Citations

AbstractQuantitative susceptibility mapping (QSM) is a tool for mapping tissue susceptibility. Using QSM for functional brain mapping, it is possible to directly quantify blood‐oxygen‐level‐dependent (BOLD) susceptibility changes. This study presents a submillimeter functional QSM (fQSM) approach compared to BOLD fMRI from data acquired with 3D gradient‐echo echo planar imaging (EPI) at ultra‐high field. Complex EPI data were acquired in nine healthy subjects with varying temporal and spatial resolutions and used for BOLD fMRI and for fQSM. Right‐hand finger tapping experiments were performed as well as one measurement with intentional subject movement. Susceptibility maps were computed using 3D path‐based unwrapping, the variable‐kernel sophisticated harmonic artifact reduction for phase data, and the streaking artifact reduction for QSM algorithm. Functional data analysis included general linear modeling and computation of z‐scores. Submillimeter data were denoised using NOise reduction with DIstribution Corrected (NORDIC), which improved z‐scores in the motor cortex for fQSM and fMRI. An expected increase in BOLD fMRI signal and corresponding decrease in magnetic susceptibility was observed in sensorimotor areas during active periods. For all experiments, fQSM showed smaller activation regions compared with fMRI. The percentage of high negative t‐values localized in the cortex was higher for fQSM (52%) than for positive or negative t‐values for fMRI (45%). For the scans with intentional motion, movement exceeded the size of a voxel, but paradigm dependent signal evolution could be recovered using motion correction. In conclusion, this study demonstrates the feasibility of submillimeter whole‐brain fQSM with voxel volume of 0.53 μL. In comparison to traditional BOLD fMRI, fQSM provided improved localization of brain activation within the cortex, especially in submillimeter 3D EPI sequences.

Purpose: We describe a case of nontraumatic macular hole in a pediatric patient associated with numerous epiretinal lesions throughout the macula. Methods: A healthy 9-year-old girl presented to retina clinic with several months of blurry vision in the right eye. Clinically, there was a full-thickness macular hole with serous detachment and white epiretinal tufts. Spectral-domain optical coherence tomography confirmed the presence of the full-thickness macular hole with hyperreflective epiretinal proliferations in the right eye and an unremarkable left eye. Systemic workup was negative. After a short period of observation, the patient underwent vitrectomy with internal limiting membrane peel and 14% C3F8 gas tamponade in the right eye. Multiple intraoperative samples were sent for further testing, which were also negative. Results: At 1- and 12 months/1 year postoperative visits, examination showed successful closure of the full-thickness macular hole with resolution of the subretinal fluid and improved VA. Conclusion: Nontraumatic macular holes in pediatric patients warrant systemic and ocular workup, including fluorescein angiography and laboratory testing. Good anatomic and visual outcomes are generally seen with spontaneous and surgical closures of macular holes in this age group. Early vitrectomy with histologic analysis of ocular samples should be considered in pediatric macular hole cases associated with vitreoretinal traction, especially those with epiretinal abnormalities.

Introduction The Rockall score and Glasgow-Blatchford score (GBS) are two scoring systems validated in the evaluation of upper gastrointestinal bleeding (UGIB). However, no meta-analysis exists to summarize the current data and clarify the use of Rockall score and GBS focusing on non-variceal UGIB. We aimed to evaluate and compare the utility of the Rockall score and GBS in predicting clinical outcomes in non-variceal UGIB. Methods We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE databases for all peer-reviewed articles using the terms including ‘Glasgow-Blatchford’, ‘Rockall’, and ‘gastrointestinal bleed’ from their inception to 22 March 2023. Outcomes included mortality, rebleeding, need for blood transfusion, and need for surgical intervention. Results Seven studies with 755 participants with non-variceal bleeding were included in the analysis. Pooled analysis demonstrated no difference in the area under the receiver operating characteristic (AUROC) between GBS and Rockall score to predict mortality [weighted mean difference (WMD) = 0.01, 95% CI: −0.06 to 0.08] or rebleeding (WMD = 0.04, 95% CI: −0.03 to 0.11). GBS had a higher AUROC to predict the outcomes compared to Rockall score for the needs for transfusion (WMD = 0.09, 95% CI: 0.01–0.16) and surgical intervention (WMD = 0.21, 95% CI: 0.14–0.29). Conclusion The GBS could be superior to the Rockall score in predicting the needs for transfusion and surgical intervention in non-variceal UGIB. However, both scores demonstrate low performance for predicting mortality or rebleeding.

Objectives Mayo Clinic’s hospital-at-home program, Advanced Care at Home (ACH), launched in 2020. While hospital-at-home literature reported safe and effective care for the general patient population and those with COVID, comparative outcomes between these two groups were unknown. The aim of this retrospective analysis was to compare the outcomes of COVID and non-COVID patients enrolled in ACH and evaluate if COVID patients can be safely treated in this setting. Methods Demographics, clinical characteristics, and safety outcomes were retrospectively analyzed to compare COVID and non-COVID patients discharged from ACH between November 2020 and May 2022. Patient characteristics analyzed included severity of illness (SOI) and risk of mortality (ROM), calculated using All Patient Refined Diagnosis Related Groups (APR-DRG). Hospitalization-specific variables included length of stay (LOS), escalation of care, and 30-day readmission rates. Results Of 1051 patients, 173 (16%) had COVID, and 878 (84%) were non-COVID patients. The average age in the COVID cohort was 66.6 (15.3) years, compared with 72.2 (14.0) in the non-COVID cohort. Extreme SOI was higher in the COVID group (43.3% versus 17.4%), as was extreme ROM (46.2% versus 16.2%), but LOS was shorter (5.7 versus 7 days). Escalation of care (7.5% in COVID cohort versus 8.4%) and 30-day readmission outcomes (9.2% for COVID patients versus 12.9%) were not statistically different between the groups. Conclusions Despite higher SOI and ROM, COVID patients had shorter LOS with outcomes that were not statistically different from non-COVID patients. COVID patients can be safely and efficiently cared for in ACH.

Background: Data on prevalence of hypertension in the United States come primarily from in-person data collected by the National Health and Nutrition Examination Survey and self-reports in the Behavioral Risk Factor Surveillance Survey. Electronic phenotypic algorithms for hypertension that include diagnosis codes, blood pressure values, and antihypertensive treatment have been proposed and tested. Objective: To describe prevalence of hypertension in Minnesota adults using data from a statewide electronic health record (EHR) consortium, the Minnesota EHR Consortium (MNEHRC). Methods: Data from 11 health systems participating in the MNEHRC were standardized to a common data model allowing for distributed querying of EHR data. Data were de-duplicated using a one-way hash algorithm. Preliminary prevalence of hypertension in 2023 was estimated in Minnesota residents with ≥ 1 encounter in the past 3 years who had ≥1 diagnosis of hypertension in the past 5 years. Medicaid insurance status was determined via linkage with state enrollment files. Residential addresses of patients were geocoded to census tracts and social vulnerability index (SVI) of census tracts was determined. Results: Among 4,369,470 Minnesotan age 18 and older in 2023, 23.6% had hypertension based on ≥1 diagnosis code. Prevalence increased with age, was higher in men (26% vs. 22% in women), and adjusted for age and sex was highest in Black (30%) and Native American (27%) compared with White (23%) and Hispanic (21%) Minnesotans. Within each race/ethnic group, those insured by Medicaid had a higher adjusted hypertension prevalence than those with other insurance types. The prevalence of hypertension in census tracts with moderate to high SVI ranged from 3% to 43%, but on average was similar to the statewide prevalence of 24% (see image 1). Prevalence of hypertension in race/ethnicity, sex, and age subgroups in higher SVI census tracts was similar to the statewide prevalence in those subgroups. Conclusions: The prevalence of hypertension in Minnesota was described in detail by demographic characteristics, geography and social vulnerability. Future work will expand the electronic hypertension phenotype and examine quality of care.

Background: Cardiovascular disease remains the most common cause of death among kidney transplant recipients, with hypertension being one of the most prevalent risk factors. Understanding the current prevalence of hypertension in this population is critical to help shape post-transplant care policies and guidelines and ensure proper management of CVD risk. Methods: We included all kidney transplant recipients who received their transplant between 2019 and 2023 at our center and who completed 24-hour ABPM at 12 months post-transplant. We reported data in mean (SD) unless noted otherwise. BP was categorized per AHA guidelines. This study was deemed exempt by the IRB. Results: A total of 940 patients were included in this study. Detailed results are seen in Figure 1 and Table 1. Notable to mention that 60% of the patients had blood pressure > 130/80 mmHg at 12 months post kidney transplant, with the majority being stage 1. Patients with more severe hypertension tended to be older, had lower eGFR, and had more comorbidities. They also had lower diastolic blood pressure than stage 1 HTN patients, consistent with older age. Night-time BP was significantly higher among stage 2 HTN patients. Conclusion: Hypertension remains a prevalent condition post-kidney transplant despite the majority of patients having satisfactory kidney allograft function. Ongoing BP monitoring and assessment of out-of-office BP post-kidney transplantation is critical to ensure control of this important cardiovascular risk factor. 24-hour ABPM has several advantages in this group, including accurate measurement of out-of-office BP and detection of nocturnal hypertension, an independent risk factor for cardiovascular events. Additional studies are needed to describe the hypertension subphenotypes (e.g., sustained vs. masked) and to identify predictors of severe uncontrolled hypertension in this patient population.