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Specific flavonoid-rich foods/beverages are reported to exert positive effects on vascular function; however, data relating to effects in the postprandial state are limited. The present study investigated the postprandial, time-dependent (0–7 h) impact of citrus flavanone intake on vascular function. An acute, randomised, controlled, double-masked, cross-over intervention study was conducted by including middle-aged healthy men (30–65 years, n 28) to assess the impact of flavanone intake (orange juice: 128·9 mg; flavanone-rich orange juice: 272·1 mg; homogenised whole orange: 452·8 mg; isoenergetic control: 0 mg flavanones) on postprandial (double meal delivering a total of 81 g of fat) endothelial function. Endothelial function was assessed by flow-mediated dilatation (FMD) of the brachial artery at 0, 2, 5 and 7 h. Plasma levels of naringenin/hesperetin metabolites (sulphates and glucuronides) and nitric oxide species were also measured. All flavanone interventions were effective at attenuating transient impairments in FMD induced by the double meal (7 h post intake; P<0·05), but no dose–response effects were observed. The effects on FMD coincided with the peak of naringenin/hesperetin metabolites in circulation (7 h) and sustained levels of plasma nitrite. In summary, citrus flavanones are effective at counteracting the negative impact of a sequential double meal on human vascular function, potentially through the actions of flavanone metabolites on nitric oxide.

Background Bicuspid aortic valve (BAV) is related to aortic dilatation, but patterns/rates are conflicting with no comparison among aneurysms of different aetiology. We sought to define ascending aorta dilatation patterns/progression rates in BAV versus other aortopathies (Marfan syndrome (MFS), degenerative aortopathy (DA)). Design and setting Retrospective, observational study. Aortic dilatation progression was evaluated in two tertiary care centres (US and European) by repeated echocardiography ≥2 years apart in adults with BAV (n=353), matched to MFS (n=50) and DA (n=51) for gender, blood pressure, and minimum follow-up time. Results At baseline, ascending aortic dilatation was present in 87% of BAV cases: tubular ascending aorta in 60% (irrespective of BAV morphology), and Valsalva sinuses dilatation in 27% (independently linked to typical BAV morphology and male gender (p=0.0001)). After 3.6±1.2 years, the aortic dilatation rate in BAV was higher than expected for the population for all aortic levels (p=0.005) and was maximal at the tubular ascending aorta for BAV (0.42±0.6 mm/year) and DA (0.20±0.3 mm/year), and was maximal at the Valsalva sinuses for MFS (0.49±0.5 mm/year). Maximal aortic dilatation rate was similar between BAV and MFS (p>0.40) and lower in DA (p=0.02) but was heterogeneous in BAV, with 43% of BAV not progressing (vs 20% of MFS, p=0.01). Aortic dilatation rate was not proportionally related to baseline aortic size or BAV type (all models p>0.40). Conclusions In patients with BAV, tubular ascending aorta dilatation is the most common pattern and exhibits the fastest growing rate, irrespective of valve morphology and function. Dilatation of the Valsalva sinuses is less common and associated with typical BAV morphology and male gender. Aortic dilatation progresses equally fast in BAV (tubular segment) and MFS (Valsalva sinuses), but a significantly higher proportion of BAV patients does not progress at all, irrespective of BAV type. Baseline aortic diameter does not proportionally predict progression rate; systematic follow-up is therefore warranted in patients with BAV.

Superior and inferior macular vortex veins are divided by a horizontal watershed passing through the macula. We evaluated macular vortex vein remodeling in eyes with pachychoroid neovasculopathy (PNV). Thirty eyes of 30 patients with treatment-naïve PNV and 30 normal eyes of 30 age-, gender-, and refraction-matched subjects were studied. We assessed the features of macular vortex veins employing en face optical coherence tomography (OCT) and determined central choroidal thickness (CCT) using B-mode OCT. Of the 30 normal eyes, a horizontal watershed was identified in 24 eyes (80%), while venous anastomosis between the superior and inferior vortex veins was observed in 6 eyes (20%). Mean CCT was 233 μm. Of the 30 eyes with PNV, vortex veins were dilated in all 30 eyes with PNV. In 27 of the 30 PNV eyes (90%), the horizontal watershed had disappeared, and collateral veins had instead developed via anastomosis between the superior and inferior vortex veins, making this finding significantly more frequent than in normal eyes ( P  < 0.001). Mean CCT was 357 μm, significantly thicker than that of normal eyes ( P  < 0.001). Remodeling of choroidal drainage routes by venous anastomosis between superior and inferior vortex veins was common in eyes with PNV. This observation suggests longstanding congestion of the choroidal veins.

In 2014, a multidisciplinary consensus on the classification of pre- and postnatal urinary tract dilation (UTD classification) was developed. Its goal was to provide a standardized system for evaluating and reporting urinary tract dilation both in the prenatal and postnatal periods. In this review, we summarize insights learned from the implementation of the UTD classification system since its inception, providing clarifications on common points of confusion. In addition, we review current literature in the clinical validation of the UTD classification system to provide credence for its use in managing fetuses and children with urinary tract dilation.

Background Aortic structural damage (ASD) may complicate the course of patients with giant cell arteritis (GCA). However the frequency and outcome of ASD has not been assessed in long term prospective studies. Methods In a previous screening of 54 biopsy proven GCA patients, significant ASD was detected in 12 (22.2%) after a median follow-up of 5.4 years. These patients were periodically evaluated (every 4 years) over a median of 10.3 years (range 4–16.6 years) in order to investigate the development of new ASD and the outcome of previously detected abnormalities. Results 18 of the 54 patients abandoned the study due to death or other reasons. The remaining 36 patients were subjected to a second screening and 14 to a third screening. 12 (33.3%) of the 36 patients re-screened and 16 (29.6%) of the initial cohort developed ASD, all but one in the thoracic aorta. Aortic diameters at the ascending and descending aorta significantly increased over time. One patient (1.9% of the initial cohort) died from aortic dissection. Surgery was advised in eight (50%) patients with ASD but could only be performed in three patients (37.7%). The development of ASD was not associated with persistence of detectable disease activity. Conclusions The incidence of ASD is maximal within the first 5 years after diagnosis but continues developing over time, affecting up to 33.3% of individuals after long term follow-up. Once ASD occurs, dilatation increases over time, underlining the need for periodic evaluation. Surgical repair is feasible in about one-third of candidates.

ObjectiveBicuspid aortic valve (BAV) is the most common congenital heart disease. This study aimed to determine the prevalence rate of BAV in first-degree relatives (FDR) and the inheritance pattern according to different morphotypes and aortic dilation.MethodsBAV probands were consecutively studied at eight tertiary referral centres. After sequential screening, FDR were included in the study. The BAV morphotype, aortic dilation and aortic phenotype were assessed by transthoracic echocardiography.ResultsSeven hundred and twenty-four FDR of 256 BAV probands agreed to undergo family screening. The prevalence of BAV was 6.4% in FDR (9.2% in men, 3.5% in women, p=0.002). Aortic dilation was diagnosed in 9.6% of FRD with tricuspid aortic valves (TAV), with a root phenotype in 2.7% and tubular in 6.9% and more frequently in the presence of arterial hypertension (OR 4.48; CI 95% 2.51 to 7.99; p=0.0001) and valvular regurgitation (OR 5.87, CI 95% 1.37 to 25.16; p=0.025). The heritability (h2 ) of BAV was highly significant (0.47; p=0.002); however, no concordance was observed among valve morphotypes. Aortic dilation heritability was not significant.ConclusionsThe BAV prevalence rate in FDR was low (6.4%) but aortic dilation was observed in 9.6% of FDR with TAV. The heritability of BAV was high without concordance in valve morphotypes, and aortic dilation heritability was not observed. Patients with BAV should be made aware of its familial pattern.

Thoracic aortic dilatations (TADs) are commonly detected incidentally. A TAD may develop into aortic aneurysm and subsequently lead to aortic dissection, a highly lethal condition. Earlier detection of TADs could improve the surveillance and surgical management of aneurysms, potentially reducing aortic ruptures. The opportunistic use of thoracic sectional imaging studies performed for other indications, including breast radiation therapy planning, could be used to detect TADs. However, the frequency of TADs and the clinical risk factors for TADs in females undergoing adjuvant breast radiation therapy remain unknown. We retrospectively collected a consecutive cohort of 861 females with breast cancer who underwent adjuvant radiotherapy planning with computed tomography (CT). Using CT scans, we manually measured thoracic aortic dimensions on the hospital’s dedicated picture archiving and communication software (PACS). Following the European Society of Cardiology guidelines, a segment of the aorta was considered dilated when its maximal diameter exceeded 40 mm. Additionally, we collected clinical patient data regarding known risk factors predisposing patients to TADs. Out of 861 patients, 80 (9.3%) had a TAD. Compared to those without any TADs, patients with at least one TAD were older (71.3 ± 9.7 years vs. 62.9 ± 11.7 years; P < .001) and more frequently displayed hypertension (62 [77.5%] vs. 354 [45.3%], P < .001), a history of a TIA or stroke (10 [12.5%] vs. 36 [4.6%], P = .007), and aortic valve insufficiency (10 [12.5%] vs. 51 [6.5%], P = .047). The opportunistic use of radiotherapy planning CT scans allows earlier TAD diagnosis, and a significantly large number of female patients (9.3%) had at least one abnormal thoracic aortic dimension. This finding could indicate a need to consider a systematic screening of TADs in patients undergoing adjuvant radiotherapy.

Common bile duct (CBD) dilation is typically an indication for intraoperative cholangiogram (IOC). We hypothesized that isolated CBD dilation on pre-operative ultrasound (US) is not predictive of choledocholithiasis (CD) on IOC. A retrospective study comparing patients with dilated versus normal CBD diameter on pre-operative US. CBD dilation on pre-operative ultrasound was defined as ≥ 0.6 ​cm, with 1 ​mm added per decade of life above 60-years-old. Demographics, laboratory values, CBD diameter, cholecystitis grades, and clinical outcomes were collected. 341 patients underwent LC with IOC during the study period, of which 46 patients had isolated CBD dilation. CBD dilation via ultrasound had a sensitivity of 80.00 ​%, specificity of 25.49 ​%, positive predictive value of 17.39 ​%, and negative predictive value of 86.67 ​%. There was no difference in demographics, cholecystitis severity, complication or readmission rates. Isolated CBD dilation does not present an increased risk of CD compared to normal CBD diameter. •Asymptomatic choledocholithiasis is present in 5–15 ​% of patients who undergo cholecystectomy for cholelithiasis.•Isolated common bile duct dilation as a predictive measure of choledocholithiasis has not been well studied.•Isolated biliary duct dilation does not present an increased risk of choledocholithiasis compared to normal common bile duct diameter.•Isolated biliary duct dilation on pre-operative ultrasound should not impact the decision to perform intraoperative cholangiogram during cholecystectomy.

Background Congenital biliary dilatation (CBD) represents a prevalent congenital anomaly in pediatric surgery, with concurrent choledocholithiasis observed in a notable subset of pediatric patients. Improper management of such cases can compromise early diagnosis of CBD and adversely impact outcomes of radical surgery. This retrospective study evaluated the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients with common bile duct dilatation complicated by choledocholithiasis, aiming to refine clinical strategies for diagnosis and preoperative management to mitigate long-term complications. Methods A retrospective analysis was conducted on pediatric patients diagnosed with common bile duct dilatation and stones who underwent therapeutic ERCP at Wuhan Children’s Hospital from August 2019 to July 2024. Clinical data, including demographic characteristics, laboratory tests, imaging findings, and ERCP-related parameters, were reviewed. Further subgroup analyses were performed based on the presence of postoperative adverse events and the coexistence of pancreaticobiliary maljunction (PBM). Results A total of 58 children with common bile duct dilatation and stones underwent 58 ERCP procedures, achieving a 100% procedural success rate. After ERCP, liver transaminase and bilirubin levels significantly decreased ( P  < 0.01). Postoperative follow-up showed a choledochal diameter of < 10 mm in 43 patients, with an overall effectiveness rate of 74.1% ( n  = 43/58). Among patients who did not undergo radical surgery ( n  = 48), the prognosis during follow-up (mean duration: 29.9 months) was favorable, and Likert scores were not associated with the presence of PBM ( P  > 0.05). The incidence of postoperative adverse events ( n  = 11/58, 19.0%) was significantly correlated with cannulation duration ( P  < 0.01). Patients in the PBM group ( n  = 21/58, 36.2%) were more likely to be female, younger, and have lower height and weight, with no differences found in other characteristics. Conclusion ERCP is a safe and effective treatment for pediatric common bile duct dilatation with stones. Regardless of whether radical surgery was performed or the presence of PBM, patients showed improved laboratory parameters and symptom relief following ERCP. The effectiveness and incidence of adverse events were not related to PBM, but postoperative adverse events were associated with cannulation duration. Beyond its diagnostic utility in CBD and PBM, ERCP serves as a safe bridging therapy prior to radical surgery.

Background Asymptomatic, mild urinary tract dilatation (UTD) that does not resolve can progress in severity, which suggests the need for continued observation. However, no studies have investigated the factors that contribute to the non-resolution of mild UTD. Methods We conducted this prospective cohort study of children who were newly diagnosed with mild UTD during the neonatal period from 2013 to 2021. The patients were evaluated by periodic kidney ultrasound until 3 years of age. Sonographic reference values for kidney length were determined according to estimation formulas, and sonographic kidney volume was calculated using kidney length, width, and depth. Results This pilot study included 33 children with mild UTD, totaling 58 kidney units. The kidney units were graded as UTD P1 in 23 and UTD P2 in 35 units. Sonographic kidney length and volume were significantly higher for kidneys with UTD P2 units that did not resolve over 3 years than in those that resolved at 3 months, 6 months, and 1 year. The time to resolution of UTD P2 units in kidneys with a length of > 0.7 standard deviations at 3 months and > 1.2 standard deviations at 6 months was significantly longer than the time to resolution in kidneys with a length of ≤ 0.7 standard deviations at 3 months ( p  < 0.01) and ≤ 1.2 standard deviations at 6 months ( p  = 0.01). Conclusions Increased sonographic kidney length in UTD P2 is a prognostic factor for non-resolution of mild UTD. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information