No abstract

CONTEXT Children with spina bifida are at high risk for urinary tract infections (UTI). However, there is no standardized definition of UTI in this population, leading to variability in both clinical management and research. This was highlighted in the 2013 systematic review on the same topic. OBJECTIVE Evaluate the frequency with which researchers are defining UTI in their studies of children with spina bifida and to determine what parameters are used. DATA SOURCES We searched Medline and Scopus databases for articles that included pediatric patients with spina bifida and used UTI as an outcome. STUDY SELECTION Exclusion criteria included publication before October 1, 2012, non-English language, and nonprimary research articles. DATA EXTRACTION Two independent reviewers each extracted data. RESULTS A total of 39 studies were included; 74% of these analyzed included an explicit definition of UTI. The most commonly used definition included a combination of symptoms and culture results (34.5%), whereas 31% used a combination of symptoms, culture results, and urinalysis data. Only 3.4% of articles used a urine culture alone to define UTI. CONCLUSIONS More articles that focus on children with spina bifida included a definition of UTI. However, significant variability persists in the definition of UTI in this patient population.

No abstract

Introduction: Increased B-type Natriuretic Peptide (NT-proBNP) levels have been associated with adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Global longitudinal strain (GLS) and wall stress (WS) are frequently reported to be abnormal in these patients as well, but studies examining how structural changes in those with HFpEF affect morbidity and mortality have been scarce. Hypothesis: NT-proBNP is a stronger predictor of death and heart failure readmissions in HFpEF patients when compared to GLS and WS. Methods: We conducted a retrospective study of 237 patients admitted with acute decompensated heart failure, all with EF > 50. Average age was 78 + 11, 69% of patients were female, and average BMI was 29 + 13. GLS was measured using speckled tracing echocardiography and WS was calculated from systolic blood pressure, end-systolic left ventricular (LV) dimension, and end-systolic posterior wall thickness. Results: During a follow-up period of 2 years, 55 patients died and 55 were readmitted with the diagnosis of acute decompensated heart failure. Mean NT-proBNP among all patients was 9982 + 16268, mean GLS -17.84 + 4.52, and mean WS was 52.27 + 25.23. 129 patients had an abnormal or borderline GLS of >-18, whereas nearly all patients (230) had an abnormal WS of <109. (See table for results.) Conclusion: GLS and WS are reduced in a significant proportion of HFpEF patients. However, our data suggests that compared to echocardiographic indices of LV systolic function, biomarkers have a stronger short-term prognostic value.

31 Background: 4Kscore was developed and validated agnostic to prostate multiparametric MRI (mpMRI) findings, with current clinical paradigms utilizing a value of 7.5% to delineate the potential for high-grade disease. A growing body of evidence suggests improved diagnostic utility when used in conjunction with mpMRI results. Incorporation of mpMRI PIRADS scores may have potential to enhance diagnostic accuracy of 4Kscore, especially for non-definitive lesions. This study aims to examine the optimal 4Kscore threshold in PIRADS 3/4 lesions to maximize test utility and help guide clinical decision-making. Methods: A single-institution review of all patients with recorded 4Kscore, prostate MRI with dominant PIRADS 3/4 lesions, and final biopsy pathology from 2016-2020 was conducted from an IRB-approved database. Clinically significant prostate cancer (csPCa) was defined as Gleason score ≥3+4 on final biopsy. Receiver operating characteristic curves were generated, and the primary data point was chosen to maximize sensitivity and specificity. Results: 88 patients with dominant PIRADS 3 (n = 40) or PIRADS 4 (n = 48) lesions were identified. For patients with PIRADS 3 lesions, area under the curve (AUC) was 0.8083 (p < 0.0039) with optimal 4Kscore threshold to detect csPCa as 18.5% (sensitivity = 70.00%, specificity = 80.00%). Negative predictive value (NPV) at 4Kscore of 18.5% in PIRADS 3 lesions was 0.93. In patients with dominant PIRADS 4 lesions, AUC was 0.7735 (p < 0.002), and optimal threshold to detect csPCa was 21.5% (sensitivity = 70.59%, specificity = 76.67%). NPV at 4Kscore of 21.5% in PIRADS 4 lesions was 0.82. Conclusions: Stratification of mpMRI PIRADS 3/4 lesions suggests that utilization of more permissive 4Kscore thresholds can improve prediction of csPCa without sacrificing NPV, especially for PIRADS 3 lesions. These findings may enhance risk-adapted prostate cancer screening, reduce unnecessary prostate biopsies, and optimize clinical management.