30-day Follow-up Research Articles

Association Between Surgeon Stress and Major Surgical Complications.

Surgeon stress can influence technical and nontechnical skills, but the consequences for patient outcomes remain unknown. To investigate whether surgeon physiological stress, as assessed by sympathovagal balance, is associated with postoperative complications. This multicenter prospective cohort study included 14 surgical departments involving 7 specialties within 4 university hospitals in Lyon, France. Exclusion criteria consisted of patient age younger than 18 years, palliative surgery, incomplete operative time-stamping data, procedures with a duration of less than 20 minutes, and invalid surgeon heart rate variability (HRV) data. Data were accrued between November 1, 2020, and December 31, 2021, with 30-day follow-up completed on May 8, 2022. Analyses were performed from January 1 to May 31, 2024. Sympathovagal balance of the attending surgeon in the first 5 minutes of surgery. Major surgical complications, extended intensive care unit stay, and mortality within 30 days, after adjustment via mixed-effects multivariable logistic regression for surgeon age, professional status, the time of incision, the random effect of the surgeon, and a composite risk score incorporating patient comorbidities and surgery characteristics. Sympathovagal balance was quantified by the low frequency to high frequency (LF:HF) ratio derived from HRV data measured by chest monitors worn intraoperatively. The LF:HF ratio was normalized at the surgeon level to the median value observed for each surgeon during the study period to control for baseline differences. A total of 793 surgical procedures performed by 38 attending surgeons were included in the analysis. Median patient age was 62 (IQR, 47-72) years, and 412 (52.0%) were female, with a median of 2 (IQR, 1-4) comorbidities. Median surgeon age was 46 (IQR, 39-52) years, 39 (78.9%) were male, and 22 (57.9%) were professors. Median surgeon heart rate was 88 (IQR, 77-99) beats per minute. Median surgeon LF:HF ratio was 7.16 (IQR, 4.52-10.72) before and 1.00 (IQR, 0.71-1.32) after normalization. Increased surgeon sympathovagal balance during the first 5 minutes of surgery was associated with significantly reduced major surgical complications (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.98; P = .04), though not with reduced intensive care unit stay (AOR, 0.34; 95% CI, 0.11-1.01; P = .05) or mortality (AOR, 0.18; 95% CI, 0.03-1.03; P = .05). Increased surgeon stress at the beginning of a procedure was associated with improved clinical patient outcomes. The results are illustrative of the complex relationship between physiological stress and performance, identify a novel association between measurable surgeon human factors and patient outcomes, and may highlight opportunities to improve patient care.

Early Versus Delayed Antihypertensive Treatment After Acute Ischemic Stroke by Hypertension History.

We performed a prespecified subgroup analysis of the CATIS-2 trial (China Antihypertensive Trial in Acute Ischemic Stroke II) to compare the effect of early versus delayed antihypertensive treatment on death and disability in patients with and without medical history of hypertension. CATIS-2 is a multicenter randomized clinical trial conducted in 106 hospitals in China. The trial randomized 4810 patients with acute ischemic stroke within 24 to 48 hours of symptom onset and elevated systolic blood pressure between 140 and <220 mm Hg to receive antihypertensive treatment immediately after randomization or to discontinue antihypertensive medications for 7 days and then receive treatment on day 8. The primary outcome was a combination of death or functional dependency (modified Rankin Scale score ≥3) at 90 days. At the 90-day follow-up, the primary outcome of death or functional dependency was not different between early- and delayed-treatment groups according to the history of hypertension; the odds ratios (95% CIs) associated with the early-treatment group were 1.11 (0.91-1.36) and 1.38 (0.92-2.08) for participants with and without a history of hypertension. However, the ordinal logistic regression showed that early antihypertensive treatment was associated with the odds of a higher modified Rankin Scale score in patients without hypertension (odds ratio, 1.35 [95% CI, 1.01-1.82]), but not in those with hypertension (odds ratio, 0.95 [95% CI, 0.82-1.10]; P=0.04 for interaction). Early antihypertensive treatment did not reduce the odds of dependency or death at 90 days by hypertension history among patients with ischemic stroke but worsened functional outcomes for patients without hypertension in the ordinal analysis. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03479554.

Enhancing Antiretroviral Therapy Initiation for Hospitalized and Recently Discharged People Living With HIV in Johannesburg, South Africa.

Despite increased antiretroviral therapy (ART) access in South Africa, HIV testing and ART initiation are suboptimal in hospital settings. Key gaps include in-hospital case finding, ART initiation support, and primary health care (PHC) facility linkage after discharge. We identified weaknesses in hospital processes by comparing them with PHC HIV services and developed a quality improvement model for implementation in 5 Johannesburg hospitals. We introduced dedicated teams of HIV testing counselors for structured case finding and ART-trained nurses and linkage officers to provide in-hospital or post-discharge ART initiation and support to strengthen PHC facility linkage. Monitoring data (May 2020-March 2021) was used to measure initiation rates. Over 11 months, despite COVID-19 pandemic-related disruptions, our model achieved 74% (5,201/7,025) ART linkage within 28 days post-discharge and 87% (6,087/7,025) overall, including all initiations (i.e., all newly diagnosed, known not on ART and reinitiating individuals). The 2 highest-performing hospitals achieved 97% (2,096/2,170) linkage overall, demonstrating the potential of implementing this quality improvement model with fidelity. Over half (58%, 4,092/7,025) of patients initiated ART within 7 days, with 39% (2,748) initiating on the same day. Women and men achieved similar initiation rates (3,010/4,015, 75%; 2,186/3,003, 73%, respectively). Combining rapid (<7 days) in-hospital ART initiation with 28-day post-discharge follow-up supported high ART initiation rates. Using the model mitigated initiation gaps for men and older people, engaging stakeholders supported implementation, and using a team-based approach founded on clear roles and responsibilities improved service delivery. This model achieved above-average ART linkage rates in a large hospitalized population. We recommend considering introducing this model or adaptations of it to hospitals across South Africa and similar settings where hospital-to-PHC ART service gaps are identified to optimize case finding, ART initiation, and post-discharge linkage support.

US multicenter outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents for acute cholecystitis

AbstractEUS-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stents (LAMS) has excellent technical and short-term clinical success for acute cholecystitis (AC). The goals of this study were to determine the long-term clinical outcomes and adverse events (AEs) of EUS-GBD with LAMS.A multicenter, retrospective study was conducted at 18 US tertiary care institutions. Inclusion criteria: any AC patient with attempted EUS-GBD with LAMS and minimum 30-day post-procedure follow-up. Long-term clinical success was defined as absence of recurrent acute cholecystitis (RAC) &gt; 30 days and long-term AE was defined as occurring &gt; 30 days from the index procedure.A total of 109 patients were included. Technical success was achieved in 108 of 109 (99.1%) and initial clinical success in 106 of 109 (97.2%). Long-term clinical success was achieved in 98 of 109 (89.9%) over a median follow-up of 140 days (range 30–1188). On multivariable analysis (MVA), acalculous cholecystitis (odds ratio [OR] 15.93, 95% confidence interval [CI] 1.22–208.52, P = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08–799.29, P &lt;0.01) were associated with RAC. AEs occurred in 38 of 109 patients (34.9%) at any time, and in 10 of 109 (9.17%) &gt; 30 days from the index procedure. Most long-term AEs (7 of 109; 6.42%) were LAMS-specific. No technical or clinical factors were associated with occurrence of AEs. LAMS were removed in 24 of 109 patients (22%). There was no difference in RAC or AEs whether LAMS was removed or not.EUS-GBD with LAMS has a high rate of long-term clinical success and modest AE rates in patients with AC and is a reasonable destination therapy for high-risk surgical candidates.

Reducing self-stigma among survivors of childhood maltreatment: Randomized controlled trial of a brief video intervention.

Survivors of childhood maltreatment (CM) often experience self-stigma, the internalization of negative attitudes such as shame, self-blame, and a reluctance to disclose their experiences. These self-perceptions pose a significant barrier to treatment-seeking and may exacerbate psychiatric distress. Prior research indicates that social contact-based interventions are effective in reducing stigma, but no study to date has examined their impact on self-stigma and increasing openness to treatment-seeking among CM survivors. This study assessed the efficacy of a brief video intervention on reducing self-stigma among CM survivors using a randomized controlled trial. We randomly assigned 655 individuals (Mage = 36.7, SD = 11.2) with a history of CM to either an intervention or control video. Participants in the intervention group viewed a 2-min video of an actor describing lifetime hardships resulting from CM and how she benefited from psychotherapy. Control group participants observed a same-length video in which the actress described her daily activities, without any mention of CM. Self-stigma was assessed before, after, and 30 days following the intervention. Mean self-stigma scores significantly decreased from pre- to postintervention in the intervention group, as compared to the control group. Increases in openness to treatment-seeking did not reach significance. We did not find significant differences between the groups at baseline and 30-day follow-up assessments. This is the first study to demonstrate the efficacy of a brief, cost-effective, and easily disseminated video-based intervention to reduce self-stigma among CM survivors. This approach could help empower individuals with a history of CM, potentially encouraging treatment-seeking. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

High versus low dose of 14 days treatment of primaquine in Plasmodium vivax infected patients in Cambodia: a randomised open-label efficacy study.

SummaryBackgroundThe WHO malaria treatment guidelines recommend a total dose in the range of 3·5 to 7·0 mg/kg of primaquine to eliminatePlasmodium vivax(P. vivax) hypnozoites and prevent relapses. There are however indications that for tropicalP. vivaxisolates, notably from Southeast Asia, the lower dose of 3·5 mg/kg is insufficient. Determining the most effective regimen to eliminateP. vivaxhypnozoites is needed to achieve elimination of this malaria parasite.MethodsWe conducted an open-label randomised controlled trial in Kampong Speu province, Western Cambodia.P. vivaxinfected patients with uncomplicated malaria, diagnosed at the community level or in health centres of the province, were offered to participate. Patients aged less than 15 years old, and pregnant or breastfeeding women were excluded. Enrolled patients were treated with a blood schizonticidal artesunate regimen of 2 mg/kg/day for 7 days. Upon enrolment, patients’ glucose-6-phosphate dehydrogenase (G6PD) activity was determined. G6PD normal patients were randomly assigned (2:2:1) to receive either (i) 3·5 mg/kg (low dose as 0·25 mg/kg/day) or (ii) 7·0 mg/kg (high dose as 0·5 mg/kg/day) of primaquine over 14 days or (iii) no primaquine as comparator arm. G6PD deficient patients were assigned to the no-primaquine comparator arm. Randomisation was done by blocks of 5 using sealed envelopes. Upon enrolment, patients were relocated to the study site in Aoral town where no malaria transmission occurs to ensure that they were not reinfected during their 90-day follow-up. After 90 days of relocation, G6PD normal patients in the no-primaquine arm were provided 3·5 mg/kg for 14 days of primaquine to be taken unsupervised. At day 90, all the patients returned home and they were further followed monthly for three months until day 180. The primary outcome was the treatment failure rate defined as the proportion of patients with at least oneP. vivaxrecurrence within 90 days of relocated follow-up. All patients that completed treatment and complied with relocation without interruption before any recurrence was detected were included in the primary efficacy analysis. All patients enrolled and assigned to an intervention arm were included in the safety analysis. The study is registered onClinicalTrials.gov(NCT04706130).FindingsBetween Nov 10, 2021, and Feb 10, 2024, a total of 160 patients were enrolled and 156 were allocated to one of the three study arms. Of these, 37 G6PD deficient patients were assigned to the no primaquine arm and 119 G6PD normal patients were randomised: 24 in the no primaquine arm, 49 in the primaquine 3·5 mg/kg arm, and 46 in the primaquine 7·0 mg/kg arm. The proportion of participants with at least oneP. vivaxrecurrence within 90 days in the no primaquine arm was 81·4% (95% CI 69·6-89·2). The proportion of participants with recurrence was higher in the low dose primaquine arm (24·4%, 95% CI 14·2-38·7) compared to the high primaquine arm (4·7%, 95% CI 0·8-15·5, p=0·0141) resulting in a hazard ratio of high dose primaquine compared to low dose of 0·17 (95% CI 0·04-0·79, p=0·0229). Both primaquine arms were well tolerated.InterpretationNot providing primaquine to patients led to a considerable rate ofP. vivaxrecurrence. The risk ofP. vivaxrecurrence was 5·9 times lower for the 7·0 mg/kg of primaquine treatment compared to 3·5 mg/kg. Tolerability and safety of both primaquine regimens in G6PD normal individuals was comparable. Policy makers in Cambodia and most likely in other Southeast Asian countries should endorse the 7·0 mg/kg of primaquine regimen to reduce the risk ofP. vivaxrelapses.FundingNational Institutes of Health (R01AI146590)Research in contextEvidence before this studyThe WHO treatment guidelines for preventingPlasmodium vivaxrelapses using primaquine recommend a range of 3·5-7·0 mg/kg. These guidelines mention that forP. vivaxinfections acquired in Southeast Asia and Oceania, 7·0 mg/kg should be preferred. We searched Pubmed for randomized controlled trials studies containing the terms “vivax” and “primaquine” published between 1990 and November 2024, with no language restrictions, to identify studies comparing primaquine regimen to treatP. vivaxinfections. Our search retrieved only two studies comparing head-to-head the efficacy of 3·5mg/kg with 7·0 mg/kg primaquine administered over a same duration of 14 days but were both conducted in South Asia and both showed similar efficacy of high dose compared to low dose primaquine. No studies compared 3·5 and 7·0 mg/kg of primaquine administered over 14 days in South East Asian countries.Added value of this studyThis randomised controlled trial compared the efficacy of a total dose of 3·5 mg/kg and 7·0 mg/kg of primaquine over 14 days to prevent relapses ofP. vivaxin Cambodia. Our study design minimized confounding factors affecting therapeutic efficacy evaluation. This study confirms that 7·0 mg/kg has greater efficacy to prevent recurrences than the low 3·5mg/kg regimen, with comparable safety and tolerability in G6PD normal patients from Cambodia.Implications of all the available evidenceOur results confirm that 7·0 mg/kg of primaquine should be recommended to prevent relapses inP. vivaxinfections acquired in Cambodia and most likely in South East Asia. National treatment guidelines in those countries should be changed to endorse this regimen rather than the 3·5 mg/kg.

Síndrome Coronariana Aguda no Brasil: Registro dos Fatores Predisponentes e Perfil Populacional em um Instituto Cardiológico Público de Referência Nacional

Abstract Background Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide. Knowing the predisposing factors is essential for preventing it. Objectives To describe the etiological and epidemiological characteristics of the population with ACS admitted to an emergency room in the State of São Paulo. Methods The prospective cohort study, based on electronic medical records from a public cardiology institute located in the state of São Paulo, Brazil, describes 5,580 patients hospitalized with ACS between August 2018 and October 2022. The main epidemiological characteristics, the association between confirmed ACS and risk scores, and adverse events during hospitalization and in the 30-day follow-up after hospital discharge were evaluated. The significance level was set at 5%. Results The main factors associated with ACS were hypertension (80.38%), obesity or overweight (72.47%), and previous coronary artery disease (CAD) (59.11%). In the GRACE score, 65.10% were considered low risk, while 81.34% in the TIMI and 71.16% in the HEART were identified as moderate risk. Catheterization represented 84.93% of the diagnostic methods. Clinical treatment was the strategy adopted in 46.47% of the cases. In the 30-day evolution, 3.10% presented major bleeding, 7.86% infarction/reinfarction, 5.55% stroke, and 2.53% evolved to death. Conclusion The results of the largest Brazilian ACS registry to date highlight the impact of potentially modifiable risk factors on the occurrence of ischemic events in the local population. The findings may contribute to the development of public policies aimed at preventing and controlling the burden of ischemic disease in the country.

GENDER DIFFERENCES IN DISEASE BURDEN AND QUALITY-OF-LIFE TRAJECTORIES AMONG OLDER ADULTS LIVING WITH MULTIMORBIDITY

Abstract Heart failure (HF) is a leading cause of hospitalization and is associated with higher multimorbidity. Despite gender disparities and differences in HF research participation and health outcomes, differences in the trajectories of their lives have not been studied enough. This study aimed to examine the 1-year trajectories of disease burden and quality of life (QoL) for older adults with multimorbidity. Multimorbidity was defined as the presence of HF and one or more conditions among common chronic conditions in older adults. The study prospectively collected socio-demographic, clinical, and outcome data at baseline, 30-day, and 1-year follow-up using an electronic patient portal among adults aged 50 years and older living with multimorbidity. Disease burden and QoL data were collected using a modified disease burden impact scale and the EuroQoL (EQ)-5D-5L. Linear mixed-effect models were used for statistical analyses. A total of 200 patients (102 women and 98 men) completed surveys at the three time points. Participants’ mean±SD age was 71±9.5 years; men were older than women. The disease burden decreased at the 30-day follow-up (23.7±14.9) and the 1-year follow-up (24.6±15.7) compared to baseline (26.3±16.3). In an unadjusted analysis, disease burden was higher in women than men (beta=2.516; p=0.017). QoL was not significantly different by gender and time. After adjusting for age and social support, there were no significant gender differences in disease burden and QoL trajectories and no time and gender interaction. There is a need for gender-based research on multimorbidity to promote health equity.

Red blood cell distribution width-to-monocyte ratio for predicting 90-day mortality of COVID-19 in patients with chronic kidney disease during the Omicron period: a prospective single-center study

We aimed to test whether red blood cell distribution width (RDW) to monocyte percentage ratio (RMR) was associated with the acute-phase prognosis of coronavirus disease 2019 (COVID-19) in chronic kidney disease (CKD) patients. Prospective enrollment and 90-day follow-up of CKD patients with COVID-19 were conducted from December 1, 2022 to January 31, 2023. Demographics, clinical data, and laboratory and radiographic findings were collected, and multiple logistic regression, subgroup analysis, and receiver operating characteristic (ROC) curve analysis were performed. A total of 218 patients were enrolled, with a mean age of 59 years and 69.7% being male. The 90-day mortality rate was 24.8%. The lnRMR level was 5.18 (4.91-5.43) and emerged as an independent risk factor (OR: 3.01, 95% CI: 1.72-5.85). The lnRMR-mortality association was consistent across sex, age, CKD stage, COVID-19 vaccination, and comorbidity subgroups. The area under the ROC curve of lnRMR was 0.737 (95% CI: 0.655-0.819). Our findings indicate that lnRMR is a simple and practical predictor for identifying high-risk CKD patients during the acute phase of COVID-19.

Predictors of good outcomes and mortality after thrombectomy for basilar artery occlusion within 12 hours of onset

BackgroundPatients with acute basilar artery occlusion (ABAO) who undergo combined standard medical treatment (SMT) and endovascular thrombectomy (EVT) may still have unsatisfactory outcomes. This study was conducted to identify the...

Efficacy of panchakarma based ischemia reversal therapy along with diet modification in management of ischemic heart disease

Background: Aim was to evaluate the efficacy of panchakarma-based ischemia reversal therapy combined with diet modification in the management of ischemic heart disease. Methods: A retrospective, single centre study was conducted at a Madhavbaug clinic in Maharashtra from February 2022 to December 2023. Patients aged 20-75 years diagnosed with ischemic heart disease were included in the study. Follow-up was conducted weekly, for total duration of 90 days. Day 1 and day 90 data were compared Results: A total of 22 patients with mean age of 58.64±9.81 years were included in this study. VO2max (day 1: 16.34±5.35 mL/kg/min and day 90: 28.11±7.39 mL/kg/min, p=0.00), duke treadmill score (day 1: -6.77±4.38 and day 90: 3.77±15.83, p=0.00), and MET value (day 1: 4.66±1.53 and day 90: 8.02±2.10, p=0.00) improved significantly at the 90-day follow-up. Conclusions: Ischemia reversal therapy has proven to be effective in improving the cardiac capacity of heart, demonstrated by improvement in VO2max. Also improved Duke’s treadmill score.

VA-ECOM assisted percutaneous mechanical thrombectomy treatment high-risk pulmonary embolism.

Percutaneous mechanical thrombectomy (PMT) is increasingly used in the treatment of intermediate and high-risk acute pulmonary embolism (PE), and the treatment of high-risk PE with the aid of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has also been reported. However, there are few reports of VA-ECOM-assisted PMT in the treatment of high-risk PE. The purpose of this study is to summarize the data of 11 patients with high-risk PE treated with VA-ECMO assisted PMT, and propose feasible treatment methods for such patients. This multicenter retrospective study included patients with acute high-risk PE who were treated with VA-ECMO-assisted PMT from January 2021 to June 2024. The analysis focused on the right/left ventricle ratio, biomarkers, and pulmonary artery pressure before and after the VA-ECMO-assisted PMT treatment. All 11 high-risk PE patients suffered cardiac arrest before treatment, computered tomograhy pulmonary angiography (CTPA) confirmed the diagnosis of PE, and all patients received VA-ECMO-assisted PMT therapy. The median age of the 11 patients was 54 years (range 18-72), the median duration of ECMO was 4.48 days (range 1.04-18.02), and the mean hospitalization time was 21 days (range 14-112). All patients received percutaneous thrombectomy, achieving a 100% technical success rate. The mortality rate was 27.3% during the 90-day follow-up. The 12-month mortality rate was 36.4%. VA-ECMO-assisted PMT technology can rapidly improve pulmonary hemodynamics while maintaining stable blood flow, thereby reducing in-hospital mortality in high-risk patients with pulmonary embolism complicated by cardiac arrest.

Association of clinical phenotypes of depression with comorbid conditions, treatment patterns and outcomes: a 10-year region-based cohort study.

Depression is a heterogeneous and complex psychological syndrome with highly variable manifestations, which poses difficulties for treatment and prognosis. Depression patients are prone to developing various comorbidities, which stem from different pathophysiological mechanisms, remaining largely understudied. The current study focused on identifying comorbidity-specific phenotypes, and whether these clustered phenotypes are associated with different treatment patterns, clinical manifestations, physiological characteristics, and prognosis. We have conducted a 10-year retrospective observational cohort study using electronic medical records (EMR) for 11,818 patients diagnosed with depression and hospitalized at a large academic medical center in Chengdu, China. K-means clustering and visualization methods were performed to identify phenotypic categories. The association between phenotypic categories and clinical outcomes was evaluated using adjusted Cox proportional hazards model. We classified patients with depression into five stable phenotypic categories, including 15 statistically driven clusters in the discovery cohort (n = 9925) and the validation cohort (n = 1893), respectively. The categories include: (Category A) the lowest incidence of comorbidity, with prominent suicide, psychotic, and somatic symptoms (n = 3493/9925); (Category B) moderate comorbidity rate, with prominent anhedonia and anxious symptoms (n = 1795/9925); (Category C) the highest incidence of comorbidity of endocrine/metabolic and digestive system diseases (n = 1702/9925); (Category D) the highest incidence of comorbidity of neurological, mental and behavioral diseases (n = 881/9925); (Category E) other diseases comorbid with depression (n = 2054/9925). Patients in Category E had the lowest risk of psychiatric rehospitalization within 60-day follow-up, followed by Category C (HR, 1.57; 95% CI, 1.07-2.30), Category B (HR, 1.61; 95% CI, 1.10-2.40), Category A (HR, 1.82; 95% CI, 1.28-2.60), and Category D (HR, 2.38; 95% CI, 1.59-3.60) with P < 0.05, after adjustment for comorbidities, medications, and age. Regarding other longer observation windows (90-day, 180-day and 365-day), patients in Category D showed the highest rehospitalization risk all the time while there were notable shifts in rankings observed for Categories A, B and C over time. The results indicate that the higher the severity of mental illness in patients with five phenotypic categories, the greater the risk of rehospitalization. These phenotypes are associated with various pathways, including the cardiometabolic system, chronic inflammation, digestive system, neurological system, and mental and behavioral disorders. These pathways play a crucial role in connecting depression with other psychiatric and somatic diseases. The identified phenotypes exhibit notable distinctions in terms of comorbidity patterns, symptomology, biological characteristics, treatment approaches, and clinical outcomes.

Effect of hydroxyapatite combined with concentrated growth factor on mastoid cavity filling during endoscopic surgery for middle ear cholesteatoma

Objective: To explore the effect of hydroxyapatite (HA) combined with concentrated growth factor (CGF) on the cavity filling during endoscopic mastoidectomy in patients with middle ear cholesteatoma. Methods: The data of patients with middle ear cholesteatoma who underwent endoscopic canal wall down (CWD) mastoidectomy and mastoid obliteration with hydroxyapatite in Huazhong University of Science and Technology Union Shenzhen Hospital from December 2017 to October 2023 were retrospectively analyzed. The patients were divided into observational group (HA+CGF) and control group (HA) according to whether CGF was used. The postoperative follow-up time was not less than 6 months.The otoendoscopy results of the two groups were collected, and the excretion incidence of hydroxyapatite bone powder exposure was observed. The degree of epithelialization of the mastoid cavity and the time required for complete epithelialization were compared between the two groups using a subjective epithelialization scoring scale at one month post-operation. Results: A total of 58 patients (36 males and 22 females) aged (39.4±13.4) years were collected, including 26 left ears and 32 right ears. There were 30 cases in HA group and 28 cases in HA+CGF group, respectively. No statistically differences in gender, location and age were detected between the two groups (all P>0.05). The excretion incidence of bone powder exposure was 3.4% (2/58), with 1 case in HA group and 1 case in HA+CGF group, respectively. The median (Q1, Q3) subjective epithelialization score at one month post-operation was 1 (1, 2) in the HA+CGF group and 2(1, 2) in the HA group, with no statistically significant difference between the two groups (P=0.032). The results of 60-day follow-up after otoendoscopy showed that the proportion of complete epithelialization was 74.1% (20/27) in HA+CGF group and 48.3% (14/29) in HA group, and there was a statistically significant difference between the two groups (P=0.048). Conclusion: HA combined with CGF has a better effect on the cavity filling during endoscopic mastoidectomy in patients with middle ear cholesteatoma.

The systemic inflammation response index as a significant predictor of short-term adverse outcomes in acute decompensated heart failure patients: a cohort study from Southern China

ObjectiveThe deterioration of acute decompensated heart failure (ADHF) is associated with abnormal activation of inflammatory pathways. This study aims to evaluate the impact and predictive value of a novel inflammatory marker, the systemic inflammation response index (SIRI), on short-term adverse outcomes in ADHF patients.MethodsThis retrospective cohort study included 1,448 ADHF patients from Jiangxi Provincial People’s Hospital between 2019-2022. SIRI was calculated using the formula: (neutrophil count × monocyte count)/lymphocyte count. In the correlation analysis, the study outcome was the 30-day mortality in patients with ADHF. Cox regression analysis and receiver operating characteristic curves were employed to investigate the risk assessment and predictive value of the SIRI for 30-day mortality in ADHF patients. Finally, we also exploratively assessed the mediation effect of nutritional factors (albumin: Alb, total cholesterol: TC, and lymphocyte count) on the association between SIRI and 30-day mortality in ADHF patients.ResultsDuring the 30-day follow-up, 53 deaths were recorded. Mortality rates across SIRI tertiles were 0.62%, 2.07%, and 8.28%, respectively. There was a significant linear positive correlation between SIRI and 30-day mortality in ADHF patients (HR: 1.21; P for non-linearity = 0.113). Additionally, compared to ADHF patients with low SIRI, those with high SIRI had a 685% increased risk of 30-day mortality (HR: 7.85). Furthermore, receiver operating characteristic curve analysis demonstrated that SIRI significantly improved the predictive value for 30-day mortality in ADHF patients compared to neutrophil count, monocyte count, and lymphocyte count alone (AUC: neutrophil count 0.7633, monocyte count 0.6835, lymphocyte count 0.7356, SIRI 0.8237; all DeLong P&amp;lt;0.05). Mediation analyses indicated that, except for lymphocyte count, both Alb and TC had significant indirect effects on the SIRI-related 30-day mortality in ADHF patients; Specifically, Alb accounted for approximately 24.46% of the mediation effect, while TC accounted for approximately 13.35%.ConclusionThis cohort study based on a Southern Chinese population demonstrates a significant linear positive correlation between SIRI and 30-day mortality in ADHF patients, highlighting its substantial predictive value. Incorporating SIRI into the monitoring regimen of ADHF patients may be crucial for preventing further disease progression.

Enteral nutrition support in patients with cancer: association of short-term prognosis and medical costs with inflammation

BackgroundEnteral nutrition (EN) is commonly used for nutritional support in patients with cancer. Whether inflammation, one of the driving factors of malnutrition and cancer, affects the association between EN and short-term prognosis and medical costs in patients with cancer remains unclear. We aimed to investigate the association between EN and short-term prognosis of patients with cancer and the effect of inflammation on EN-associated medical costs.MethodsThis multicentre prospective cohort study evaluated patients with pathologically confirmed solid tumours. After admission, all patients who received EN, including oral or tube feeding, were assigned to the EN group. The log-rank test was used to identify the optimal cutoff values for inflammatory markers. Cox regression analysis was used to analyse the associations among EN, inflammation, and prognosis. Propensity score matching was used to balance biases between the EN and non-EN groups and validate the stability of the results.ResultsA total of 5121 patients were included, with 2965 (57.90%) men and an average age of 59.06 (11.30) years. A total of 462 patients received EN, with 390 (84.4%) receiving oral nutritional supplementation. During the 90-day follow-up, 304 patients died. In the low inflammation group, there was no association between EN and short-term prognosis (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.39–2.18). In the high inflammation group, EN significantly improved the short-term prognosis (HR = 0.48, 95% CI = 0.30–0.76). In patients with low inflammation (p < 0.001), EN increased hospitalisation costs (p < 0.001) without reducing length of stay (LOS) (p = 0.15). In patients with high inflammation, EN did not increase hospitalisation expenses (p = 0.47) but reduced the LOS (p = 0.004).ConclusionEN can improve the short-term prognosis of patients with high inflammation and reduce LOS without increasing the hospitalisation expenses. Baseline inflammation levels may serve as effective indicators for personalised and precise EN treatment.Clinical trial registrationChiCTR1800020329 (chictr.org.cn).

The Artisse Intrasaccular Device: A New Intrasaccular Flow Diverter for the Treatment of Cerebral Aneurysms.

This animal study was designed to evaluate in vivo the acute and short-term safety and efficacy of the new Artisse intrasaccular device (ISD) for aneurysm occlusion and to gain knowledge about the behavior in the aneurysms. The device was implanted in 7 white New Zealand rabbits with bifurcation aneurysms. Immediate and 90-day angiographic follow-up as well as histologic and scanning electron microscope imaging were evaluated. Immediate postinterventional angiograms showed excellent flow reduction in all aneurysms. Progressive improvements of occlusion rate could be observed in 5 of 7 aneurysms. One device migration was noted due to undersizing, resulting in corresponding worsening of occlusion rate. Three-month microscopic examinations demonstrated excellent biocompatibility. Notably, the Artisse ISD showed increased connective tissue formation within the aneurysm sac, which correlated with the angiographic results. The new Artisse ISD adapted well to aneurysm morphology and created immediate contrast stasis and excellent neck coverage. While angiographic results showed only moderate adequate occlusion at 3 months, histologic data showed excellent biocompatibility and good connective tissue formation within the aneurysm sac in all aneurysms treated with the Artisse ISD. Sizing and correct positioning appear to be crucial for adequate occlusion.

Lung ultrasound on first postoperative day predicts out-of-hospital pulmonary complications following video-assisted thoracic surgery: A prospective cohort study.

The integration of enhanced recovery after surgery (ERAS) protocols into the peri-operative management of video-assisted thoracic surgery (VATS) has facilitated rapid patient recovery, enabling discharge within 48 h. However, postoperative pulmonary complications (PPCs) postdischarge pose significant concerns for patient welfare. Despite the established utility of lung ultrasound (LUS) in diagnosing the causes of dyspnoea, the effectiveness of quantitative LUS in predicting PPCs after VATS remains uncertain. To determine whether quantitative LUS performed 24 h after surgery can identify patients with a higher risk of developing PPCs within 30 days after discharge from hospital. Single-centre prospective cohort study. Academic tertiary care medical centre. Adults scheduled for elective VATS under general anaesthesia from November 2022 to January 2023. This primary aim was to verify the association between lung ultrasound score (LUSS) on postoperative day 1 (POD1) and PPCs. The secondary aim was to identify other relevant peri-operative factors closely related to PPCs and establish a model capable of predicting the risk of PPCs in patients undergoing fast-track VATS. Of the 200 recruited patients, 182 completed the LUS examination and 30-day follow-up. Of these, 66 (36.2%) developed various types of PPCs. These patients had a higher LUSS on POD 1 (P < 0.001), and more subpleural consolidation areas compared to those without PPCs (P < 0.001). Receiver-operating characteristics (ROC) analysis identified the optimal LUSS cut-off value at 6 points for predicting the occurrence of PPCs, with an area under the curve (AUC) of 0.838 (95% CI, 0.768 to 0.909). Patients with PPCs had higher rates of immune system diseases and ARISCAT score, longer hospital stay and procalcitonin levels, increased frequency of lobar resection, longer durations of surgical and mechanical ventilation, and greater incidence of unplanned hospital readmissions within 30 days postdischarge, compared with those without PPCs (all P < 0.001). Multivariable logistic regression analysis indicated that the comorbidity of immune system disease, along with postoperative 24 h LUSS, were independent risk factor for PPCs within 30 days after VATS. LUSS on POD 1 emerged as an independent risk factor for PPCs in fast-track VATS patients and reliably predicted the occurrence of PPCs within 30 days of hospital discharge. ClinicalTrials. gov No. ChiCTR2200065865.

Early discharge with elevated C-reactive protein levels is safe after endoscopic-assisted coronary bypass grafting: Optimisation of postoperative care.

This study describes the perioperative kinetics of C-reactive protein in patients undergoing endoscopic coronary artery bypass grafting for single target vessel left anterior descending disease, with early postoperative discharge. From July 2021 to April 2024, patients were included in this single-centre retrospective study (N = 208), excluding C-reactive protein-modulating complications. Perioperative and 14-day follow-up C-reactive protein levels and clinical signs of infections were analysed. After endoscopic coronary artery bypass grafting, the C-reactive protein values on the first postoperative day were 44 [24-65] and 140 [88-200] mg/L at Day 3. Most patients were discharged after 3 days (64.4%), regardless of the level of C-reactive protein, and the majority experienced a return of C-reactive protein levels to baseline during follow-up, 6 [6-15] mg/L. Two patients had an infection requiring intervention and readmission (1.0%). The return of C-reactive protein to baseline levels at follow-up and the low incidence of clinical infections suggest that patients can be discharged safely, and prolonged hospitalisation is unnecessary. For perioperative care practitioners, these findings underscore the value of shorter hospital admissions in optimising resource use and improving patient flow, enhancing both patient outcomes and operational efficiency.

Evaluating perioperative risks in total knee arthroplasty patients with normal preoperative cardiac stress tests.

While it is generally accepted that most patients undergoing joint replacement do not require a cardiac stress test, individuals with existing or potential cardiac conditions may be at an increased risk of perioperative complications following primary total knee arthroplasty (TKA). This study aims to analyze the immediate postoperative outcomes of patients who underwent primary TKA, comparing those who had a cardiac stress test with no abnormal results and subsequent cardiac interventions to those who did not undergo a stress test. This retrospective cohort study utilized the TriNetX Research Network. The first cohort included patients who underwent a stress test within one year prior to their TKA, had no abnormal results, and did not undergo cardiac catheterization within two weeks post-stress test (Normal Stress Test). The second cohort consisted of patients who did not have a stress test in the year preceding their TKA (No Stress Test). The study analyzed data collected between January 1, 2003, and January 1, 2024. To control for confounding variables, propensity score matching was employed. P < 0.01 was considered significant. A total of 13,881 patients successfully matched in each cohort. Within 30 days following TKA, patients in the Normal Stress Test cohort exhibited a significantly elevated risk of several complications: Transfusion (RR: 1.702), Myocardial Infarction (MI) (RR: 1.908), Acute Renal Failure (ARF) (RR: 1.504), Acute Posthemorrhagic Anemia (RR: 1.245), Wound Dehiscence (RR: 1.549), and Pneumonia (RR: 2.051). These results were consistent at the 90-day follow-up. Notably, the risk of death was only elevated before propensity score matching (RR: 2.115). Our findings suggest that the underlying conditions prompting the use of a cardiac stress test, including congestive heart failure and renal insufficiency, may themselves be indicative of a higher overall perioperative risk, regardless of the stress test results. Level III: Case-control study or retrospective cohort study.