Predictors of ischemic stroke in Chagas disease: Insights into mechanisms beyond cardiomyopathy severity.

BACKGROUND: Chagas disease is a risk factor for ischemic stroke, which causes high mortality rates and significant disability. This study aims to determine the incidence and risk factors for ischemic strokes in a large cohort of Chagas cardiomyopathy patients, with a particular focus on the mechanisms involved in the pathophysiology of stroke in this condition. METHODS: The study enrolled 517 patients with Chagas cardiomyopathy who were referred to our institution from March 2000 to December 2021. All patients underwent systematic cardiological and neurological assessments. The primary outcome was the occurrence of ischemic stroke during the follow-up period, classified based on the SSS-TOAST and CCS criteria. Natural cubic splines functions were applied to examine the potential nonlinear association between continuous variables and stroke risk. RESULTS: The mean age of the cohort was 52 ± 13 years, and 299 (58 %) were men. During a mean follow-up period of 4.8 years (interquartile range-IQR 1.1 to 7.1 years), a total of 72 patients (14.8 %) had an ischemic stroke, being fatal in 10. The overall incidence rate of ischemic stroke was 3.0/100 patient-years (95 % confidence interval 2.4 to 3.8). The stroke subtypes were cardioembolic (n = 41), undetermined (n = 11), and other subtypes (n = 20). The predictors of stroke were age, left atrial volume, left ventricular ejection fraction (LVEF), LV thrombus and prior stroke with thrombus. There was a nonlinear relationship between stroke risk, LVEF, and left atrial volume. A bimodal distribution of stroke occurrences was observed according to the severity of LV dysfunction, with a threshold for LVEF of 45 %. The final model for stroke risk prediction showed good discrimination, with a C statistic of 0.775. CONCLUSIONS: In a contemporary cohort of Chagas disease patients with a broad spectrum of disease severity, stroke incidence remains high despite anticoagulation. Stroke risk shows a nonlinear association with ventricular dysfunction and left atrial size, highlighting a distinct bimodal pattern of stroke occurrence in Chagas disease.

Predictive Validity of the Academy of Nutrition and Dietetics/American Society for Parental Nutrition Indicators to Diagnose Malnutrition and the Screening Tool for Risk on Nutritional Status and Growth among Hospitalized Children Relative to Medical Outcomes.

OBJECTIVE: To evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. STUDY DESIGN: A prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. RESULTS: Three hundred and forty-five children were enrolled in the cohort (n = 188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department visits and hospital readmissions, hospital length of stay (LOS), or health care resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more emergency department visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio 1.65, 95% CI: 1.09, 2.49, P = .018; high risk - incidence rate ratio 1.64, 95% CI: 1.05, 2.56, P = .028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, P = .023) for children at high risk compared with children at low risk after adjusting for patient characteristics. CONCLUSIONS: Malnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.

A Rare Case of Pulmonary Artery Trunk Aneurysm.

BACKGROUND: Pulmonary artery trunk aneurysm (PATA) is a rare and complex vascular anomaly characterized by the abnormal dilation of the initial portion of the pulmonary artery, posing significant diagnostic and therapeutic challenges. PURPOSE: This clinical case report aims to describe the follow-up of a patient with PATA, emphasizing the role of imaging in diagnosis and monitoring, as well as discussing potential associations with other conditions. RESEARCH DESIGN: The study is designed as a clinical case report, detailing the longitudinal follow-up of a single patient with PATA. STUDY SAMPLE: The subject of this study is a 48-year-old female patient with a history of idiopathic hypertension who developed a PATA. Data Collection and/or Analysis: Since 2010, the patient underwent various imaging exams, including echocardiography, computed tomography, and catheter angiography, to detect and evaluate the aneurysm at different stages. RESULTS: The imaging results indicated a progression of the aneurysm over time, underscoring the importance of imaging in the early identification and monitoring of PATA. The report also explores the possible association of PATA with conditions such as pulmonary hypertension, Behçet's disease, and Hughes-Stovin syndrome, highlighting the diagnostic complexity. CONCLUSIONS: Imaging diagnosis is crucial for the detection, characterization, and monitoring of PATA, providing essential information for selecting appropriate treatment options and achieving a satisfactory prognosis. An individualized treatment approach, considering both medical and surgical options, is necessary based on the clinical characteristics of each patient.

Validation of the R3-AFP model for risk prediction of HCC recurrence after liver transplantation in the SiLVER randomized clinical trial.

Explant-based models for assessing HCC recurrence after liver transplantation serve as the gold standard, guiding post-liver transplantation screening and immunosuppression adjustment. Incorporating alpha-fetoprotein (AFP) levels into these models, such as the novel R3-AFP score, has notably enhanced risk stratification. However, validation of these models in high-evidence data is mandatory. Therefore, the aim of the present research was to validate the R3-AFP score in a randomized clinical trial. We analyzed the intention-to-treat population from the 2-arm SiLVER trial (NCT00355862), comparing calcineurin-based ([calcineurin inhibitors]-Group A) versus mammalian target of rapamycin inhibitors-based (sirolimus-Group B) immunosuppression for post-liver transplantation HCC recurrence. Competing risk analysis estimated sub-hazard ratios, with testing of discriminant function and calibration. Overall, 508 patients from the intention-to-treat analysis were included (Group A, n = 256; Group B, n = 252). The R3-AFP score distribution was as follows: 42.6% low-risk (n = 216), 35.7% intermediate-risk (n = 181), 19.5% high-risk (n = 99), and 2.2% very-high-risk (n = 11) groups. The R3-AFP score effectively stratified HCC recurrence risk, with increasing risk for each stratum. Calibration of the R3-AFP model significantly outperformed other explant-based models (Milan, Up-to-7, and RETREAT), whereas discrimination power (0.75 [95% CI: 0.69; 0.81]) surpassed these models, except for the RETREAT model ( p = 0.49). Subgroup analysis showed lower discrimination power in the mammalian target of rapamycin group versus the calcineurin inhibitors group ( p = 0.048). In conclusion, the R3-AFP score accurately predicted HCC recurrence using high-quality evidence-based data, exhibiting reduced performance under mammalian target of rapamycin immunosuppression. This highlights the need for further research to evaluate surveillance schedules and adjuvant regimens.

Correlation between antihypertensive drugs and cerebral hemodynamic parameters: insights from observational findings using transcranial Doppler.

BACKGROUND: Antihypertensives (AHD) can influence cerebral autoregulation (CA) and attenuate hypertrophic concentric remodelling of arterioles. The aim of this study was to examine the associations between AHD, CA and structural and functional properties of cerebral arteries. METHODS: In this observational, cross-sectional study 115 volunteers were divided in group 1 (non-hypertensive) [n = 30]; group 2 (hypertensive with systolic blood pressure [SBP] < 140 and diastolic blood pressure [DBP] < 90 mmHg) [n = 54]; group 3 (hypertensive with SBP ≥ 140 or DBP ≥ 90 mmHg) [n = 31] and simultaneous measurements of systemic blood pressure (BP) and middle cerebral artery blood flow velocity (CBFV) were obtained from digital plethysmography and transcranial Doppler. Beat-to-beat, critical closing pressure (CrCP), resistance-area product (RAP) and autoregulation index (ARI) values were extracted by linear regression analysis of instantaneous BP and CBFV waveforms using computerised analysis. Pulsatility index (PI) was calculated and CO2 reactivity was assessed by the breath-holding test. RESULTS: Despite their higher RAP (1.7 [±0.7], p < 0.001) compared to groups 1 and 2, uncontrolled hypertensive using diuretics (p = 0.047) and α2-agonists (p = 0.009) had significantly lower PI. Impaired CO2 reactivity was common between the two hypertensive groups (p = 0.008), however ARI, CrCP and CBFV did not differ between them and non-hypertensive individuals and also did not correlate with any AHD used. CONCLUSIONS: Unlike the RAP, PI does not seem to reflect the real cerebrovascular resistence resulting from chronic arterial remodelling. Despite impaired CO2 reactivity, hypertensive have arterial tonus and CA comparable to non-hypertensive. Experimental studies involving an untreated hypertensive control group are required to robustly make definitive conclusions about these questions.

Using different anthropometric indices of obesity as predictors for type 2 diabetes mellitus in older adults.

BACKGROUND AND AIMS: There is some evidence that anthropometric measurements can be associated with the risk of type 2 diabetes mellitus (T2DM). Nevertheless, there is no comprehensive consensus on which anthropometric index is the best for evaluating the risk and predicting T2DM, especially in older adults. For this reason, we compared the performance of six indices for detecting T2DM in a population of Colombian older adults. METHODS AND RESULTS: We conducted a cross-sectional study of 3453 older adults (≥60 years old; 2023 women), analysing demographic characteristics, biochemical markers, and anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), adiposity index (VAI), conicity index (C-Index), and body roundness index (BRI). T2DM was defined as fasting plasma glucose ≥126 mg/dl (≥7.0 mmol/l). All the anthropometric indices correlated significantly with the presence of T2DM. An analysis of the receiver operating characteristic curve showed that for men the VAI (AUC = 0.71; moderate ES (0.78); OR = 4.13), BMI (AUC = 0.68; moderate ES (0.68); OR = 3.38), and WC (AUC = 0.68; moderate ES (0.68); OR = 3.38) are the best predictors for identifying T2DM. For women, however, the WC (AUC = 0.63; ES = 0.46; OR = 2.34) and C-Index (AUC = 0.63; ES = 0.46; OR = 2.34) were better indicators for predicting T2DM. Cut-off points for all the anthropometric indices were provided. CONCLUSIONS: In summary, the VAI, BMI, and WC in men, and WC and the C-Index in women have a moderate discriminating power for detecting T2DM in Colombian older adults, evidencing that these anthropometric indices are suitable screening tools for use in the elderly.

Comparison of Morphological and Functional MRI Assessments of Periprostatic Fat for Predicting Prostate Cancer Aggressiveness.

PURPOSE: The objective of this study was to evaluate whether morphological (linear measurements) and functional (ADC value) assessments of periprostatic fat can predict the aggressiveness of prostate cancer (PCa) over a 5-year follow-up period. MATERIAL AND METHODS: This retrospective study included patients with histologically proven PCa who underwent 3.0T MRI between July 2016 and June 2018. Clinical and demographic data collected included PSA, PSA density (dPSA), ISUP grade, clinical and pathological staging, and treatment details. MRI-derived parameters were assessed by an experienced radiologist, who measured subcutaneous and periprostatic fat thickness, and calculated ADC values from ROI plots in periprostatic fat. Clinical and MRI parameters were analyzed for associations with biochemical recurrence, systemic metastasis, and PCa-related mortality. RESULTS: After applying exclusion criteria, 109 patients were included. Using the Cox model, dPSA (p<0.01), systemic disease at diagnosis (p<0.01), and mean ADC (p<0.02) were independent predictors of overall survival (OS). For progression-free survival (PFS), only dPSA (p<0.01) and systemic disease at diagnosis (p<0.01) were significant predictors. In the Poisson Model for systemic recurrence risk, dPSA had a relative risk (RR) of 1.04 (95%CI 1.0-1.07, p=0.03), systemic disease at diagnosis had an RR of 63.3 (95%CI 3.7-86.4, p<0.01), and average ADC had an RR of 3.42 (95%CI 1.52-7.69, p<0.01). CONCLUSIONS: The ADC value of periprostatic fat may serve as an additional tool for PCa risk stratification, correlating with poorer outcomes such as systemic recurrence and overall survival. If validated by external, prospective, multicenter studies, these findings could impact future therapeutic decisions.

Case Report: Acute Additive Polyarthritis as a Presentation of Type 2 Lepromatous Reaction: The Role of Differential Diagnosis.

INTRODUCTION: Type 2 lepromatous reaction is a severe complication triggered by proinflammatory cytokines, it affects patients with lepromatous leprosy and border lepromatous leprosy. This reaction can occur before, during, or after treatment. CASE REPORT: We report a case of acute polyarthritis as type 2 lepromatous reaction debut. A 30-year-old male with a history of Hansen's disease 5 years ago received a complete therapeutic regimen with cure criteria. Consulted due to a 3-day history of arthralgia predominantly affecting the hands, knees, and feet. On the fifth day of hospitalization, the patient developed intensely painful, nodular erythematous lesions. The pathological history, clinical presentation, and the presence of polymorphonuclear cells led to the diagnosis of type 2 lepromatous reaction. CONCLUSION: Identifying individuals with risk factors or a history of leprosy, along with a high index of suspicion, positively impacts the early identification of leprosy reactions as an imitator of other causes of acute or chronic symmetrical polyarthritis.

Bone Erosions and Systemic Bone Loss on HR-pQCT in Men With Tophaceous Gout.

AIMS: Gout, a prevalent inflammatory arthropathy, predominantly affects males and arises from persistent hyperuricemia, resulting in monosodium urate crystal deposition. Hyperuricemia is associated with comorbidities, exacerbating patient morbidity. Conflicting literature exists regarding uric acid's impact on bone mineral density (BMD), with potential proinflammatory effects in gout patients. Localized bone destruction (erosions) is a hallmark of gout, necessitating early detection due to its predictive role in musculoskeletal disability. METHODS: This cross-sectional study included 26 tophaceous gout patients. Clinical and densitometric parameters were assessed, and high-resolution peripheral quantitative computed tomography (HR-pQCT) was used for bone microarchitecture evaluation, as well as bone erosions in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. A healthy control group of 52 age and BMI-matched individuals was included. RESULTS: Despite normal areal bone mineral density (BMD), tophaceous gout patients exhibited impaired HR-pQCT parameters, including lower cortical volumetric BMD (Ct.vBMD) and higher cortical porosity at the distal radius. Similar trends were observed at the tibia. Bone erosions were prevalent (96%), with distribution across MCP and PIP joints. Patients with ≥ 4 erosions displayed increased tophi prevalence and longer uricosuric use. Erosions correlated with compromised microarchitecture, emphasizing their association with disease activity. CONCLUSION: Despite normal BMD, tophaceous gout patients manifest systemic bone loss, with bone microarchitectural deterioration and localized bone erosions, underscoring the need for detailed clinical approaches to prevent musculoskeletal disabilities, including fragility fractures, in this population.

Systemic Inflammatory Indices as New Biomarkers for Hemodynamically Significant Ductus Arteriosus. / Índices Inflamatórios Sistêmicos como Novos Biomarcadores para Canal Arterial Hemodinamicamente Significativo.

BACKGROUND: Increased oxygen tension and decreased prostaglandin levels cause ductal closure. The diagnostic role of systemic inflammatory indices in hemodynamically significant ductus arteriosus (hsPDA) in premature infants is unknown. OBJECTIVES: We aimed to evaluate the role of systemic inflammatory indices in the predictivity of hsPDA. METHODS: Premature infants with gestational weeks (GW) of <32 weeks were evaluated retrospectively. Systemic inflammatory indices neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), pan-immune- inflammation value (PIV), and systemic inflammation response index (SIRI) were calculated. Systemic inflammatory indices were compared between hsPDA and non-hsPDA groups. A p <0.05 was considered as statistically significant. RESULTS: A total of 1228 patients were included in the study, including 447 patients in the hsPDA group and 781 patients in the non-hsPDA group. The PIV value [median (Q1 - Q3): 5.18 (2.38-10.42)] in the hsPDA group was statistically significantly higher than the PIV value [median (Q1 - Q3): 3.52 (1.41-6.45)] in the non-hsPDA group (p<0.001). According to the ROC analysis, the AUC value of PIV for the predictivity of hsPDA was 0.618, and the cutoff level was >8.66. After even multiple logistic regression analyses, PIV was shown to be a significant parameter for the diagnosis of hsPDA (OR 1.972, 95% CI 1.114-3.011. p=0.001). CONCLUSIONS: A high PIV value may be a quickly used indicator with low-cost, simple, and easily accessible for the early diagnosis of hsPDA.

Clinical predictor of volume hypoperfusion in patients treated with extended window mechanical thrombectomy: an external validation study.

INTRODUCTION: Treatment of ischemic stroke has expanded beyond the 6-hour window, but identification of eligible patients requires advanced imaging, which is often unavailable. This study aimed to validate a prediction model using the NIHSS score (a measure of stroke severity) to estimate hypoperfusion volume and determine eligibility for DEFUSE 3 treatment criteria. MATERIALS AND METHODS: Data from ischemic stroke patients with less than 24 hours' evolution were analyzed. A previously developed prediction rule based on the NIHSS score was used to estimate the volume of hypoperfused tissue with Tmax>6s, a marker for eligibility for the DEFUSE 3 treatment criteria. This estimated volume was compared with actual perfusion volumes obtained by magnetic resonance imaging or computed tomography with AI segmentation. Sensitivity, specificity and predictive values for determining DEFUSE 3 eligibility were calculated. RESULTS: Sixty-one patients were included (age: 71.9 ± 14.8 years, female: 60%, NIHSS: 16.5 ± 7.4 points). The prediction rule showed high accuracy in determining DEFUSE 3 eligibility with a sensitivity of 0.96, specificity of 0.93, positive predictive value of 0.98 and negative predictive value of 0.87. DISCUSSION: Estimating hypoperfusion volume directly from the NIHSS score using a simple prediction rule provides a reliable and readily available method for identifying patients potentially eligible for DEFUSE 3 treatment. Rapid and reliable estimation of hypoperfusion volume could improve access to advanced stroke care in settings with limited imaging resources.

Introducción: El tratamiento del accidente cerebrovascular isquémico se ha ampliado más allá de la ventana de 6 horas, pero la identificación de pacientes elegibles requiere imágenes avanzadas, que a menudo no están disponibles. Este estudio tuvo como objetivo validar un modelo de predicción utilizando la escala NIHSS (una medida de la gravedad del accidente cerebrovascular) para estimar el volumen de hipoperfusión y determinar la elegibilidad para los criterios de tratamiento DEFUSE 3. Materiales y métodos: Se analizaron datos de pacientes con accidente cerebrovascular isquémico con menos de 24 horas de evolución. Se utilizó una regla de predicción previamente desarrollada basada en la escala NIHSS para estimar el volumen de tejido hipoperfundido con Tmax>6s, un marcador de elegibilidad para los criterios de tratamiento DEFUSE 3. Este volumen estimado se comparó con los volúmenes de perfusión reales obtenidos por resonancia magnética o tomografía computarizada con segmentación de inteligencia artificial. Se calcularon la sensibilidad, especificidad y valores predictivos para determinar la elegibilidad de DEFUSE 3. Resultados: Se incluyeron 61 pacientes (edad: 71.9 ± 14.8 años, mujeres: 60%, NIHSS: 16.5 ± 7.4 puntos). La regla de predicción mostró una alta precisión en la determinación de la elegibilidad de DEFUSE 3 con una sensibilidad de 0.96, especificidad de 0.93, valor predictivo positivo de 0.98 y valor predictivo negativo de 0.87. Discusión: Estimar el volumen de hipoperfusión directamente a partir de la escala NIHSS utilizando una regla de predicción simple proporciona un método confiable y fácilmente disponible para identificar a los pacientes potencialmente elegibles para el tratamiento DEFUSE 3. La estimación rápida y confiable del volumen de hipoperfusión podría mejorar el acceso a la atención avanzada del accidente cerebrovascular en entornos con recursos de imágenes limitados.

Serum hCG levels in the prediction of molar pregnancy below 11 weeks of gestational age.

OBJECTIVE: The aim of this study was to evaluate the serum hCG level in the differential diagnosis between non-molar miscarriage and complete hydatidiform mole in<11 weeks gestation. METHODS: This was a retrospective collaborative cohort study. This study included women with gestational age<11 weeks, with ultrasound evidence of failed pregnancy and available serum hCG pre-uterine evacuation, divided into two groups: the non-molar miscarriage group and the complete hydatidiform mole group. Serum hCG levels were compared according to gestational age. Statistical analysis used a nonparametric test with a 5% significance level (p<0.05). RESULTS: In total, 416 patients were included, out of which 79 were included in the non-molar miscarriage group and 337 in the complete hydatidiform mole group. The calculated power of the sample was more than 80%. Data analysis showed that the 75th quartile of the median in the non-molar miscarriage group was always lower than the 25th quartile of the median in the complete hydatidiform mole group [9,721 mUI/mL/16,435 mUI/mL (6-7 weeks), 20,229 mUI/mL/64,911 mUI/mL (8-9 weeks), and 29,633 mUI/mL/126,278 mUI/mL (10-11 weeks), respectively; p<0.001]. CONCLUSION: Facing failed pregnancies, hCG>16,435 mUI/mL at 6-7 weeks, hCG>64,911 mUI/mL at 8-9 weeks, and hCG >126,278 mUI/mL at 10-11 weeks were most prevalent on complete hydatidiform mole diagnosis. On the contrary, hCG<30,000 mUI/mL at 10-11 weeks was most prevalent in non-molar miscarriage diagnosis.

Sphingolipid profiling as a biomarker of type 2 diabetes risk: evidence from the MIDUS and PREDIMED studies.

BACKGROUND: Type 2 diabetes (T2D) has become a worldwide pandemic. While ceramides may serve as intermediary between obesity-related lipotoxicity and T2D, the relationship with simple glycosphingolipids remains uncertain. The aim of this study was to characterize the associations between blood glycosphingolipid and ceramide species with T2D and to identify a circulating sphingolipid profile that could serve as novel biomarker for T2D risk. METHODS: Cross-sectional relationship between sphingolipid levels, insulin resistance, and T2D prevalence were evaluated in 2,072 American adults from MIDUS cohort. Prospectively, the association between sphingolipid species and the incidence of T2D was analyzed using a case-cohort design nested within the PREDIMED trial (250 cases and a random sample of 692 participants, with 3.8 years of median follow-up). Circulating levels of sphingolipid species in both populations were measured using LC/MS. Hazard ratios were estimated with weighted Cox regression models using Barlow weights. RESULTS: In American adults, only CER18:0 and CER22:0 were linked to insulin resistance and a higher prevalence of T2D. Conversely, three lactosylceramides (LCER 14:0, 16:0, and 24:1) showed a strong inverse relationship with both insulin resistance and T2D. These findings led to development of two sphingolipid scores. In the prospective analysis, these scores consistently predicted a reduced risk of T2D incidence in PREDIMED (HR: 0.64, 95% CI 0.44 to 0.94 and 0.58, 0.40 to 0.85 respectively) between extreme quartiles, with 5-year absolute risk differences of 9.6% (95% CI: 0.3-20.5%) and 11.4% (1.0-21.6%). They were validated in the same trial with samples obtained after 1 year of follow-up. CONCLUSIONS: Our findings support the potential usefulness of circulating sphingolipid profiles as novel biomarkers for T2D risk. Moreover, this study opens the door for future research on the predictive value and possible protective roles of lactosylceramides in T2D.

Diagnostic value of contrast-enhanced ultrasound combined with serum procalcitonin in tuberculous lymph nodes and metastatic lymph nodes.

OBJECTIVE: To investigate the value of Contrast-Enhanced Ultrasound (CEUS) combined with Procalcitonin (PCT) in differentiating Tuberculous Lymph Nodes (TLN) from Metastatic Lymph Nodes (MLN). METHODS: This prospective cohort study included 207 consecutive patients diagnosed with CTL. All patients underwent routine ultrasound and CEUS prior to pathology or laboratory confirmation. Serum indicators were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Predictive modeling was performed by multifactorial logistic regression. Evaluate the diagnostic and calibration performance of the predictive model by drawing Receiver Operating Characteristic (ROC) curves and calibration curves, and using Area Under the Curve (AUC) and Hosmer-Lemeshow (H-L) tests. RESULTS: The diagnosis of MLN was confirmed pathologically or laboratory in 102 of 207 patients (49.27 %), and 50.8 % were confirmed to be TLN. According to imaging findings of CEUS, TLN was more commonly associated with enhanced concentric performance in the arterial phase (67.65 % vs. 40.95 %) and heterogeneous enhancement pattern in lymph nodes (70.59 % vs. 52.38 %). Peak Intensity (PI) of lesions was higher in patients with MLN. Increased age-enhanced concentric performance in the arterial phase, increased PI, and serum PCT greater than 5.39 ng/mL were independent risk factors for MLN. The prediction model of serum PCT combined with CEUS had a higher diagnostic value for MLN. The H-L test indicated a satisfactory model fit (all p > 0.05), and the calibration curve closely approximates the ideal diagonal. CONCLUSION: CEUS combined with serum PCT has better clinical application value in the differential diagnosis of TLN and MLN.

The predictive ability of Controlling Nutritional Status score on in-hospital mortality in patients admitted to coronary care unit.

OBJECTIVE: Controlling Nutritional Status score was previously described and has been used in predicting short- and long-term outcomes in different patient populations. The aim of this study was to test the relationship between Controlling Nutritional Status score and in-hospital mortality in coronary care unit patients (MORCOR-TURK population). METHODS: In this multicenter and national study, all patients with an available Controlling Nutritional Status score were included in the analysis. The Controlling Nutritional Status score was calculated according to previously described criteria. To be able to understand the significance of the Controlling Nutritional Status score, we constructed two models. Model 1 included age, heart failure, chronic kidney disease, hypertension, diabetes mellitus, and coronary artery disease history. Model 2 included the Controlling Nutritional Status score and Model 1. We then statistically compared the performances of the two models. RESULTS: A total of 1,018 patients with known Controlling Nutritional Status scores were included in the analysis. Demographic characteristics are shown. In Model 1, the -2 log-likelihood ratio was 395.995, Nagelkerke R2 was 0.133, and area under the curve was 0.739 (95%CI 0.67-0.81). In the second model to which the Controlling Nutritional Status score is added (Model 2), the -2 log-likelihood ratio was 373.743, Nagelkerke R2 was 0.191, and area under the curve was 0.787 (95%CI 0.72-0.85). The area under the curve value of Model 2 was statistically higher than Model 1 (DeLong p-value: 0.01). A statistically significant correlation was found between death and Controlling Nutritional Status score in Model 2 [OR 1.347 (1.193-1.521), p<0.001]. CONCLUSIONS: Our study showed that the Controlling Nutritional Status score may be a significant predictor of in-hospital mortality in coronary care unit patients.

Predictive value of cardiac electrophysiological balance index for recurrent atrial fibrillation after ablation.

OBJECTIVE: This study aimed to evaluate the prognostic significance of the cardiac electrophysiological balance index in predicting the recurrence of atrial fibrillation following radiofrequency ablation. METHODS: Patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation were enrolled from July 2021 to March 2023 and categorized into recurrence and non-recurrence groups based on postoperative atrial fibrillation recurrence during a 6- to 12-month follow-up. Clinical and electrocardiogram data at admission were collected, and cardiac electrophysiological balance index was calculated. Multivariate logistic regression analysis identified independent factors contributing to atrial fibrillation recurrence. Receiver operating characteristic curves assessed predictive values. RESULTS: Among 127 subjects, 36 experienced postoperative recurrence (22 paroxysmal atrial fibrillation, 10 atrial flutter, and 4 atrial tachycardia). Significant differences in hypersensitive C-reactive protein levels, QT, QRS, and cardiac electrophysiological balance index were observed between recurrent and non-recurrent groups. Multivariate analysis revealed cardiac electrophysiological balance index as an independent risk factor for recurrence (OR 1.766, 95%CI 1.415-2.204, p<0.001). Receiver operating characteristic curve analysis showed cardiac electrophysiological balance index's predictive value with an area under the curve of 0.865 (95%CI 0.807-0.923, p<0.001), and a cutoff value of 4.3 demonstrated a sensitivity of 87.67% and a specificity of 71.23%. CONCLUSIONS: The cardiac electrophysiological balance index emerges as a non-invasive tool with substantial predictive value for estimating the likelihood of paroxysmal AF recurrence post-ablation.

Predictive efficacy of immature granulocytes in acute complicated appendicitis.

OBJECTIVE: Acute appendicitis is the most common cause of acute abdomen. It is important to differentiate between complicated and uncomplicated appendicitis before surgery in the emergency department. Recently, immature granulocytes have become one of the biomarkers used as predictors of inflammation. The aim of this study was to determine whether immature granulocyte levels are a biomarker that can predict whether acute appendicitis is complicated or not in patients admitted to the emergency department. METHODS: Patients aged 18 years and older who presented to the emergency department between May 1, 2023, and April 30, 2024, and were diagnosed with appendicitis were included in the study. Patients with a histopathologic diagnosis of acute appendicitis were divided into two groups: acute simple appendicitis (n=149) and acute complicated appendicitis (n=103). Demographic characteristics, imaging results, and laboratory results were recorded. RESULTS: White blood cell, neutrophil count and percentage, lymphocyte count and percentage, immature granulocyte count and percentage, direct bilirubin, C-reactive protein, and procalcitonin values were found to be significantly higher in the complicated appendicitis group than in the uncomplicated group (p-values; 0.001, <0.001, <0.001, <0.001, 0.001, <0.001, <0.001, <0.001, <0.001, 0.016, <0.001, and 0.001, respectively). The immature granulocyte percentage was 92% specific for the diagnosis of complicated appendicitis at a cut-off value of 0.6. CONCLUSION: The immature granulocyte percentage may be useful as a predictive biomarker in the diagnosis of complicated acute appendicitis with a specificity of 92%. Additionally, the immature granulocyte percentage has a higher discrimination power than the immature granulocyte count, C-reactive protein, and procalcitonin.

Predicting treatment responses using magnetic resonance imaging-based radiomics in hepatocellular carcinoma patients undergoing transarterial radioembolization.

OBJECTIVE: This study evaluates the efficacy of magnetic resonance imaging-based radiomics in predicting treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization. METHODS: Pre-treatment magnetic resonance imaging scans from 65 hepatocellular carcinoma patients were analyzed. Radiomic features were extracted from axial T1-weighted and T2-weighted sequences using a standardized workflow involving image preprocessing, segmentation, and feature extraction. Multivariate logistic regression models combining radiomic and clinical features were developed to predict treatment outcomes. The performance of the models was evaluated using the area under the curve metric. RESULTS: The study included 65 patients with a median age of 64 years; 44.6% showed a complete response, while 55.4% showed a non-complete response. The median radiomics score in the T1-weighted portal phase was -0.49 for non-complete responders and -0.07 for complete responders (p<0.001). In the T2-weighted sequence, the median radiomics score was -0.76 for non-complete responders and 1.1 for complete responders (p<0.001). Tumor size ≥5 cm was a significant predictor of non-complete response in univariate analysis (p=0.027) but not in multivariate analysis after adding radiomics scores. The area under the curve for the radiomics signature in predicting non-complete response was 0.754 for T1-weighted and 0.850 for T2-weighted sequences. CONCLUSION: Magnetic resonance imaging-based radiomics enhances the prediction of treatment responses in hepatocellular carcinoma patients undergoing transarterial radioembolization. Integrating radiomic features with clinical parameters significantly improves predictive accuracy.

Efficacy of Molecular Methods for the Diagnosis of Enteropathogenic Microorganisms Associated with Diarrhoea: A Systematic Review.

BACKGROUND AND AIMS: Diarrhoea has a significant health impact and requires accurate diagnostic approaches, despite the limitations of many existing methods. This review examines various molecular techniques aimed at facilitating the rapid diagnosis of diarrhoeal diseases caused by bacterial, viral and parasitic pathogens. METHODS: A comprehensive systematic literature review was conducted using six prestigious databases, including WOS, Scopus, Science Direct, Embase, PubMed and LILACS Plus. This rigorous approach allowed the synthesis of reviews on molecular diagnostic techniques for infectious diarrhoeal diseases. RESULTS: This research began with a careful systematic literature review of 2,760 scientific papers published in the last ten years (2014-2024), culminating in the inclusion of 18 studies following rigorous screening and eligibility criteria. In particular, multiplex polymerase chain reaction (PCR), isolation of genomic DNA from stool samples and the Luminex xTAG Gastrointestinal Pathogen Assay emerged as the predominant molecular methods. These techniques demonstrated remarkable consistency in sensitivity, specificity and rapid diagnostic capability, particularly in the context of acute infectious diarrhoeal diseases. They also demonstrated the ability to simultaneously detect and identify multiple pathogens, including bacteria, viruses and parasites. CONCLUSIONS: The use of multiplex real-time PCR assays has not only improved the detection rates of enteropathogens, but has also revealed previously unrecognised gaps in the diagnosis of infectious diarrhoea. Our study highlights the importance of using molecular methods for comprehensive diagnosis in terms of sensitivity, specificity and rapid diagnostic capability. This will provide healthcare professionals with timely and accurate diagnostic data, enabling more effective treatment strategies for this public health problem.

Early prediction of functional mobility severity after stroke: two key milestones.

BACKGROUND: The prognosis for functional recovery is crucial for discharge planning, optimizing healthcare resources and improving recovery chances. Prediction tools are key but must be usable from the beginning of rehabilitation and easy to use in clinical routine. Simple mobility milestones have shown predictive potential for stroke recovery. This study aims to identify the most efficient milestones for predicting the severity level of stroke patients' mobility at an early stage of recovery. METHODS: In this retrospective cohort study medical records from a private hospital were reviewed through convenience sampling. The data collected included the Standardized Five Questions, Functional Status Score for the Intensive Care Unit, Berg Balance Scale, and Modified Rankin Scale, all unified by the Complexity-Based Model for Categorizing Rehabilitation, establishing severity levels. To predict mobility severity levels at reevaluations, CHAID (Chi-Square Automatic Interaction Detector) decision tree analysis and exact logistic regression analysis were employed. This involved using conventional mobility milestones alongside the clinical and demographic characteristics of the patients. RESULTS: 50 patients met the criteria from admission (Evaluation 1: first week from stroke) to the first discharge point (Evaluation 2: second week from stroke). Only 25 patients remained for the second discharge point (Evaluation 3: fourth week from stroke). There were significant differences when comparing the functional assessments. The milestones "Sitting to standing" and "Sitting unsupported" were the most efficient predictors of future mobility complexity. CONCLUSIONS: "Sitting balance" and "Sitting unsupported" were the best predictors. These simple milestones are feasible to assess in daily clinical practice.