Valve surgery improved functional class and resulted in RV reverse remodelling with improved survival rates at 2 y compared with those not proceeding to operation. These data highlight the importance of close collaboration between NET clinicians, cardiology, and cardiothoracic surgery teams. Early referral can improve functional capacity but more research is needed to define the selection of appropriate candidates and randomized data are needed to define the effect of surgery on prognosis.

Background Tryptophan catabolism, measured by the kynurenine:tryptophan (kyn/trp) ratio, is associated with gut microbiota alterations in people with HIV (PWH). We examined the association of the kyn/trp ratio with liver fibrosis in women with/without HIV infection. Methods The plasma kyn/trp ratio was measured in 137 HIV-monoinfected, HIV/hepatitis C virus (HCV)–coinfected, and uninfected women in the Women’s Interagency HIV Study. Fibrosis was estimated using FIB-4 in all participants and vibration-controlled transient elastography liver stiffness measurement (LSM) in a subset (n = 83). We used multivariable linear regression to evaluate the associations of infection status and kyn/trp ratio with relative differences in fibrosis estimates. Results The median kyn/trp ratio (interquartile range) was 0.056 (0.045–0.066) in HIV/HCV-coinfected, 0.038 (0.032–0.046) in HIV-monoinfected, and 0.031 (0.025–0.034) in uninfected women (P < .001). After adjustment for sociodemographic, lifestyle, and metabolic factors, HIV monoinfection and HIV/HCV coinfection were associated with 37% (95% confidence interval [CI], 9% to 73%) and 164% (95% CI, 100% to 250%) greater FIB-4, respectively. When kyn/trp ratio was included, higher kyn/trp ratio was associated with greater FIB-4 (27% per kyn/trp doubling; 95% CI, 5% to 53%), and the associations of HIV monoinfection (29% per kyn/trp doubling; 95% CI, 2% to 63%) and HIV/HCV coinfection (123% per kyn/trp doubling; 95% CI, 63% to 203%) with greater FIB-4 were attenuated. Among those with LSM, higher kyn/trp ratio was associated with greater LSM (43% per kyn/trp doubling; 95% CI, 15% to 79%) in multivariable analysis. Conclusions The kyn/trp ratio is elevated in PWH and is associated with greater liver fibrosis. Tryptophan catabolism may modify the relationships between HIV, HCV, and fibrosis.

In this study, we evaluated fracture incidence over a 10-year period among men with and without osteomyelitis from the Veterans Aging Cohort Study. Fracture incidence was significantly higher among those with osteomyelitis at all osteoporotic fracture sites after adjusting for key related risk factors. Future prospective studies are warranted.

autoimmunity is a known cause of hypothyroidism. Overt hypothyroidism is an established cause of recurrent pregnancy loss (RPL) that is effectively treated with levothyroxine (LT).As it is unclear how thyroperoxidase antibody (TPOAb) positivity impacts thyroid stimulating hormone (TSH) levels during subsequent pregnancies, the primary objective of this study was to examine the TSH levels for RPL patients during pregnancies following the index visit.A preliminary analysis was performed to ascertain if subclinical hypothyroidism can be treated with LT to improve live birth rate (LBR), LBR in borderline subclinical hypothyroidism (B-SCH) (TSH 2.5-4 mIU/L) and clinical/subclinical hypothyroidism (C/SCH) (TSH > 4 mIU/L) with and without LT was compared to euthyroid patients (TSH 0.1-2.5 mIU/L).MATERIALS AND METHODS: A retrospective chart review of 1444 RPL patients seen at the BC Women's Hospital was conducted. 828 euthyroid patients, 269 B-SCH (116 treated, 153 untreated), and 103 C/SCH (65 treated, 38 untreated) were included. TSH in pregnancies after the initial visit across TPOAb status was analyzed using mixed-effects linear regression. Across euthyroid, B-SCH, or C/SCH patients, LBR was analyzed using Poisson regression.RESULTS: The baseline characteristics showed no significant difference in age, body mass index, or number of previous live births or pregnancy losses between euthyroid, B-SCH, or C/SCH groups. The distribution of RPL causes between groups revealed no difference in genetic or anatomic causes but a higher rate of hyperprolactinemia (p¼0.003) and anti-phospholipid antibody syndrome (APS; p¼0.026) in those with C/SCH. Analysis of TSH showed no significant change across TPOAb or treatment status (p¼0.24) for up to four subsequent pregnancies. An increased LBR in B-SCH when treated with LT relative to untreated B-SCH (OR¼ 1.67, p¼0.0037) was seen. In C/SCH patients, there was no significant change in LBR when treated with LT relative to untreated C/SCH patients (OR¼1.52, p¼0.17).CONCLUSIONS: In the RPL population, TPOAb positivity is not correlated with change in TSH levels over time. RPL patients with C/SCH are more likely to have hyperprolactinaemia and APS.IMPACT STATEMENT: This research provides evidence for how TSH levels change following the index visit in the RPL population.

was 121.7 mIU/mL (IQR 86.0, 115.5), in those 35 -40 the median hCG level was 110.2 mIU/mL (IQR 75.8, 155.8), and in those > 40 the median hCG level was 119.8 mIU/mL (IQR 78.2, 173.8) at mean of 13.4 days AOR.CONCLUSIONS: Specific rises in early hCG levels after SET were associated with LB when hCG levels were checked 15 days AOR. In cycles where hCG levels both doubled and reached 100 mIU/mL by 15 days AOR, the LB rate was 84% and this was a stronger predictor of LB than either parameter alone. LB was only achieved in 9% of cycles where hCG levels neither ''doubled'' nor ''reached 100''. Age was not associated with early hCG levels in cycles that ended in LB.IMPACT STATEMENT: Defining explicit parameters related to early hCG levels that can reliably predict LB can improve counseling. Using ''doubling'' and ''reaching 100'' 15 days AOR as parameters may help guide patient's expectations regarding pregnancy outcomes as early as possible after SET.