In our institute, resection and aortic anastomosis for newborns and infants with coarctation of the aorta are typically performed using continuous nonabsorbable (polypropylene) sutures. This cross-sectional survey aims to examine the anastomosis site, focusing on the prevalence of growth and its correlation with recoarctation in cases requiring surgical reintervention.

Patients who underwent aortic anastomosis for symptomatic coarctation during their first year of life between 2008 and 2023 and were still alive were included in the study for evaluation. Aortic arch diameters were assessed using computed tomography angiography (CTA), and z-scores were calculated. For patients with recurrent stenosis who required subsequent surgery, the surgical pathology was reviewed.

A total of 15 patients underwent CTA assessment, with a median time from surgery to CTA of 8.08 years (4.39, 10.02). The z-scores for the diameters at the repaired areas were as follows: for the distal transverse arch, the median z-score was - 0.08 (-0.52, 0.59), and for the descending aorta at the anastomosis, it was 1.13 (0.18, 1.72). When comparing the two subgroups-7 patients with aortic arch hypoplasia and 8 without-no significant differences were found in the z-scores of the diameters at the repaired sites. In one case of restenosis at the 4-year follow-up, subsequent surgery revealed that the suture line did not align with the narrowest segment.

Using continuous non-absorbable suture for aortic anastomosis in coarctation repair for newborns and infants can result in the growth of the aortic arch and the anastomosis site reaching the normal range, regardless of the presence of aortic arch hypoplasia. Pathological findings from a surgical reintervention indicate that the aortic wall segment containing suture material does not align with the area exhibiting the greatest narrowing.

Trial registration number (Study ID): TCTR20240412007.

Elevated admission blood glucose (ABG) is increasingly recognized as a prognostic marker in intracerebral hemorrhage, but its specific role in pontine hemorrhage (PH) remains underexplored. This retrospective study analyzed data from 247 PH patients admitted to two tertiary hospitals between 2012 and 2016 to evaluate the association between ABG and 30-day mortality. Receiver operating characteristic analysis identified 8.69 mmol/L as the optimal hyperglycemia threshold predictive of mortality. Survival analysis revealed significantly lower 30-day survival rates in hyperglycemic patients compared to non-hyperglycemic patients (P = 0.0017). In multivariate regression models, ABG (per 1 mmol/L increase) independently increased mortality risk, with an adjusted odds ratio (aOR) of 1.295 (P = 0.0097) in the overall cohort and an aOR of 1.266 (P = 0.0210) in the nondiabetic patients. Hyperglycemia was significantly associated with increased mortality compared to non-hyperglycemia, with an aOR of 3.641 (P = 0.0024) in the overall cohort and an aOR of 3.492 (P = 0.0035) in the nondiabetic subgroup. Notably, no significant association was observed in diabetic patients (P > 0.05). These findings suggest that elevated ABG serves as an independent predictor of 30-day mortality following PH, particularly in nondiabetic populations, and may facilitate early risk stratification.

Flow diverters are a crucial element in the treatment of intracranial aneurysms. However, the optimal non-invasive follow-up imaging modality, particularly for the detection of in-stent stenosis, remains uncertain. This study aims to compare the performance of photon-counting detector CT (PCD-CT) in ultra-high-resolution (UHR) mode with flat-panel CT (FP-CT) for the evaluation of intracranial flow diverters. A phantom model for intracranial vessels was used to evaluate 15 flow diverters of various sizes and designs. Imaging was performed using both PCD-CT and FP-CT. Qualitative assessment of the stent lumen was conducted by three experienced neuroradiologists using a 5-point Likert scale. Quantitative analysis included measurements of lumen area, contrast to noise ratio and signal to noise ratio. FP-CT provided a significantly larger assessable stent lumen than PCD-CT at all dose levels (p < 0.05), with no significant differences between PCD-CT dose levels (p = 0.999). Increasing PCD-CT dose did not improve lumen visualization. SNR and CNR increased with PCD-CT dose (p < 0.001), peaking at CTDI 20, but showed diminishing returns beyond CTDI 10. Flow diverter diameter correlated positively with SNR and CNR (p < 0.05). Subjective image quality improved with PCD-CT dose (p < 0.001) but showed no significant difference beyond 10 mGy (p > 0.05). FRED devices had the lowest ratings, independent of imaging modality (p = 0.80). Our study demonstrated that while FP-CT provided superior visualization of the flow diverter lumen in a head phantom vessel model, subjective assessability ratings were comparable between FP-CT and PCD-CT when evaluated by experienced readers. PCD-CT at a CTDIvol of 10 mGy offered the best balance between image quality and radiation dose, making it a viable alternative for post-interventional assessment of flow diverters.

Abdominal aortic aneurysm (AAA) is characterized by irreversible localized dilatation of the abdominal aorta. It poses a significant health risk. As AAA size tends to increase over time, there is a heightened risk of rupture, resulting in a substantially high mortality rate. Although AAA screening programs targeting specific demographics are available, there is room for improvement in terms of inclusivity and cost-effectiveness. This study aimed to develop a predictive model for AAA occurrence utilizing seven years of data from the Korean National Health Insurance Service database (NHIS). This study utilized NHIS data from 2009 to 2020. A total of 4,234,415 individuals who underwent health examinations in 2009 were identified. After applying exclusion criteria, a total of 3,937,535 individuals were selected. Of them, 70% were used for model development and 30% were used for validation. The mean follow-up duration was 10.11 ± 1.29 years, during which 2,836 cases of AAA were identified among 1,181,131 (2.4%) participants in the validation cohort. The model incorporated a set of 10 variables, encompassing age, sex, obesity, smoking, drinking, diabetes (DM), hypertension (HTN), dyslipidemia, chronic kidney disease (CKD), and cardiocerebrovascular disease (CVD). Evaluation of the model's predictive performance revealed an area under the curve (AUC) of 0.807 (95% CI: 0.80-0.81) when it was applied to the development cohort. The AUC remained high at 0.803 (95% CI: 0.79-0.81) when the model was applied to the validation cohort, indicating its effectiveness in forecasting AAA occurrence. A multivariable risk model for predicting the onset of AAA was successfully developed, showcasing an excellent performance with an AUC value of 0.807, surpassing traditional screening methods. This model has the potential to selectively identify high-risk patients from a slightly broader pool than current screening approaches. Priority should be given to proactive screening efforts targeting individuals at elevated risk for AAA, with the goal of reducing AAA-related mortality.

Patient identification for national registries often relies upon clinician recognition of cases or retrospective searches using potentially inaccurate clinical codes, leading to incomplete data capture and inefficiencies. Natural Language Processing (NLP) offers a promising solution by automating analysis of electronic health records (EHRs). This study aimed to develop NLP models for identifying and classifying abdominal aortic aneurysm (AAA) repairs from unstructured EHRs, demonstrating a proof-of-concept for automated patient identification in registries like the National Vascular Registry. Using the MIMIC-IV-Note dataset, a multi-tiered approach was developed to identify vascular patients (Task 1), AAA repairs (Task 2), and classify repairs as primary or revision (Task 3). Four NLP models were trained and evaluated using 4870 annotated records: scispaCy, BERT-base, Bio-clinicalBERT, and a scispaCy/Bio-clinicalBERT ensemble. Models were compared using accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). The scispaCy model demonstrated the fastest training (2 min/epoch) and inference times (2.87 samples/sec). For Task 1, scispaCy and ensemble models achieved the highest accuracy (0.97). In Task 2, all models performed exceptionally well, with ensemble, scispaCy, and Bio-clinicalBERT models achieving 0.99 accuracy and 1.00 AUC. For Task 3, Bio-clinicalBERT and the ensemble model achieved an AUC of 1.00, with Bio-clinicalBERT displaying the best overall accuracy (0.98). This study demonstrates that NLP models can accurately identify and classify AAA repair cases from unstructured EHRs, suggesting significant potential for automating patient identification in vascular surgery and other medical registries, reducing administra.

The C-reactive protein(CRP)-triglyceride glucose index (CTI) is a new composite biomarker used to assess inflammation and insulin resistance(IR) severity. Heart failure (HF) poses a substantial epidemiological threat with increasing incidence and mortality worldwide. However, the relationship between CTI and HF has not been extensively investigated. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2001-2010, 21,974 participants ≥ 20 years were included. HF diagnosis was based on self-reported medical history. Multivariable logistic regression adjusted for demographic, lifestyle, and clinical covariates. Smooth curve fitting analyzed dose-response relationships, while subgroup analyses explored effect heterogeneity. The research cohort comprised 21,974 individuals (631 HF cases, 21,343 non-HF). HF patients exhibited significantly higher CTI levels (p < 0.001), and a positive correlation with HF prevalence was observed (p < 0.001). Consistent positive associations were maintained across subgroups, with no significant interactions detected. Logistic regression analysis demonstrated adjusted ORs for HF per 1-unit CTI increase of 1.492 (model 1, unadjusted) and 1.279 (model 3, fully adjusted). Quartile analysis revealed a progressive increase in prevalent HF with higher CTI levels, and model 3 confirmed a nonlinear dose-response relationship (p < 0.001) with a threshold at 11.657. CTI is positively associated with the presence of HF in US adults, suggesting its potential as a biomarker for HF prevention and treatment strategies.

Chronic hepatitis B virus (HBV) infection is a significant global health issue, leading to liver-related morbidity and mortality. The systemic immune-inflammation index (SII), a marker of systemic inflammation and immune response, may predict disease outcomes. However, its role in HBV infection and its relationship with HBV surface antibody (HBsAb) status is not well understood. This study investigates the association between SII, HBsAb status, and their combined effects on all-cause and cardiovascular disease (CVD) mortality.

We analyzed data from 43,539 participants in the National Health and Nutrition Examination Survey (NHANES), categorizing them into four groups based on SII and HBsAb status: high/low SII with HBsAb-negative/positive. Mortality outcomes were assessed using Cox proportional hazards models adjusted for age, sex, race/ethnicity, BMI, and comorbidities.

In the analysis of 43,539 participants, the fully adjusted model revealed that SII was significantly associated with both all-cause mortality (HR = 1.138, p < 0.001) and cardiovascular disease mortality (HR = 1.402, p < 0.0001), indicating that higher SII independently increases the risk of both outcomes. While the crude model showed a protective effect of HBV surface antibody on all-cause mortality (HR = 0.491, p < 0.0001) and cardiovascular disease mortality (HR = 0.478, p < 0.0001), this effect diminished after full adjustment. Additionally, the combined effect of SII and HBV surface antibody on both mortality outcomes remained significant in the fully adjusted model (HR = 1.402, p < 0.0001).

Higher SII is independently associated with increased risks of all-cause and cardiovascular disease mortality. The protective effect of HBV surface antibody on mortality diminished after adjustment for confounders. The combined effect of SII and HBV surface antibody on mortality highlights the complex interaction between inflammation and immune response in chronic HBV infection. SII may serve as a useful predictor of long-term health risks in HBV-infected individuals.

Stroke is a leading cause of mortality and disability worldwide, with disproportionate impacts in low- and middle-income countries due to limited healthcare resources. Monitoring vital signs during the acute phase of a stroke is critical for detecting complications. We aimed to assess the impact of intensive (6-hourly) versus usual practice (12-hourly) vital sign monitoring strategies on stroke outcomes at Mloganzila Hospital, Tanzania.

We conducted a prospective cohort study of patients with first-ever stroke admitted to Mloganzila Hospital between October 2023 and March 2024. Participants were assigned to 6-hourly or 12-hourly vital signs monitoring for the first 72 hours, after which all received usual care. Monitoring frequency reflected routine clinical practice; no investigational treatments were introduced, and therapeutic decisions were unaffected by group allocation. The primary outcome was 30-day all-cause mortality; secondary outcomes included functional disability measured by the modified Rankin Scale. Ethical approval was obtained, and informed consent was secured. Data were analyzed using SPSS version 26 and Stata version 15. Survival was assessed using Kaplan-Meier analysis, and factors associated with 30-day mortality identified using modified Poisson regression.

Of 306 participants (mean age: 59.6 ± 14.0 years; 53.6% male), 63.7% experienced a hemorrhagic stroke. There were no significant differences in stroke severity or functional disability at 72 hours between the groups. Intensive vital signs monitoring was associated with significantly lower 30-day mortality compared to usual monitoring (35.9% vs. 49.7%; p = 0.015).

Frequent monitoring of vital signs during the acute phase of stroke may enhance clinical stability and improve patient outcomes. Our findings demonstrate a significant reduction in 30-day mortality with intensive monitoring. These findings support the establishment of dedicated stroke units with structured monitoring protocols in resource-limited settings to strengthen stroke care systems and reduce preventable deaths.

Paraclinoid aneurysms continue to present a surgical challenge, even in the modern endovascular era. Although these aneurysms are uncommon, surgical clipping remains the treatment of choice in select cases. Successful surgical management requires both extensive experience and a comprehensive understanding of paraclinoid anatomy. In this report, we outline our approach to planning and surgical techniques for managing paraclinoid aneurysms.

Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially in the elderly, which is usually diagnosed by computed tomography (CT) scan and often treated surgically. After surgery patients shows favourable outcomes with improvement in symptomatology. Despite the availability of various surgical techniques, complications continue to occur frequently due to the advanced age of patients and underlying medical conditions. Burr-hole craniotomy followed by placement a closed-system drainage is widely considered the best treatment for CSDH, although technical challenges and a high recurrence rate remain. Postoperative pneumocephalus is a potential risk factor for recurrence. While the majority of patients recover well after surgery, recurrence or persistence of CSDH occurs in 0.35-33% of cases, sometimes necessitating additional surgeries.

This retrospective study comprehensively evaluates the clinical data of 229 patients diagnosed with chronic subdural hematoma (CSDH) who underwent surgical intervention, specifically burr-hole craniotomy with drainage between 2016 and 2021. The primary objective is to measure the prognostic significance of postoperative pneumocephalus as a predictor of recurrence of CSDH. Furthermore, the obtained univariate and multivariate regression analyses examines various patient-specific factors, including age, gender, location of CSDH (unilateral or bilateral), anticoagulation therapy status, neurosurgical follow-up outcomes, hospital readmission rates, and the incidence of repeat surgical procedures.

Among the analysed characteristics, postoperative pneumocephalus exceeding a specified volumetric threshold emerges as the only significant predictor of CSDH recurrence. This recurrence of CSDH is additionally associated with a substantial prolongation of the patient's hospitalization, highlighting its clinical and logistical significance.

A postoperative pneumocephalus is nearly unavoidable; however, optimizing surgical technique to minimize its volume below 5.2 cm³ reduces significantly the recurrence rate of CSDH.