Memorial Medical Center

Previous single-center studies conducted in the United States in women with suspected preeclampsia indicated that serum soluble fms-like tyrosine kinase 1-to-placental growth factor ratio values of >38 measured on a widely available Elecsys immunoassay platform during the third trimester of pregnancy predicted the development of preeclampsia with severe features and adverse outcomes within 2 weeks of testing. This study aimed to validate the Elecsys soluble fms-like tyrosine kinase 1-to-placental growth factor ratio test for the prediction of preeclampsia with severe features in a United States population using the prospective Preeclampsia Risk Assessment: Evaluation of Cut-offs to Improve Stratification cohort that recruited women with a hypertensive disorder of pregnancy (gestational hypertension, chronic hypertension, de novo and superimposed preeclampsia) across 18 tertiary and community hospitals throughout the United States. We measured soluble fms-like tyrosine kinase 1-to-placental growth factor ratios using the Elecsys platform in archived serum samples from the Preeclampsia Risk Assessment: Evaluation of Cut-offs to Improve Stratification study that recruited hospitalized women with a hypertensive disorder of pregnancy between 23 0/7 and 34 6/7 weeks of gestation. The primary study outcome was prediction of preeclampsia with severe features within 2 weeks after testing. The secondary outcomes included a composite of adverse maternal and fetal/neonatal outcomes and prediction of delivery within 2 weeks. In the validation cohort of the Preeclampsia Risk Assessment: Evaluation of Cut-offs to Improve Stratification study (556 enrollments), the serum soluble fms-like tyrosine kinase 1-to-placental growth factor ratio at a cutoff value of >38 demonstrated a 67% positive predictive value (95% confidence interval, 61-73) and a 95% negative predictive value (95% confidence interval, 92-97) for the progression to preeclampsia with severe features within 2 weeks. Among women at <30 weeks of gestation (n=188), serum soluble fms-like tyrosine kinase 1-to-placental growth factor ratio at a cutoff value of >38 demonstrated a 78% positive predictive value (95% confidence interval, 68-86) and a 100% negative predictive value (95% confidence interval, 96-100) for the progression to preeclampsia with severe features within 2 weeks. The Elecsys soluble fms-like tyrosine kinase 1-to-placental growth factor ratio test performed better than standard-of-care clinical measures, with an area under the receiver operating characteristic curve of 0.92 (95% confidence interval, 0.89-0.90) for soluble fms-like tyrosine kinase 1-to-placental growth factor ratio vs <0.70 for standard-of-care tests, such as liver enzymes, platelet count, and serum creatinine (P<.001). Compared with women with a ratio of ≤38, those with a ratio of >38 had a higher risk of developing adverse maternal (relative risk, 4.9 [95% confidence interval, 2.6-9.9]; P<.001) and fetal/neonatal (relative risk, 3.2 [95% confidence interval, 2.6-4.0]; P<.001) outcomes and were more likely to deliver within 2 weeks (adjusted hazard ratio, 3.3 [95% confidence interval, 2.7-4.0]; P<.001). The soluble fms-like tyrosine kinase 1-to-placental growth factor ratio of >38 measured on the Elecsys platform predicted the development of preeclampsia with severe features, delivery, and adverse maternal and fetal/neonatal outcomes within 2 weeks of testing among preterm pregnant women hospitalized with a hypertensive disorder of pregnancy.

<title>Abstract</title> Background: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a potentially reversible autoimmune encephalitis, most commonly affecting young women and children. It typically follows a prodromal illness and progresses to prominent neuropsychiatric symptoms, movement disorders, seizures, and autonomic instability. While cerebellar ataxia may occur during the disease course, it is rarely the initial or isolated presenting feature, particularly in adults, and may result in diagnostic delay. Case Presentation: We report a case of a woman in her 20s with no prior medical history who presented with progressive cerebellar ataxia, including unsteady gait and impaired fine motor coordination, without preceding systemic or prodromal symptoms. Three days after admission, she developed a generalised tonic-clonic seizure followed by rapid-onset behavioural changes, hallucinations, and cognitive decline. Neurological examination revealed cerebellar signs including dysmetria, horizontal nystagmus, and a positive Romberg test. Brain MRI was unremarkable. Electroencephalography showed diffuse delta slowing. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis and tested positive for anti-NMDAR antibodies. There was no evidence of malignancy on pelvic ultrasound or CT imaging. The patient was treated with first-line immunotherapy, including intravenous immunoglobulin and corticosteroids. Her neuropsychiatric symptoms improved significantly over the following two weeks. At one-month follow-up, she had near-complete recovery in mobility and cognition. Conclusion: This case highlights an unusual adult presentation of anti-NMDAR encephalitis in which cerebellar ataxia appeared before other symptoms. Clinicians should consider autoimmune encephalitis in patients with isolated cerebellar signs followed by rapid neurological decline, even without prodromal features or imaging abnormalities. Early diagnosis and prompt immunotherapy are essential for favourable outcomes.

Atrial fibrillation (AF) commonly coexists with hypertrophic obstructive cardiomyopathy (HOCM) and is associated with increased risks of stroke and mortality. While catheter ablation (CA) is effective in AF, outcomes in patients with HOCM remain underreported. We sought to evaluate the association between CA and long-term outcomes in patients with paroxysmal AF (PAF) and HOCM. Using the TriNetX Research Network, we identified adults (≥18 years) diagnosed with HOCM and PAF between 2015 and 2021. Patients were stratified into CA vs. non-CA groups. Propensity score matching (1:1) was used to adjust for differences in demographics, comorbidities, and medications. The primary outcome was all-cause mortality and ischemic stroke at 3 years; secondary outcomes included cardioversion and new-onset heart failure. Kaplan-Meier analysis and Cox proportional hazards regression were used to estimate adjusted hazard ratios (HRs). Among 8593 patients with HOCM and PAF, 1018 (11.8%) underwent CA. Post-PSM, 966 patients were matched per group. All-cause mortality was markedly reduced in the CA group (4.9% vs. 13.7%, HR: 0.35, 95% CI: 0.25-0.49, P < 0.0001). Ischemic stroke rates were significantly lower in the CA group (6.4% vs. 9.7%, HR: 0.63, 95% CI: 0.46-0.87, P < 0.01), including among patients without prior stroke (de novo stroke: 3.7% vs. 5.7%, HR: 0.63, 95% CI: 0.40-0.98, P < 0.05). Cardioversion was significantly higher following CA (30.1% vs. 10.1%, HR: 3.2, 95% CI: 2.5-4.0, P < 0.0001). There was no significant difference in new-onset heart failure between the CA and non-CA groups (69.1% vs. 72.0%; HR: 1.08, 95% CI: 0.84-1.40, P = 0.53). In patients with HOCM and PAF, CA was associated with significantly lower risks of ischemic stroke and all-cause mortality.

Chronic venous insufficiency (CVI) resulting in venous hypertension can cause lifestyle-limiting debilitation. Studies have identified racial and ethnic disparities in CVI presentation and clinical severity; however, there is limited literature examining disparities in CVI management and procedural outcomes among different racial and ethnic groups. The aim of this study was to characterize differences in endovenous treatment paradigms between racial and ethnic groups and to assess how this affected patient outcomes. The national Vascular Quality Initiative Varicose Vein Registry database was queried for superficial venous interventions, including endovenous radiofrequency ablation, endovenous laser ablation, high ligation, stripping, and microphlebectomy, performed from April 2014 to March 2024. We categorized patients as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino, Asian, and Other (including American Indian, Alaskan Native, Native Hawaiian, other Pacific Islander, more than one race, and unknown/other). Baseline demographics, clinical and treatment characteristics, complication rates, and changes in quality-of-life endpoints (ie, revised Venous Clinical Severity Score [rVCSS] and Heaviness, Achiness, Swelling, Throbbing, Itching [HASTI] score) were compared between racial/ethnic groups with NHW as the reference category. Linear regression and logistic regression/χ2 tests were used to compare continuous/ordinal and categorical variables, respectively. A total of 65,090 superficial venous procedures encompassing endovenous thermal ablations, stripping/high ligation, and microphlebectomy were included. NHW patients underwent interventions for less severe baseline CVI based on CEAP class and had more superficial venous interventions (2.45 ± 1.95; P < .001) and repeat thermal ablations (1.66 ± 1.14; P < .001) than other groups. NHB had more severe baseline CVI based on higher prevalence of severe CEAP (ie, C5, C6, and C6r disease: 5.8%, 11.8%, and 0.9%, respectively; P < .05). NHB patients were less likely to have concomitant microphlebectomy than NHW (odds ratio, 0.79; 95% confidence interval, 0.73-0.87; P < .001). NHB had the highest rVCSS score preoperatively (8.17 ± 4.02; P < .001) with the largest improvement at ≤3 (-4.40 ± 5.23; P < .001) and >3 months (-7.00 ± 5.00; P < .001) following intervention. Hispanic/Latinos had the highest preoperative HASTI score (10.34 ± 5.40; P < .001) and the largest score reduction at ≤3 months (-6.62 ± 6.51; P < .001). Post procedure, Hispanics and other study groups were more likely to experience blistering and medication induced ulcer (P < .05). The other group was less likely to experience hematoma postoperatively (P < .05). This study highlights significant differences across racial/ethnic groups in the presentation, treatment and outcomes of patients with treated for CVI. Black patients undergo fewer ablations and superficial venous procedures overall; however, once treated, they exhibit significant symptomatic improvement.