Hyperosmolar therapies for neurological deterioration in mild and moderate traumatic brain injury: towards new research.

The scoping review by Nicolò Marchesini and colleagues about the use of hyperosmolar therapies (HTs) in patients with traumatic brain injury (TBI) points out a significant gap in scientific literature regarding this topic. Although there are few high-quality recommendations, it is important to provide care under certain physiologic parameters. Through this letter we comment on the importance of guidelines to administer and monitor the use of HTs in the Neuro-ICU.

Pediatric kidney dimensions and risk of persistent albuminuria in Mexican adolescents.

In Mexico, chronic kidney disease of unknown origin is highly prevalent. Screening studies in adolescents have shown persistent microalbuminuria (pACR), adaptive podocytopathy and decreased kidney volume (KV). Here, we sought to develop normality tables of kidney dimensions by ultrasound in the Mexican state of Aguascalientes pediatric population (0 to 18y) and evaluate the relationship between the KV and pACR among the region's adolescents in a cross-sectional study. Kidney length (KL) and KV were determined by ultrasound. Our findings were compared with those in international literature of different populations where tables and graphs of normal kidney dimensions by ultrasound were reported. We compared organ dimensions in individuals above the age of 11 without albuminuria with those in patients with pACR recruited through screening studies in adolescents in Aguascalientes. This included 1068 individuals to construct percentile tables and graphs of the KL. Kidney dimensions were significantly lower when compared with all international comparisons. From a total 14,805 screen individuals, we compared 218 adolescents with pACR and 377 individuals without significant albuminuria. The Total KV adjusted to body surface (TKVBS) was significantly associated with pACR (odds ratio 1.03, 95% confidence interval 1.02-1.03). The upper quartile of TKVBS was highly associated with pACR (7.57, 4.13-13.87), hypertension (2.53, 1.66-3.86), and hyperfiltration (26 vs 11.5%). Thus, TKVBS is directly associated with pACR while greater KV, arterial hypertension, and hyperfiltration in patients with pACR suggest that the increase in volume is secondary to kidney hypertrophy. Additionally, the adaptative podocytopathy with low fibrosis seen on kidney biopsy which was performed in a subset of patients, and the smaller kidney dimensions in our population point to prenatal oligonephronia as the primary cause of the detected kidney disease.

Current management of atrial fibrillation in routine practice according to the last ESC guidelines: an EHRA physician survey-how are we dealing with controversial approaches?

AIMS: Although guidelines for the management of atrial fibrillation (AF) are regularly published, many controversial issues remain, limiting their implementation. We aim to describe current clinical practice among European Heart Rhythm Association (EHRA) community according to last guidelines. METHODS AND RESULTS: A 30 multiple-choice questionnaire covering the most controversial topics related to AF management was distributed through the EHRA Research Network, National Societies, and social media between January and February 2023. One hundred and eighty-one physicians responded the survey, 61% from university hospitals. Atrial fibrillation screening in high-risk patients is regularly performed by 57%. Only 42% has access to at least one programme aiming at diagnosing/managing comorbidities and lifestyle modifications, with marked heterogeneity between countries. Direct oral anticoagulants are the preferred antithrombotic (97%). Rhythm control is the preferred strategy in most AF phenotypes: symptomatic vs. asymptomatic paroxysmal AF (97% vs. 77%), low vs. high risk for recurrence persistent AF (90% vs. 72%), and permanent AF (20%). I-C drugs and amiodarone are preferred while dronedarone and sotalol barely used. Ablation is the first-line therapy for symptomatic paroxysmal AF (69%) and persistent AF with markers of atrial disease (57%) and is performed independently of symptoms by 15%. In persistent AF, 68% performs only pulmonary vein isolation and 32% also additional lesions. CONCLUSION: There is marked heterogeneity in AF management and limited accordance to last guidelines in the EHRA community. Most of the discrepancies are related to the main controversial issues, such as those related to AF screening, management of comorbidities, pharmacological treatment, and ablation strategy.

Relaciones afectivas y calidad de vida en el ámbito de las enfermedades raras: una revisión sistemática / Affective Relationships and Quality of Life in Rare Diseases: A Systematic Review

La calidad de vida en pacientes y cuidadores no puede ser concebida sin incluir a las necesidades sociales. El objetivo de esta investigación es realizar una revisión sistemática que muestre evidencias empíricas de cómo influyen las relaciones afectivas en la calidad de vida de pacientes con enfermedades raras y sus cuidadores. Se realizó una búsqueda en las bases de datos Web of Science, Scopus y PsycInfo. Se encontraron 4923 artículos que tras el proceso de cribado quedaron reducidos a 12 estudios. Se hallaron efectos de las relaciones afectivas tanto el núcleo familiar como en sus componentes de forma independiente (padres, hermanos y pacientes). Se evidencia que tanto el ámbito familiar como extrafamiliar son esenciales para abordar una mejora de la calidad de vida. Se recomienda en futuras investigaciones el estudio de las interacciones entre las relaciones establecidas para poder ofrecer una mejor intervención . (AU)

Quality of life in patients and caregivers cannot be conceived without including social needs. The aim of this research is to conduct a systematic review showing empirical evidence of how affective relationships influence the quality of life of patients with rare diseases and their caregivers. A search was conducted in the Web of Science, Scopus and PsycInfo databases. A total of 4923 articles were found, which after the screening process were reduced to 12 studies. The effects of affective relationships were found both in the family nucleus and in its components independently (parents, siblings and patients). It is evident that both the family and the extra-familial environment are essential to improve quality of life. It is recommended that future research should study the interactions between the established relationships to offer a better intervention. (AU)

Relaciones afectivas y calidad de vida en el ámbito de las enfermedades raras: una revisión sistemática / Affective Relationships and Quality of Life in Rare Diseases: A Systematic Review

La calidad de vida en pacientes y cuidadores no puede ser concebida sin incluir a las necesidades sociales. El objetivo de esta investigación es realizar una revisión sistemática que muestre evidencias empíricas de cómo influyen las relaciones afectivas en la calidad de vida de pacientes con enfermedades raras y sus cuidadores. Se realizó una búsqueda en las bases de datos Web of Science, Scopus y PsycInfo. Se encontraron 4923 artículos que tras el proceso de cribado quedaron reducidos a 12 estudios. Se hallaron efectos de las relaciones afectivas tanto el núcleo familiar como en sus componentes de forma independiente (padres, hermanos y pacientes). Se evidencia que tanto el ámbito familiar como extrafamiliar son esenciales para abordar una mejora de la calidad de vida. Se recomienda en futuras investigaciones el estudio de las interacciones entre las relaciones establecidas para poder ofrecer una mejor intervención . (AU)

Quality of life in patients and caregivers cannot be conceived without including social needs. The aim of this research is to conduct a systematic review showing empirical evidence of how affective relationships influence the quality of life of patients with rare diseases and their caregivers. A search was conducted in the Web of Science, Scopus and PsycInfo databases. A total of 4923 articles were found, which after the screening process were reduced to 12 studies. The effects of affective relationships were found both in the family nucleus and in its components independently (parents, siblings and patients). It is evident that both the family and the extra-familial environment are essential to improve quality of life. It is recommended that future research should study the interactions between the established relationships to offer a better intervention. (AU)

Complete genome sequences of cluster F1 and cluster B1 Mycobacterium smegmatis phages Karhdo and Basato.

We present the complete genome sequences of Mycobacterium smegmatis phages Karhdo and Basato, isolated in Clark County, Nevada. The phages were isolated and annotated by students enrolled in undergraduate research courses over two semesters at the University of Nevada, Las Vegas.

Biofilm Formation by Escherichia coli Isolated from Urinary Tract Infections from Aguascalientes, Mexico.

Uropathogenic Escherichia coli (UPEC) strains are among the leading causes of urinary tract infections (UTIs) worldwide. They can colonize the urinary tract and form biofilms that allow bacteria to survive and persist, causing relapses of infections and life-threatening sequelae. Here, we analyzed biofilm production, antimicrobial susceptibility, virulence factors, and phylogenetic groups in 74 E. coli isolated from diagnosed patients with UTIs to describe their microbiological features and ascertain their relationship with biofilm capabilities. High levels of ceftazidime resistance are present in hospital-acquired UTIs. Isolates of multidrug resistance strains (p = 0.0017) and the yfcV gene (p = 0.0193) were higher in male patients. All the strains tested were able to form biofilms. Significant differences were found among higher optical densities (ODs) and antibiotic resistance to cefazolin (p = 0.0395), ceftazidime (p = 0.0302), and cefepime (p = 0.0420). Overall, the presence of fimH and papC coincided with strong biofilm formation by UPEC. Type 1 fimbriae (p = 0.0349), curli (p = 0.0477), and cellulose (p = 0.0253) production was significantly higher among strong biofilm formation. Our results indicated that high antibiotic resistance may be related to male infections as well as strong and moderate biofilm production. The ability of E. coli strains to produce biofilm is important for controlling urinary tract infections.

The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes.

Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.

Patrones de presión arterial de 24 horas en pacientes con insuficiencia cardiaca estable. Prevalencia y factores asociados / Twenty-four hour ambulatory blood pressure monitoring in patients with stable heart failure. Prevalence and associated factors

Introducción y objetivos: La hipertensión arterial (HTA) está muy presente en la insuficiencia cardiaca (IC). Sin embargo, su prevalencia, su variación circadiana y la relación con los fenotipos de IC es poco conocida. Nuestro objetivo es describir esta prevalencia y sus patrones en la IC.Métodos: Estudio observacional y transversal sobre la IC crónica estable optimizada. Se obtuvo la presión arterial (PA) en consulta y monitorización ambulatoria durante 24 h. Se estimó la prevalencia de HTA, sus patrones diurnos (controlada, no controlada, de bata blanca y enmascarada) y nocturnos (dipper, nondipper y reverse dipper). Se analizaron factores asociados con patrones y fenotipos de IC.Resultados: Entre 2017 y 2021, se incluyó a 266 pacientes con una media de edad de 72±12 años; el 67% eran varones y el 46% tenían IC con FEVI reducida. El 83% tenía HTA: el 68% controlada, el 10% no controlada, el 10% de bata blanca y el 11% enmascarada. El 51% de los pacientes con PA elevada en consulta resultaron en HTA de bata blanca. El 14% de los pacientes con PA normal en consulta tenían HTA enmascarada. Las prevalencias de dipper, nondipper y reverse dipper fueron del 31, el 43 y el 26% respectivamente. La PA sistólica fue menor en la IC con FEVI reducida que en la IC con FEVI conservada (p <0,001).Conclusiones: La monitorización ambulatoria de la PA en IC identificó HTA de bata blanca en más de la mitad de los pacientes con PA elevada en consulta y un porcentaje relevante de HTA enmascarada. La distribución de patrones diurnos fue similar a la de la población sin IC descrita. Sin embargo, la mayoría tuvo un patrón nocturno patológico.(AU)

Introduction and objectives: Hypertension is highly common in heart failure (HF). However, there is limited information on its prevalence, circadian variation, and relationship with the various HF phenotypes. The objective of this study was to describe the prevalence of hypertension and its patterns in HF.Methods: This was a cross-sectional observational study of patients with optimized stable chronic HF. The patients underwent blood pressure (BP) measurement in the office and 24-hour ambulatory monitoring. We estimated the prevalence of hypertension, and its diurnal (controlled, uncontrolled, white coat, and masked) and nocturnal (dipper, nondipper, and reverse dipper) patterns. We also analyzed the factors associated with the different patterns and HF phenotypes.Results: From 2017 to 2021, 266 patients were included in the study (mean age, 72±12 years, 67% male, 46% with reduced ejection fraction). Hypertension was present in 83%: controlled in 68%, uncontrolled in 10%, white coat in 10%, and masked in 11%. Among patients with high office BP, 51% had white coat hypertension. Among those with normal office BP, 14% had masked hypertension. The prevalence of dipper, nondipper, and reverse dipper patterns was 31%, 43%, and 26%, respectively. Systolic BP was lower in HF with reduced ejection fraction than in HF with preserved ejection fraction (P <.001).Conclusions: Ambulatory BP monitoring in HF identified white coat hypertension in more than half of patients with high office BP and masked hypertension in a relevant percentage of patients. The distribution of daytime patterns was similar to that of the population without HF in the literature, but most of the study patients had a pathological nocturnal pattern.(AU)

Reirradiation salvage radiotherapy for recurrent prostate cancer after primary low-dose brachytherapy.

PURPOSE: Local recurrence of prostate cancer after low-dose rate brachytherapy is a clinical problem with limited salvage treatment options. This prospective study evaluated the tolerability and outcome of salvage external beam radiation therapy (S-EBRT) for locally recurrent prostate cancer after primary low-dose rate prostate brachytherapy (LDR-BT). MATERIALS AND METHODS: Between October 2012 and 2022, 18 patients with biopsy-proven locally recurrent prostate cancer after primary LDR-BT and received S-EBRT. We evaluated biochemical failure (BF), overall survival (OS) and acute/late gastrointestinal and urinary toxicities (CTCAE v5.0 or CTCAE v4, only before 2017). RESULTS: Median follow-up was 32 months (range, 5-124). The median age was at S-EBRT 68 years (range 59-79). 34% (6/18) were low risk, 44% (8/18) intermediate risk, 5% (1/18) high risk, and 17% (3/18) not specified. All patients were treated with IMRT/VMAT and received 60 Gy (2.5 Gy/fraction) to the prostate and 40% (7/18) 55.2 Gy (2,3 Gy/fx) to the seminal vesicles. 56% received ADT The 3-year OS and biochemical relapse-free survival after S-EBRT were 100% and 89%, respectively, with a median PSA nadir 0,035 ng/mL (0,01-0,34). Acute cystitis was present in 72% (13/18) of patients (27% of Grade > 2). Urethritis was present in 78% (14/18) patients (16% of cases Grade > 3), and acute rectitis occurred in 22% (4/18) of patients (no cases Grade > 3). CONCLUSIONS: Our data suggest that the treatment of locally recurrent prostate cancer with S-EBRT could provide adequate disease control safely and be used as an additional treatment in the natural history of prostate cancer patients. However, the results are still early and the sample is small; larger studies with longer follow-up would be mandatory.

Influence of body mass index on recurrence of atrial fibrillation after electrical cardioversion.

BACKGROUND: Several studies have shown an independent relationship between body mass index (BMI) and the incidence of atrial fibrillation (AF). However, little is known about the influence of BMI on AF recurrence after electrical cardioversion (ECV). METHODS: We selected 1121 patients who reverted to sinus rhythm after scheduled ECV and were included in three prospective Spanish registries of ECV in persistent AF. The patients were classified according to baseline BMI into three categories (normal weight, overweight, obesity). We assessed the influence of BMI on the rate of AF recurrence at 3 months. RESULTS: We identified 538 patients (48%) who had AF recurrence in the first 3 months after successful ECV. The patients who suffered AF recurrence had a higher BMI than those who remained in sinus rhythm (29.66±4.57 vs. 28.87±4.64 Kg/m2, respectively; p = 0.004). We observed a higher incidence of AF recurrence in the overweight and obese patients (BMI ≥25 kg/m2) than in those classified as normal weight (50.5% vs. 35.6%, respectively; p<0,001). BMI≥25 Kg/m2 was shown to be independently related to of AF recurrence in the multivariate analysis (OR = 1.75, 95% confidence interval = 1.20-2.58; p = 0.004). CONCLUSIONS: Increased BMI is independently related to AF recurrence after ECV. BMI should also be taken into account when making decisions about the indication for ECV in persistent AF.

Dynamics of High-Density Unipolar Epicardial Electrograms During PFA.

BACKGROUND: Pulsed field ablation (PFA) is a novel nonthermal cardiac ablation technology based on irreversible electroporation (IRE). While areas of IRE lead to durable lesions, the surrounding regions, where reversible electroporation occurs, recover. The behavior of local electrograms in areas of different electroporation levels remains unknown. The goal of this study is to characterize electrogram dynamics after PFA in IRE and reversible electroporation areas. METHODS: A total of 6 domestic swine were used. PFA was applied in the epicardium of the right and left ventricles using a focal monopolar catheter. Additional radiofrequency ablations were performed. Epicardial unipolar electrograms were acquired at baseline and for 60 minutes post PFA/radiofrequency ablation using a high-density electrode matrix attached to the epicardium. Electrogram dynamics were analyzed in areas corresponding to different levels of electroporation. Acute lesion formation was assessed after 3 to 5 hours by triphenyl tetrazolium chloride staining. RESULTS: Electrogram analysis demonstrated a clear association between electrogram changes and the level of electroporation. Immediately after PFA, electrograms displayed the following: a significant decrease in R/S-wave amplitude; a large elevation of the ST-segment; and a large decrease in their |(dV/dt)|max. Marked changes in electrograms were observed beyond the lesion area. Thereafter, a gradual recovery was observed. The evolution of all the electrogram parameters throughout the 60 minutes after PFA was significantly different (P<0.05) between the IRE and reversible electroporation areas. Acute lesion staining showed significantly larger depth for PFA lesions compared with radiofrequency ablation. CONCLUSIONS: This study shows that unipolar electrograms can differentiate between reversible electroporation and IRE areas during the first 30 minutes post ablation. Differences after the first 30 minutes are less evident. Our findings could result useful for immediate lesion assessment after PFA and warrant further investigation.

Sustainable universities: The LGBTQIAP+ inclusive model.

The construction of a model with strategies target at the LGBTQIAP+ was performed aiming at integration of gender and sexuality conceptions in universities to promote sustainable development. We used a multicriteria analysis to identify indicators and create an evaluation model (decision tool) for sustainable universities. The decision tree includes validation through literature review of 127 publications, secondary data, LGBTQIAP+ pro-inclusion practices of international universities, and the analysis of experts around sustainable development in universities through questionnaires. The result was the development of a validated model of social and sustainable inclusion to be applied by universities in: education, research, and management.

Cognition in older adults with healthy aging: analysis of the Mexican Health and Aging Study 2012-2015.

Introduction: Maintaining older adults' health and well-being can be achieved through the optimization of physical and mental health, while preserving independence, social participation, and quality of life. Cognitive change has been described as a normal process of aging and it involves domains such as processing speed, attention, memory, language, visuospatial abilities, and executive functioning, among others. Objective: To describe cognitive changes in older adults with healthy aging. Methods: This is a study that involved data from 14,893 and 14,154 individuals aged >60 years or older from the 2012 and 2015 waves, respectively, who participated in the Mexican Health and Aging Study (MHAS). Participants with healthy aging were identified and described in the MHAS-2012 wave and followed to 2015. Eight cognitive domains evaluated in the Cross-Cultural Cognitive Evaluation (CCCE,) as well as sociodemographic and health characteristics, were described. Criteria for healthy aging involved the following: CCCE ≥ -1.5 standard deviations above the mean on reference norms, independence on basic and instrumental activities of daily living, self-reported "life close to ideal," and preserved functional and social performance. Results: From a total of n = 9,160 older adults from the MHAS-2012 wave, n = 1,080 (11.8%) had healthy aging. In the healthy aging group, the median age was 67 years (IQR: 63-73), 58.1% were female and the median for education was 6 (IQR: 3-8) years. The mean CCCE score was 57 (SD: 16.9) points. In the MHAS-2012 cross-sectional analysis, except for orientation, visuospatial abilities, and verbal fluency, all cognitive domain scores were lower with passing age. When comparing cognitive domain scores in the 225 older adults identified with healthy aging between the 2012 and 2015 MHAS waves, there were almost no observable differences. Conclusion: In the cross-sectional analysis, Mexican adults with healthy aging had lower scores in the verbal learning memory, visual scanning, numeracy, visual memory, and verbal recall domains', as well as lower global cognitive scores in the higher age groups. There were no cognitive changes in the 3 year follow-up, except for a lower gradient of scores in the verbal recall memory domain. Longer prospective studies are needed to characterize greater cognitive changes.

Occupational radiation exposure of electrophysiology staff with reproductive potential and during pregnancy: an EHRA survey.

AIMS: Electrophysiology (EP) is a growing field in cardiology, with an increasing involvement of young people. Nevertheless, concerns about radiation exposure and its impact on reproduction and pregnancy may discourage the choice of an EP career. The study is aimed at investigating the level of awareness and main sources of concern about the effects of radiation on reproductive potential and pregnancy, exploring the safety measures adopted in different EP labs, and verifying the adherence to the current guidelines. METHODS AND RESULTS: An online survey was conducted using the European Heart Rhythm Association (EHRA) infrastructure from April to June 2022. A total of 252 EP personnel (42% women) participated, from 50 countries and different professional roles. Most participants expressed concerns regarding the effects of radiation on reproductive capacity (67.1%) and offspring diseases (68.2%). Only 37.9% of participants were aware of the EHRA 2017 consensus document about occupational radiation exposure. Most participants (80.9%) considered that occupational radiation during pregnancy is not safe. EP female staff were not allowed to work in the EP lab during pregnancy in 48.1% of cases. Zero-fluoroscopy was the preferred choice to continue working in the EP lab during pregnancy. CONCLUSION: EP staff, including both men and women, have concerns about the effects of radiation on reproductive capacity. Despite the recommendations issued by international bodies, implementation of the policies regarding pregnancy and occupational radiation exposure is heterogeneous. Zero-fluoroscopy is the preferred approach to ensure safety during pregnancy in the EP lab.

Effects of Fabaceae and Poaceae Pollen Accessibility and Traits on the Pollinivory of Adult Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae).

Pollen is a food source for adult Chrysoperla externa (Hagen), whose larvae are biocontrol agents against pests. However, adults may face challenges in foraging for pollen due to differences in pollen accessibility and variability in pollen morphology and chemistry. In the laboratory, we investigated the ability of adult C. externa to consume pollen from flowers of Cajanus cajan, Canavalia ensiformis, Crotalaria juncea, Flemingia macrophylla, Avena strigosa, Pennisetum glaucum, Sorghum bicolor, and Zea mays, and we explored whether adults chose any of these pollens based on their quantitative and qualitative features. Cajanus cajan and F. macrophylla pollen were the only ones not consumed by adults when confined to flowers. Pollen removed from the preanthesis buds was offered simultaneously for 24 and 48 h. In both periods, adults consumed more of the medium-sized P. glaucum (with the second largest exine thickness) and large-sized Z. mays (with the thinnest exine) pollen, even though they had significantly less crude protein than Fabaceae pollen, whose sizes varied from medium (C. juncea, with the thickest exine) to large (C. ensiformis, whose exine thickness was equal to that of P. glaucum). Overall, adults consumed more Poaceae pollen than Fabaceae pollen, but the palynological features and the protein contents did not affect this choice. Our results highlighted that C. juncea, P. glaucum, S. bicolor and Z. mays are good pollen sources for adult C. externa and should be considered promising candidates in the selection of insectary plants to deploy in biocontrol programs aimed at the conservation of this lacewing.

Application of IPSET-thrombosis in 1366 Patients Prospectively Followed From the Spanish Registry of Essential Thrombocythemia.

The International Prognostic Score of thrombosis in Essential Thrombocythemia (IPSET-thrombosis) and its revised version have been proposed to guide thrombosis prevention strategies. We evaluated both classifications to prognosticate thrombosis in 1366 contemporary essential thrombocythemia (ET) patients prospectively followed from the Spanish Registry of ET. The cumulative incidence of thrombosis at 10 years, taking death as a competing risk, was 11.4%. The risk of thrombosis was significantly higher in the high-risk IPSET-thrombosis and high-risk revised IPSET-thrombosis, but no differences were observed among the lower risk categories. Patients allocated in high-risk IPSET-thrombosis (subdistribution hazard ratios [SHR], 3.7 [95% confidence interval, CI, 1.6-8.7]) and high-risk revised IPSET-thrombosis (SHR, 3.2 [95% CI, 1.4-7.45]) showed an increased risk of arterial thrombosis, whereas both scoring systems failed to predict venous thrombosis. The incidence rate of thrombosis in intermediate risk revised IPSET-thrombosis (aged >60 years, JAK2-negative, and no history of thrombosis) was very low regardless of the treatment administered (0.9% and 0% per year with and without cytoreduction, respectively). Dynamic application of the revised IPSET-thrombosis showed a low rate of thrombosis when patients without history of prior thrombosis switched to a higher risk category after reaching 60 years of age. In conclusion, IPSET-thrombosis scores are useful for identifying patients at high risk of arterial thrombosis, whereas they fail to predict venous thrombosis. Controlled studies are needed to determine the appropriate treatment of ET patients assigned to the non-high-risk categories.