A retrospective study of the prevalence in equine postmortems of cranial mesenteric arteritis caused by Strongylus vulgaris in Alberta (2010 to 2022).

Background: Strongylus vulgaris is one of the most pathogenic nematodes affecting equids. Larval migration through the cranial mesenteric artery (CMA) with attendant arteritis and thromboembolism can result in fatal non-strangulating intestinal infarction. Once considered a historical disease, recent studies have described the reemergence of this pathogen in several European countries; however, little is known of the current prevalence of S. vulgaris in the Canadian horse population. Objective: To determine the prevalence of active S. vulgaris cranial mesenteric arteritis in horses submitted for postmortem examination to the Diagnostic Services Unit (DSU) at the University of Calgary Faculty of Veterinary Medicine. Animals and procedure: We conducted a retrospective review of all equine postmortem cases submitted to the DSU between July 1, 2010 and June 30, 2022. Over 12 y, 510 horses > 2 mo of age from Alberta were submitted to the DSU for necropsy. Active cases were defined as those with endarteritis and thrombosis in the CMA or its branches. Those cases with only intimal scarring of the CMA were classified as historical. Results: The prevalence of all CMA lesions (both historical and active) over the study period was 17.3% (88/510). Active S. vulgaris cranial mesenteric arteritis was documented in 6.1% (31/510) of equine postmortems and the sequelae of verminous arteritis were the cause of euthanasia or death in 1.5% (8/510) of the cases submitted. Conclusion and clinical relevance: Even after historically intense efforts to eradicate this parasite, the continued effects of S. vulgaris are demonstrated by the results of this study. Strongylus vulgaris should not be regarded as a parasite of the past and verminous arteritis remains an important differential diagnosis for horses in western Canada presenting with mild colic or dull demeanor and anorexia of duration > 24 h. Furthermore, S. vulgaris should be taken into careful consideration when implementing antiparasitic control strategies. Practitioners should remain current on prevention, diagnosis, and treatment of this potentially reemerging and fatal equine disease.

Étude rétrospective de la prévalence lors d'autopsies équines de l'artérite mésentérique crâniale causée par Strongylus vulgaris en Alberta (2010 à 2022). Contexte: Strongylus vulgaris est l'un des nématodes les plus pathogènes affectant les équidés. La migration des larves à travers l'artère mésentérique crâniale (CMA), accompagnée d'artérite et de thromboembolie, peut entraîner un infarctus intestinal non étranglant mortel. Autrefois considérée comme une maladie historique, des études récentes ont décrit la réémergence de cet agent pathogène dans plusieurs pays européens; cependant, on sait peu de choses sur la prévalence actuelle de S. vulgaris dans la population équine canadienne. Objectif: Déterminer la prévalence de l'artérite mésentérique crâniale active à S. vulgaris chez les chevaux soumis pour examen post mortem au Diagnostic Service Unit (DSU), College of Veterinary Medicine, University of Calgary. Animaux et procédure: Nous avons effectué un examen rétrospectif de tous les cas post-mortem d'équidés soumis au DSU entre le 1er juillet 2010 et le 30 juin 2022. Sur 12 ans, 510 chevaux âgés de plus de 2 mois de l'Alberta ont été soumis au DSU pour autopsie. Les cas actifs ont été définis comme ceux présentant une endartérite et une thrombose dans la CMA ou ses branches. Les cas présentant uniquement des cicatrices à l'intima de la CMA ont été classés comme anciens. Résultats: La prévalence de toutes les lésions de CMA (anciennes et actives) au cours de la période d'étude était de 17,3 % (88/510). Une artérite mésentérique crâniale active à S. vulgaris a été documentée dans 6,1 % (31/510) des autopsies équines et les séquelles de l'artérite vermineuse ont été la cause de l'euthanasie ou du décès dans 1,5 % (8/510) des cas soumis. Conclusion et pertinence clinique: Malgré des efforts historiquement intenses pour éradiquer ce parasite, les effets continus de S. vulgaris sont démontrés par les résultats de cette étude. Strongylus vulgaris ne doit pas être considéré comme un parasite du passé et l'artérite vermineuse demeure un diagnostic différentiel important pour les chevaux de l'ouest du Canada présentant des coliques légères ou un comportement abattu et une anorexie de durée > 24 h. De plus, S. vulgaris doit être attentivement pris en compte lors de la mise en œuvre de stratégies de contrôle antiparasitaire. Les praticiens doivent rester informés de la prévention, du diagnostic et du traitement de cette maladie équine potentiellement ré-émergente et mortelle.(Traduit par Dr Serge Messier).

Nonarteritic anterior ischemic optic neuropathy and incidence of Parkinson's disease based on a nationwide population based study.

This study aimed to investigate the association between nonarteritic anterior ischemic optic neuropathy (NAION) and Parkinson's disease (PD) using a retrospective, nationwide, population-based cohort in South Korea. This study utilized data from the Korean National Health Insurance database, including 43,960 NAION patients and 219,800 age- and sex-matched controls. Cox proportional hazards regression models were used to assess the risk of developing PD in the NAION group compared to the control group after adjusting for various confounding factors. Subgroup analyses were conducted based on sex, age, and comorbidities. The incidence rate of PD was higher in the NAION group (1.326 per 1000 person-years) than in the control group (0.859 per 1000 person-years). After adjusting for confounding factors, the risk of developing PD was significantly higher in the NAION group (adjusted hazard ratio [aHR] 1.516, 95% confidence interval [CI] 1.300-1.769). Subgroup analyses did not reveal a significant difference in the risk of PD development based on sex, age, or comorbidities. This retrospective, nationwide, population-based cohort study revealed a significant association between NAION and an increased risk of developing PD in a South Korean population. The incidence rate of PD was observed to be higher in individuals diagnosed with NAION than in age- and sex-matched controls even after adjusting for potential confounding variables, with the risk being approximately 51.6% higher in the NAION group. Further research is necessary to elucidate the underlying pathophysiological mechanisms linking NAION to PD and to determine whether similar associations exist in other ethnic and geographical populations.

Hormone Replacement Therapy and the Incidence of Nonarteritic Anterior Ischemic Optic Neuropathy: a Nationwide Population-Based Study (2009-2018).

PURPOSE: This study aimed to assess the association between hormone replacement therapy (HRT) and the prevalence of nonarteritic anterior ischemic optic neuropathy (NAION) in menopausal women using national data from the entire Korean population. METHODS: The health screening data of 1,381,605 women between 40 and 90 years of age collected by the National Health Insurance Service (NHIS) of Korea between January 1, 2009, and December 31, 2018, were retrospectively reviewed. Before data analysis, the potential cofounders were adjusted for among all participants. Based on HRT use and its duration (classified into four groups), the hazard ratio (HR) and 95% confidence interval (CI) of NAION development were calculated via a Cox proportional hazards regression analysis using the nonuser group as a reference. RESULTS: Overall, 7824 NAION diagnoses were made during the mean follow-up of 8.22 years (standard deviation: 1.09 years) in 1,381,605 post-menopausal women. NAION was more common in the HRT group than in the non-HRT group (HR [95% CI]: 1.268 [1.197-1.344]). Furthermore, the risk of NAION increased along with increased HRT duration (p < 0.0001). In the multivariate analysis, the adjusted HRs of the < 2-year HRT group, the 2-5-year HRT group, and the ≥ 5-year HRT group were 1.19 (95% CI: 1.10-1.28), 1.3 (95% CI: 1.17-1.45), and 1.473 (95% CI: 1.31-1.65), respectively. Compared to women younger than 65 years, the HR of HRT for NAION was significantly higher than that of women older than 65 years (p < 0.0001). CONCLUSION: Our population-based cohort study found that HRT was significantly associated with increased incidence of NAION. The incidence of NAION also increased with the duration of HRT.

Necrotizing Skin and Soft Tissue Infections Admitted to Intensive Care Unit in Reunion Island: A Retrospective Cohort Study.

This retrospective and single-center study in Reunion Island (Indian Ocean) assessed frequency, mortality, causative pathogens of severe necrotizing skin, and necrotizing skin and soft tissue infections (NSSTIs) admitted in intensive care unit (ICU). Sixty-seven consecutive patients were included from January 2012 to December 2018. Necrotizing skin and soft tissue infection represented 1.06% of total ICU admissions. We estimate the incidence of NSSTI requiring ICU at 1.21/100,000 person/years in Reunion Island. Twenty (30%) patients were receiving nonsteroidal anti-inflammatory drugs (NSAIDs) prior to admission in ICU and 40 (60%) were diagnosed patients with diabetes. Sites of infection were the lower limb in 52 (78%) patients, upper limb in 4 (6%), and perineum in 10 (15%). The surgical treatment was debridement for 40 patients, whereas 11 patients required an amputation. The most commonly isolated microorganisms were Streptococci (42%) and Gram-negative bacteria (22%).The mortality rate was 25.4%. NSAIDs did not influence mortality when interrupted upon admission to ICU.

Investigating an outbreak of equine viral arteritis at two connected premises.

In early 2019, four stallions in the south of England tested positive for equine viral arteritis following routine prebreeding screening. Here, a team from Defra and the APHA describe the epidemiological investigation that was carried out to determine the origin of infection and the potential for its transmission across the country.

Arterial Wall Inflammation and Increased Hematopoietic Activity in Patients With Primary Aldosteronism.

CONTEXT: Primary aldosteronism (PA) confers an increased risk of cardiovascular disease (CVD), independent of blood pressure. Animal models have shown that aldosterone accelerates atherosclerosis through proinflammatory changes in innate immune cells; human data are scarce. OBJECTIVE: The objective of this article is to explore whether patients with PA have increased arterial wall inflammation, systemic inflammation, and reprogramming of monocytes. DESIGN: A cross-sectional cohort study compared vascular inflammation on 2'-deoxy-2'-(18F)fluoro-D-glucose; (18F-FDG) positron emission tomography-computed tomography, systemic inflammation, and monocyte phenotypes and transcriptome between PA patients and controls. SETTING: This study took place at Radboudumc and Rijnstate Hospital, the Netherlands. PATIENTS: Fifteen patients with PA and 15 age-, sex-, and blood pressure-matched controls with essential hypertension (EHT) participated. MAIN OUTCOME MEASURES AND RESULTS: PA patients displayed a higher arterial 18F-FDG uptake in the descending and abdominal aorta (P < .01, P < .05) and carotid and iliac arteries (both P < .01). In addition, bone marrow uptake was higher in PA patients (P < .05). Although PA patients had a higher monocyte-to-lymphocyte ratio (P < .05), systemic inflammatory markers, cytokine production capacity, and transcriptome of circulating monocytes did not differ. Monocyte-derived macrophages from PA patients expressed more TNFA; monocyte-derived macrophages of healthy donors cultured in PA serum displayed increased interleukin-6 and tumor necrosis factor-α production. CONCLUSIONS: Because increased arterial wall inflammation is associated with accelerated atherogenesis and unstable plaques, this might importantly contribute to the increased CVD risk in PA patients. We did not observe inflammatory reprogramming of circulating monocytes. However, subtle inflammatory changes are present in the peripheral blood cell composition and monocyte transcriptome of PA patients, and in their monocyte-derived macrophages. Most likely, arterial inflammation in PA requires interaction between various cell types.

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy After Cataract Surgery.

PURPOSE: To determine whether the development of nonarteritic anterior ischemic optic neuropathy (NAION) is increased after receiving cataract surgery in a large general population. DESIGN: Nationwide, population-based, retrospective cohort study. METHODS: Setting: A 12-year nationwide, population-based, retrospective cohort study including 1,025,340 beneficiaries in the 2002-2013 Korean National Health Insurance Service database. PATIENTS: We identified 40,356 patients who had undergone cataract surgery and matched non-cataract surgery controls (1:2) using estimated propensity scores in reference to age, sex, demographics, comorbidities, and co-medications. OBSERVATIONS: Kaplan-Meier curves and Cox proportional hazard models were generated to determine the risk of developing NAION in the cataract surgery group compared to the non-cataract surgery group. MAIN OUTCOME MEASURES: Effect (hazard ratio [HR]) of cataract surgery on NAION development. RESULTS: The 10-year incidence probability of NAION was 0.70% (95% confidence interval [CI], 0.55%-0.86%) in the cataract surgery group and 0.27% (95% CI, 0.25%-0.29%) in the non-cataract surgery group (P < .0001, log-rank test). The cataract surgery group had an increased risk of developing NAION compared to the non-cataract surgery group (HR = 1.80; 95% CIs, 1.46-2.21) even after adjusting for demographics, comorbidities, Charlson comorbidity index, and co-medications. CONCLUSION: Our results suggest that patients undergoing cataract surgery have an increased risk of NAION.

Characteristics and prognosis of IgG4-related periaortitis/periarteritis: A systematic literature review.

OBJECTIVE: Immunoglobulin G4 (IgG4)-related disease is a systemic chronic fibroinflammatory disease that can affect almost every organ of the body. IgG4-related periaortitis/periarteritis is a newly recognized subset of IgG4-related disease, and its characteristics and prognosis remain unclear. We investigated the clinical characteristics and prognosis of IgG4-related periaortitis/periarteritis. METHODS: We performed a systematic literature review of IgG4-related periaortitis/periarteritis. Additionally, we have summarized the characteristics and prognosis of IgG4-related coronary arteritis. RESULTS: We investigated 248 patients with IgG4-related periaortitis/periarteritis. All studies reported the condition in elderly patients, and male predominance was observed. The infra-renal abdominal aorta and iliac arteries were the most commonly affected sites. Most reports showed the serum C-reactive protein elevation in this disease entity, in contrast to non-vascular IgG4-related disease. Based on radiological findings observed in 27 patients with IgG4-related coronary arteritis, vasculitic lesions were classified into 3 types: stenotic (67% of patients), aneurysmal (42%), and diffuse wall thickening type (92%). Serum IgG4 level, but not C-reactive protein level, was associated with the number of affected organs in IgG4-related coronary arteritis. Corticosteroid treatment with or without cardiac surgery or percutaneous coronary intervention was effective in most patients with IgG4-related coronary arteritis; however, 33% of patients showed an unfavorable clinical course including disease progression, relapse, or death. Pre-treatment stenosis and/or aneurysms were associated with progression of stenosis or aneurysm after corticosteroid treatment. CONCLUSION: Most clinical characteristics were similar between the IgG4-related periaortitis/periarteritis and the non-vascular IgG4-related disease groups; however, serum C-reactive protein level elevation was observed only in the former. Although corticosteroid treatment was effective, this disease can be life-threatening secondary to myocardial infarction, aortic dissection, and aneurysmal rupture. Pre-treatment evaluation of stenosis or aneurysms is important for predicting progression of stenosis or aneurysm after corticosteroid treatment.

Equine viral arteritis: not just a reproductive disease.

Following the recent confirmation of cases of equine viral arteritis in stallions in south-west England, James Crabtree of Equine Reproductive Services (UK) discusses the disease and its potential routes of spread into and around the UK.

Risk Factors for Fellow Eye Involvement in Nonarteritic Anterior Ischemic Optic Neuropathy.

BACKGROUND: Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in individuals older than 50 years. Demographic, ocular, and systemic risk factors for NAION have been identified, and we sought to determine which, if any, of these factors also increase risk of NAION in the fellow eye. METHODS: We performed a retrospective chart review of patients with "ischemic optic neuropathy" (based on International Classification of Disease [ICD] codes) seen at a single eye center between 2007 and 2017. Patients who met diagnostic criteria for unilateral NAION without fellow eye optic neuropathy at diagnosis were included. Demographic information, ocular comorbidities, and systemic diagnoses were recorded, in addition to whether the fellow eye developed NAION during the follow-up period. Univariate and multivariate Cox proportional hazard regression were used to calculate hazard ratios (HRs) for fellow eye involvement. RESULTS: Three hundred eighteen patients were identified by ICD codes, and 119 were included in the study. Twenty-nine (24%) patients developed NAION in the fellow eye over the mean follow-up period of 3.6 years (range: 1 month-11 years). Significant risk factors for fellow eye NAION included the presence of bilateral optic disc drusen (ODD, HR 2.78, 95% confidence interval [CI] 1.12-6.90, P = 0.02) and noncompliance with continuous positive airway pressure (CPAP) in patients with moderate-to-severe obstructive sleep apnea (HR 4.50, 95% CI 1.79-11.3, P = 0.0015). CONCLUSIONS: Bilateral ODD and noncompliance with CPAP when indicated are associated with increased risk of NAION in the fellow eye. Patients with these risk factors should be counseled on the potentially devastating visual consequences of bilateral NAION, and compliance with CPAP should be stressed when appropriate.

[Anemia in patients with acute coronary syndrome in the Vichy Hospital center]. / Anémie chez les patients avec syndrome coronarien aigu au centre hospitalier de Vichy.

INTRODUCTION: Objectives were to determine the clinical, epidemiological and biological profile of the patients suffering from acute coronary syndrome and presenting the anaemia, the determinants of variation of the haemoglobin rate, and to estimate the impact of the anaemia on the prognosis of these patients. PATIENTS AND METHODS: Retrospective and observational study conducted in the cardiology department of Vichy Hospital in France. All patients with acute coronary syndrome admitted from 31 of October 2015 to 30 of April 2016 were selected. The patients were followed for 1 month. The anaemia was defined by: less than 13g/dL in man and less than 12g/L in woman (WHO definition). Biological markers were taken at the admission. Factors associated to the haemoglobin rate were analysed by multivariate linear regression and those associated to the mortality within 30 days were analysed by logistic regression. RESULTS: Among 251 included patients, there were 180 males and 71 females with the average age of 67 years. 94 patients had ST elevation myocardial infarction (STEMI), 116 had Non ST myocardial infarction (NSTEMI) and 41 had unstable angina. Haemoglobin value was known in 238 patient's, among whom 44.1% were anaemic (105/238). The anaemia was more frequent in women. The tobacco was less frequent; High blood pressure, renal failure, malnutrition, subclinical atherosclerosis, lower limb arteritis and the inflammatory syndrome were more frequent in patients with anaemia. They presented more complications. The age (P=0,003), the pulsed pressure (P=0,007), LVEF (P=0,005), the albumin (P=0,010), Creatine kinase (CK) level (P=0,048) and of CRP (P=0,011), were linear factors of variations of the haemoglobin rate (R2=0,955). Ten patients died during the follow-up. The multivariate analysis revealed the anaemia as independently associated with the mortality in 30 days (Odds Ratio 3,69; P=0,02). CONCLUSION: Anaemia is frequent in patients with an ACS, and it is associated with a particular clinical and biological profile. The patients with anaemia have a mortality rate in 30 days higher than the patients without anaemia.

Risk of Ischemic Kidney Injury in Patients With Nonarteritic Anterior Ischemic Optic Neuropathy: A Nationwide Population-based Study.

PURPOSE: To investigate the risk of acute tubular necrosis (ATN) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: Population-based cohort study. METHODS: This is a nationwide, population-based, retrospective study using data from the Korean national health claims database from 2011 through 2015. Patients with NAION and randomly selected control subjects from the entire population of South Korea were enrolled. A log-rank analysis was used to evaluate a risk of ATN in the group of patients with NAION (study group) compared to an age-, sex-, and comorbidities-matched control group. Comorbidities included diabetes, chronic lung disease, congestive heart failure, ischemic stroke, anemia, septic shock, and antibiotic use. A Cox proportional hazards regression analysis with cluster effect was performed to calculate the adjusted hazard ratio (aHR) of ATN. RESULTS: A total of 22 498 patients were included in the study group and 31 475 in the control group. Twenty-six cases of ATN were observed in the NAION group and 11 in the control group. The study group was more likely to have ATN (aHR = 2.55, 95% confidence interval: 1.50-5.91, P = .029) than the control group. Among the 26 newly developed cases of ATN, 13 (50%) occurred in the 0-6 months before/after NAION. CONCLUSIONS: We demonstrated that subjects with NAION are at increased risk of ATN and suggested a possible common mechanistic link between the 2 diseases. These results provide significant evidence that proper patient education and further systemic evaluation of the possibility of ATN development are required in patients with NAION.

Prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy in South Korea: a nationwide population-based study.

AIMS: To determine the age and sex-specific prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy (NAION) in South Korea. METHODS: This is a nationwide population-based study using data from the Korean national health claims database to identify patients with NAION using the registration programme database, which comprises ophthalmologist-confirmed NAION from 2011 through 2015. We evaluated prevalence and incidence rates using these data. RESULTS: Among 25 816 797 of entire population 40 years of age or older, 26 167 patients had NAION (47.8% men) during the 5-year study period. The prevalence in the general population 40 years of age or older was 102.87 (95% CI 95.22 to 110.53) per 100 000 people. In men, it was 111.10 (95% CI 101.19 to 121.02), and in women, it was 94.64 (95% CI 89.25 to 100.03) per 100 000 people. The prevalence increased with advancing age and peaked at 70-74 years in men and 65-69 years in women. The incidence in the general population 40 years of age or older was 11.35 (95% CI 10.37 to 12.33) per 100 000 person-years. In men, it was 14.89 (95% CI 12.26 to 16.91), and in women, it was 9.92 (95% CI 8.85 to 10.99) per 100 000 person-years. The incidence increased with advancing age and peaked at 80-84 years in men and 70-74 years in women. CONCLUSIONS: The prevalence and incidence estimates of NAION are comparable with those of Caucasians. These detailed estimates could promote understanding of the disease's pathophysiology and allow for appropriate planning within the healthcare system.

Association of Arterial and Lymph Node Inflammation With Distinct Inflammatory Pathways in Human Immunodeficiency Virus Infection.

Importance: Human immunodeficiency virus (HIV) infection is associated with a high risk of cardiovascular disease and increased arterial inflammation. In HIV, inflammation is also increased within lymph nodes (LNs), tissues known to harbor the virus even among treated and suppressed individuals. Objective: To test the hypothesis that arterial inflammation is linked to HIV disease activity and to inflammation within HIV-infected tissues (LNs). Design, Setting, and Participants: For this case-control study, participants were recruited from the SCOPE (Observational Study of the Consequences of the Protease Inhibitor Era) cohort, a clinic-based cohort of individuals receiving care at San Francisco General Hospital and the San Francisco Veteran's Affairs Medical Center. Arterial and LN inflammation were measured using 18F-fluorodeoxyglucose positron emission tomography. Detailed immunophenotyping was performed, along with measurement of viral activity/persistence and of circulating inflammatory biomarkers. Main Outcomes and Measures: Arterial and LN inflammation. Results: A total of 74 men were studied (45 HIV-infected men with a median age of 53 years [interquartile range, 49-59 years] and 29 uninfected male controls with a median age of 52 years [interquartile range, 46-56 years]). Lymph node inflammation was higher in HIV-infected individuals and correlated with markers of viral disease activity (viral load, CD8+ T cells, and CD4/CD8 ratio) and CD4+ T-cell activation. Uninfected controls had the lowest LN activity (mean [SD] maximum axillary LN standardized uptake value, 1.53 [0.56]), the elite controller and ART-suppressed groups had intermediate levels of LN (mean [SD] maximum axillary LN standardized uptake value, 2.12 [0.87] and 2.32 [1.79], respectively), and the noncontrollers had the highest activity (mean [SD] maximum axillary LN standardized uptake value, 8.82 [3.08]). Arterial inflammation was modestly increased in HIV-infected individuals and was positively correlated with circulating inflammatory biomarkers (high-sensitivity C-reactive protein and IL-6) and activated monocytes (CD14dimCD16+; nonclassical) but not with markers of HIV. While LN and arterial inflammation were increased in HIV, inflammatory activity in these tissues was not related (r = 0.09, P = .56). Conclusions and Relevance: While LNs and, to a lesser degree, the arterial wall are inflamed in HIV, inflammation in these tissues is not closely linked. Namely, measures of HIV disease activity are strongly associated with LN inflammation but not with arterial inflammation. These data suggest that LN and arterial inflammation do not share underlying pathways of immune activation and also that therapeutic interventions that reduce viral disease activity may not predictably reduce arterial inflammation in HIV or its downstream consequence (ie, cardiovascular disease).

Gastrointestinal aspects of vasculitides.

Systemic vasculitides are caused by inflammation of blood vessels and can affect any organ and any part of the gastrointestinal tract, hepatic and biliary system, as well as the pancreas. These disorders can cause a wide array of gastrointestinal manifestations, from asymptomatic elevated transaminase levels and mild abdominal pain to potentially life-threatening bowel perforations and peritonitis. A diagnosis based solely on gastrointestinal symptoms is challenging as these manifestations are not specific. Conversely, diagnostic and therapeutic delays can be rapidly detrimental. In this article, we review the epidemiology, characteristics and management of the main gastrointestinal manifestations of systemic vasculitides, including polyarteritis nodosa and antineutrophil cytoplasm antibody-associated vasculitides, as well as isolated vasculitides limited to the gastrointestinal tract.

Comparison of Visual Outcomes of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients with and without Diabetes Mellitus.

PURPOSE: Diabetic patients have a greater risk of nonarteritic anterior ischemic optic neuropathy (NAION) than nondiabetic patients. We compare visual outcomes, prevalence of bilateral/sequential ION, and predictors of visual outcomes in NAION between diabetic and nondiabetic patients. DESIGN: Case-control study. PARTICIPANTS: All 231 patients with NAION seen by the Neuro-Ophthalmology Service, Wilmer Eye Institute, between 2002 and 2011 were screened for study inclusion. METHODS: Patients presenting within 4 weeks of symptom onset (30 with diabetes mellitus, 62 control patients) were included in baseline demographic assessments of vascular risk factors. Interval and final visual outcomes (logarithm of the minimum angle of resolution [logMAR] visual acuity [VA]) were evaluated in the 81 patients in this group with clinical follow-up for ≥3 months, and population average logistic regression models were used to determine risk factors for worse visual outcomes. MAIN OUTCOME MEASURES: Visual acuity at last follow-up. RESULTS: The median follow-up duration was 38.7 weeks in diabetic patients and 52.9 weeks in nondiabetic patients. The majority (92.5%) of patients presented within 2 weeks of symptom onset. In nondiabetic patients, the most prevalent risk factor for NAION was hyperlipidemia (62.9%); for diabetic patients, NAION risk factors included hypertension (83.3%), hyperlipidemia (83.3%), and small cup-to-disc ratio (63.3%). Sequential NAION occurred in 36.8% of diabetic patients and 20.9% of nondiabetic patients. At last follow-up, 48% of diabetic and 62% of nondiabetic patients had VA better than 20/40. Similar proportions of diabetic and nondiabetic patients (8 [27%] diabetic and 14 [22.5%] nondiabetic patients) recorded a final follow-up vision of 1.0 logMAR or worse at a minimum of 3 months. Ischemic heart disease (odds ratio [OR], 7.21; P < 0.001) and greater age (OR, 1.05; P = 0.045) were associated with increased risk for final VA <20/200 in the multiple regression model (OR, 4.35; P = 0.011). CONCLUSIONS: The VA at presentation and at final follow-up in diabetic patients with NAION were not significantly different from nondiabetic controls, although diabetic patients had a higher prevalence of cardiovascular risk factors. Ischemic heart disease and greater age, but not diabetes, independently correlated with worse VA outcome.

Demographic, Systemic, and Ocular Factors Associated with Nonarteritic Anterior Ischemic Optic Neuropathy.

OBJECTIVE: Nonarteritic anterior ischemic optic neuropathy (NAION) is a devastating ocular condition causing permanent vision loss. Little is known about risk factors for developing this disease. We assessed demographic, systemic, and ocular factors associated with NAION. DESIGN: Retrospective longitudinal cohort study. PARTICIPANTS: Beneficiaries between 40 and 75 years old without NAION at baseline enrolled in a large U.S. managed care network. METHODS: Enrollees were monitored continuously for ≥2 years between 2001 and 2014 to identify those newly diagnosed with NAION (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 377.41). All persons were under ophthalmic surveillance and all cases had ≥1 confirmatory ICD-9-CM code for NAION during follow-up. MAIN OUTCOME MEASURES: Multivariable Cox regression modeling was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs) to describe the statistical relationship between selected demographic characteristics, systemic and ocular conditions, and the hazard of developing NAION. RESULTS: Of 1 381 477 eligible enrollees, 977 (0.1%) developed NAION during a mean ± standard deviation (SD) follow-up of 7.8±3.1 years. The mean ± SD age for NAION cases at the index date was 64.0±9.2 years vs. 58.4±9.4 years for the remainder of the beneficiaries. After adjustment for confounding factors, each additional year older was associated with a 2% increased hazard of NAION (HR = 1.02; 95% CI: 1.01-1.03). Female subjects had a 36% decreased hazard of developing NAION (HR = 0.64; 95% CI: 0.55-0.74) compared with male subjects. Compared with whites, Latinos had a 46% decreased hazard of developing NAION (HR = 0.54; 95% CI: 0.36-0.82), whereas African ancestry was not significantly associated with NAION (HR = 0.91; 95% CI: 0.72-1.15). Systemic diseases associated with NAION included hypertension (HR = 1.62; 95% CI: 1.26-2.07) and hypercoagulable states (HR = 2.46; 95% CI: 1.51-4.00). Although diabetes mellitus (DM) was not significantly associated with NAION compared with those without DM (P = 0.45), patients with end-organ involvement from DM had a 27% increased hazard of NAION relative to those with uncomplicated DM (HR = 1.27; 95% CI: 1.01-1.59). Ocular diseases associated with NAION were age-related macular degeneration (HR = 1.29; 95% CI: 1.08-1.54) and retinal vein occlusion (HR = 3.94; 95% CI: 3.11-4.99). CONCLUSIONS: Our study identified several modifiable risk factors that may be associated with NAION. Should future studies confirm these findings, they may offer opportunities to prevent or treat this debilitating condition.

Increased Risk of Stroke in Patients With Nonarteritic Anterior Ischemic Optic Neuropathy: A Nationwide Retrospective Cohort Study.

PURPOSE: To investigate the incidence and prevalence of nonarteritic anterior ischemic optic neuropathy (NAION), and to extrapolate the risk of cerebrovascular events following NAION. DESIGN: Retrospective cohort study. METHODS: We identified NAION patients first, and then looked for the diagnosis of stroke after the diagnosis of NAION. SETTING: The study group was composed of patients diagnosed with NAION seeking ambulatory care from 2000 to 2011. The control group was extracted from a database by randomly selecting 2 patients for every NAION patient, matched by age and sex. MAIN OUTCOME MEASURES: Cox proportional hazards regression analysis was performed to calculate adjusted hazard ratio (aHR) of stroke for the 2 groups. Subgroup analysis of subjects with or without comorbidities was also investigated. RESULTS: Four hundred and fourteen patients were included in the study group and 789 in the control group. The mean follow-up period was 5.9 years. The incidence of NAION was 3.72/100 000 person-years in Taiwan, and the prevalence of NAION was 48.18/100 000 persons. The study group was more likely to have ischemic stroke (aHR = 2.03, P = .003), but not hemorrhagic stroke (aHR = 1.24, P = .696), than the control group. Among the subgroup with comorbidities, the risk of ischemic stroke among the subjects with NAION was 3.35 times higher than those without NAION (95% confidence interval: 1.67, 6.70). CONCLUSIONS: Patients with NAION have an increased risk of ischemic stroke. Physicians should refer all patients with NAION for systemic survey of vasculopathy and control of modifiable risk factors to prevent irreversible neurological sequelae.

Diagnostic accuracy of 18F-FDG PET or PET/CT for large vessel vasculitis : A meta-analysis.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of 18F-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) or positron-emission tomography/computed tomography (PET/CT) for patients with large vessel vasculitis. METHODS: Based on a search in the PubMed, Embase, and Cochrane Library databases, a meta-analysis was performed on the diagnostic accuracy of 18F-FDG PET or PET/CT in patients with large vessel vasculitis. RESULTS: A total of eight studies involving 400 subjects (170 vasculitis patients and 230 controls) were selected for meta-analysis. The pooled sensitivity and specificity of 18F-FDG PET or PET/CT were 75.9 % (95 % confidence interval, CI 68.7-82.1) and 93.0 % (95 % CI 88.9-96.0), respectively. The positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 7.267 (95 % CI 3.707-14.24), 0.303 (95 % CI 0.229-0.400), and 32.04 (95 % CI 13.08-78.45), respectively. The area under the curve (AUC) was 0.863 and the Q* index 0.794, indicating good diagnostic accuracy. There was no evidence of a threshold effect (Spearman's correlation coefficient = 0.120, p = 0.776). When the data were limited to giant cell arteritis (GCA), the pooled sensitivity and specificity of 18F-FDG PET or PET/CT were 83.3 % (95 % CI 72.1-91.4) and 89.6 % (95 % CI 79.7-95.7), respectively; AUC was 0.884, and the Q* index 0.815, indicating modest accuracy with a small increase in diagnostic accuracy. CONCLUSION: This meta-analysis of published studies demonstrates that 18F-FDG PET or PET/CT has good diagnostic accuracy for large vessel vasculitis and plays an important role in the diagnosis of this condition.