Coronary artery disease (CAD) is a major risk factor for the development of heart failure (HF) with preserved ejection fraction (HFpEF) and is associated with increased mortality. However, an optimal strategy to screen for HFpEF among patients with CAD has not yet been established. The HFpEF-ABA score was introduced to estimate the pretest probability of HFpEF and was shown to predict adverse HF events. This retrospective multicenter cohort study included patients registered in the Clinical Deep Data Accumulation System database who underwent percutaneous coronary intervention from April 2013 to March 2019. Patients with a left ventricular (LV) ejection fraction ≥ 50
This study aimed to evaluate the clinical feasibility of dental magnetic resonance imaging (MRI) using a microscopy coil by comparing imaging positions in healthy volunteers. Twenty-six healthy volunteers underwent dental MRI in supine and prone positions using a 47 mm microscopy coil on a 3.0T system. T1-weighted (T1W), T2-weighted (T2W), and proton density-weighted (PDW) sequences were acquired. Participant-reported burden was assessed using a 10-point scale. Image quality was evaluated using a 4-point scale for sharpness, artifact, perceived signal-to-noise ratio (SNR), and overall quality. SNR and contrast-to-noise ratio (CNR) were calculated from 1 mm2 regions of interest in dental pulp, inferior alveolar neurovascular bundle, and bone marrow. Statistical analyses included the Wilcoxon signed-rank test, Fisher’s exact test, and paired t-test. Participant-reported burden was lower in the supine position (1.7 ± 1.1) than in the prone (4.7 ± 2.1). Visual assessments demonstrated superior image quality in supine across all sequences. The proportion of non-diagnostic images was higher in the prone position: T1W (50
Abstract At the 2024 annual meeting of the Japanese Society for Dialysis Therapy (JSDT), a symposium on disaster preparedness in dialysis facilities was held, featuring a comprehensive report from Indonesia. Indonesia has a history of frequent disasters, including earthquakes, tsunamis, and floods caused by tropical cyclones. This article describes strategies and countermeasures designed to protect dialysis centers in Indonesia from the impacts of natural disasters. By recognizing the essential role these centers have in delivering life-sustaining treatment to individuals with end-stage kidney disease (ESKD) and examining existing protocols, disaster response plans, and lessons from past incidents, this article provides insights into proactive strategies that, perhaps, should facilitate protection of dialysis facilities and ensure continuity of care even amid adverse environmental conditions. During the preparation of this manuscript, an earthquake struck Myanmar on 28 March 2025, resulting in extensive damage that was reported worldwide. The regions surrounding Mandalay and Naypyidaw were particularly impacted. Prof. Kriang Tungsanga of the Nephrology Society of Thailand (NST) acted swiftly by obtaining information from a past president of the Myanmar Nephro-Urology Society (MNUS) and promptly contacted us on the Japanese side. Dialysis professionals from Japan, Thailand, and Myanmar had established collaborative ties through activities within the International Society of Nephrology (ISN) Oceania and Southeast Asia Regional Board, and the Japanese Society for Dialysis therapy international forum being held during the JSDT annual meeting. Through this network, dialysis supplies were urgently dispatched from Japan to the disaster-stricken areas in Myanmar. This paper chronologically outlines the methods and characteristics of international dialysis supply support to a conflict-affected country.
BACKGROUND:Patients with extensive ischaemic change are often excluded from endovascular thrombectomy. We aimed to synthesise the evidence from recent trials in these patients by performing a systematic review and individual patient data meta-analysis to estimate treatment benefit, including within clinical and imaging subgroups. METHODS:In this systematic review and meta-analysis, we searched PubMed and Embase for randomised trials published between March 1, 2018, and March 1, 2025, that evaluated efficacy and safety of endovascular thrombectomy compared with medical management in patients with large-core ischaemic stroke (based on an Alberta Stroke Program Early CT Score [ASPECTS] of ≤5 or estimated ischaemic core ≥50 mL) presenting within 24 h of onset. Individual patient-level data from all eligible trials were obtained. A central imaging core laboratory readjudicated ASPECTS and reanalysed ischaemic core volume. A two-stage meta-analysis with random-effects model was used to evaluate the distribution of 90-day modified Rankin Scale (mRS) scores (the primary outcome) using adjusted pooled generalised odds ratios (aGenORs). Missing data were handled by multiple imputation. Safety outcomes were all-cause mortality within 90-day follow-up and neurological worsening within 24-48 h of randomisation, reported as adjusted pooled relative risk (aRR); and symptomatic intracerebral haemorrhage within 36 h of randomisation (reported as risk difference). Subgroup analyses based on clinical and imaging characteristics were done, including subgroups defined by ischaemic core volume, ASPECTS, and time window from onset to randomisation. The meta-analysis was registered with PROSPERO (CRD420251058584). FINDINGS:We included 1886 patients (944 assigned to endovascular thrombectomy and 942 assigned to medical management) from six trials. Baseline characteristics were similar between treatment groups. At day 90, the distribution of mRS scores was improved in patients in the endovascular thrombectomy group (median score 4 [IQR 3-6]; n=940) versus those in the medical management group (5 [4-6]; n=931; aGenOR 1·63 [95% CI 1·42-1·88], p<0·0001). The endovascular thrombectomy group also had reduced mortality (292 [31·1%]) compared with the medical management group (347 [37·3%]; aRR 0·82 [95% CI 0·70-0·97], p=0·022). No significant differences were observed in symptomatic intracranial haemorrhage (ten [1·1%] of 944 vs nine [1·0%] of 942 patients; pooled unadjusted risk difference -0·17 percentage points [95% CI -1·01 to 0·67], p=0·69) or neurological worsening (197 [22·0%] of 896 patients vs 161 [17·9%] of 899; aRR 1·19 [0·87-1·62], p=0·27). Improved functional outcomes with endovascular thrombectomy were consistent across clinical and imaging subgroups, except for those with an estimated ischaemic core volume of 150 mL or greater, in whom point estimates favoured endovascular thrombectomy, particularly in the early time window (0-6 h), but wide 95% CIs limited interpretation. INTERPRETATION:Endovascular thrombectomy was associated with improved functional outcomes and reduced mortality versus medical management in patients with large-core ischaemic stroke presenting within 24 h of onset. With the exception of very extensive ischaemic changes (core volume ≥150 mL) presenting beyond 6 h, where evidence remains limited, benefit was sustained across ASPECTS and ischaemic core strata for patients presenting up to 24 h after onset. FUNDING:None.
