We observed a significantly thicker cIMT in children with migraine compared with the controls. The brief time interval between the onset of the disease and the time of the study makes it unlikely that repetitive migraine attacks could be responsible for the thickening of the cIMT. Thus, it may be speculated that primitive vascular function abnormalities were wholly or partly responsible for the development of migraine in this paediatric cohort.

Keywords Flow-mediated dilatation (FMD) . L-thyroxin . Subclinical hypothyroidism . TSHThe aim of this study was to determine whether endothelial function, which is altered in patients with hypothyroidism and returns to normal with replacement therapy, can be used as a sensitive marker of tissue hypothyroidism. Our results suggest that endothelial function is not correlated with thyroid stimulating hormone (TSH) and, therefore, that it is not a useful marker for determining when L-thyroxin should be started in subclinical hypothyroidism.The timing of initiating L-thyroxin therapy in patients with subclinical hypothyroidism is still open to debate. In adults, there is a relative consensus among clinicians for treating patients with TSH serum levels above 10 mU/L, but there is still a degree of uncertainty of what to do when TSH levels are between 5 and 10 mU/L, or even lower [2,4]. The main problem is the lack of a sensitive tissue marker signaling at which TSH level hypothyroidism starts to manifest itself at the cellular level and, therefore, when treatment should be started. Endothelial dysfunction has recently been described in patients with subclinical hypothyroidism, which returns to normal following L-thyroxin therapy [3]. This led us to the question of whether endothelial function would be a sensitive marker of tissue hypothyroidism. To this end, we carried out the present study to evaluate the correlation between TSH serum levels and endothelial function.We studied 32 pediatric patients (19 males and 13 females) with a mean chronological age of 10.0±4.5 years, height standard deviation score (SDS) of 0.42±1.20 and a body mass index (BMI) SDS of 0.57±1.58. Seventeen of the patients had Hashimoto's thyroiditis (HT), one had a thyroid hemiagenesis while in the other patients the cause for the hypothyroidism was unknown. Seven patients with HT were euthyroid at the time of the study, and the remaining 25 patients were affected with subclinical hypothyroidism, defined by a TSH level above the normal range for our laboratory (>4.2 mU/L) together with normal fT4 and fT3 levels. No patient was taking any medication at the time of the study. Twenty-five healthy subjects (16 males and nine females), with a mean age of 10.9±3.6 years and normal height and weight, were enrolled as controls.Endothelial function was assessed in a non-invasive manner with high-resolution ultrasound by measuring the brachial artery responses to reactive hyperaemia according to the recently published guidelines [1]. The dilatation of the artery caused by the increased blood flow is known as flow-mediated dilatation (FMD). TSH was measured by radioimmunoassay (DiaSorin, Dietzenbach, Germany); the intra-and inter-assay coefficient of variance (CV) were 2.5 and 5.7%, respectively, and the sensitivity limit was 0.02 mIU/ml. fT4 and fT3 serum levels, total cholesterol, HDL cholesterol, triglycerides, insulin and glycaemia were also measured.

Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient’s physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial fibrillation and borderline renal dysfunction who was switched from warfarin to rivaroxaban and subsequently developed bruising with hemorrhagic shock and acute on chronic renal failure. Administration of 4-factor prothrombin complex concentrate effectively reversed coagulopathy and stopped bleeding. Retrospective determination of circulating plasma levels of rivaroxaban and warfarin confirmed that excessive anticoagulation was likely due to warfarin that the patient probably continued to take although rivaroxaban was initiated. Pharmacodynamic interaction between rivaroxaban and warfarin may not only be additive but synergistic. In patients at high risk of complications, judicious prescribing and dosing of NOACs, and regular monitoring of concomitant medications and renal function are highly recommended.

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Funding Acknowledgements Type of funding sources: None. Introduction Many patients with cardiac implantable electronic devices (CIED) need to undergo magnetic resonance imaging (MRI). However, a significant proportion has a CIED system in place that has not been classified "MRI-conditional" because of generators and leads from different brands ("mixed-brand" group), although the individual components per se are MRI-conditional. There is only limited data available concerning the outcome of these patients with "mixed-brand" CIED systems undergoing MRI. Purpose To analyse complications or adverse effects in "mixed-brand" CIED patients undergoing MRI, compared to patients with a fully "MRI-conditional" CIED system. Methods A retrospective single-centre study was performed, including patients undergoing MRI between January 2013 until May 2020. Short- and long-term outcomes were compared between both groups. We defined the primary endpoint as death or any adverse event necessitating hospitalization or CIED revision in association with the MRI examination. Secondary endpoints were the occurrence of any surrogate for beginning device or lead failure or patient discomfort during MRI. Results A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with a range of 1-9 MRIs per patient. Mean age was 73 years and 52 (32.9%) patients were female. We identified 38 patients undergoing 54 procedures in the "mixed-brand" group and 89 patients undergoing 134 MRI procedures in the "MRI-conditional" group. In 31 patients undergoing 39 MRI examinations the MRI-conditionality could not be determined. "Mixed-brand" patients were older than MRI-conditional patients (mean 77 vs. 72 years, p = 0.003). The primary endpoint occurred in 0% in the "mixed-brand" group and in 2.2% in the "MRI conditional" group (p = 1.000). Complications were as follows: Two patients had first diagnosed atrial fibrillation directly associated with the procedure, of whom one additionally had a transient CIED dysfunction. No patient in the "mixed-brand" group and three patients (3.4%) in the "MRI conditional" group met the secondary endpoints (p = 0.554). In patients with undeterminable MRI conditionality the complication rate was similar (0% for both the primary and secondary endpoints). Conclusion The complication rate of CIED patients undergoing MRI was low. There was no signal for increased risk of adverse events in patients with a CIED without MRI certification due to mixed brands systems compared to patients with "MRI-conditional" CIED systems.