BL/6 mice, RSE and SE mitigated weight increase, averted fatty liver, and diminished fat accumulation. In the adipose tissue, we also noted the enhanced browning of white adipocytes through elevated expression of UCP1 and PGC1α. Increased mitochondrial numbers in treated adipocytes supported this effect. Additionally, RSE and SE improved glucose homeostasis and insulin sensitivity in high-fat diet-fed mice, indicating RSE's potential to prevent obesity and diabetes by enhancing adipocyte thermogenesis.

Background this study aimed to investigate the efficacy of recombinant human thrombopoietin (rhTPO) in the treatment of sepsis-associated thrombocytopenia, and to evaluate its impact on coagulation function, inflammatory markers, platelet (Plt) count, and patient prognosis. Methods a total of 144 patients with sepsis-associated thrombocytopenia, admitted to our hospital between 2022 and 2023, were selected for the study. The patients were randomly divided into two groups using a random number table: the control group (Group C, n = 72) and the research group (Group R, n = 72). The Group C received standard treatment, while the Group R received rhTPO in addition to standard care. We compared the general demographic data, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, coagulation parameters, serum levels of Toll-like receptor 4 (TLR4), interleukin-6 (IL-6), serum creatinine (SCr), tumor necrosis factor-alpha (TNF-α), Plt count, transfusion volume, treatment duration, incidence of complications, and mortality rates between the two groups. Results there were no significant differences in the general demographic characteristics between the two groups ( P > 0.05). After treatment, the APACHE II scores in both groups significantly decreased, with a more pronounced reduction observed in the Group R. Coagulation function indicators, including activated partial thromboplastin time (APTT), fibrinogen (FIB), plasminogen activator inhibitor-1 (PAI-1), antithrombin III (AT-III), protein C, thrombomodulin (TM), and Plt factor 4 (PF4), showed greater improvement in the Group R compared to the Group C ( P 0.05). The Plt count in the Group R began to significantly increase on day 3 of treatment, and was consistently higher than that in the Group C on days 3, 5, and 7 ( P 0.05). However, the ICU and overall hospital mortality rates were significantly lower in the Group R than in the Group C ( P

Background: Periprosthetic joint infections (PJIs) are a significant complication following total hip arthroplasty, impacting patient health and healthcare costs. This study examines the incidence of acute kidney injury (AKI) in patients undergoing hip PJI treatment with a combination of intravenous and intra-articular antibiotic infusion therapies. Methods: A retrospective review of 151 patient records from May 1, 2010 to December 30, 2022 was conducted at a single academic hospital. Patients were treated for hip PJIs using debridement, antibiotics, and implant retention or single-stage revision surgeries. AKI was classified according to the Kidney Disease: Improving Global Outcomes criteria. Results: Among 151 patients, 17 (11.26%) developed AKI, with 13 cases resolving transiently before discharge. The median onset of AKI was on postoperative day 2, with stage I AKI being the most prevalent, accounting for 64.71% of cases. Diabetes and low baseline serum creatinine levels were identified as independent risk factors for AKI, with odds ratios of 9.69 and 1.09, respectively. Conclusions: The combined regimen of intra-articular and intravenous antibiotic infusion appears to have a manageable risk profile regarding AKI. This approach could serve as a viable alternative for PJI management, emphasizing the importance of careful patient monitoring and tailored antibiotic regimens. Further studies are recommended to optimize treatment protocols and mitigate risks.

Background: HIV induced endothelial dysfunction (ED) contributes to cardiovascular disease (CVD) in women with HIV (WWH). Although psychosocial stress has been implicated in the development of CVD in HIV, its impact on ED in WWH remains unknown. Objectives: The authors hypothesized that posttraumatic stress disorder (PTSD) and HIV interact to contribute to ED in WWH. Methods: We enrolled 87 women from the Women’s Interagency HIV Study in Atlanta, Georgia, who reported previous trauma and completed the PTSD Checklist: Civilian Version (PCL-C), which assesses PTSD symptom severity (PCL-C score) and PTSD status (PCL-C >44). Brachial artery flow-mediated dilation (FMD) was measured to assess endothelial function. The impact of PTSD, HIV, and their interaction on endothelial function was evaluated using linear regression models adjusted for demographics, CVD risk factors, depressive symptoms, and statin use. Results: Overall, 55 (63.2%) had HIV, 24 (27.5%) had PTSD, and 13 (14.9%) had both. Those with PTSD were more likely to smoke (18 [75%] vs 28 [44.4%], P = 0.02) and have depressive symptoms (14 [58.3%] vs 18 [28.6%], P = 0.02) than those without PTSD. In adjusted models, the HIV-PTSD (severity and status) interaction effect on FMD was significant (P = 0.01). Both PTSD severity (β per 10-point increase: −0.72% [95% CI: −1.22 to −0.21], P = 0.01) and PTSD status (β: −2.51% [95% CI: −4.21 to −0.77], P = 0.01) were independently associated with lower FMD in WWH but not in those without HIV. Conclusions: PTSD is independently associated with ED in WWH. Whether treatment for PTSD improves ED and CVD in WWH needs further study.

Purpose: Treatment options for leptomeningeal metastasis (LM) are limited. A recent phase 2 study found that proton craniospinal irradiation (pCSI) was well-tolerated and improved survival. We report our experience with pCSI for solid-tumor LM. Methods and Materials: This is a retrospective review of patients treated with pCSI for solid-tumor LM from December 2020 to January 2024 at our center. Patient characteristics were summarized using descriptive statistics. Median overall survival and median central nervous system progression-free survival from the first day of pCSI were estimated using Kaplan-Meier survival curves. Results: We identified 45 patients who completed pCSI. The median age was 54 years (range, 23-79); 73% were female, and 53% lived more than 100 miles from our center. Breast cancer (53%), lung cancer (20%), and melanoma (9%) were the most common primary cancers; 51% of patients had stable systemic disease at LM diagnosis. All had imaging evidence of LM, and 64% of cases were confirmed using cytologic examination of the cerebrospinal fluid. Eighty percent had symptomatic LM, and the median Karnofsky performance scale at LM diagnosis was 80. The median time from primary cancer diagnosis to LM detection was 23.1 months (range, 0-221.3). Fifty-three percent of patients had active brain metastasis at LM diagnosis; 33% of all patients had received prior intracranial radiation. The median time from simulation to pCSI start was 12 days. At the first visit following pCSI, the median Karnofsky performance scale score was 70. During or right after radiation, 76% of patients reported nausea, 51% headache, and 31% fatigue. Following pCSI, 4% received intrathecal chemotherapy, 67% systemic therapy, and 9% hospice care; 18% were observed and 2% lost to follow-up. Median overall survival was 13.7 months (95% confidence interval [CI], 11.2 to not reached), and median progression-free survival was 6.5 months (95% CI, 4.9-12.8). Conclusions: The outcomes in our cohort are comparable to those recently reported in a phase 2 trial. Further study is indicated to determine the optimal candidates for pCSI and sequential therapies.

Purpose: The objective of this study was to explore the performance of a predictive model for swallowing-induced breakthrough pain established using a redefined delineation method based on the common occurrence sites of radiation-induced oral mucositis (RIOM) in locally advanced nasopharyngeal carcinoma (NPC). Methods and Materials: A total of 208 patients with locally advanced NPC were included in the study cohort, and the test cohort consisted of 88 patients. The oral mucosa structure was contoured using oral cavity contour (OCC), mucosal surface contour (MSC), and oral-pharyngeal mucosa (OPM) methods, and relevant dosimetric parameters were collected. Assessment of the severity of RIOM was made with the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0. The random forest classification method was chosen to establish and validate the predictive models based on 3 contouring methods. Results: The area under the curve of the OPM-based model was higher than that of the OCC- and MSC-based models in both the validation cohort and the test cohort (0.800, 0.739, and 0.750; 0.670, 0.605, and 0.609, respectively). Better predictive performance could also be observed under the OPM method than the OCC and MSC methods in terms of accuracy. The OPM-based model showed high specificity (greater than 90%) in both the validation cohort and the test cohort. According to the mean decrease in the Gini index, the maximum dose was the most important predictor of severe oral mucositis in the OPM-based model. Conclusions: We redefined a delineation method for oral mucosa structure based on the common occurrence sites of RIOM in locally advanced NPC. The model for swallowing-induced breakthrough pain constructed based on this method demonstrated good predictive performance. New parameters were found as predictors of severe swallowing-induced breakthrough pain in locally advanced NPC.

A rare injection site reaction known as Nicolau syndrome can occur in patients receiving subcutaneous immunotherapy. This syndrome has been reported only a handful of times in the literature related to subcutaneous immunotherapy.

Purpose The predictive sensitivity of carbohydrate antigen 19-9 (CA19-9) in assessing the prognosis of intrahepatic cholangiocarcinoma (ICC) remains inadequate. Integrating CA19-9 with tumor volume offers a potentially viable strategy for improving prognostic accuracy. This study aimed to develop a prognostic model utilizing volume-adjusted CA19-9 (VACA) for ICC patients. Patients and Methods A retrospective analysis was conducted on data from 436 ICC patients. These patients from two centers were divided into the training (n = 291, Center 1) and validation (n = 145, Center 2) cohorts. Using the training cohort, univariate and multivariable Cox regression analyses were employed to identify clinicopathological characteristics significantly associated with overall survival (OS) and recurrence-free survival (RFS), which enabled the construction of prognostic nomograms both with and without VACA. The nomograms’ discriminatory and calibration abilities were assessed using receiver operating characteristic (ROC) curves, decision curve analysis (DCA) curves, and calibration curves, applying both training and validation cohorts. Results VACA emerged as an independent variable that significantly correlated with prognosis. The nomogram incorporating VACA demonstrated superior accuracy in predicting OS and RFS rates compared to the model without VACA. In the validation cohort, the nomogram with VACA yielded area under the ROC curve (AUC) values of 0.695 (95% CI = 0.597∼0.793) and 0.666 (95% CI = 0.559∼0.773) (1- year), 0.662 (95% CI = 0.518∼0.806) and 0.651 (95% CI = 0.446∼0.857) (3- years), and 0.701 (95% CI = 0.486∼0.916) and 0.703 (95% CI = 0.428∼0.978) (5- years) for OS and RFS, respectively, along with improved calibration and DCA curves. Conclusions VACA, formed by integrating tumor volume with CA19-9, exhibits promising prognostic capabilities. The nomogram incorporating data from two centers and utilizing VACA demonstrates robust prognostic performance and holds clinical utility. Condensed abstract Combining CA19-9 with tumor volume presents a potentially viable strategy for improving prognostic accuracy. The nomogram incorporating VACA demonstrates robust prognostic performance and holds clinical utility.

Background Serum high-density lipoprotein cholesterol (HDL-c) may influence cancer development. However, its relationship with the histological grade of pancreatic ductal adenocarcinoma (PDAC) is not well understood. This study aims to explore the potential associations between serum HDL-c levels and different histological grades of PDAC. Methods This retrospective study included 181 patients with pathologically confirmed PDAC who underwent radical surgery. Clinical data, blood biochemical results, imaging features, and pathological details of the patients were collected, such as age, gender, diabetes, hypertension, tumor grade, tumor size and location, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA). Results Patients with high-grade PDAC had significantly lower HDL-c levels compared to those with low-grade PDAC across both training and validation cohorts ( P < 0.05). Significant associations were found between HDL-c levels and high-grade PDAC in the training ( P < 0.001) and validation ( P = 0.044) groups. Moreover, HDL-c levels were inversely related to lymph node metastasis in the training ( P = 0.001) and validation ( P = 0.012) sets. Conclusions Lower HDL-c levels are associated with high-grade PDAC and lymph node metastasis, suggesting that HDL-c may play a protective role in the progression of PDAC.

Background: With an increasing number of non-small cell lung cancer (NSCLC) patients being offered surgical treatment, postoperative rehabilitation is also being increasingly emphasized. Traditional Chinese medicine (TCM) holds promise for enhancing postoperative recovery, with treatment methods still in refinement. This study aims to evaluate the efficacy of Chinese herbal decoction and Liuzijue exercises in NSCLC patients during the rapid postoperative recovery period. Methods: A randomized, parallel-group clinical trial assigned 50 patients to receive Chinese herbal medicine and Liuzijue exercise plus symptomatic treatment, and 49 to symptomatic treatment alone. Treatment continued until postoperative complications resolved, chest tubes were removed, and no abnormal examination findings were reported. The primary outcome was Quality of Life Questionnare-Core 30 (QLQ-C30) score. Secondary outcomes included MOS item short form 36-Item Short Form Health Survey (SF-36) score, rate of complications, six-minute walk test (6MWT) distance, Leicester Cough Questionnaire (LCQ) score, numerical rating scale (NRS) score, and functional activity score (FAS). Results: Significant improvements in role (MD: 12.15, 95%CI: 2.99-21.32, P

Introduction Precision radiotherapy relies on accurate segmentation of tumor targets and organs at risk (OARs). Clinicians manually review automatically delineated structures on a case-by-case basis, a time-consuming process dependent on reviewer experience and alertness. This study proposes a general process for automated threshold generation for structural evaluation indicators and patient-specific quality assurance (QA) for automated segmentation of nasopharyngeal carcinoma (NPC). Methods The patient-specific QA process for automated segmentation involves determining the confidence limit and error structure highlight stage. Three expert physicians segmented 17 OARs using computed tomography images of NPC and compared them using the Dice similarity coefficient, the maximum Hausdorff distance, and the mean distance to agreement. For each OAR, the 95% confidence interval was calculated as the confidence limit for each indicator. If two or more evaluation indicators (N2) or one or more evaluation indicators (N1) exceeded the confidence limits, the structure segmentation result was considered abnormal. The quantitative performances of these two methods were compared with those obtained by artificially introducing small/medium and serious errors. Results The sensitivity, specificity, balanced accuracy, and F-score values for N2 were 0.944 ± 0.052, 0.827 ± 0.149, 0.886 ± 0.076, and 0.936 ± 0.045, respectively, whereas those for N1 were 0.955 ± 0.045, 0.788 ± 0.189, 0.878 ± 0.096, and 0.948 ± 0.035, respectively. N2 and N1 had small/medium error detection rates of 97.67 ± 0.04% and 98.67 ± 0.04%, respectively, with a serious error detection rate of 100%. Conclusion The proposed automated patient-specific QA process effectively detected segmentation abnormalities, particularly serious errors. These are crucial for enhancing review efficiency and automated segmentation, and for improving physician confidence in automated segmentation.

Background:. The reverse fragility index (RFI) is a measure used to evaluate the neutrality of statistically nonsignificant findings in randomized controlled trials (RCTs). The RFI represents the minimum number of events needed to reverse a statistically nonsignificant result into a significant one. This study applied the RFI to examine the robustness of statistically nonsignificant RCTs in plastic surgery. Methods:. A systematic literature search of the 10 highest impact journals covering plastic and reconstructive surgery topics was conducted to identify RCTs published between January 2000 and March 2023. The Fisher exact test was used to calculate the RFI for each primary outcome. Bivariate analysis was performed to investigate the association of trial characteristics with the RFI. Results:. Forty RCTs that yielded 65 primary outcomes were included in the analysis with a median sample size of 76 participants (interquartile range [IQR], 49–129) and a median of 10 events (IQR, 3–22). The median RFI was 4 (IQR, 3–5), indicating that statistical significance would have been achieved if 4 participants had a change in event status. The median RFQ was 0.053 (IQR, 0.038–0.08). Most studies (21 of 40) did not perform statistical power analysis. Twelve of 40 RCTs did not report or clearly indicate loss to follow-up. Conclusions:. The findings of RCTs in the plastic surgery literature demonstrate fragility as the preservation of nonsignificant results rested on a small number of events. The RFI is a useful measure to complement the P value and examine the neutrality of null clinical trials.

Hematologic diseases are considered important contributors to cerebral venous sinus thrombosis (CVST) cases. This retrospective study aims to compare the difference of the clinical and radiological characters between CVST patients with and without hematologic diseases. Consecutive hospitalized CVST patients with hematologic disorders constituted the hematologic disorder group, while that without identifiable risk factors comprised the control group in this study. We systematically documented the various types of hematologic diseases associated with CVST, along with laboratory tests. Clinical manifestations, imaging findings, as well as treatment and prognosis, were recorded. A comparative analysis was conducted between the hematologic disorder group and the control group based on the aforementioned parameters. The final analysis included 97 CVST cases associated with hematologic diseases and 65 cases without any identified risk factors. The spectrum of hematologic diseases in our study ranged from iron-deficiency anemia to acute leukemia. Patients with hematologic disorder showed higher admission mRS, greater thrombotic burden, and higher incidence of stroke and cerebral hemorrhage (p

Background This study compared anatomical imaging features between high-risk and non-high-risk groups in neuroblastoma with at least one image-defined risk factor (IDRF). It also assessed the diagnostic performance of these features in identifying the high-risk group. Methods A retrospective analysis of neuroblastoma patients with at least one IDRF was conducted. Imaging features, including estimated tumor volume and IDRFs, were compared between the two groups. The diagnostic performance of these features was assessed using receiver operating characteristic (ROC) curves, and the areas under the ROC curves (AUCs) along with their 95% confidence intervals (CIs) were calculated. Additionally, to internally validate their diagnostic performance, the bootstrap resampling method with 1000 bootstrap resamples was employed. Results The study included 255 patients (185 high-risk cases, 70 non-high-risk cases). Significant differences were found in estimated tumor volume and IDRF number between the high-risk and non-high-risk groups ( P < 0.001). The estimated tumor volume and the IDRF number-based cluster were independent risk factors, and their combination achieved an AUC of 0.801 (95% CI: 0.747-0.848) for high-risk group diagnosis, with the average AUC of the 1000 bootstrap samples of 0.800 (95% CI: 0.798-0.802). In abdominal lesions, specific IDRF categories differed between high-risk and non-high-risk groups ( P < 0.05). Conclusion Our study reveals anatomical imaging differences between high-risk and non-high-risk groups in neuroblastoma with at least one IDRF.

Introduction Metastasis remains a major cause of death among patients with malignant tumors. Radiotherapy is one of the main modalities of cancer treatment. The rapid development of radiotherapy technology has enabled the widespread application of hypofractionated radiotherapy (HFRT) in clinical practice. This study aimed to evaluate the effect of HFRT on the survival and safety of patients with oligometastatic tumors. Methods We conducted a retrospective study that involved 65 patients with well-controlled primary tumors and 1–5 metastatic foci treated at the study site between January 2020 and December 2022. Patients were aged >18 years and had a ≥ 6-month life expectancy. The patients received standard treatments plus HFRT for all metastatic foci. The dose fractionation regimen was adjusted according to the location and size of the patient’s metastatic foci. The planning gross tumor volume of HFRT was 82.93 cm 3 (range: 10.12-562.80 cm 3 ), and the radiation dose range was 20 Gy/5 F–60 Gy/15 F. Progression-free survival (PFS), overall survival (OS), local control rates, and incidence of adverse events of the patients were observed. Results Among the 65 patients, the median follow-up time, PFS, and OS were 26 months (95% CI: 0.80-37.50), 15 months (95% CI: 9.36-20.64), and 28 months (95% CI: 16.71-39.29), respectively. The 1- and 2-year PFS were 53.8% and 40.0%, respectively, while the 1- and 2-year OS rates were 73.8% and 56.9%, respectively. In total, 13.8%, 55.4%, 20.0%, and 13.8% of patients showed complete response, partial response, stable disease, and progressive disease, respectively. Four patients developed grade 3 or worse adverse events, and no treatment-related deaths occurred. Conclusions HFRT showed favorable clinical efficacy and safety in patients with oligometastatic tumors, generally achieving a good OS rate. Further randomized trials should be conducted.

ABSTRACT: Background: It is well-known that substandard serum valproic acid (VPA) concentrations may lead to treatment failure of epilepsy. However, there is still a lack of a quick method to predict whether a patient's serum VPA concentration will reach the standard. Objective: The aims of this study were to investigate the factors leading to substandard serum VPA concentrations in Chinese patients with epilepsy and develop a related nomogram for risk prediction. Methods: From January 2019 to March 2022, a total of 1143 serum VPA concentrations were collected from 630 hospitalized Chinese patients with epilepsy who were monitored by the Department of Pharmacy of Lu'an People's Hospital, and complete clinical data were collected from the corresponding patients for retrospective analysis. All monitored serum VPA concentrations were further divided into a training cohort and a validation cohort. For the training cohort, serum VPA concentrations below 50 µg/mL and between 50 and 100 µg/mL were classified into the subtherapeutic group and therapeutic group, respectively. The variables were selected from the clinical data, and differences between the variables of the subtherapeutic and therapeutic groups were analyzed. The influencing factors leading to substandard serum VPA concentrations were screened via logistic regression analysis, and the screened influencing factors were used to establish the nomogram prediction model. Results: Multivariate logistic regression analysis revealed that the daily dose per unit of body weight (mg/kg/d), route of administration, presence of hepatic lesions, hypoalbuminemia, and combination with carbapenems or barbiturates were independent factors influencing the occurrence of substandard serum VPA concentrations. On the basis of the results of the multivariate logistic regression analysis, a nomogram risk prediction model for substandard serum VPA concentration was established. The values of the C-index and internal verification results indicated that the nomogram model had good accuracy and discrimination. The decision curve revealed that the nomogram that predicted the risk of substandard serum VPA concentration had a greater net benefit value (ranging from 12% to 94%), indicating that the model had a wide prediction interval. Conclusions: Our study established a nomogram risk prediction model for substandard serum VPA concentrations in Chinese patients with epilepsy, which can help doctors or patients control the serum VPA concentration within the target concentration range as soon as possible.

Background: Early-onset ischemic heart disease (IHD) is a growing burden associated with high disability and death. Objectives: This study aimed to estimate the burden of incidence, prevalence, and disability-adjusted life years (DALY) of early-onset IHD from 1990 to 2019. Methods: Data on the burden of early-onset IHD (men

Background: Immunosuppressive agents like cyclosporine have proven effective in some pediatric cases, although there are limited case reports considering potential risks such as secondary infections. Objective: This study investigated the safety and efficacy of Cyclosporine A in children who did not respond to high-dose corticosteroids combined with intravenous immunoglobulin (IVIG). Methods: We reported four pediatric patients diagnosed with toxic epidermal necrolysis (TEN) received treatment at our institution. All patients were previously healthy children with a median age of 7 years, comprising three boys and one girl (Table 1). Epidermal exfoliation and vesicular lesions ranged from 32.5% to 54.5% of the body surface area (BSA). Despite the administration of treatment comprising high-dose corticosteroids and intravenous immunoglobulin (IVIG), new cutaneous herpes continually emerged. This prompted a transition to cyclosporine treatment (3–5 mg/kg/d) administered in 1–2 oral doses. Results: Lesions stopped progressing, and bullous lesions started epithelialization after 13–27 days of hospitalization. Cases 1 and 2 faced secondary bacterial and fungal infections, respectively, and their temperatures stabilized after administration of antibiotics. Cases 3 and 4 experienced fever again when the dosage of corticosteroids was tapered off, with no discernible evidence of infection. The patients’ temperatures normalized upon the continuation of cyclosporine therapy. Among the patients, three presented asymptomatic elevated serum amylase, one of which met the diagnostic criteria for acute pancreatitis. Two children showed mildly raised aminotransferases, with one experiencing mild coronary artery dilation, two contracted onychomadesis, and three developed corneal ulceration/keratitis and atretoblepharia, which eventually resolved after vigorous ophthalmologic treatment. None of the children had any permanent sequelae after being discharged from the hospital for six months. Conclusions: Cyclosporine A is generally safe and effective for children who fail to respond to high-dose corticosteroids in combination with IVIG.

Background The proportion and impact of minimal pleural effusion (PE) on prognosis remain blurred in operable non-small cell lung cancer (NSCLC) patients who reported minimal PE on imaging. Methods Clinical and prognostic data of operable NSCLC patients who presented no distant metastasis, no direct pleural invasion, but minimal PE on preoperative imaging were retrospectively analyzed. The patients were divided into surgical (81 cases) and non-surgical (10 cases) cohorts. Potential or suspected malignant PE or pleural metastases were confirmed by surgery. The overall survival (OS) was analyzed by Kaplan-Meier curve and prognostic factors by multivariate Cox regression. Results The surgical cohort reported no pleural invasion on preoperative imaging and no pleural metastases by postoperative pathology, with an overall median disease-free survival of 36.7 (28.6, 44.7) months and a median OS of 59.8 (45.7, 73.2) months, with the latter significantly longer in the surgical cohort than in the non-surgical cohort (59.8 months vs 20.37 months, P < 0.001). Multivariate analysis indicated surgical treatment as an independent prognostic factor for OS. Conclusion Malignant PE is rare in operable NSCLC patients who report the presence of minimal PE but no distant metastasis or direct pleural invasion on preoperative imaging. Surgery may be the preferred treatment for these patients.

Background: The treatment of refractory chronic rhinosinusitis with nasal polyps (CRSwNP) with omalizumab has been well studied based on clinical evaluation. Nevertheless, ideal quantitative or qualitative biomarkers for predicting a different response to biologics urgently need to be explored. We aim to identify potential biomarkers for predicting a good or poor response in patients with refractory CRSwNP. Methodology: Patients received an endoscopic and radiological evaluation, a visual analogue scale (VAS) assessment, and a 22-item sinonasal outcome test (SNOT-22). Forty-eight biomarkers involving type 1 (T1), type 2 (T2), and type 3 (T3) inflammatory factors, chemokines, and remodeling factors were detected in nasal secretion and serum samples at baseline and after 24 weeks of omalizumab treatment. Results: Eighteen patients with CRSwNP and 16 patients as control were enrolled. Patients with CRSwNP who received oamlizumab treatment with the SNOT-22 and VAS scores improved by 8.9 and 2 points in 72.22% and 50%, respectively. The nasal polyp score (NPS) and Lund-Mackay score were significantly improved in 55.56% of patients. The concentrations of T2 inflammatory biomarker, granulocyte-macrophage colony-stimulating factor (GM-CSF), T3 inflammatory biomarkers, granulocyte colony-stimulating factor (G-CSF), chemokine (C-X-C motif) ligand (CXCL)-1, and chemokine (C–C motif) ligand-20 (CCL-20), T1 inflammatory biomarker, IP-10 (CXCL-10), and granzyme B in nasal secretion and serum periostin were significantly decreased. Serum CCL-3 (AUC = 0.836) and CCL-4 (AUC = 0.909) levels predicted the improvement of SNOT-22 score, respectively. Serum IL-8 (AUC = 0.883) predicted poor improvement in nasal congestion score. Nasal secretion CXCL-1 (AUC = 0.812), GM-CSF (AUC = 0.813), IgE (AUC = 0.900) and IP-10 (AUC = 0.800) effectively predicted none or less improvement in nasal polyp score. Conclusions: Omalizumab remarkably affects inflammatory mediators in different pathways. CCL-3 and CCL-4 in serum and IgE, CXCL-1, GM-CSF, and IP-10 in nasal secretion may be considered as preferable biomarkers for predicting favorable or ineffective response to omalizumab therapy in patients with refractory CRSwNP comorbid with asthma, based on various clinical indicators.

Dupilumab is the first monoclonal antibody approved for treating moderate-to-severe atopic dermatitis (AD) and has significantly improved the quality of life of AD patients. However, the safety of dupilumab is yet unclear in the context of cancer. Therefore, we aimed to investigate the safety of dupilumab and its relationship with the progression and occurrence of tumors. By reviewing relevant medical records of 90 patients who had pre-existing tumors before dupilumab treatment or presented new tumors after dupilumab treatment, we found that dupilumab probably had no significant negative effects on most tumors, but several patients with Cutaneous T-cell lymphomas (CTCLs) had relatively unfavorable outcomes during dupilumab treatment. Besides, CTCLs and lymphomas accounted for the majority of patients who presented new tumors after dupilumab treatment. Several patients were first diagnosed with presumed AD and probably were the presentations of CTCL at an early stage, and they developed typical CTCL symptoms after dupilumab treatment. Finally we came to the conclusion that dupilumab is safe for most patients with cancer. However, the effect of dupilumab on CTCLs is disputable. The use of dupilumab requires individual evaluation and closely monitored. When the efficacy is poor, re-evaluation of the diagnosis, especially of CTCLs and related diseases, is necessary.