Centro Hospitalar de Vila Nova de Gaia

Autosomal dominant polycystic kidney disease (ADPKD) is associated with distinct vascular remodeling; however, its impact on arteriovenous fistula (AVF) outcomes in hemodialysis patients remains unclear. This study aimed to compare AVF patency and survival between patients with and without ADPKD. We conducted a retrospective observational cohort study including 38 patients with ADPKD and 38 age-matched non-ADPKD patients who underwent first-time AVF creation between 2013 and 2021. Patients were followed for 24 months. Primary failure, primary patency, and assisted primary patency were assessed. Statistical analyses included Student's t-test, chi-square test, and Kaplan-Meier survival analysis. Compared with non-ADPKD patients, those with ADPKD had a significantly lower prevalence of diabetes mellitus (7.9% vs 52.6%, p < 0.001), ischemic heart disease (2.6% vs 31.6%, p < 0.001), and peripheral artery disease (5.3% vs 23.7%, p = 0.022). Distal AVF creation was more frequent in the ADPKD group (73.7% vs 57.9%, p = 0.147). At 24 months, primary patency was 63.2% in the ADPKD group and 60.5% in the non-ADPKD group (p = 0.81), while assisted primary patency was 84.2% and 73.7%, respectively (p = 0.26). Kaplan-Meier analysis showed no significant difference in AVF survival between groups (p = 0.22). Despite a lower burden of traditional atherosclerotic risk factors, patients with ADPKD exhibited AVF patency and survival comparable to those without ADPKD. These findings suggest that disease-specific vascular remodeling, rather than atherosclerosis alone, plays a key role in AVF outcomes. Larger prospective studies are warranted to further elucidate the mechanisms influencing vascular access performance in ADPKD.

Abstract Functional capacity, muscle strength, and patient-reported outcome measures are important indicators of health. In chronic obstructive pulmonary disease (COPD), these traits are often impaired beyond normal age-related decline. Substantial variability exists in both COPD and healthy populations, the biological basis of which remains poorly understood. Given the known contribution of genetics to complex traits, genetic factors may partly explain this variability. This study aimed to identify genetic variants associated with measures used to characterise extrapulmonary traits in COPD. Genome-wide association studies were conducted on the Lab3R-ESSUA cohort for the 6-minute walk test (6MWT), the 1-minute sit-to-stand test (1-min STS), the quadriceps maximal voluntary contraction (QMVC), the handgrip muscle strength, and the chronic airways assessment test (CAAT), adjusting for age, sex, body mass index, pack-years and ancestry. Variants with P&lt;1E -05 were selected for replication in the EARLYCOPD cohort, and effects compared between COPD and healthy populations (two-way ANOVA). A total of 639 participants (364 people with COPD, 275 healthy; 75% male, median age 67 years; BMI of 27 Kg/m 2 ; 10 pack-years) were included. Significant variants were identified for the 6MWT (rs1108983:G, β=-186.5m, P=4.8E -08 ), the 1-min STS (rs5889103:GTT, β=4.2reps, P=4.8E -08 ), the Handgrip (rs67352743:A, β=-4.4Kg, P=2.8E -08 ), and for the CAAT (rs11747040:C, β=4.4points, P=4.0E -09 ; rs11041680:A, β=-2.6points, P=2.5E -08 ). Effects were independent of COPD diagnosis. Replication in EARLYCOPD (n=282) confirmed one SNP for 6MWT and three for CAAT. These findings highlight genetic contributions to functional capacity, muscle strength, and disease burden. COPD-related impairments appear to build on pre-existing genetic predisposition, contributing to disease heterogeneity.

Multinucleated cell angiohistiocytoma is a rare benign neoplasm of unknown etiology that progresses slowly.We report the case of a 50-year-old man with erythematous-violaceous papules and plaques on the dorsal aspect of his left hand, which gradually increased in size and evolved into subcutaneous nodules.Histopathological examination revealed a multinucleated cell neoplasm with vascular proliferation, consistent with multinucleated cell angiohistiocytoma.Given the absence of symptoms and benign nature, an active surveillance approach was adopted.This case emphasizes the importance of considering rare skin lesions in differential diagnoses and reinforces the value of multidisciplinary evaluation to avoid unnecessary interventions.

BackgroundContinuous atrial fibrillation (AF) burden assessment is clinically relevant post-ablation but often limited by the invasiveness of current monitoring tools. Wearable technology may enable real-world AF burden tracking, but evidence in post-ablation patients is limited.ObjectiveTo assess the feasibility of smartwatch-based AF burden quantification after catheter ablation, including its association with quality-of-life.MethodsThis prospective, single-centre study enrolled a convenience sample of patients undergoing AF ablation. Participants used a smartwatch daily for 12 months within a digital follow-up program (daily smartwatch electrocardiogram (ECG) recommended). AF burden was defined as the percentage of monitored days with AF-detected ECGs. A Bayesian multilevel model examined the association between AF burden and quality-of-life score (AFEQT).ResultsTwenty patients (mean age 52.6 ± 10.3 years; 10% female) were enrolled. Over 12 months, 3604 smartwatch ECGs were collected (mean 180 per participant), with AF detected in 55% of patients. Patients submitted an ECG in 36% of days, and the median AF burden was 1.4% (IQR 4.6%), ranging from 0% to 25%. Quality-of-life improved significantly over time: AFEQT score increased 1.64 points per month (95% Credible Interval: 0.77 to 2.51), with 69% of patients achieving a clinically meaningful improvement. In contrast to AF recurrence as a binary variable, higher AF burden was associated with smaller improvements in AFEQT scores in the Bayesian model (interaction estimate: -0.22; 95% Credible Interval: -0.39 to -0.05). Each 1% increase in AF burden corresponded to an estimated 3.8-point reduction in AFEQT at 12 months.ConclusionSmartwatch-based monitoring is a feasible method for estimating AF burden after ablation. Higher AF burden was associated with smaller improvements in Qol, supporting its relevance as a meaningful outcome metric.Remote Monitoring Workflow12-Month Smartwatch AF burden