Medical University of South Carolina

To identify factors associated with secondary surgery for velopharyngeal insufficiency in children following primary palatoplasty. A retrospective review was conducted of children with cleft palate who were seen at a single academic center between August 2014 and April 2024 and underwent primary palatoplasty. Demographic and clinical data were collected, and the need for and number of secondary velopharyngeal surgeries were recorded. Univariate analyses and multivariate logistic regression were used to identify associated factors. Of 251 children who underwent primary palatoplasty, 27 (10.8%) required secondary velopharyngeal surgery. Univariate analyses revealed no association between secondary surgery and cleft type, presence of a syndrome, or timing of palatoplasty. Multivariate logistic regression controlling for race, insurance type, age at primary palatoplasty, and presence of 22q11.2 microdeletion syndrome revealed private insurance was associated with decreased odds of secondary velopharyngeal surgery (OR = 0.230, 95% CI: 0.069-0.765, p = 0.017), whereas Asian race was associated with increased odds (OR = 5.853, 95% CI: 1.105-30.998, p = 0.038). Among those requiring velopharyngeal surgery, 74.1% underwent one procedure and 25.9% underwent two. The presence of 22q11.2 microdeletion syndrome was significantly associated with needing two surgeries (p = 0.042), while female sex was associated with requiring only one surgery (p = 0.006). Clinical and sociodemographic factors were predictive of secondary velopharyngeal surgery following primary palatoplasty, with different risk factors associated with the need for more than one procedure. Larger studies are warranted to corroborate these findings and guide risk stratification and family counseling.

Infection enteritis is associated with the development of irritable bowel syndrome (IBS) and functional dyspepsia. This study aimed to examine the long-term risk of IBS and functional dyspepsia, and associated health care utilisation following infection enteritis. We conducted a retrospective cohort study using TriNetX U.S. Network. Adults with infection enteritis were identified and matched to controls, balancing demographics and comorbidities. Primary outcomes were the risk of incident IBS and functional dyspepsia diagnoses at 1, 5, and 10 years. Secondary outcomes were rates of IBS- and functional dyspepsia-related medications, endoscopy, abdominal imaging, and hospitalizations. Pathogen-specific and multivariate analyses were performed to assess variations in IBS risk. After matching, 202,244 patients were identified in each study cohort. At 1year of follow-up, the infection enteritis cohort had higher rates of IBS (RR = 2.35; 95% CI: 2.14-2.59), functional dyspepsia (RR = 2.02; 95% CI: 1.84-2.22), use of IBS-related medications (RR = 1.29; 95% CI: 1.26-1.31), functional dyspepsia-related medications (RR = 1.56; 95% CI: 1.55-1.59), abdominal imaging (RR = 2.42; 95% CI: 2.29-2.54), and Oesophagogastroduodenoscopy/colonoscopy (RR = 1.57; 95% CI: 1.50-1.65). These risks remained significantly higher in the IE cohort at 5 and 10 years. Salmonella/Shigella (RR = 6.48), and Giardia lamblia (RR = 5.05) had the highest risk of developing incident IBS. Infection enteritis was associated with increased risk of IBS and functional dyspepsia, rates of related medication use, and greater healthcare utilisation.

To assess the diagnostic accuracy of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT for detecting obstructive and non-obstructive coronary in-stent restenosis (ISR), using invasive coronary angiography (ICA) as the reference. Consecutive patients with coronary stents who underwent clinically indicated coronary CT angiography (CCTA) on a dual-source PCD-CT were retrospectively identified from two academic centers. All UHR scans were reconstructed at 0.2mm and 0.4mm slice thickness, the latter served as an energy-integrating detector CT-like proxy. Series were assessed for the presence of non-obstructive (<50%) and obstructive (≥50%) ISR, with diagnostic accuracy validated against ICA in the overall cohort and in a sub-analysis of stents<3 mm in diameter. Fifty patients (16.0% women; 70.9±10.8years) with 106 coronary stents were included. ICA identified 17 non-obstructive and 27 obstructive ISR. Non-obstructive ISR was detected in 10 stents on 0.2mm UHR and 14 on 0.4mm EID-like standard-resolution reconstructions.Obstructive ISR was described in 26 (0.2mm) vs. 32 (0.4mm) stents, respectively. The proportion of evaluable stents increased from 91.5% based on 0.4mm to 99.1% with 0.2mm UHR. Compared with standard-resolution images, 0.2-mm UHR improved non-obstructive ISR sensitivity (90.5%vs82.9%), specificity (100.0%vs78.5%), and accuracy (96.2%vs80.2%); and in obstructive ISR, specificity (98.7%vs82.3%), positive predictive value (96.3%vs64.1%), and accuracy (98.1%vs84.9%). Thin-slice UHR achieved higher accuracy in small-caliber stents (<3mm), for both non-obstructive (94.1vs73.5%) and obstructive ISR (94.1%vs79.4%). UHR PCD-CT demonstrated excellent diagnostic accuracy and significant improvements in ISR detection compared to the quasi-standard reconstructions, including non-obstructive and small-caliber stent ISR.

Tandem lesions (TLs) are a subtype of acute ischemic stroke, which involve an extracranial carotid lesion (ie, severe carotid stenosis ≥70%) with large vessel occlusion. While large vessel occlusion has a standard approach with mechanical thrombectomy (MT), the best practice for intervention of the carotid lesion is not well-established. Utilizing data from the ASSIST registry, we investigated the differences in clinical and procedural outcomes between acute versus nonacute stenting. The ASSIST registry (an international acute ischemic stroke MT prospective study) was utilized to identify the subgroup of patients with acute ischemic stroke secondary to TL who received MT. The TLs were grouped by MT+acute carotid stenting (CAS) versus MT+acute carotid nonstenting. The demographics and clinical outcomes (90-day modified Rankin Scale score) were compared between TL and non-TL groups, and between MT+CAS and MT+acute carotid nonstenting. Multivariable analyses were performed to determine independent predictors of clinical outcomes. A total of 183 of 1270 (14.4%) TLs were identified in the ASSIST registry. MT+CAS was performed in 83 of 183 (45.4%) subjects, and 100 of 183 (54.6%) received MT+acute carotid nonstenting. There are no significant differences at baseline between the 2 groups in the National Institutes of Health Stroke Scale score, Alberta Stroke Program Early Computed Tomography Score, or target vessel. Achieving a modified Rankin Scale score of 0 to 2 at 90 days was 70.9% in the MT+CAS group versus 48.9% in the MT+acute carotid nonstenting group (P=0.001), with a modified Rankin Scale score of 0 to 2 being significantly associated with the MT+CAS group in multivariable analysis (odds ratio, 2.14 [95% CI, 1.01-4.51]). There was no significant difference in mortality or symptomatic intracerebral hemorrhage between the groups. In acute ischemic stroke, secondary to TLs treatment with thrombectomy and acute carotid stenting is associated with improved 90-day functional outcome without an increase in symptomatic intracerebral hemorrhage compared with no acute stenting approach. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03845491.

Left ventricular (LV) dysfunction is a potential cardioembolic source of ischemic stroke, but its role in recurrent stroke risk and treatment response remains unclear. We explore whether LV injury associates with the risk of recurrent stroke and modifies the association between anticoagulation and stroke recurrence using real-world data. We performed a multicenter, retrospective study of Cardiac Abnormalities in Stroke Prevention and Recurrence cohort across 27 US sites. Patients with LV ejection fraction ≥20% were included. LV injury, defined as LV ejection fraction 20% to 40% and wall motion abnormality, was the primary exposure and treatment effect modifier. The treatment of interest was anticoagulant versus antiplatelet therapy. The composite outcome included recurrent stroke, major bleeding, or death. Outcomes were evaluated using unadjusted and inverse probability weighting adjusted Cox proportional hazards models, with treatment effect modification tested by LV injury status. Among 2685 patients enrolled, 2328 with complete data were analyzed (median age, 65 years; 49.8% female; median follow-up, 1.6 years). LV injury was present in 310 patients (13.3%). Overall, 535 events occurred: 258 recurrent ischemic strokes, 28 hemorrhagic strokes, 67 major hemorrhages, and 256 deaths. LV injury was associated with a higher unadjusted risk of the primary outcome (hazard ratio [HR], 1.51 [95% CI, 1.21-1.87]), though nonsignificant after inverse probability weighting adjustment (adjusted HR, 1.29 [95% CI, 0.97-1.70]). In the LV injury subgroup, anticoagulation versus antiplatelet therapy was associated with a lower risk of the primary outcome (adjusted HR, 0.24 [95% CI, 0.10-0.59]), relative to the non-LV injury subgroup (adjusted HR, 1.28 [95% CI, 0.83-1.95]; p[LV-interaction], 0.001). Similar interactions were seen for EF 20% to 40% (versus >40%; adjusted HR, 0.19 [95% CI, 0.04-0.86]; p[LV-interaction], 0.001) and wall motion abnormality (versus no wall motion abnormality; adjusted HR, 0.33 [95% CI, 0.15-0.73]). After cryptogenic stroke, anticoagulation in those with LV injury was associated with lower rates of recurrent stroke, major bleeding, and death. These findings warrant confirmation in a dedicated randomized controlled trial. URL: https://www.clinicaltrials.gov; Unique identifier: NCT06398366.

Ex-utero intrapartum treatment (EXIT) procedures are employed during delivery to establish a safe airway on placental support for neonates with potential airway obstruction. While EXITs are typically planned with a multidisciplinary team, these procedures may occur emergently due to preterm labor, late diagnosis, or delayed transfer of care. This systematic review compares outcomes of scheduled versus unscheduled/emergent EXIT procedures. We searched PubMed, Scopus, and CINAHL in March 2025 to identify observational studies describing EXIT procedures. Studies were included if they identified the procedure as scheduled/unscheduled and had at least one neonatal and maternal outcome of interest. We assessed quality using the Joanna Briggs Institute (JBI) checklists. Raw data were pooled and assessed with summary statistics. 67 articles were included for data extraction and synthesis. Primary findings were: (1) the unscheduled group had a significantly higher maternal estimated blood loss (EBL) and (2) rates of neonatal perioperative mortality were higher for the unscheduled group. Though the mortality difference was clinically significant (16% unscheduled versus 4.9% scheduled), it was not statistically significant. Furthermore, a higher percentage of patients in the unscheduled group were managed with tracheostomy (49%) as compared to the scheduled group (30%, p-value variable across imputation sets, range 0.029 - 0.076). EXIT procedures should always be carefully planned and coordinated with a multidisciplinary team. However, if necessary, unscheduled EXIT procedures can be safely performed by experienced personnel in prepared centers, though they may have a slight increase in maternal EBL.