Cardiomyopathies in children and adolescents: aetiology, management, and outcomes in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Registry.

BACKGROUND AND AIMS: Childhood-onset cardiomyopathies are rare and poorly characterized. This study examined the baseline characteristics and 1-year follow-up of children with cardiomyopathy in the first European Cardiomyopathy Registry. METHODS: Prospective data were collected on individuals aged 1-<18 years enrolled in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis long-term registry (June 2014-December 2016). RESULTS: A total of 633 individuals aged ≤18 years with hypertrophic [HCM; n = 388 (61.3%)], dilated [DCM; n = 206 (32.5%)], restrictive [RCM; n = 28 (4.4%)], and arrhythmogenic right ventricular cardiomyopathy [ARVC; n = 11 (1.7%)] were enrolled by 23 referral centres in 14 countries. Median age at diagnosis was 4.0 [interquartile range (IQR) 0-10] years, and there was a male predominance [n = 372 (58.8%)] across all subtypes, with the exception of DCM diagnosed <10 years of age; 621 (98.1%) patients were receiving cardiac medication and 80 (12.6%) had an implantable cardioverter-defibrillator. A total of 253 patients (253/535, 47.3%) had familial disease. Genetic testing was performed in 414 (67.8%) patients with a pathogenic or likely pathogenic variant reported in 250 (60.4%). Rare disease phenocopies were reported in 177 patients (28.0%) and were most frequent in patients under 10 years [142 (30.9%) vs. 35 (19.6%); P = .003]. Over a median follow-up of 12.5 months (IQR 11.3-15.3 months), 18 patients (3.3%) died [HCM n = 9 (2.6%), DCM n = 5 (3.0%), RCM n = 4 (16.0%)]. Heart failure events were most frequent in RCM patients (36.0%). CONCLUSIONS: The findings confirm the heterogeneous aetiology of childhood cardiomyopathies and show a high frequency of familial disease. Outcomes differed by cardiomyopathy subtype, highlighting a need for disease-specific evaluation and treatment.

Ultrasound guided erector spinae plane block versus thoracic epidural analgesia in traumatic flail chest, a prospective randomized trial.

Background and Aims: Pain contributes to flail chest morbidities. The aim of this study was to compare the analgesic effects of ultrasound-guided erector spinae plane block (ESPB) with thoracic epidural analgesia (TEA) in patients with traumatic flail chest. Material and Methods: Sixty patients aged 18 - 60 years, ASA I-II, with unilateral flail chest were allocated into TEA group with a loading dose of 6 ml bupivacaine 0.25% and 2 µg/ml fentanyl and ESPB group with a loading dose of 20 ml bupivacaine 0.25% and 2 µg/ml fentanyl. This was followed by continuous infusion of 6 ml/hour bupivacaine 0.125% and 2 µg/ml fentanyl in both groups for 4 days. Pain scores at rest and on coughing, rescue analgesic consumption, PaO2/FIO2 ratio, PaCO2, pulmonary functions and adverse events were recorded. Results: In both groups, Visual Analog Scale (VAS) scores at rest and on coughing were significantly decreased after block initiation as compared to pre-block value. At all-time points, VAS scores at rest and on coughing were insignificantly different between both groups. PaO2/FIO2 ratio, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were significantly increased and respiratory rate, PaCO2, were significantly decreased as compared to pre-block values of the same group without significant difference between both groups. The incidence of hypotension was significantly higher in TEA group than ESPB group. Conclusions: ESPB can achieve adequate analgesia in traumatic flail chest equivalent to that of TEA with significant improvement of arterial oxygenation and pulmonary functions and without serious adverse effects.

Analgesic efficacy of ultrasound guided quadratus lumborum block versus ilioinguinal/iliohypogastric nerve block following pediatric open inguinal hernia repair: A prospective randomized controlled trial.

Background and Aims: Inguinal hernia repair is a common surgical procedure. We compared the analgesic efficacy of ultrasound-guided anterior quadratus lumborum (QL) block versus ilioinguinal/iliohypogastric (II/IH) nerve block in pediatric patients undergoing open inguinal hernia repair. Material and Methods: It was a prospective randomized study in which 90 patients of 1-8 years of age were randomly assigned into control (general anesthesia only), QL block, and II/IH nerve block groups. Children's Hospital Eastern Ontario Pain Scale (CHEOPS), perioperative analgesic consumptions, and time to first analgesic request were recorded. The normally distributed quantitative parameters were analyzed by one-way ANOVA with post-hoc Tukey's HSD test while parameters that did not follow a normal distribution and the CHEOPS score were analyzed using the Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferonni correction for post-hoc analysis. Results: In the 1st 6h postoperative, the median (IQR) CHEOPS score was higher in the control group than II/IH group (P = 0.000) and QL group (P = 0.000) while comparable between the latter two groups. CHEOPS scores were significantly lower in the QL block group than the control group and II/IH nerve block group at 12 and 18h. The intraoperative fentanyl and postoperative paracetamol consumptions in the control group were higher than II/IH and QL groups while lower in QL than II/IH group. Conclusion: Ultrasound-guided QL and II/IH nerve blocks provided effective postoperative analgesia in pediatric patients undergoing inguinal hernia repair with lower pain scores and less perioperative analgesic consumptions in the QL block group compared to II/IH group.

Dexmedetomidine induced hypotension and hemostatic markers.

Background and Aims: The hemostatic system undergoes extensive alterations following surgical trauma leading to a hypercoagulable state. We assessed and compared the changes in platelet aggregation, coagulation, and fibrinolysis status during normotensive and dexmedetomidine-induced hypotensive anesthesia in patients undergoing spine surgery. Material and Methods: Sixty patients undergoing spine surgery were randomly allocated into two groups: normotensive and dexmedetomidine-induced hypotensive groups. Platelet aggregation was assessed preoperatively, 15 min after induction, 60 min, and 120 min after skin incision, at the end of surgery, 2 h and 24 h postoperatively. Prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count, antithrombin III, fibrinogen, and D-dimer levels were measured preoperatively, 2 h and 24 h postoperatively. Results: Preoperative platelet aggregation (%) was comparable between both groups. Platelet aggregation significantly increased intraoperative at 120 min after skin incision and postoperatively in the normotensive group compared to the preoperative value (P < 0.05) but it was insignificantly decreased during the intraoperative induced hypotensive period in the dexmedetomidine-induced hypotensive group (P > 0.05). Postoperative PT, aPTT significantly increased and platelet count, and antithrombin III significantly decreased in the normotensive group compared to the preoperative value (P < 0.05) but they were not significantly changed in the hypotensive group (P > 0.05). Postoperative D-dimer significantly increased in the two groups compared to the preoperative value (P < 0.05). Conclusion: Intraoperative and postoperative platelet aggregation significantly increased in the normotensive group with significant alterations of the coagulation markers. Dexmedetomidine-induced hypotensive anesthesia prevented the increased platelet aggregation that occurred in the normotensive group with better preservation of platelet and coagulation factors.

Development of novel cyanopyridines as PIM-1 kinase inhibitors with potent anti-prostate cancer activity: Synthesis, biological evaluation, nanoparticles formulation and molecular dynamics simulation.

Recently, inhibition of PIM-1 enzyme is found as an effective route in the fight against proliferation of cancer. Herein, new cyano pyridines that target PIM-1 kinase were designed, synthesized, and biologically evaluated. Two prostate cell lines were used to examine each of the new compounds in vitro for anticancer activity, namely, PC-3 and DU-145. The cyanopyridine derivatives 2b, 3b, 4b, and 5b with an N,N-dimethyl phenyl group at the pyridine ring's 4-position showed considerable antitumor effect on the tested cell lines. Additionally, the high selectivity index revealed that these compounds were less cytotoxic to normal WI-38 cells. Furthermore, they exhibited strong inhibitory effect on PIM-1 having IC50 = 0.248, 0.13, 0.326 and 0.245 µM, respectively. The most powerful derivatives2b, 3b, 4b, and 5b, were chosen for further examination of their inhibitory potential on both kinases (PIM-2 and PIM-3). Interestingly, upon loading compound 3b in a cubosomes formulation with nanometric size, improvements in cytotoxicity and inhibitory effect on PIM-1 kinase were observed. In silico ADME parameters study revealed that compound 3b is orally bioavailable without penetration to the blood-brain barrier. Further, the docking simulations revealed the ability of our potent compounds to well accommodate the PIM-1 kinase active site forming stable complexes. In a 150 ns MD simulation, the most powerful PIM-1 inhibitor 3b produced stable complex with the PIM-1 enzyme (RMSD = 1.76). Furthermore, the 3b-PIM-1 complex has the low binding free energy (-242.2 kJ/mol) according to the MM-PBSA calculations.

Possible protective role of L-thyroxin on the parotid gland of adult male albino rat in carbimazole induced hypothyroidism: histological, histomorphometry, and ultrastructural study.

BACKGROUND: Thyroid disorders are among the most common metabolic disorders worldwide. Thyroid dysfunction affects salivary glands function, causing hyposalivation. It also provokes physiological and histological changes in parotid, submandibular, and in particular the sublingual gland. THE AIM OF THIS WORK: The aim of this work was to clarify the histological and ultrastructural changes that occur in the parotid gland following carbimazole-induced hypothyroidism in adult male albino rats. The study also aims to investigate the possible protective role of L-thyroxin supplementation on the rat parotid glands after long and short duration of hypothyroidism. MATERIAL AND METHODS: Fifty-five adult male albino rats of Sprague Dawley strain; were divided into four groups and eleven subgroups, five rats each. G І received nothing. G П given normal saline orally daily. G Ш (medical Hypothyroidism, short duration - long duration - recovery group) given Carbimazole orally by gastric tube in a dose of 0.05 mg/kg daily for 3,6 successive weeks for group (a, b) and for 6 successive weeks then were left without any medication for another 3 weeks in recovery group c. G IV-b, c (L-Thyroxine supplemented group, short duration-long duration) given Carbimazole orally daily for 3,6 successive weeks then L-thyroxine was given orally in a dose of (10 µg/100 g/B.W) daily for another 3 successive weeks. Animals were sacrificed 24 hours after the last dose of Carbimazole in G III-a, b and 3 weeks after stoppage the drug in G III-c. Animals were sacrificed 24 hours after the last dose of L- Thyroxine in G IV-b, c. The parotid specimens were processed for histopathological examination by light and electron microscopy. The medically induced Hypothyroidism resulted in significant parotid gland damage which was more obvious with longer duration; as follow: a) most of the acini had irregular outlines and were widely separated with narrow lumen and cytoplasmic vacuoles. b) some acinar cells contained ill defined, irregular, pyknotic or hyperchromatic nuclei. c)Vascular changes: dilated and engorged with blood. d) the interlobular and striated ducts appeared disrupted and dilated. e) extravasated blood with cellular infiltration were seen in the interstitial space. IN CONCLUSION: Thyroid hormones (THs) had a significant effect in protection of parotid gland against damage induced by carbimazole, as it preserved the normal histological architecture of the parotid gland. This beneficial effect of THs was mostly related to its antioxidant properties. The expression of BCL-2 has certain regularity in apoptosis after drug administration. Regulation of glandular atrophy and apoptosis are closely related. The molecular mechanism of the apoptosis of the gland is not clear, and further study is needed in the future.

Protective effects of Saraca indica L. leaves extract (family Fabaceae) against gamma irradiation induced injury in the kidney of female albino rats.

This work was designed to estimate the protective effect of Saraca indica L. leaves ethanolic exract against γ-irradiation induced renal damage in rats. Phytochemical examinations of S. indica L. leaves extract resulted in the separation of three flavanone glycosides: Astilibin (1), Neoastilbin (2), and Eriodictyol-7-O-α-l-rhamnopyranoside (3); two flavonols: Quercetin (4) and Quercetin-3-O-α-l-arabinopyranosyl-(1'''-6'')-O-ß-D-galactopyranoside (5) in addition of Gallic acid (6) and methyl gallate (7). Their structures elucidated by chemical evidences and spectroscopic analysis (1 and 2D-NMR, -ESI-MS, UV). Female rats were used and classified into: control, Ext (200 mg/kg body wt/day orally for 7 days), IRR (8Gy), Ext + IRR, and Sily+IRR groups (received silymarin 50 mg/kg b.wt orally as reference drug). Results showed that S. indica L. leaves extract ameliorated the kidney function tests, hs-CRP, IL-1ß, ACE, TNF-α, GSH, and MDA as well as, decreased the histopathological changes of kidney. In conclusion, S. indica L. leaves extract had a renoprotective activity against irradiation induced renal injury due to its flavononid contents.

Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Laparoscopic Bariatric Surgery: A Prospective Randomized Controlled Trial.

BACKGROUND: Bariatric surgery is frequently complicated with considerable postoperative pain. We evaluated the impact of ultrasound-guided erector spinae plane block on perioperative analgesia and pulmonary functions following laparoscopic bariatric surgery. METHODS: A total of 60 patients aged 18 to 65 years with a body mass index (BMI) of ≥ 40 kg/m2 were randomly allocated into two groups. Patients received either bilateral erector spinae plane block using 20 mL bupivacaine 0.25% at the level of the T7 transverse process or bilateral sham block using 20 mL normal saline on each side. Visual analog scale, intraoperative fentanyl consumption, the cumulative 24-hour postoperative morphine consumption, and postoperative pulmonary functions were recorded. RESULTS: Visual analog scale for the first eight postoperative hours were significantly lower in the erector spinae plane block group than the control group. The median (interquartile range [IQR]) intraoperative fentanyl consumption was higher in the control group (159.5 [112.0 to 177.8] µg) than in the erector spinae plane block group (0.0 [0.0 to 74.5] µg) (P < 0.001). The median (IQR) cumulative 24-hour postoperative morphine consumption was lower in the erector spinae plane block group (8.0 [7.0 to 9.0] mg) than in the control group (21.0 [17.0 to 26.25] mg) (P < 0.001, 95% CI [11.00, 15.00]). Postoperative pulmonary functions were significantly impaired in both groups compared with baseline values without significant difference between both groups. CONCLUSION: Ultrasound-guided erector spinae plane block provided satisfactory postoperative analgesia following laparoscopic bariatric surgery with decreased analgesic consumption without significant difference in postoperative pulmonary functions compared with the control group.

Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study.

BACKGROUND: Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6-T9). METHODS: Sixty patients 18-65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block at the level of T7 transverse process using 20 mL of bupivacaine 0.25% on each side, while the control group received bilateral sham erector spinae plane block using 1 mL of normal saline. All patients underwent general anesthesia for surgery. Pain severity (visual analog scale), consumption of intraoperative fentanyl, time to first request of rescue analgesia, and postoperative pethidine consumption were recorded over the first 24 hours postoperatively. RESULTS: At 2 hours postoperatively, the visual analog scale pain score was significantly lower in the erector spinae plane block group compared to the control group (estimated main effect of 2.53; P < .001; 95% CI, 1.8-3.2) and remained lower until 12 hours postoperatively (P < .001 from postanesthesia care unit admission to 4 hours postoperatively, .001 at 6 hours, .025 at 8 hours, and .043 at 12 hours). At 18 and 24 hours, visual analog scale pain scores were not significantly different between both groups (P = .634 and .432, respectively). Four patients in the erector spinae plane block group required intraoperative fentanyl compared to 27 patients in control group. The median (quartiles) of intraoperative fentanyl consumption in the erector spinae plane block group was significantly lower (0 µg [0-0 µg]) compared to that of the control group (94 µg [74-130 µg]). Ten patients in the erector spinae plane block group required postoperative rescue pethidine compared to 25 patients in control group. The median [quartiles] of postoperative rescue pethidine consumption was significantly lower in the erector spinae plane block group (0 mg [0-33 mg]) compared to that of the control group (83 mg [64-109 mg]). Time to first rescue analgesic request was significantly prolonged in the erector spinae plane block group compared to control group (P < .001). CONCLUSIONS: Ultrasound-guided bilateral erector spinae plane block provided lower postoperative visual analog scale pain scores and decreased consumption of both intraoperative fentanyl and postoperative rescue analgesia for patients undergoing open epigastric hernia repair.

Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy: A prospective randomized controlled trial.

BACKGROUND: Many analgesic modalities have been investigated in pediatrics. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in pediatric patients undergoing open midline splenectomy. METHODS: Sixty patients aged 3-10 years were randomly assigned into two groups: Control group received general anesthesia with bilateral sham erector spinae plane block using 0.3 mL/kg normal saline on each side. Erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block using 0.3 mL/kg bupivacaine 0.25% (on each side) with a maximum dose of 2 mg/kg. Children's Hospital Eastern Ontario Pain Scale (CHEOPS), total consumption of intraoperative fentanyl (1 µg/kg IV in case of inadequate analgesia), time to first rescue analgesic administration, and postoperative paracetamol consumption were recorded over the first 24 hours postoperatively. RESULTS: The median (IQR) postoperative CHEOPS score at 1 hour was lower in erector spinae plane block group (5.0 (4.75 -5.25)) than the control group (7.0 (6.0-10.0)) (P < .001, 95% CI: 1.0; 5.0). The CHEOPS scores for the first eight postoperative hours were lower in the erector spinae plane block group (5.0 (5.0-6.0)) than the control group (6.0 (6.0 -10.0)) (P Ë‚ .001, 95% CI: 1.0; 2.0). Intraoperative fentanyl administration was higher in the control group 40.0 (21.5-50.0) µg compared to erector spinae plane block group 0.0 (0.0-0.0) µg (P Ë‚ .001, 95% CI: 23.0; 48.0). The total postoperative paracetamol consumption was higher in the control group (37.5 ± 17.1 mg/kg) compared to erector spinae plane block group (8.5 ± 10.9 mg/kg) (P Ë‚ .001, 95% CI: 21.57; 36.43). The time to the first postoperative rescue analgesic requirement was longer in the erector spinae plane block group. CONCLUSION: Ultrasound-guided erector spinae plane block reduced CHEOPS score for the first eight hours postoperatively with the reduction of intraoperative fentanyl and postoperative paracetamol consumptions.

Can mesenchymal stem cells pretreated with platelet-rich plasma modulate tissue remodeling in a rat with burned skin?

Our aim was to study the effect of platelet-rich plasma (PRP) on the proliferation of bone-marrow-derived mesenchymal stem cells (BM-MSCs) and to investigate their roles in the healing of experimental burn injury and the possible mechanism of action. Our work was divided into in-vitro and in-vivo studies. The in-vitro study included untreated MSCs and MSCs treated with PRP. Levels of TGF-ß and cell proliferation were assessed. In the in-vivo study, 72 rats were distributed equally among 6 groups: control, burn, burn with MSCs, burn with PRP, burn with both MSCs and PRP, and burn with MSCs pretreated with PRP. On the 7th and 20th day after injury, the serum levels of transforming growth factor beta (TGF-ß) and tumor necrosis factor alpha (TNF-α), as well as interleukin-10 (IL-10) levels in skin tissue were measured by ELISA; histopathology and gene expression of MMP-1, TIMP-2, Ang-1, Ang-2, and vimentin by real-time PCR were performed in all groups. In vitro: proliferation of MSCs and TGF-ß increased in the PRP-treated group compared with the control group. In vivo: Ang-1, Ang-2, and vimentin were upregulated, whereas MMP-1 and TIMP-2 were downregulated. TGF-ß and IL-10 were increased, whereas TNF-α was decreased in all treated groups with more significance in MSCs and PRP on day 20. Histopathology of burn skin was improved in all treated groups, particularly in MSCs pretreated with PRP 20 days post-burn.

Multi-Reservoir Phospholipid Shell Encapsulating Protamine Nanocapsules for Co-Delivery of Letrozole and Celecoxib in Breast Cancer Therapy.

PURPOSE: In the current work, we propose a combined delivery nanoplatform for letrozole (LTZ) and celecoxib (CXB). METHODS: Multi-reservoir nanocarriers were developed by enveloping protamine nanocapsules (PRM-NCs) within drug-phospholipid complex bilayer. RESULTS: Encapsulation of NCs within phospholipid bilayer was confirmed by both size increase from 109.7 to 179.8 nm and reduction of surface charge from +19.0 to +7.78 mV. The multi-compartmental core-shell structure enabled biphasic CXB release with initial fast release induced by complexation with phospholipid shell followed by prolonged release from oily core. Moreover, phospholipid coating provided protection for cationic PRM-NCs against interaction with RBCs and serum proteins enabling their systemic administration. Pharmacokinetic analysis demonstrated prolonged circulation and delayed clearance of both drugs after intravenous administration into rats. The superior anti-tumor efficacy of multi-reservoir NCs was manifested as powerful cytotoxicity against MCF-7 breast cancer cells and marked reduction in the mammary tumor volume in Ehrlich ascites bearing mice compared with free LTZ-CXB combination. Moreover, the NCs induced apoptotic caspase activation and marked inhibition of aromatase expression and angiogenic marker, VEGF as well as inhibition of both NFκB and TNFα. CONCLUSIONS: Multi-reservoir phospholipid shell coating PRM-NCs could serve as a promising nanocarrier for parenteral combined delivery of LTZ and CXB.

The effect of ultrasound-guided transversus abdominis plane (TAP) block on postoperative analgesia and neuroendocrine stress response in pediatric patients undergoing elective open inguinal hernia repair.

BACKGROUND: Transversus abdominis plane block (TAP) is a compartmental block of the anterior abdominal wall. Surgical trauma produces multisystem reactions. Anesthetic techniques can modify the neuroendocrine surgical stress response. AIM: The aim of this study was to evaluate the effect of TAP block on the modification of the surgical neuroendocrine stress response as well as its analgesia effect in children undergoing open inguinal hernia repair. METHOD: Sixty children aged 3-10 years undergoing elective unilateral open inguinal hernia repair were randomized into group I (general anesthesia) or group II (received TAP block after induction of general anesthesia). Serum cortisol, blood glucose, quality of analgesia, postoperative need for rescue analgesia, and complications and degree of satisfaction of the patients and their parents were assessed. RESULTS: Serum cortisol level was significantly lower in group II as compared to group I intraoperatively (17.73 ± 1.51 vs 21.80 ± 2.22 µg·dl-1 ) and 30 min postoperatively (15.03 ± 1.56 vs 18.30 ± 1.53 µg·dl-1 ). Blood glucose level was significantly lower in group II as compared to group I intraoperatively (107.57 ± 3.77 vs 115.40 ± 6.30 mg·dl-1 ) and 30 min postoperatively (104.13 ± 3.78 vs 110.73 ± 4.83 mg·dl-1 ). The quality of analgesia as indicated by CHEOPS and OPS scales was significantly better in group II. The consumption of postoperative rescue analgesia was significantly higher in group I as compared to group II (27.00 ± 9.97 vs 13.00 ± 9.43 mg·kg-1 ). CONCLUSION: TAP block is effective as a part of multimodal analgesia for children undergoing open inguinal hernia repair with significant attenuation in the neuroendocrine stress response induced by surgery.

Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome.

OBJECTIVE: To determine the impact of CKD on the completeness of revascularization and major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS). PATIENTS AND METHODS: The study enrolled 400 CCS patients who underwent revascularization by PCI. They were separated into two categories according to their eGFR levels: the control group: 200 patients with eGFR ≥60mL/min/1.73m2, and the CKD Group: 200 patients with eGFR< 60ml/min/1.73m.2 Patients were reclassified according to revascularization into complete and incomplete revascularization groups with one-year follow-up to assess the MACE. RESULTS: CKD patients were significantly older (65.78 ± 6.41 vs. 56.70 ± 9.20 years, P=<0.001). They had higher syntax scores (P = 0.005), CIN (P = 0.001), all-cause mortality (P = 0.02), MACE (P = 0.037), and heart failure (P = 0.014). After reclassification according to revascularization. GFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 vs. 65.67 ± 26.62, respectively, P =<0.001). Repeated revascularization (P < 0.001), STEMI (P = 0.003), stent thrombosis (P = 0.015), MACE (P < 0.001), stroke (P < 0.001), and all-cause mortality (P < 0.001) were more prevalent among patients with incomplete revascularization. Multivariate regression analysis revealed eGFR (P = 0.001) and Syntax score (SS) (P=<0.001) as independent predictors of incomplete revascularization. The optimal eGFR cutoff value for predicting partial revascularization is 49.50mL/min/1.73m2, with 58.8% sensitivity and 69.3 % specificity. CONCLUSION: Chronic kidney disease is associated with a higher syntax score and incomplete revascularization prevalence in CCS patients. Additionally, incomplete revascularization is associated with an increased incidence of major adverse cardiac events. In patients with CCS, CKD predicts partial revascularization and subsequent MACE.

The burden of entheseal involvement in systemic lupus erythematosus: a comparative ultrasonograghic study.

BACKGROUND: Imaging is crucial for identifying and diagnosis of the musculoskeletal (MSK) symptoms, which are one of the most typical manifestations of systemic lupus erythematosus (SLE). For the joints, tendons, and entheseal sites, ultrasonography has shown to be sensitive and accurate for the diagnosis of both inflammation and structural damage. AIM: The goal of the current investigation is to determine the prevalence and the distribution of entheseal abnormalities in SLE patients, using musculoskeletal ultrasonography (MSUS) and to assess the relationship between entheseal sonographic changes and the SLE disease activity. PATIENTS AND METHODS: One hundred sixty-eight subjects were studied (56 SLE patients, 56 psoriatic arthritis (PSA) patients, and 56 normal cases). To compare the frequency and the distribution of entheseal involvement, high-resolution MSUS was conducted to assess the entheseal sites of all patients in accordance with the Madrid Sonographic Enthesitis Index (MASEI). RESULTS: Clinical enthesitis was detected in 39.3% of the SLE patients using the Leeds Enthesitis Index compared to 71% detected via US examination, indicating a high proportion of subclinical enthesitis in our SLE patients. The most frequently affected enthesis was the distal insertion of the patellar tendon at the tibial tuberosity which was detected in 41% of SLE patients. Enthesitis was significantly more frequent in PSA patients (100%) compared to SLE patients (71.4%) (p < 0.05) and more significantly frequent in SLE patients compared to the healthy controls (19.6%). There was a significant correlation between MASI and SLEDAI scores (r = 0.250*, p = 0.048) and the total protein in 24 h (r = 0.289*, p = 0.031). In addition, there was an inverse significant correlation between MASEI and serum albumin (r = - 0.324*, p = 0.015). CONCLUSION: In SLE patients, enthesitis is frequently clinical and ultrasound-verified. The most impacted enthesis is at the insertion of the quadriceps tendon. Enthesitis presence and the rise in the MASI score can serve as indicators of the severity of the SLE disease. Key Points • The most impacted entheseal site lies at the insertion of the quadriceps tendon. • The presence and the rise in MASEI score can serve as indicators of the severity of the SLE disease.

Association of Left Atrial Deformation Analysis by Speckle Tracking Echocardiography With Left Atrial Appendage Thrombus in Patients With Primary Valvular Heart Disease.

BACKGROUND: This study aimed to investigate the correlation between the functional parameters of the left atrium (LA) derived from deformation imaging, two-dimensional (2D) speckle tracking echocardiography (STE), and tissue Doppler imaging (TDI) strain and strain rate (SR) and the function of the left atrial appendage (LAA) as measured by transesophageal echocardiography (TEE) in patients with primary valvular heart disease. METHODS: This cross-sectional research included 200 primary valvular heart disease cases, categorized into Group I (n = 74) with thrombus and Group II (n = 126) without thrombus. All patients were subjected to standard 12 lead electrocardiography, transthoracic echocardiography (TTE), strain and SR imaging of the LA by TDI and 2D speckle tracking, and TEE. RESULTS: At a cut-off value of <10.50%, peak atrial longitudinal strain (PALS) is a predictor of thrombus with an area under the curve (AUC) of 0.975 (95% CI: 0.957-0.993), sensitivity of 94.6%, specificity of 93.7%, positive predictive value (PPV) of 89.7%, negative predictive value (NPV) of 96.7%, and accuracy of 94%. At a cut-off value of <0.295 m/s, LAA emptying velocity is a predictor of thrombus with an AUC of 0.967 (95% CI: 0.944-0.989), sensitivity of 94.6%, specificity of 90.5%, PPV of 85.4%, NPV of 96.6%, and accuracy of 92%. The PALS (<10.50%) and LAA velocity (<0.295 m/s) are significant predictors of thrombus (P = 0.001, ß = 2.745, SE = 0.804, OR = 15.56, and 95% CI: 3.219-75.245; and P = 0.002, ß = 2.499, SE = 0.799, OR = 12.17, and 95% CI: 2.543-58.201, respectively). Peak systolic strain < 12.55% and SR < 1.065/s are insignificant predictors of thrombus (ß = 1.167, SE = 0.996, OR = 3.21, and 95% CI: 0.456-22.631; and ß = 1.443, SE = 0.929, OR = 4.23, and 95% CI: 0.685-26.141, respectively). CONCLUSIONS: Among LA deformation parameters derived from TTE, PALS is the best predictor of reduced LAA emptying velocity and LAA thrombus in primary valvular heart disease, regardless of the rhythm.

The relation between pericoronary fat thickness and density quantified by coronary computed tomography angiography with coronary artery disease severity.

OBJECTIVE: To study the correlation between epicardial fat thickness (EFT), pericoronary fat thickness (PCFT), and pericoronary fat density (PCFD) with the existence and severity of coronary artery disease (CAD). METHODS: This cross-sectional study included 210 patients referred for multislice CT angiography. Group I normal CTCA, Group II patients had non-obstructive atherosclerosis, and Group III patients had obstructive atherosclerosis. All patients underwent a clinical examination, history taking, and multislice CT angiography. RESULTS: The mean EFT was significantly greater in group III (10.43 ± 2.31 mm) compared to groups II (6.30 ± 1.61 mm) and I (5.06 ± 1.14 mm). The mean PCFT was significantly greater in group III (17.96 ± 2.89 mm) compared to group II (11.47 ± 2.51 mm) and group I (9.67 ± 1.99 mm). PCFD was significantly higher adjacent to the lesion (-80.47 ± 29.14) compared to the normal segment (-109.03 ± 35.24), higher in the obstructive group (-59.44 ± 20.10) compared to the non-obstructive group (-101.51 ± 20.23), but lower in calcified lesions (-89.58 ± 28.94) compared to non-calcified (-75.01 ± 29.20), and mixed lesions (-74.83 ± 26.90). EFT and PCFT cut-off values for predicting obstructive CAD were 8.3 and 12.4 mm, respectively, with 87.1% and 92.9% sensitivity and 92.9% and 86.4% specificity, respectively. CONCLUSION: There is a significant association between epicardial fat thickness, pericoronary fat thickness and density with the severity of coronary artery disease.

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion.

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P ≤ 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02). Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO.

The Interspace Between Popliteal Artery and Posterior Capsule of the Knee (IPACK) Block in Knee Arthroplasty: A Prospective Randomized Trial.

BACKGROUND: Optimal analgesia following knee surgery is essential for early mobilization and rehabilitation and minimizing morbidity. OBJECTIVES: We compared the addition of the interspace between the popliteal artery and the posterior capsule of the knee (IPACK) block to the adductor canal block (ACB) versus ACB alone on postoperative analgesia and ambulation ability in patients undergoing total knee arthroplasty (TKA). STUDY DESIGN: A prospective randomized study. SETTING: An academic medical center. METHODS: Eighty patients undergoing TKA were randomly allocated to receive either ACB or combined ACB-IPACK block at the end of surgery. ACB was performed using 20 mL bupivacaine 0.25% in both groups, while IPACK block using 30 mL bupivacaine 0.25% was added in the ACB-IPACK group only. Visual analog scale (VAS) was evaluated at rest and with 45° knee flexion at 4, 6, 12, and 24 hours postoperatively. The quadriceps muscle power and mobilization ability were assessed at 12 hours and 24 hours postoperative. Total 24 hour postoperative morphine consumption, time to first rescue analgesic request, and patient satisfaction were documented. RESULTS: The mean postoperative morphine consumption was higher in the ACB group (20.93 ± 7.17 mg) than the ACB-IPACK group (9.68 ± 3.56 mg) (P < 0.001, 95% CI; 8.71; 13.79). The time to 1st rescue analgesic consumption was longer in the ACB-IPACK group (645 ± 254 min) than ACB group (513 ± 247 min) (P = 0.021, 95% CI; 20.4; 243.6). At 4 hours, 6 hours, and 12 hours postoperative, the median postoperative VAS scores were higher in the ACB group than those of the ACB-IPACK group at rest (P = 0.003, 0.001 and 0.007) and on 45° knee flexion (P = 0.001, 0.001, 0.002) respectively. At 24 hours, the median VAS score was comparable between both groups both at rest and on 45° knee flexion (P = 0.358 & 0.054), respectively. The TUG test and the straight leg raise (MRC) scales at 12 hours, and 24 hours postoperative were comparable between both groups (P > 0.05). LIMITATIONS: This study was limited by its small sample size. CONCLUSION: The addition of IPACK to the ACB significantly reduced the postoperative morphine consumption and postoperative pain scores compared to the ACB alone without significant difference in mobilization ability in patients undergoing TKA.