Flow diverters (FDs) have dramatically altered the treatment of intracranial aneurysms. Several literature studies have demonstrated the safety and effectiveness of individual devices. However, in clinical practice, different FDs are used, for different aneurysms, ruptured and unruptured.
Aim of Study
To assess the safety, long term angiographic and clinical outcomes in a real-world scenario.
Methods
We retrospectively analyzed data from all consecutive patients with intracranial aneurysms treated with FDs at our tertiary center between January 2010 and December 2019. Clinical presentations, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with long-term follow-up. Logistic regression analysis was performed to evaluate for possible variables associated with aneurysm occlusion, and early ischemic stroke after FD.
Results
A total 169 patients with 202 aneurysms were included. Seventeen aneurysms (8.4%) were ruptured. Technical success was achieved in 97.5% of cases. Aneurysm occlusion rates were 52.0% (64/123), 70.4% (88/125), and 81.5% (101/124) at 6 ,12 and 24-month follow-up, respectively. Intraprocedural complications occurred in 4.7% of patients, and postprocedural complications in 20.1%. The most frequent complication was ischemic stroke (14.9%), which was independently associated with older age and higher number of devices used.
Conclusion
Our series suggests that treatment with FD is feasible in a wide spectrum of cases, including aneurysms in different locations, sizes and morphology, ruptured and non-ruptured, reflecting a real-world scenario. Although available devices may differ, they seem to demonstrate comparable and adequate safety and effectiveness.
To characterize quantitative optical coherence tomography angiography (OCT-A) parameters in active neovascular age-related macular degeneration (nAMD) patients under treatment and remission nAMD patients.Retrospective, cross-sectional study.One hundred and four patients of whom 72 were in Group 1 (active nAMD) and 32 in Group 2 (remission nAMD) based on SD-OCT (Spectral Domain OCT) qualitative morphology.This study was conducted at the Centre Ophtalmologique de l'Odeon between June 2016 and December 2017. Eyes were analyzed using SD-OCT and high-speed (100 000 A-scans/second) 1050-nm wavelength swept-source OCT-A. Speckle noise removal and choroidal neovascularization (CNV) blood flow delineation were automatically performed. Quantitative parameters analyzed included blood flow area (Area), vessel density, fractal dimension (FD) and lacunarity. OCT-A image algorithms and graphical user interfaces were built as a unified tool in Matlab coding language. Generalized Additive Models were used to study the association between OCT-A parameters and nAMD remission on structural OCT. The models' performance was assessed by the Akaike Information Criterion (AIC), Brier Score and by the area under the receiver operating characteristic curve (AUC). A p value of ≤ 0.05 was considered as statistically significant.Area, vessel density and FD were different (p<0.001) in the two groups. Regarding the association with CNV activity, Area alone had the highest AUC (AUC = 0.85; 95%CI: 0.77-0.93) followed by FD (AUC = 0.80; 95%CI: 0.71-0.88). Again, Area obtained the best values followed by FD in the AIC and Brier Score evaluations. The multivariate model that included both these variables attained the best performance considering all assessment criteria.Blood flow characteristics on OCT-A may be associated with exudative signs on structural OCT. In the future, analyses of OCT-A quantitative parameters could potentially help evaluate CNV activity status and to develop personalized treatment and follow-up cycles.
Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. To identify baseline characteristics that might influence echocardiographic response to CRT. We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%). At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. From a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response. ClinicalTrials.gov identifier: NCT02413151. A terapêutica de ressincronização cardíaca (CRT) modificou o prognóstico da insuficiência cardíaca (HF) com disfunção ventricular esquerda. Contudo, 30% dos doentes não são respondedores. A grande questão está em identificar preditores de resposta. Identificar características basais que podem influenciar a resposta ecocardiográfica à CRT. Estudo cohort prospetivo, unicêntrico, hospitalar, de doentes consecutivos com HF selecionados para CRT (classes II-IV NYHA, fração de ejeção ventricular esquerda <35% e QRS≥120 mseg). Os respondedores foram definidos por aumento absoluto de fração de ejeção ventricular esquerda ≥5% aos 6 meses. Antes da implantação do ressincronizador, foram avaliados parâmetros clínicos, eletrocardiográficos, laboratoriais, ecocardiográficos, autonómicos, endoteliais e funcionais cardiorrespiratórios. Utilizaram-se modelos de regressão logística. Incluíram-se 79 doentes, 54 masculinos (68,4%), idade 68,1 (SD=10,2) anos, 19 isquémicos (24%). Aos 6 meses, consideraram-se respondedores 51 doentes (64,6%). Apesar de, por análise univariável, a excursão sistólica do plano do anel tricúspide (TAPSE) e a creatinina sérica serem significativamente diferentes nos respondedores, em análise multivariável, apenas TAPSE foi independentemente associada a resposta, sendo valores superiores preditivos de resposta positiva à CRT (OR=1,13; 95% CI: 1,02-1,26; p=0,020). A TAPSE≥15 mm teve forte associação com resposta, enquanto TAPSE<15 mm a não resposta (p=0,005). Respondedores não tiveram valores de TAPSE inferiores a 10 mm. De um conjunto de características basais clínicas e técnicas, a análise multivariável apenas identificou TAPSE como preditor independente de resposta a CRT, associando TAPSE<15 mm a não resposta. Este estudo destaca a importância da disfunção ventricular direita na resposta à CRT. ClinicalTrials.gov identifier: NCT02413151.
OBJECTIVE Clinical outcome in nontraumatic subarachnoid hemorrhage (SAH) is multifactorial and difficult to predict. Diffusion tensor imaging (DTI) findings are a prognostic marker in some diseases such as traumatic brain injury. The authors hypothesized that DTI parameters measured in the subacute phase of SAH can be associated with a poor clinical outcome. METHODS Diffusion tensor imaging was prospectively performed in 54 patients at 8–10 days after nontraumatic SAH. Logistic regression analysis was performed to evaluate the association of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values with a poor clinical outcome (modified Rankin Scale score ≥ 3) at 3 months. RESULTS At 8–10 days post-SAH, after adjusting for other variables associated with a poor outcome, an increased ADC at the frontal centrum semiovale was associated with a poor prognosis (OR estimate 1.29, 95% CI 1.04–1.60, p = 0.020). Moreover, an increase of 0.1 in the FA value at the corpus callosum at 8–10 days after SAH corresponded to 66% lower odds of having a poor outcome (p = 0.002). CONCLUSIONS Decreased FA and increased ADC values in specific brain regions were independently associated with a poor clinical outcome after SAH. This preliminary exploratory study supports a potential role for DTI in predicting the outcome of SAH.
Newborn mortality and adverse birth outcomes (ABOs) in Sao Tome & Príncipe (STP) are overwhelmingly high, and access to quality-antenatal care (ANC) is one of the strategies to tackle it. This study aimed to fill the gaps in ANC screenings with a focus on how to improve neonatal outcomes. We conducted a retrospective hospital-based study in which ANC pregnancy cards were reviewed. Screenings were described and compared according to the total number of ANC contacts: 1-3 (inadequate), 4-7 (adequate), and ≥8 (complete). The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Statistical significance was considered at a p-value ≤0.05. A total of 511 ANC pregnancy cards were reviewed. Mothers' mean age was 26.6 (SD = 7.1), 51.7% had a first trimester early booking, 14.9% (76) had 1-3 ANC contacts, 46.4% (237) had 4-7 and 38.7% (198) ≥8. Screening absence was found in 24%-41%, lack of money was registered in 36%. Pregnant women had no screening performed for HIV in 4.5%, syphilis in 8.8%, HBV 39.3%, malaria 25.8%, hemoglobin 24.5%, blood glucose 45.4%, urine 29.7%, stool exams 27.8% and 41.1% had no ultrasound. Screening completion for blood group, HIV, malaria, urine, hemoglobin, and coproparasitological exam were found to have a statistically significant difference (p<0.001) for the complete ANC group when compared to other groups. Antenatal problems identified were: 1) bacteriuria (43.2%); 2) maternal anemia (37%); 3) intestinal parasitic infections (59.2%); 4) sickle cell solubility test positive (13%); and 5) a RhD-negative phenotype (5.8%). Missed-ANC treatments were up to 50%. This study reveals a coverage-quality gap in STP since no pregnant woman is left without ANC contact, although most still miss evidence-based screenings with an impact on neonatal outcomes. Strategies such as implementing a total free ANC screening package in STP would enhance maternal diagnosis and prompt treatments.
Some B-cell subsets contribute to the regulation of immune responses, mainly through the secretion of interleukin-10, which suppresses T-helper 1 (Th1) and Th17 cells and induces regulatory T-cells (Tregs). The role of Bregs and Tregs in Sjögren's syndrome (pSS) pathogenesis is an active field of research.
Objectives
To evaluate the distribution of regulatory and effector T and B-lymphocytes, in patients with pSS and healthy controls (HC), and the relation between regulatory-like B-cell subsets and the pSS phenotype.
Methods
Fifty-seven pSS patients (2002 AECG criteria) and 24 HC were included. Circulating T and B-lymphocytes were characterized by flow cytometry and groups were compared. Significance was considered for p<0.05.
Results
Compared to HC, pSS patients had lower percentages (16.9 vs 32.0%, p<0.001) and absolute numbers (28 vs 81 cells/μL, p<0.001) of Breg-enriched CD24hiCD27+ B-cells, and a decrease in CD24hiCD38hi B-cells percentages (6.2 vs 7.7%, p=0.09). Lower frequencies of CD24hiCD27+ B-cells were found in anti-SSA-positive (n=38) compared to anti-SSA-negative (n=19) patients (15.0 vs 19.6%, p=0.170), as well as lower absolute counts (26 vs 31 cells/μL; p=0.173). Anti-SSA-positive patients presented higher CD24hiCD38hi B-cells percentages (6.2 vs 4.2%; p=0.260) and absolute counts (10 vs 5 cells/μL; p=0.343) compared to anti-SSA-negative patients. Although CD24hiCD27+ B-cells frequencies and absolute counts did not differ between patients with active (n=27) or inactive disease (n=30), (16.9% vs 17.0%, p=0.946; 25 vs 31 cells/μl, p=0.179), patients with higher disease activity (ESSDAI≥5) (n=9) presented lower absolute counts of CD24hiCD27+ B-cells (18 vs 31 cells/μL, p=0.096) and lower CD24hiCD38hi B-cells (4 vs 10 cells/μL, p=0.075), and higher Th1/Breg CD24hiCD27+ ratios, (16.2 vs 9.2, p=0.064). Considering all patients, a negative correlation was found between the ESSDAI score and the absolute numbers of either CD24hiCD27+ B-cells (r= -0.277; p=0.037) and Tregs (r= -0.311; p=0.019). Correlations with ESSDAI was stronger when looking at patients with ESSDAI≥5: for the percentages of CD24hiCD27+ B-cells, r=-0.705, p=0.023; for CD24hiCD27+ B-cells absolute counts, r= -0.644; p=0.045; and for the absolute counts of Tregs, r= -0.862; p=0.001. Using ROC curves to discriminate pSS from HC, better AUCs were obtained for CD24hiCD27+Breg cells (cut-off 34 cells/μL, AUC=0.81), Tregs/CD24hiCD27+Breg ratio (cut-off 1.98, AUC=0.74) and Th1/CD24hiCD27+Breg ratio (cut-off 12.23, AUC=0.70), corresponding to a specificity for pSS of 0.83, 0.75 and 0.70, respectively, and sensitivity of 0.75, 0.72 and 0.67, respectively. In pSS, lower CD24hiCD27+ B-cell counts, as well as higher Tregs/CD24hiCD27+Breg and Th1/CD24hiCD27+Breg ratios, were associated to a higher frequency of autoantibodies and higher gammaglobulin.
Conclusion
Our findings demonstrated a significant decrease in the Breg-enriched CD24hiCD27+ B-cell subset in pSS, which presented a negative correlation with the disease activity. We have demonstrated significant differences in the CD24hiCD27+ B-cell subset and respective ratios, presenting a good discriminatory capacity compared to HC. Therefore, this subset may have diagnostic utility in pSS, as it may support the presence of immune dysregulation in suspected cases that don't fulfil the pSS classification criteria. Further studies with increased number of samples and a prospective design are needed to explore this hypothesis.
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