Efficacy and safety of a novel polytetrafluoroethylene-coated self-expandable metal stent for distal malignant biliary obstruction.

Background: Stent migration and sludge formation remain significant problems associated with covered self-expandable metal stents (CSEMSs). The EGIS biliary stent fully covered flare type (EGIS biliary stent), a new type of polytetrafluoroethylene-coated self-expandable metal stent with low axial force and an anti-migration system, was developed to overcome these disadvantages. We conducted this study to evaluate the efficacy and safety of this stent in comparison with conventional CSEMS (c-CSEMS). Methods: We retrospectively analyzed consecutive patients with unresectable pancreatic cancer who received initial CSEMS for distal malignant biliary obstruction. The primary outcome was time to recurrent biliary obstruction (RBO). Secondary outcomes included technical success rate, functional success rate, stent-related adverse events, causes of RBO, and re-intervention. Results: A total of 40 patients were included (EGIS group: 20; c-CSEMS group: 20). The technical and functional success rates were similar between the two groups. Stent-related adverse event rates (20% vs. 15%, p > 0.99) and overall RBO rates (56% vs. 50%, p > 0.99) were not significantly different between the two groups. Stent migration was the most common cause of RBO in the EGIS group, while stent occlusion was in the c-CSEMS group. The median time to RBO (102 vs. 434 days, p = 0.10) was not significantly different between the two groups. Endoscopic transpapillary re-intervention was successful in most patients in both groups. Conclusions: The EGIS biliary stent was not associated with a longer time to RBO compared to c-CSEMS. Further improvements, especially against stent migration, are needed to improve its efficacy.

Unmasking the hidden culprit: Recurrent syncope in a 62-year-old man linked to severe internal carotid artery stenosis.

Syncope, a brief loss of consciousness, has many potential causes, with internal carotid artery (ICA) stenosis being a relatively uncommon but serious one. We present the case of a 62-year-old man from Dhaka, Bangladesh, who experienced recurrent syncope over 6 months, characterized by a brief loss of consciousness, occasional dizziness, and blurred vision. Despite a history of hypertension and hyperlipidemia, initial cardiac and neurogenic investigations were inconclusive. Magnetic resonance angiography revealed 90% stenosis of the right ICA, which was confirmed by digital subtraction angiography. The patient was treated with antiplatelet therapy, statins, and antihypertensives, and underwent carotid artery stenting. His postoperative recovery was uneventful, and he remained symptom-free during follow-up. This case underscores the importance of considering ICA stenosis in patients with recurrent syncope and comorbid vascular disease, particularly in resource-limited settings where timely diagnosis and intervention can prevent serious cerebrovascular complications.

Predicting urinary stone recurrence: a joint model analysis of repeated 24-hour urine collections from the MSTONE database.

To address the limitations in existing urinary stone recurrence (USR) models, including failure to account for changes in 24-hour urine (24U) parameters over time and ignoring multiplicity of stone recurrences, we presented a novel statistical method to jointly model temporal trends in 24U parameters and multiple recurrent stone events. The MSTONE database spanning May 2001 to April 2015 was analyzed. A joint recurrent model was employed, combining a linear mixed-effects model for longitudinal 24U parameters and a recurrent event model with a dynamic first-order Autoregressive (AR(1)) structure. A mixture cure component was included to handle patient heterogeneity. Comparisons were made with existing methods, multivariable Cox regression and conditional Prentice-Williams-Peterson regression, both applied to established nomograms. Among 396 patients (median follow-up of 2.93 years; IQR, 1.53-4.36 years), 34.6% remained free of stone recurrence throughout the study period, 30.0% experienced a single recurrence, and 35.4% had multiple recurrences. The joint recurrent model with a mixture cure component identified significant associations between 24U parameters - including urine pH (adjusted HR = 1.991; 95% CI 1.490-2.660; p < 0.001), total volume (adjusted HR = 0.700; 95% CI 0.501-0.977; p = 0.036), potassium (adjusted HR = 0.983; 95% CI 0.974-0.991; p < 0.001), uric acid (adjusted HR = 1.528; 95% CI 1.105-2.113, p = 0.010), calcium (adjusted HR = 1.164; 95% CI 1.052-1.289; p = 0.003), and citrate (adjusted HR = 0.796; 95% CI 0.706-0.897; p < 0.001), and USR, achieving better predictive performance compared to existing methods. 24U parameters play an important role in prevention of USR, and therefore, patients with a history of stones are recommended to closely monitor for future recurrence by regularly conducting 24U tests.

Endoscopic Hemostasis and Antithrombotic Management.

This review highlights the available literature for antithrombotic management and hemostasis techniques that can be leveraged when caring for patients on antithrombotic medications who may develop gastrointestinal bleeding (GIB). Risks of both index GIB as well as risk of recurrent GIB are reviewed with emphasis on the balance between therapeutic benefits and bleeding hazards that are inherent with these medications. For management of these complications, an in-depth review of the various endoscopic hemostasis techniques that can be utilized is also provided.

Endoscopic Retrograde Cholangiopancreatography: Pancreatic Endoscopy.

The evolution of pancreatic endoscopic retrograde cholangiopancreatography (ERCP) has transformed from a diagnostic tool to now a primarily therapeutic modality. Mainly utilized within the spectrum of pancreatitis, pancreatic ERCP can help resolve pancreatic duct (PD) leaks, disruptions, and pancreatic fluid collections. In chronic pancreatitis, ERCP is effective for the treatment of PD strictures and stones with the improvement of pancreatoscopy greatly facilitating targeted therapy. Pancreatoscopy also allows for accurate mapping of main duct intraductal papillary mucinous neoplasms, which can help guide surgical resection.

Spatiotemporal wind speed forecasting using conditional local convolution and multidimensional meteorology features.

Wind speed prediction is crucial for precisely wind power forecasting and reduced maintenance costs. Highland regions, which possess a considerable wind potential, present complex meteorological conditions, making wind speed prediction challenging. Traditional weather forecasting relies on complex statistical methods and extensive prior knowledge. While recent deep learning models have improved prediction accuracy, they often assume uniform influence weight structure, limiting model effectiveness. This study introduces an enhanced Conditional Local Convolution Recurrent Network (CLCRN) model to improve spatiotemporal wind speed forecasting using multidimensional meteorological inputs such as temperature, pressure, and dew point, alongside wind components. This model addresses uniform influence model weight issue by redesigning convolution kernels to better capture local meteorological features and integrating multiple influencing factors. Our model consistently achieves lower Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE) values across various prediction intervals (3, 6, 9, and 12 h) compared to other models, supported by the meteorological station data from 2019 to 2021. Furthermore, the spatial distribution of the local convolution weights aligns with local wind velocity patterns in Inner Mongolia, enhancing model interpretability. These results demonstrate potential for practical applications in renewable energy planning and wind dynamics simulation.

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction.

OBJECTIVE: To analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. METHODS: This retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2. RESULTS: The mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery. CONCLUSIONS: The best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

Concomitant osteochondral lesion of the talus in ankle instability: Utilizing clinical presentation to guide imaging decision.

Low ankle sprains are a prevalent issue, often involving the anterior talofibular ligament. While there is increased attention placed on ligamentous injuries in ankle sprains, concomitant cartilaginous injuries are frequently overlooked. This article aims to [1] evaluate the significance of magnetic resonance imaging in anterior talofibular ligament injuries to detect concurrent osteochondral lesions of the talus as well as other associated ligamentous injuries; [2] determine the importance of clinical presentation and its association with the risk of concomitant osteochondral lesions in anterior talofibular ligament injuries. We conducted a retrospective analysis of 129 patients who underwent anterior talofibular ligament reconstruction, reviewing patient data to assess the incidence of osteochondral lesions of the talus and associated ligamentous injuries. Clinical presentations were then reviewed to identify signs and symptoms associated with the occurrence of osteochondral lesions of the talus. The results indicated that calcaneofibular ligament was most injured in association with anterior talofibular ligament injuries (69.52%; n=73). Furthermore. 31.78% (n=41) of patients with anterior talofibular ligament injuries had concurrent osteochondral lesion of the talus. Analysis on clinical presentation revealed statistical significance (p<.001) between patients that had ankle joint line tenderness lasting for more than 6 weeks and the occurrence of osteochondral lesions of the talus. This study concludes that magnetic resonance imaging could be beneficial in anterior talofibular ligament injuries with patients exhibiting persistent joint line tenderness to evaluate for osteochondral lesions to ensure a comprehensive pre-operative assessment.

CDC42 deficiency leads to endometrial stromal cell senescence in recurrent implantation failure.

STUDY QUESTION: Does the downregulation of cell division cycle 42 (CDC42) protein in endometrial stroma lead to endometrial senescence in patients with recurrent implantation failure (RIF), and what is the potential mechanism? SUMMARY ANSWER: CDC42 deficiency causes endometrial stromal senescence and decidualization defects, impairing uterine receptivity of RIF patients, via activation of Wnt signaling pathway. WHAT IS KNOWN ALREADY: Uterine aging is unique due to the cyclic remodeling and decidualization of endometrial tissue. Several transcriptomic studies have reported increased senescence in the endometrium in young patients with RIF. Our previous transcriptomic sequencing study discovered that endometrium from women with RIF showed downregulation of CDC42, which is an essential molecule affected by various senescence-related diseases. STUDY DESIGN, SIZE, DURATION: The endometrial samples of a total of 71 fertile control patients and 37 RIF patients were collected to verify the association between CDC42 expression and endometrial senescence of RIF patients. Primary endometrial stromal cells (EnSCs) were isolated from endometrial biopsies taken from patients without any endometrial complications and planning to undergo IVF, then subjected to adenovirus-mediated CDC42 knockdown and decidualization induction to explore the detailed mechanism by which CDC42 governs stromal senescence and decidualization. Wnt inhibitor XAV-939 was used to correct the endometrial senescence and decidualization defect. PARTICIPANTS/MATERIALS, SETTING, METHODS: Senescence was determined by cell cycle arrest markers (e.g. P16, P21, and P53), SASP molecules (e.g. IL6 and CXCL8), and SA-ß-gal staining. Masson's staining and Sirius Red staining were used to detect the endometrial fibrosis. Decidualization was evaluated by the mRNA expression and protein secretion of PRL and IGFBP1, F-actin immunostaining, and the BeWo spheroids 'in vitro implantation' model. Methods used to assess cell function included adenovirus transduction, RNA-sequencing, bioinformatic analysis, western blotting, RT-qPCR, ELISA, and immunofluorescence. MAIN RESULTS AND THE ROLE OF CHANCE: Here, we observed remarkably increased levels of stromal senescence and fibrosis, along with stromal CDC42 deficiency, in the endometrium of patients with RIF (P < 0.001). Knockdown of CDC42 effectively induced premature senescence in EnSCs, leading to aberrant accumulation of senescent EnSCs and collagen deposition during decidualization. CDC42 deficiency in EnSCs restrained the decidualization differentiation and receptivity to trophoblast cells. Transcriptomic analysis revealed Wnt signaling activation as a critical downstream alteration in CDC42-deficient EnSCs. Mechanistically, CDC42 interacted with AKT competitively to impede the binding of GSK3ß to AKT. Knockdown of CDC42 increased AKT-mediated phosphorylation of GSK3ß to inactivate the Axin-GSK3ß destruction complex, leading to accumulation and nuclear translocation of ß-catenin. Importantly, Wnt signaling inhibitors partially corrected the endometrial senescence caused by CDC42 deficiency, and improved both decidualization and trophoblast invasion. LARGE SCALE DATA: RNA-seq data sets generated in this study have been deposited at the NCBI database with BioProject accession number PRJNA1102745. LIMITATIONS, REASONS FOR CAUTION: The present study was based on in vitro cell cultures. Further studies involving CDC42-regulated endometrial senescence are needed in knockout mice model and human endometrial assembloids. WIDER IMPLICATIONS OF THE FINDINGS: In addition to uncovering endometrial senescence in RIF, our findings underscore the significance of CDC42 in modulating EnSC senescence to maintain the decidualization function, and suggest Wnt signaling inhibitors as potential therapeutic agents for alleviating endometrial senescence. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the National Natural Science Foundation of China [82271698 (R.J.), 82030040 (H.S.), 82288102 (H.W.), and 82371680 (G.Y.)]; the Natural Science Foundation of Jiangsu Province [BK20231117 (R.J.)]; and the Medical Science and Technology Development Foundation of Nanjing Department of Health [YKK23097 (Y.Z.)]. The authors declare no potential conflicts of interest.

Cellular-resolution optogenetics reveals attenuation-by-suppression in visual cortical neurons.

The relationship between neurons' input and spiking output is central to brain computation. Studies in vitro and in anesthetized animals suggest that nonlinearities emerge in cells' input-output (IO; activation) functions as network activity increases, yet how neurons transform inputs in vivo has been unclear. Here, we characterize cortical principal neurons' activation functions in awake mice using two-photon optogenetics. We deliver fixed inputs at the soma while neurons' activity varies with sensory stimuli. We find that responses to fixed optogenetic input are nearly unchanged as neurons are excited, reflecting a linear response regime above neurons' resting point. In contrast, responses are dramatically attenuated by suppression. This attenuation is a powerful means to filter inputs arriving to suppressed cells, privileging other inputs arriving to excited neurons. These results have two major implications. First, somatic neural activation functions in vivo accord with the activation functions used in recent machine learning systems. Second, neurons' IO functions can filter sensory inputs-not only do sensory stimuli change neurons' spiking outputs, but these changes also affect responses to input, attenuating responses to some inputs while leaving others unchanged.

Unveiling Rheumatoid Arthritis: Recurrent Pericarditis as the Sentinel Manifestation.

A 69-year-old man presented with corticosteroid-dependent colchicine-resistant chronic recurrent pericarditis initially thought to be idiopathic in etiology. Transitioning from anakinra to rilonacept revealed rheumatoid arthritis as the underlying cause. Anakinra demonstrated superior efficacy in managing both pericarditis and rheumatoid arthritis symptoms.

RFNet: Multivariate long sequence time-series forecasting based on recurrent representation and feature enhancement.

Multivariate time series exhibit complex patterns and structures involving interactions among multiple variables and long-term temporal dependencies, making multivariate long sequence time series forecasting (MLSTF) exceptionally challenging. Despite significant progress in Transformer-based methods in the MLSTF domain, many models still rely on stacked encoder-decoder architectures to capture complex time series patterns. This leads to increased computational complexity and overlooks spatial pattern information in multivariate time series, thereby limiting the model's performance. To address these challenges, we propose RFNet, a lightweight model based on recurrent representation and feature enhancement. We partition the time series into fixed-size subsequences to retain local contextual temporal pattern information and cross-variable spatial pattern information. The recurrent representation module employs gate attention mechanisms and memory units to capture local information of the subsequences and obtain long-term correlation information of the input sequence by integrating information from different memory units. Meanwhile, we utilize a shared multi-layer perceptron (MLP) to capture global pattern information of the input sequence. The feature enhancement module explicitly extracts complex spatial patterns in the time series by transforming the input sequence. We validate the performance of RFNet on ten real-world datasets. The results demonstrate an improvement of approximately 55.3% over state-of-the-art MLSTF models, highlighting its significant advantage in addressing multivariate long sequence time series forecasting problems.

Evaluation for genetic disease in kidney transplant candidates: A practice resource.

The increasing availability of clinically approved genetic tests for kidney disease has spurred the growth in the use of these tests in kidney transplant practice. Neither the testing options nor the patient population where this should be deployed has been defined and its value in kidney transplant evaluation has not been demonstrated. Transplant providers may not always be aware of the limitations of genetic testing and may need guidance on comprehending test results and providing counsel, as many centers do not have easy access to a renal genetic counselor or a clinical geneticist. In this practice resource, a working group of nephrologists, geneticists and a genetic counselor provide a pragmatic, tailored approach to genetic testing, advocating for its use only where the genetic diagnosis or its exclusion can impact the choices available for transplantation or post-transplant management or the work-up of living donor candidates at increased risk for heritable disease.

Orbital Lymphoma Presenting As Recurrent Orbital Cellulitis: A Diagnostic Challenge.

Orbital cellulitis is an infection of the orbital tissue behind the orbital septum. We report a case of a 71-year-old Malay lady, a passive smoker for 20 years, presenting with recurrent orbital cellulitis at the same site. She initially presented with right periorbital swelling, redness, and reduced vision worsening over two weeks, along with a firm swelling over the right temple. CT of the brain and orbit revealed a homogenous mass extending from the right sphenoid bone to the right orbit. The initial diagnosis was right sphenoid meningioma or metastasis. Her symptoms improved after 10 days of intravenous cefuroxime, prescribed for catheter-related phlebitis over her right hand, which developed during the admission. A follow-up MRI of the brain and orbit showed osteomyelitis changes in the right orbit and sphenoid bone. Histopathology revealed chronic inflammation without malignancy, and cultures were negative. The diagnosis was revised to right orbital cellulitis secondary to cranial osteomyelitis. The patient was lost to follow-up but returned three months later with recurrent symptoms, including right periorbital swelling, reduced vision, ophthalmoplegia, and right forehead swelling. She was treated with intravenous ceftriaxone, which resulted in partial symptom resolution. Neurosurgery planned a right craniotomy, but she was undecided and again lost to follow-up due to deteriorating health. Over time, her condition worsened, leading to readmission. A repeated CT scan of the brain and orbit showed a lobulated, enhancing soft tissue lesion in the right periorbital area with intralesional calcification and bony erosion. A biopsy confirmed it as high-grade B-cell lymphoma. The patient succumbed to the illness a few weeks later. This case highlights that orbital lymphoma can manifest as orbital cellulitis. Failure to respond to conventional orbital cellulitis treatment should raise suspicion of a more serious underlying cause. We advocate that clinicians consider orbital lymphoma as a potential diagnosis in elderly patients presenting with recurrent, culture-negative orbital cellulitis.

Granulomatosis With Polyangiitis Mimicking Infective Endocarditis: A Case Report.

Granulomatosis with polyangiitis is a rare systemic disease that causes necrotizing granulomatous inflammation of small- and medium-sized blood vessels. We present the case of a 46-year-old male with medical history significant for chronic sinusitis, prior history of drug abuse, and a recent tooth infection. He was suspected to have infective endocarditis, but further workup revealed diagnostic findings of granulomatosis with polyangiitis. We discuss how the signs and symptoms of granulomatosis with polyangiitis can overlap with infective endocarditis, a pathophysiologically distinct condition with a strikingly similar presentation.

A Random Survival Forest Model for Predicting Residual and Recurrent High-Grade Cervical Intraepithelial Neoplasia in Premenopausal Women.

Purpose: Loop electrosurgical excision procedure (LEEP) for high-grade cervical intraepithelial neoplasia (CIN) carries significant risks of recurrence and persistence. This study compares the efficacy of a random survival forest (RSF) model with that of a conventional Cox regression model for predicting residual and recurrent high-grade CIN in premenopausal women after LEEP. Methods: Data from 458 premenopausal women treated for CIN2/3 at our hospital between 2016 and 2020 were analyzed. The RSF model incorporated demographic, pathological, and treatment-related variables. Feature selection utilizing LASSO and three other algorithms was performed to enhance the RSF model, which was further compared to a Cox regression model. Model performance was assessed using area under the curve (AUC), out-of-bag (OOB) error rates, and SHAP values to interpret predictor importance. Results: The RSF model showed superior performance compared to the Cox regression model, with AUC values of 0.767-0.901 and peak predictive performance at 36 months post-LEEP. In contrast, the highest AUC achieved by Cox regression was 0.880. The RSF model also exhibited relatively lower OOB error rates, indicating better generalizability. Moreover, SHAP value analysis identified margin status and CIN severity as the most prominent predictors that directly affected risk predictions. Lastly, an online tool providing real-time predictions in clinical settings was successfully implemented using the RSF model. Conclusion: The RSF model outperformed the traditional Cox regression model in predicting residual and recurrent high-grade CIN risks post-LEEP. This model may be a more accurate clinical tool that facilitates improved personalized care and early interventions in gynecological oncology.

Doppler Evaluation of Uterine Blood Flow in Patients with Unexplained Recurrent Pregnancy Loss.

Objective: This study aimed to analyze uterine artery and spiral artery hemodynamics in patients with unexplained recurrent pregnancy loss (URPL) with varying pregnancy outcomes. Methods: 174 pregnant women with URPL and 144 pregnant women without adverse pregnancy histories were enrolled in this retrospective study. Based on pregnancy outcomes, these patients were divided into two groups: normal pregnancy outcomes (URPL-N, n=138) and adverse pregnancy outcomes (URPL-A, n=36). Control group participants were categorized into normal pregnancy outcomes (CON-N, n=129) and adverse pregnancy outcomes (CON-A, n=15). We compared uterine artery and spiral artery hemodynamics during different stages of gestation and the predictive value of these parameters for pregnancy outcomes. Results: URPL-N group had fewer pregnancy losses and lower BMI compared to URPL-A group (P< 0.05). Spiral artery hemodynamics in URPL-N and CON-N groups were lower than those in URPL-A and CON-A groups during the mid-luteal phase, 11-13 weeks, 15-17 weeks, and 19-21 weeks of gestation, respectively. Uterine artery hemodynamics ((Pulsatility index (mPI), resistive index (mRI), and systolic-to-diastolic ratio (mS/D)) in the mid-luteal period were lower in URPL-N group than URPL-A group. Similarly, in CON-N group were lower than CON-A group. The URPL-A and CON-A groups had higher uterine artery and spiral artery hemodynamics when compared to the URPL-N and CON-N groups. Spiral artery hemodynamics exhibited larger areas under the ROC curve compared to uterine artery parameters. Conclusion: Abnormal hemodynamics in these arteries may contribute to URPL and adverse pregnancy outcomes. Spiral artery hemodynamics are more reliable predictors of pregnancy outcomes than uterine artery parameters.

Injectable hydrogels for Fenton-like Mn2+/Fe2+ delivery with enhanced chemodynamic therapy prevent osteosarcoma recurrence and promote wound healing after excision surgery.

Local recurrence of osteosarcoma and wound healing after excision surgery are major challenges in clinical research. The present anti-tumor treatments could inhibit normal tissues, resulting in difficulties in surgical wound healing. In this study, we constructed an injectable hydrogel as a platform to co-deliver MnO2 nanoparticles and ferrocene Fc, termed as (MnO2/Fc)@PLGA for osteosarcoma treatment and wound healing after excision. By simple local injection, the hydrogel could form a protective barrier on the surgical wound after osteosarcoma excision, which could promote wound healing and steady release of MnO2/Fc nanoparticles. The released MnO2/Fc might undergo the Fenton reaction through Mn2+/Fe2+ to inhibit osteosarcoma cells with chemodynamic therapy (CDT). Furthermore, MnO2 could catalyze endogenous H2O2 to produce O2, which eliminates the adverse effects of H2O2 and remodels the hypoxic state in the local lesions. The increased O2 facilitated surgical wound healing and anti-tumor effects by regulating the hypoxia inducible factor-1 functions. In conclusion, (MnO2/Fc)@PLGA hydrogel could effectively prevent local recurrence of osteosarcoma and promote wound healing after excision surgery, thereby providing a novel strategy for tumor treatment and tissue repair.

Delayed Diagnosis of Constrictive Pericarditis Resulting in Recurrent Heart Failure: A Case Report.

Constrictive pericarditis can lead to compromised diastolic ventricular filling due to pericardial inflammation and fibrosis. A diagnosis of constrictive pericarditis was established by identifying structural and hemodynamic features through echocardiography. We present a case of constrictive pericarditis, which manifested in the form of gradually worsening dyspnea and lower-extremity edema over a 7 years period. The patient was diagnosed with constrictive pericarditis using echocardiography, and underwent a pericardiectomy.