bluuebunny/crossref_metadata_2025 huggingface dataset:
P194 VERY LOW-DOSE CYPROTERONE ACETATE (12.5 MG/DAY) IS EFFECTIVE AS ANDROGEN BLOCKER; WELL TOLERATED AND NOT ASSOCIATED WITH HYPERTENSION DEVELOPMENT IN YOUNG FEMALE TRANSGENDER PEOPLE
Authors: de Leon-Durango RJ , Hernandez-Lazaro A , Rios-Gomez C , Santana-Ojeda B , Molinero-Marcos I , Arnas-Leon C , Hernandez-Hernandez I , Acosta-Calero C , Kuzior A , Perez-Rivero JM , Perez-Garcia MP , Martinez-Martin FJ
Published: September 2024

Background and Objective:

Cyproterone acetate (CPA) has serious adverse effects (hyperprolactinemia, obesity, depression, thrombogenesis, liver toxicity, meningioma…) but the optimal dose has not been established. CPA is associated with a high risk of hypertension development, even with doses as low as 25 mg/day. We sought to establish if a very low CPA dose (12.5 mg/day) is effective as antiandrogen, its side effect profile, and if it is associated with hypertension development.

Methods:

Consecutive non-orchidectomized transgender women <30 years were offered CPA 12.5 mg/day instead of the regular 50-100 mg/day dose, along with estradiol (individually titrated); CPA dose was increased to 25 (eventually 50) mg/day if plasma testosterone was >2 nmol/L or there was clinical hyperandrogenism. Body weight, blood pressure, AST, ALT, GGT, prolactin, FSH, LH, estradiol and testosterone were monitored. A matched group of patients with LHRH agonist as antiandrogen plus estradiol served as control. Hypertension was diagnosed according to the current ESH guidelines. All patients gave informed consent.

Results:

39 patients were recruited, median follow-up was 2.3 years. 32 were maintained on CPA 12.5 mg/day, two increased to 25 mg/day, one to 50 mg/day, two withdrew due to gender-affirming surgery; one was lost to follow-up. There were no serious side effects or related withdrawals. The control group included 35 patients without significant differences at baseline. Suppression of testosterone, LH and FSH were effective and comparable with the control group but a moderate increase in prolactin was observed (26±12 to 38±22 ng/mL, p=0.034). Neither group had changes in liver enzymes. Blood pressure and body weight did not increase significantly in either group; the incidence of hypertension was low in both groups (1 patient each).

Conclusions:

Very low-dose CPA was effective and well tolerated as antiandrogen in a large majority of our patients. While CPA is reportedly associated with a striking dose-dependent increase in the incidence of hypertension in the 25-100 mg/day dose-range, the 12.5 mg/day dose appears to be safer.
P195 CARDIOVASCULAR OUTCOMES IN PATIENTS WITH AORTIC STENOSIS AND HYPERTENSION UNDERGOING AORTIC VALVE REPLACEMENT
Authors: Dueñas Criado Karen Alexandra , Ortiz Carlos Andres , Perez Oscar Mauricio , Alarcon Nicolas , Camacho Jaime , Cabrales Jaime , Echeverry Dario , Pineda Ivone , Garcia Laura
Published: September 2024

Background and Objective:

Aortic valve stenosis (AS) is most common valvular heart disease and in its severe form requires aortic valve replacement (AVR). The prevalence of both AS and arterial hypertension (HTN) increases with age and the conditions therefore often co-exist. Co-existence of AS and HTN is associated with higher global left ventricular (LV) pressure overload, more abnormal LV geometry and function, and more adverse cardiovascular outcome. Management of HTN in AS has historically been associated with prudence and concerns, mainly related to drug-induced potential adverse consequences.

We evaluated the cardiovascular outcomes of patients with AS and HTN undergoing to AVR

Methods:

A retrospective cohort study where all the patients who underwent AVR between 2019- 2024, in a 4-level center in Bogotá, Colombia. A descriptive analysis was performed. Continuous variables were expressed as mean or median with their respective measure of dispersion, standard deviation or interquartile range (ICR), the categorical variables were expressed in proportions and absolute numbers.

Results:

We analyzed 1043 Patients with moderate/severe AS undergoing AVR, 64.3% (671 with HTN), median age for all of 69.8 years ICR (61.7-77.4) Hypertensive patient being older (72 years p<0.0001). In the HTN group 57.8% were men, and more frequently they had diabetes and dyslipidemia comorbidities (p<0.001) as well as greater baseline renal involvement (p<0.001) comparatively with NO-HTN. In addition, hypertensive patient had better LVEF and were treated with ARA II/IECA (55,6% vs 19.4% p<0.001), beta blockers (60.4% vs 47.3% p< 0.001) and anti-calcium medication (13,1% vs 19,5% p<0.001).Table 1. Cardiovascular outcomes showed greater tendency towards worsening of renal function. There were no statistically significant differences in mortality.

Conclusions:

AVR is presented as a safe procedure in patients with AS and HTN in developing countries. The institutional results show a safe technique, associated with low mortality rates. Hypertensive patients had more acute kidney injury in the post-surgical period, which leads us to propose kidney protection strategies in this group.
P196 UNVEILING THE LINK BETWEEN ISOLATED NOCTURNAL ARTERIAL HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA
Authors: Geliz-vilaro Carlos , Mercado-Marchena Riguey , del Valle Carlos Campos , Hernandez-Nieto Bryan , Pimienta Camilo , Barrios-Agamez Wilfrido , Buelvas-Herazo Jannes , Urina-Triana Manuel , Urina-Triana Miguel , Quintero-Baiz Adalberto , Barros Guillermo , Corbacho Daniel Porto
Published: September 2024

Background and Objective:

Isolated nocturnal hypertension (INH), characterized by elevated nighttime blood pressure alongside normal daytime readings, often correlates with obstructive sleep apnea (OSA). However, understanding this association remains limited. This study aims to elucidate the relationship between OSA and INH, facilitating early interventions and optimizing patient outcomes.

Methods:

A convenience sample of patients diagnosed with INH via ambulatory blood pressure monitoring (ABPM), regardless of prior hypertension diagnosis, was included. Polysomnography assessed the presence of OSA. Patient demographics were analyzed, and OSA patterns within this cohort were described.

Results:

Forty-three participants with an average age of 60.6±13.54 were enrolled, comprising 30 individuals with hypertension and 13 without hypertension, with 24 males and 19 females included in the analysis. Polysomnography findings revealed obstructive sleep apnea (OSA) in 97.64% of participants (n=42) across all severity levels. Specifically, severe OSA was observed in 10 subjects, moderate in 20, and mild in 12. Interestingly, the distribution of OSA severity was similar between hypertensive and non-hypertensive subjects.

Conclusions:

This study found a close correlation between nocturnal arterial hypertension and the presence of obstructive sleep apnea in both hypertensive and non-hypertensive subjects. Therefore, INH is a strong predictor of OSA, and it could be better than other predictive tests.
P199 HYPERTENSIVE EMERGENCIES: CHARACTERISATION, TREATMENT, AND OUTCOMES IN A SINGLE-CENTRE STUDY
Authors: Graziani Laura , Ramirez Eliel Ivan , de los Angeles Tenuta Maria , Ojeda Valentin , Vargas Pablo , Moles Julieta , Arrupe Matias , Ramirez Jesica Magalí , Diez Emiliano Raul , Renna Nicolás Federico
Published: September 2024

Objective:

• Characterise patients admitted to the Coronary Care Unit with hypertensive emergency.

• Analyse the reasons leading to hospitalisation.

• Evaluate treatment and discharge diagnosis.

Methodology

A single-centre longitudinal prospective registry was conducted, including patients admitted to the Coronary Care Unit of the Spanish Hospital of Mendoza with a diagnosis of hypertensive emergency, from May 1, 2022, to April 30, 2024. Age, gender, pre-discharge treatment, cardiovascular risk, pre-existing diagnosis of hypertension, quantity and type of medications at admission, quantity and type of medications at discharge, presence of target organ damage, and diagnosis of secondary hypertension were recorded. Statistical analysis was performed using JAMOVI.

Results:

Fifty-nine patients with hypertensive emergency were admitted, 61% of whom were women. Sixty-four percent had a prior diagnosis of hypertension. Of these, 72% had no treatment at admission, 12% were on monotherapy, and 10% were on dual therapy. Only 10% of patients on combination therapy had preferred combination therapy. Twenty-five percent had low cardiovascular risk, 42% moderate, 25% high, and 6% very high. Fifty-four percent were diagnosed with target organ damage. Secondary causes were found in 31.5% of patients, including gestational hypertension or preeclampsia (19%), primary hyperaldosteronism (7%), renovascular hypertension (3%), and pheochromocytoma (2%). The mean number of medications at admission was 0.64 (CI=0.52,0.76) and at discharge was 2.90 (CI: 2.72,3.24). All were preferred combinations. No re-admissions were recorded during the 2-year follow-up.

Conclusions:

According to the data, non-adherence and medical inertia were the most frequent causes of hospitalisation for hypertensive emergency. Only 12% of patients had a diagnosis of secondary hypertension, and 19% of admissions were related to pregnancy. However, it is noteworthy that more than half of the patients had target organ damage, reclassifying patients at higher cardiovascular risk. Following guidelines and using preferred combinations controlled cardiovascular events 100% during follow-up.
P211 PRESCRIPTION AND DISPENSING DURATION OF MEDICINES FOR CHRONIC CONDITIONS: A REVIEW OF INTERNATIONAL POLICIES AND EVIDENCE TO INFORM THE AUSTRALIAN SETTING
Authors: Geijerstam Peder Af , Falster Senior Research Fellow Michael O. , Chalmers John , McLachlan Andrew J. , Rodgers Anthony , Schutte Aletta E.
Published: September 2024

Objective:

To summarize the current legislative and regulatory framework in Australia and abroad, as well as evidence on the potential impact that dispensed quantity and prescription durations may have on patient outcomes and costs.

Methods:

We searched the PubMed database for peer-reviewed articles using the search terms “prescription duration”[title], “*duration prescriptions”[title], “prescription length”[title], “prescription period”[title], “extended prescription”[title], “repeat prescription”[title], “repeat prescribing”[title], and “dispensing duration”[title]. In addition, for a selection of countries, we also searched for and asked national health care authorities or local experts via e-mail regarding dispensing and prescription duration limitations based on legislation, health service guidelines, and subsidy program regulations. To achieve a representative sample, we included the world's 5 most populous countries, as well as the most populous country from each continent. We defined “prescription duration” as the entire period of treatment, based on the quantity of medication, for which a healthcare provider may prescribe a medication, and “dispensing duration” as the period of treatment for which a pharmacist may dispense the medication at a single time point.

Results:

In 31 countries, the most common limitation for dispensing durations were either 30, 60 or 90 days, and for prescription durations either 3, 6 or 12 months. Evidence on the impact of dispensing and prescription durations is limited in quality, but suggests that longer dispensing durations are less costly to the patient (and funder) and improve adherence compared with shorter dispensing durations. There is not enough evidence to draw any conclusions regarding the effects on medicines supplies or health outcomes. To understand the full effects of different prescription and dispensing durations, and to improve the quality of evidence of what previous studies have thus far suggested, randomized controlled trials are needed.

Conclusions:

Prescription and dispensing durations vary widely between countries, but the effects of such limitations are largely unknown. More rigorous research is needed to identify the ideal prescription duration by also addressing the impact it has on other aspects such as health outcomes, medicine waste, savings to the health system and loss of working hours.
P212 COMPARISON OF COLLEGE STUDENTS’ HEALTH METRICS DURING TRADITIONAL AND VIRTUAL REALITY BASED CYCLING
Authors: Stoltzfus Diana , Cadet Ishmael , Carvalho Alex , Veerabhadrappa Praveen
Published: September 2024

Background:

Most college students do not meet the recommended physical activity guidelines. Novel technology such as virtual reality (VR) may be used to promote physical activity among sedentary students. Purpose: To investigate physiological changes in heart rate (HR), blood-pressure (BP) and rating of perceived exertion (RPE) among college students during stationary cycling with and without VR.

Methods:

Twenty-two college-students (7 M/15F; 18-30years) were recruited on campus. Students separately & randomly completed 2 separate cycling-sessions (with and without VR). The VZFit Ring Racer application with Meta Quest 2 VR Headset synced to a RENPHO smart AI bike was used for the VR session. HR, BP and RPE were assessed at 5-min intervals.

Results:

Only, RPE at 5-min interval was significant (p=0.032) between the non-VR and VR groups, which may be attributed to the fact that participants were focused more on the VR environment rather than the exercise session, potentially lowering their RPE.

Conclusions:

In this preliminary data, college students HR, BP & RPE were influenced during the VR session with RPE being lower. This suggests that VR may reduce the perception of effort for a given exercise intensity, and it could be used as a tool to engage students and promote physical activity, in an otherwise sedentary student population.
P213 UNDERSTANDING THE INFLUENCE OF SOCIAL SUPPORT ON ANTIHYPERTENSIVE MEDICATION ADHERENCE IN URBAN NEPAL: A QUALITATIVE STUDY
Authors: Yao Zhengbang , Pangeni P M , Koirala S , Neupane D , Winch P J , Inagaki Y
Published: September 2024

Background and objective:

Hypertension is a critical public health challenge in Nepal, particularly in urban settings, contributing to the high morbidity and mortality from cardiovascular diseases. Despite the presence of effective treatment options, adherence to antihypertensive medication remains suboptimal. Emerging evidence suggests that social support plays a crucial role in improving medication adherence. This study aims to explore the influence of social support on antihypertensive medication adherence among hypertensive patients in urban Nepalese communities, specifically within the Community-based management of non-communicable disease in Nepal (COBIN cohort) located in the eastern part of Pokhara Metropolitan City, Nepal.

Methods:

A qualitative study was conducted involving in-depth interviews with 19 hypertensive patients. An individual was eligible if 318 years old, taking antihypertensive medications for 3 two months and living in Lekhnath area of Pokhara. Interviews were conducted by an English-speaking researcher, with support from translator speaking both English and Nepali, using the interview guide. The study utilized a thematic analysis to explore patients’ perceptions and experience related to social support while taking antihypertensive medicines regularly.

Results:

The findings revealed a complex interplay of positive and negative influences of social support on antihypertensive medication adherence. Positive influence, being reminders from family members and healthcare providers, appeared to improve participants’ self-esteem and self-efficacy on adhering to medications. In contrast, social interactions including suggestions of taking traditional remedies and misinformation about prescribed antihypertensive medications appeared to diminish medication adherence. The role of Female Community Health Volunteers (FCHVs) was overall positive, bridging the gap between healthcare services and community needs, however its sustainability needs to be addressed.

Conclusion:

Social support is perceived to be pivotal in enhancing medication adherence among hypertensive patients in urban Nepal. Strengthening such support through community-based interventions and enhancing the role of FCHVs could significantly improve health outcomes. This study underscored the need for comprehensive strategies that integrate social support into hypertension management programs in low-resource settings.
P217 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY IN RELATION TO AGE AND SEX
Authors: Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta , Stergiou George , Poulter Neil
Published: September 2024

Background and Objective:

Within-visit blood pressure variability (BPV) is predictive of cardiovascular events independent of mean blood pressure (BP) levels and may serve as marker of cardiovascular aging. This study aimed to explore changes in BPV by age, and sex in May Measurement Month (MMM) 2019 survey participants.

Methods:

Adults (≥18 years) were surveyed opportunistically from 92 countries and up to three standardized seated BP readings were recorded. This analysis included all participants who were not taking BP-lowering medication and with complete data on age, sex, and three valid BP recordings. Three indices of BPV were compared: the standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM). A linear regression model was created for each index. Models were adjusted for mean BP, age, sex, and an interaction between age and sex. Age and mean BP were each included as natural cubic splines with 11 and 5 knots, respectively, to allow for flexibility with modelling relationships.

Results:

Data from 842,356 participants were included. The mean age was 42.9 (SD 15.9) years and 51.5% were female. Patterns of BPV from 18-90 years and by sex were consistent across BPV indices. Systolic BPV was higher in female than male participants between the ages of 30 and 80. In female participants, systolic BPV declined with age from 18-25, after which systolic BPV increased with age. In male participants, systolic BPV declined with age from 18-45, after which systolic BPV increased with age. Diastolic BPV was highest at the youngest and oldest ages, and lowest between 45 and 55 in both sexes.

Conclusions:

There was a highly consistent pattern amongst three commonly used indices of BPV in their relationships with age and sex. The BPV of screened adults was lower in males than females and varied non-linearly with age, with markedly higher BPV at younger and older ages, with distinct patterns of variation observed between systolic and diastolic BPV.
P219 ASSOCIATION OF 24-HOURS BLOOD PRESSURE VARIABILITY WITH BRAIN MRI REGIONS OF INTEREST FOR ALZHEIMER'S DISEASE
Authors: Melgarejo Jesus , Charisis Sokratis , Vatcheva Kristina , Mejia-Arango Silvia , Mena Luis , Garza Shana , Satizabal Claudia , Silva Egle , Lee Joseph , Terwilliger Joseph , Gutierrez Jose , Seshadri Sudha , Maestre Gladys
Published: September 2024

Introduction:

Variability in blood pressure (BP) has been associated with Alzheimer's disease (AD). However, it is unclear whether high variability in BP over 24-hours (24-h) is associated with the pre-clinical stage of AD. By examining brain MRI regions that atrophy decades before AD develops, we investigated the association between 24-h BP variability and MRI regions of interest for AD.

Methods:

We included baseline information of 324 participants aged ≥40 years old from a population-based study who underwent 24-h ambulatory BP monitoring and brain MRI scans. 24-h systolic BP variability was quantified using the average real variability (ARV) index. Brain MRI regions of interest for AD included the superior and middle frontal gyrus, supramarginal, superior, and precuneus gyrus, temporal pole, medial and inferior gyrus, entorhinal cortex, and hippocampus. We performed adjusted linear regression models to evaluate the association between 24-h systolic BP variability and MRI regions of interest for AD.

Results:

The mean age was 58.8±12.5 and 75.3% (n=244) were women. The mean thickness of MRI regions of interest for AD ranged from 2.12 mm3 to 4.04 mm3. In linear regression models, every +1.85 mmHg increase in 24-h systolic ARV was associated with lower thickness of the superior (adjusted mean mm3, -0.10; 95% confidence interval [CI], -0.21 and -0.01) and middle (adjusted-mean, -0.12 mm3; 95% CI, -0.24 and -0.01) frontal gyrus, medial temporal gyrus (adjusted mean, -0.21 mm3; 95% CI, -0.32 and -0.10), entorhinal cortex (adjusted-mean, 0.11 mm3; 95% CI, -0.21 and -0.01), and hippocampus (adjusted-mean, -0.14 mm3; 95% CI, -0.25 and -0.03); analyses also accounted for the 24-h systolic BP level. High 24-h systolic BP level was associated with lower thickness in 3/10 regions of interest for AD (P≤0.029).

Conclusions:

Elevated 24-h systolic BP variability is associated with thinning of brain MRI regions of interest for AD. Prospective data are needed to examine whether 24-h BP variability associated with thinning in brain MRI regions will increase the risk of AD.
P225 RISK FACTORS FOR CEREBROVASCULAR DISEASE IN WOMEN ADMITTED TO THE INTERNAL MEDICINE SERVICE OF THE EMERGENCY DEPARTMENT OF THE CENTRAL HOSPITAL IN SAN CRISTOBAL (TACHIRA, VENEZUELA)
Authors: Delgado E.A. Montilla , Menegaldo A. A. Bettiol
Published: September 2024

Background and objective:

Cerebrovascular disease is a leading cause of mortality and disability worldwide. Research has focused on determining the risk factors for cerebrovascular disease independent of gender; however, it has been important to differentiate between men and women due to the variety of causes that occur in the latter. Therefore, the aim was to determine the risk factors for cerebrovascular disease in women admitted to the internal medicine service of the Central Hospital of San Cristóbal (Táchira, Venezuela).

Methods:

A case-control study was performed. Cases were female patients diagnosed with acute cerebrovascular disease (24 to 72 hours after symptom onset). Controls were hospitalized or community-based female subjects without pathologies associated with cardiovascular disorders. The case-control ratio was 1:2, of equal age or ± 5 years. All participants signed the informed consent form and completed the data collection form. Odds ratios (OR) were calculated, with 95% confidence intervals.

Results:

In the period between February 2 to July 15, 2020, 111 female participants entered the study, 37 cases (26 with ischemic cerebrovascular disease and 11 with hemorrhagic cerebrovascular disease) and 74 controls. Of the risk factors studied: arterial hypertension, diabetes mellitus, dyslipidemia, physical inactivity, smoking, alcohol consumption, overweight, obesity, atrial fibrillation, use of oral contraceptives, use of hormone replacement therapy, autoimmune diseases, only association was found between atrial fibrillation (OR 9.1736, 95% CI 3.3638-25.0173), autoimmune diseases (OR 9.1736, 95% CI 3.3638-5.0173) and ischemic cerebrovascular disease. No association was found with any risk factor and hemorrhagic cerebrovascular disease.

Conclusions:

The risk factors for cerebrovascular disease in the female population are modifiable and treatable, being pertinent to determine their presence and carry out the necessary actions to reduce morbimortality in this population group.
P226 EMPAGLIFLOZIN IS ABLE TO REDUCE COLLAGEN DEPOSITION IMPROVING HEART FUNCTION IN MYOCARDIAL INFARCTED RATS
Authors: Durante da Silva Bruno , Souza Biologist Leandro , Barbosa Biologist Maikon , Borges Luciano , Nascimento-Carvalho Msc Bruno , Moreira Nathalia Juocys D. , Consolim-Colombo Fernanda , Nascimento Biologist Antonio , Godoy Biologist Andressa , De Angelis Katia , Irigoyen Maria Claudia
Published: September 2024

Cardiovascular diseases, particularly Acute Myocardial Infarction (AMI), are the leading cause of death worldwide. Studies show that empagliflozin improves cardiac function and outcomes in patients with heart failure. This study hypothesizes that different doses of empagliflozin (3 mg/kg and 10 mg/kg) affect collagen deposition and cardiac function differently.

Male Wistar rats were divided into four groups: control (Ctrl), infarcted (AMI), infarcted treated with empagliflozin 3 mg/kg (AMI+EMPA3), and infarcted treated with empagliflozin 10 mg/kg (AMI+EMPA10). Infarcted groups underwent left coronary artery occlusion. Treated groups received empagliflozin for 14 days via oral gavage. Echocardiographic evaluation was followed by euthanasia and tissue collection. Collagen deposition was assessed histologically and stained with picrosirius red, with area calculations done. Data were analyzed using the 1-way ANOVA test.

Echocardiographic results showed an improvement in diastolic function index (E’/A’) in the AMI+EMPA10 group (1.654 ± 0.3) in relation to the Ctrl (0.98 ± 0.5), AMI (0.58 ± 0.1) and AMI+EMPA3 (1.02 ± 0.4). Systolic function, measured by ejection fraction, was reduced in AMI (30.14 ± 9.7%) and AMI+EMPA3 (33.68 ± 13.2%) compared to Ctrl (77.09 ± 8.1%). The AMI+EMPA10 group showed improved ejection fraction (50.69 ± 14.5%). Fractional area change showed similar patterns (Ctrl: 61.18 ± 5.7; AMI: 23.94 ± 5.7%; AMI+EMPA3: 27.39 ± 7.2%; AMI+EMPA10: 38.46 ± 7.1%).

Histology revealed no difference in total left ventricle area among groups, but collagen area was increased in AMI (81.30 ± 16.2 mm2) and AMI+EMPA3 (86.64 ± 15.3 mm2) compared to Ctrl (62.89 ± 16.2 mm2), but not in AMI+EMPA10 (77.68 ± 8.5 mm2).

In conclusion, empagliflozin treatment improved left ventricular diastolic and systolic function dose-dependently and reduced collagen deposition in infarcted rats.

Supported by: CNPq 312962/2020-7
Development and Validation of a Two-step Model to Predict Outcomes After Endovascular Treatment for Patients With Acute Ischemic Stroke
Authors: Wang Xinyan , Liang Fa , Wu Youxuan , Jia Baixue , Wang Anxin , Zhang Xiaoli , Zhang Kangda , Hou Xuan , Jian Minyu , Wang Yunzhen , Liu Haiyang , Miao Zhongrong , Han Ruquan
Published: September 2024

Background:

Physicians and patients are eager to know likely functional outcomes at different stages of treatment after acute ischemic stroke (AIS). The aim of this study was to develop and validate a 2-step model to assess prognosis at different time points (pre- and posttreatment) in patients with AIS having endovascular thrombectomy (EVT).

Methods:

The prediction model was developed using a prospective nationwide Chinese registry (ANGEL-ACT). A total of 1676 patients with AIS who underwent EVT were enrolled into the study and randomly divided into development (n=1351, 80%) and validation (n=325, 20%) cohorts. Multivariate logistic regression, least absolute shrinkage and selection operator regression, and the random forest recursive feature elimination algorithm were used to select predictors of 90-day functional independence. We constructed the model via discrimination, calibration, decision curve analysis, and feature importance.

Results:

The incidence of 90-day functional independence was 46.3% and 40.6% in the development and validation cohorts, respectively. The area under the curve (AUC) for model 1 which included 5 pretreatment predictors (age, admission National Institutes for Health Stroke Scale score, admission glucose level, admission systolic blood pressure, and Alberta Stroke Program Early Computed Tomography score) was 0.699 (95% confidence interval [CI], 0.668-0.730) in the development cohort and 0.658 (95% CI, 0.592-0.723) in the validation cohort. Two treatment-related predictors (time from stroke onset to puncture and successful reperfusion) were added to model 2 which had an AUC of 0.719 (95% CI, 0.688-0.749) and 0.650 (95% CI, 0.585-0.716) in the development cohort and validation cohorts, respectively.

Conclusions:

The 2-step prediction model could be useful for predicting the functional independence in patients with AIS 90-days after EVT.
Advanced Management of Distal Lower Extremity Congenital Constriction Bands for Foot Salvage
Authors: Bautista Catherine H. , Vitale Alexandra S. , Chen Joanna , Ormiston Laurel , Collar Yagas Lucia , Johns Dana N.
Published: September 2024

Constriction ring syndrome is a rare congenital condition characterized by the formation of fibrous amniotic bands, which can result in limb or digit deformation, malformation, or autoamputation. Surgical intervention is necessary for patients with progressive or severe forms of constriction banding, but the timing and operative approach vary widely. Here, the authors present a case report detailing the successful removal of multiple congenital constriction bands (CBs), uniquely affecting the distal ankle and foot in an infant meeting Patterson type-2 criteria. This type is characterized by CBs resulting in distal deformation with or without swelling. In this case, urgent intervention was prompted by concerns of vascular compromise, and amputation was considered due to the severity of the banding. However, the authors advocated for a staged approach, with the aim of preserving the patient’s limb. A series of three separate procedures tailored to the patient’s banding pattern and subsequent tissue complications were required to achieve restoration of ankle and foot functions, as well as satisfactory cosmesis. This case report underscores the importance of a customized surgical approach in addressing complex CBs and emphasizes the need for proactive consideration of salvage interventions by surgeons.
Barriers to Care After Intimate Partner Violence Acquired Brain Injury: Current Systems Silence Survivors and Providers
Authors: Tsu Loretta , Varty Maureen , Reinken Desiree , Coats Heather
Published: September 2024

Objective:

A qualitative meta-synthesis was conducted to answer the following question—What barriers are experienced by survivors of intimate partner violence and service providers when seeking or providing resources or care after experiencing brain injury (BI)?

Setting:

This approach was completed through 2 main phases—a systematic search and literature appraisal and reciprocal translation with interpretive triangulation of the extracted data. The databases searched were PubMed, CINAHL, and PsycInfo.

Participants:

The initial search yielded 559 articles. The final synthesis included 16 articles for the qualitative meta-synthesis.

Design:

After data extraction, a qualitative exploratory design evaluated the experiences of survivors and service providers when connecting with resources.

Results:

The findings highlight larger systemic barriers preventing smooth relationships between survivors and providers. Survivor barriers include risk-driven safety mechanisms and a lack of awareness and understanding of BI. Provider barriers are a lack of clarity within providers’ scope and training limitations, diagnosis complexity, first responder’s initial response to survivors, lack of open discussion, screening limitations, financial barriers, infrastructure barriers, and lack of resources. Systemic barriers include stigmatization, BI symptoms mistaken as other diagnoses like mental health, access and awareness of resources, and navigation of complex systems.

Conclusion:

This qualitative meta-synthesis demonstrates that survivors and providers face multiple individual and systemic barriers when seeking and providing resources after BI. Future research is needed to understand survivors’ help-seeking behaviors and assistance needs and providers’ education about BI and organizational relationships and networks. Recommendations are made for future research to understand how to reduce barriers for providers working with survivors, from trauma-informed education and communication to connecting with resources, where to concentrate, and initiatives for collaboration to increase the network of resources yet improve its accessibility.
Transdifferentiation of pancreatic cells: therapeutic implications for pancreatic diseases
Authors: Wang Jun-jie , Zhu Lei , Li Dong-xue , Zhang Zhi-gang
Published: September 2024

The pancreas is a unique organ, integrating both exocrine and endocrine functions, playing critical roles in the secretion of digestive enzymes and the production of glucose-regulating hormones. An intriguing phenomenon exists where dynamic intercellular transdifferentiation occurs within the pancreas, particularly pronounced in pancreatic diseases. In diabetic patients, the transdifferentiation of pancreatic islet cells may potentially compensate for impaired pancreatic function. Conversely, abnormal transdifferentiation of exocrine cells may promote the progression of pancreatic cancer. These highlight the plasticity of pancreatic cells in adapting to changes in their microenvironment by regulating their own functions to cope with external pressures. This review summarizes recent researches into the transdifferentiation processes and mechanisms within pancreatic exocrine and endocrine cells, as well as between pancreatic and non-pancreatic cells, providing a new perspective for clinical interventions. The aim of this review is to offer novel insights and propose potential therapeutic strategies to address pancreatic-related diseases, contributing to the advancement of medical research in this field.
Give It a Rest: The Impact of Rest Days on Musculoskeletal Injuries Among Starting Pitchers in Major League Baseball
Authors: Waldrop Matthew , Sitton Zachary , Swisher Jeremy , Mullur Kiran , Davis Stephen
Published: September 2024

OBJECTIVE:

Examine the impact of rest days on musculoskeletal (MSK) injury incidence in Major League Baseball (MLB) starting pitchers.

DESIGN:

Descriptive epidemiological study.

SETTING:

MLB pitching and injury reports.PARTICIPANTS: MLB starting pitchers.

METHODS:

Data (2022-2023) were obtained from Baseball-Reference.com and fangraphs.com. Teams were grouped by average rest days between starts (Group A <5 rest days, Group B>5 rest days). Poisson regression was used to compare main outcome measure incidence rate ratios (IRRs).

INDEPENDENT VARIABLES:

Number of rest days between starts.

MAIN OUTCOME MEASURES:

Pitches per start, MSK injury incidence, injured list (IL) days for MSK injury.

RESULTS:

From 2022 to 2023, the average MLB rest days between starts was 4.80. Group A had 54 teams. Group B had 6 teams. The range of average rest days per start by team was 4.56 to 5.73 with a mean of 4.80. Group B pitchers spent 10.7 days on IL for MSK injuries per 1000 pitches, while Group A spent 13.6 days on IL (IRR = 0.78 [95% CI, 0.72-0.85];P< 0.0001). Group B averaged 0.93 more pitches per start than Group A (P= 0.0164). Group B had a lower number of IL assignments for MSK injuries per 1000 pitches (0.245 vs 0.351, IRR = 0.70 [95% CI, 0.38-1.18];P= 0.1715).

CONCLUSIONS:

Starting pitchers on MLB teams averaging>5 rest days between starts spent less time on the IL for MSK injuries than MLB teams averaging < 5 rest days from 2022 to 2023. There was no clinically significant difference in pitch count and no significant difference in the number of IL assignments for MSK injuries.
Systematic review with meta-analysis of the effectiveness of subcutaneous biologics versus intravenous biologics in inflammatory bowel diseases
Authors: Elford Alexander T. , Heldt Rishni , Kamal Shahed , Christensen Britt , Segal Jonathan P.
Published: September 2024

Background

Biologic therapies are commonly used for inflammatory bowel disease (IBD) patients. Multiple biologic medicines can now be given both intravenously and subcutaneously. The different administration routes present provide different advantages regarding dose escalation, healthcare resource utilisation, pharmacokinetics, convenience and safety. Comparator effectiveness studies between intravenous and subcutaneous administration are lacking.

Aim

Our primary outcome was to compare the effectiveness between intravenous and subcutaneous biologics in rates of clinical remission.

Methods

We performed a systematic review and meta-analysis to include all relevant articles from MEDLINE (Ovid), EMBASE, PubMed and Cochrane Central Register of Controlled Trials from 1 January 2003 to 28 January 2024. Studies that compared intravenous and subcutaneous administration of the same biologic therapy in IBD patients and reported effectiveness outcomes were included. This study was registered on PROSPERO (CRD42023442675).

Results

Twenty studies met the inclusion criteria for the systematic review. Nine vedolizumab cohort studies were meta-analysed for clinical remission and no difference was found in clinical remission rates between intravenous and subcutaneous administration (relative risk = 0.99; 95% confidence interval: 0.88, 1.11). Six infliximab cohort studies were meta-analysed for clinical remission and no difference was found in clinical remission rates between intravenous and subcutaneous administration (relative risk = 0.91; 95% confidence interval: 0.77, 1.08).

Conclusions

Our findings in the first meta-analysis comparing the effectiveness of intravenous and subcutaneous biologic therapies in IBD suggest there is no difference in the effectiveness between these two administration routes. However, further high-quality studies, particularly head-to-head studies are needed to confirm this finding.
Recent advances in the understanding of the peritoneal membrane
Authors: Seghers François , Tintillier Michel , Morelle Johann
Published: September 2024

Purpose of review

The efficiency of peritoneal dialysis (PD) as a life-sustaining replacement therapy for patients with kidney failure relies on the integrity and function of the peritoneal membrane. Here, we review the most recent advances in the understanding of the peritoneal membrane and its role in PD.

Recent findings

A recent update of the ISPD guidelines proposed a revised definition of membrane dysfunction, emphasizing the importance of fluid balance in patients treated with PD and identified three main mechanisms leading to insufficient peritoneal ultrafiltration (UF). The Bio-PD study, the first genomewide association study in PD, demonstrated that 20% of the interindividual variability in the peritoneal solute transfer rate is genetically determined, and identified several loci of potential relevance for peritoneal transport. A candidate-gene approach identified and characterized a common and functional variant in the promoter of the AQP1 gene associated with water transport and clinical outcomes in PD. Innovative strategies to preserve the integrity of the peritoneal membrane and to enhance UF are also discussed, including the use of gliflozins; steady glucose concentration PD; modulation of GLUT proteins; and cytoprotective additives.

A comprehensive understanding of the peritoneal membrane and of the mechanisms driving UF may help individualizing PD prescription and improving outcomes in patients treated with PD.
Adjuvant treatment for renal cell carcinoma: current status and future
Authors: Leung David K.W. , Siu Brian W.H. , Teoh Jeremy Y.C.
Published: September 2024

Purpose of review

Renal cell carcinoma (RCC) is resistant to chemotherapy. Adjuvant interferon and tyrosine kinase inhibitors were ineffective. Immune checkpoint inhibitors (ICIs), however, have shed new hope in this setting. In the current review, updated evidence of adjuvant therapy in RCC is summarized.

Recent findings

KEYNOTE-564 demonstrated survival benefits of adjuvant Pembrolizumab in RCC. EAU guidelines now recommend adjuvant pembrolizumab to ccRCC patients at an increased risk of recurrence, as defined in the study. At a median follow-up of 24 months, the disease-free survival (DFS) was significantly longer for the Pembrolizumab group than placebo group [DFS 77.3 vs. 68.1%; hazard ratio for recurrence or death, 0.68; 95% confidence interval (95% CI), 0.53–0.87; P = 0.002]. From its updated analysis, at median follow up of 57.2 months, overall survival (OS) benefit of Pembrolizumab was demonstrated (hazard ratio for death, 0.62; 95% CI, 0.44–0.87; P = 0.005). A number of other adjuvant ICI trials have though been negative.

Pembrolizumab is currently the only adjuvant therapy for RCC showing survival benefits, amid a number of negative trials on adjuvant immunotherapy. Currently, there is no role for adjuvant tyrosine-kinase inhibitors and radiotherapy for RCC. Meanwhile, a multidisciplinary approach and shared decision-making should be adopted.
Hypertrophic nonunion management with distraction osteogenesis: a scoping review of the literature
Authors: Rouse Benjamin J. , Sheridan Gerard A. , Page Brian J. , Fragomen Austin T. , Rozbruch S. Robert
Published: September 2024

Introduction:

Traditionally, stiff hypertrophic nonunions have been managed with open preparation of the nonunion site, which is then secured with internal fixation. Alternative surgical options are available including distraction osteogenesis with an external fixator. There is currently a limited amount of literature pertaining to the use of distraction osteogenesis in the management of hypertrophic nonunion. The aim of this systematic review was to collate and assess the effectiveness of distraction osteogenesis (DO) in the management of hypertrophic nonunions and to evaluate the complications that are commonly reported in the literature.

Methods:

We searched for articles pertaining to the treatment of hypertrophic nonunion using distraction osteogenesis. Several electronic bibliographic databases and clinical trial registries were searched using the MeSH terms “hypertrophic non-union,” “distraction osteogenesis,” “stiff non-union,” and “External Fixation” in various combinations to return the maximal number of studies for review. We performed a systematic review and identified a total of 11 studies eligible for review.

Results:

The review of the literature demonstrated that this technique is highly effective in achieving bony union with minimal complications. The most common complication is mild superficial pin site infections, usually managed with oral antibiotics and effective wound hygiene. Other complications reported were deep pin tract infections, broken hardware, and deformity recurrence due to collapse of regenerate bone.

Conclusion:

The use of distraction osteogenesis with external fixator devices is an effective and safe method for producing bony union in hypertrophic nonunions. There were minimal associated complications.
Susceptibility Screening of HIV-1 Viruses to Broadly Neutralizing Antibodies, Teropavimab and Zinlirvimab, in People With HIV-1 Suppressed by Antiretroviral Therapy
Authors: Selzer Lisa , VanderVeen Laurie A. , Parvangada Aiyappa , Martin Ross , Collins Sean E. , Mehrotra Megha , Callebaut Christian
Published: September 2024

Background:

HIV envelope (env) diversity may result in resistance to broadly neutralizing antibodies (bNAbs). Assessment of genotypic or phenotypic susceptibility to antiretroviral treatment is often performed in people with HIV-1 (PWH) and used for clinical trial screening for HIV-1 bNAb susceptibility. Optimal bNAb susceptibility screening methods are not yet clear.

Methods:

Phenotypic and genotypic analyses were conducted on 124 screening samples from a phase 1b study of bNAbs teropavimab (3BNC117-LS) and zinlirvimab (10-1074-LS) administered with lenacapavir in virally suppressed PWH. Phenotypic analysis was conducted on integrated HIV-1 provirus and stimulated outgrowth virus, with susceptibility to bNAbs defined as 90% inhibitory concentration ≤2 μg/mL. The proviral DNA HIV env gene was genotyped using deep sequencing, and bNAb susceptibility predicted using published env amino acid signatures.

Results:

Proviral phenotypic results were reported for 109 of 124 samples; 75% (82/109) were susceptible to teropavimab, 65% (71/109) to zinlirvimab, and 50% (55/109) to both bNAbs. Phenotypic susceptibility of outgrowth viruses was available for 39 samples; 56% (22/39) were susceptible to teropavimab, and 64% (25/39) to zinlirvimab. Phenotypic susceptibilities correlated between these methods: teropavimab r = 0.82 (P < 0.0001); zinlirvimab r = 0.77 (P < 0.0001). Sixty-seven samples had genotypic and phenotypic data. Proviral genotypic signatures predicted proviral phenotypic susceptibility with high positive predictive value (68%–86% teropavimab; 63%–90% zinlirvimab).

Conclusions:

bNAb susceptibility was correlated among all 3 in vitro assays used to determine teropavimab and zinlirvimab susceptibility in virally suppressed PWH. These findings may help refine PWH selection criteria for eligibility for future studies.
FIBRINOLYTIC DYSFUNCTION AND ENDOTHELIOPATHY AFTER MAJOR THERMAL INJURY: CONSIDERATIONS NEEDED FOR NEW APPROACHES TO BURN SHOCK RESUSCITATION
Authors: Pusateri Anthony E. , Moffatt Lauren T. , Ho Dao H. , Neidert Leslie E. , Morgan Clifford G. , Tejiram Shawn , Cardin Sylvain , Shupp Jeffrey W.
Published: September 2024

In recent years, it has become apparent that fibrinolytic dysfunction and endotheliopathy develop in up to 40% of patients during the first hours following thermal injury and are associated with poor outcomes and increased resuscitation requirements. Rapidly following burn injury, the fibrinolytic system is activated, with activation generally greater with increased severity of injury. Very high plasma concentrations of plasmin-antiplasmin complex (marker of activation) have been associated with mortality. Patients display hyperfibrinolytic, physiologic/normal, or hypofibrinolytic/fibrinolytic shutdown phenotypes, as assessed by viscoelastic assay. Phenotypes change in over 50% of patients during the acute burn resuscitation period, with some patterns (maladaptive) associated with increased mortality risk and others (adaptive, trending toward the physiologic phenotype) associated with survival. Endotheliopathy, as reflected in elevated plasma concentrations of syndecan-1 has also been associated with increased mortality. Here we review the incidence and effects of these responses after burn injury and explore mechanisms and potential interactions with the early inflammatory response. Available data from burn and nonburn trauma suggest that the fibrinolytic, endothelial, and inflammatory systems interact extensively and that dysregulation in one may exacerbate dysregulation in the others. This raises the possibility that successful treatment of one may favorably impact the others.
Disrupted functional connectivity of bilateral nucleus accumbens in major depressive disorder with and without melancholic features
Authors: Yan Hezhi , Chu Zhaosong , Shen Zonglin , Yuan Lijin , Wu Yanru , Lu Yi , Jiang Hongyan , Xu Xiufeng
Published: September 2024

Our study aims to explore the differences in functional connectivity in the nucleus accumbens (NAc) between patients with melancholic depression and non-melancholic depression (NMD) and their relation to melancholic depression’s pathogenesis. We recruited 60 melancholic depression, 58 NMD, and 80 healthy controls, all matched for gender, age, and education. Functional connectivity analysis focused on bilateral NAc as the region of interest, comparing it with the whole brain and correlating significant differences with clinical scores. Melancholic depression patients showed reduced functional connectivity between the left NAc and anterior brain regions, and between the right NAc and temporal and frontal areas, compared to healthy controls. In contrast, NMD patients displayed reduced functional connectivity only between the left NAc and the posterior cingulate cortex. Melancholic depression patients also exhibited increased functional connectivity between the right NAc and the middle frontal gyrus, unlike NMD patients. The findings suggest that melancholic depression patients exhibit unique NAc functional connectivity patterns, particularly with the default mode network and prefrontal areas, suggesting atypical reward-circuitry interactions. The right NAc’s connection to the prefrontal gyrus may distinguish melancholic depression from NMD.