Assessment Of Short-term Outcomes Research Articles

Nomogram for short-term outcome assessment in AChR subtype generalized myasthenia gravis

BackgroundAn accurate prediction for prognosis can help in guiding the therapeutic options and optimizing the trial design for generalized myasthenia gravis (gMG). We aimed to develop and validate a predictive nomogram to assess the short-term outcome in patients with the anti-acetylcholine receptor (AChR) subtype gMG.MethodsWe retrospectively reviewed 165 patients with AChR subtype gMG who were immunotherapy naïve at the first visit from five tertiary centers in China. The short-term clinical outcome is defined as the achievement of minimal symptom expression (MSE) at 12 months. Of them, 120 gMG patients from Huashan Hospital were enrolled to form a derivation cohort (n = 96) and a temporal validation cohort (n = 24) for the nomogram. Then, this nomogram was externally validated using 45 immunotherapy naïve AChR subtype gMG from the other four hospitals. Multivariate logistic regression was used to screen independent factors and construct the nomogram.ResultsMSE was achieved in 70 (72.9%), 20 (83.3%), and 33 (73.3%) patients in the training, temporal validation, and external validation cohort, respectively. The duration ≤ 12 months (p = 0.021), ocular score ≤ 2 (p = 0.006), QMG score > 13 (p = 0.008), and gross motor score ≤ 9 (p = 0.006) were statistically associated with MSE in AChR subtype gMG. The nomogram has good performance in predicting MSE as the concordance indexes are 0.81 (95% CI, 0.72–0.90) in the development cohort, 0.944 (95% CI, 0.83–1.00) in the temporal validation cohort, and 0.773 (95% CI, 0.63–0.92) in the external validation cohort.ConclusionThe nomogram achieved an optimal prediction of MSE in AChR subtype gMG patients using the baseline clinical characters.

Evaluation of the short-term outcomes of minimally invasive surgery in colon cancer: an initial experience in a Middle Eastern oncology center using a randomized comparative design

Background The surgical approach to treat colon cancer has remained a matter of debate for many years. The assessment of short-term outcomes of the most common available modalities for surgical resection of colon cancer, which are the laparoscopic and open techniques, is considered a tool by which the best approach for colon cancer resection can be judged and documented. The aim of this work was to report on the initial experience in laparoscopic resection of colon cancer in a Middle Eastern oncology center. Patients and methods A total of 88 patients were involved in the current study who were proved to have colon cancer by a confirmed biopsy. They were subjected randomly to open or laparoscopic colectomy (LAC) and followed up for short-term outcomes (operative time, blood loss, and postoperative sequelae) to determine the most beneficial strategy based on its advantages. Data were collected and analyzed using Statistical Package for the Social Sciences version 20. Results The results showed that LAC was significantly different compared with open colectomy (OC) regarding the postoperative pain score, which was 3.14 and 6.85 for LAC and OC, respectively (P=0.02). Time to bowel sounds return was faster in LAC at 3.48 vs 7.5 h in OC (P Conclusion LAC showed multiple advantages over OC in many aspects related to short-term outcomes. The results of this study support the view that minimally invasive LAC is an effective and safe procedure for resection of colon cancer.

Assessment of short-term outcome with TiO2 mesh in laparoscopic repair of large paraesophageal hiatal hernias

BackgroundLaparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™).MethodsA retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks.ResultsTwenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred.ConclusionsTiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.

The use of mesh in direct-to-implant breast reconstruction—an assessment of short-term outcomes

Breast cancer is the most commonly diagnosed cancer among women in the world today (1). Current 5-year survival rates are reaching upwards of 90% in European and North American nations (2) and approximately one-fifth of those who undergo surgical treatment of their breast cancer ultimately opt for some form of reconstructive procedure (3).

Comparative assessment of the short-term outcomes of robotassisted and laparoscopic surgery for colorectal cancer

Aim of the study. a comparative assessment of perioperative parameters and short-term outcomes of robotic and laparoscopic surgery for colorectal cancer (CRC). Material and methods. The results of surgical treatment of 101 patients with colorectal cancer underwent robotic (I group, n = 30) and laparoscopic (II group, n = 71) radical operations were analyzed. Results. Surgery duration in I group ranged from 140 to 420 minutes (on average 260,9 ± 80,1 min.), in II group - 120-465 minutes (on average - 243,3 ± 72,9 min.; P = 0,314). Blood loss in I group averaged on 100 ± 29,4 ml (50,0-150,0 ml) compared to 141,7 ± 76 ml in II group (the difference is statistically significant, P = 0,006). Conversion rate, complications, duration of the postoperative period did not have a statistically significant difference between the groups. The study of circular resection margins after robotic surgeries confirmed the radical intervention (R0-resection) in all cases. Differences in the number of lymph nodes (12-22) between the groups were not observed. Conclusion. Safety and efficacy of robotic colorectal surgery is comparable to laparoscopic surgery. Long-term results require further study.

Is the assessment of short-term outcome after PCI in the setting of cardiogenic shock reliable by inhospital mortality data? A report from the Belgian registry of PCI

Background: In many registries dealing with cardiac interventions, inhospital mortality is used for short-term outcome measurement, thereby missing events after hospital discharge at home or transferal on their hospital. We hypothesized that the lack of information on survival status influences outcome measurements by comparing the cumulative event rate and the Kaplan-Meier method. Methods: According to the Belgian Working Group of Invasive Cardiology (BWGIC) database, 2390 PCI procedures were performed in Belgium in the setting of cardiogenic shock (representing 1.9% of all PCI procedures) during the 5-year period (01.01.2006 – 31.12.2010). Subsequently 459 patients (19.2%) were transferred alive to referring/revalidation centers (ranges: 6 – 35%). Mean age: 68.2±12.7 y; female gender: 30%; renal failure: 7%; active/former smoker: 28%/18%; CRR prior to PCI: 48.5%, hemodynamic support: 61%; 1 vessel disease: 31%, 0 VD: 30%; 3 VD: 37%; left main PCI: 8%; PCI on saphenous grafts: 2%. Inhospital complications: stroke: 1.5%; emergency CABG: 3.2%; mortality: 41.2%. Results: In the BWGIC database, survival status at 30 days were known for 1189 patients (930 deaths + 259 still in hospital), 459 patients were transferred and 1742 were discharged alive at home. The 30-day inhospital mortality was 39% by the cumulative event rate (Crudemortality) and 51% by the Kaplan-Meier method. The lack of information on survival status (in 51% of the cases) at 30 days has a major impact on the outcome assessment. The discordance between the 2 methods started at day 4 after the PCI and increased progressively to the absolute difference of 12% at 30 days. These differences were found in all centers ranging from 4-23%. We found a significant relationship between the transfer rate and the difference between 30-day crude mortality – KM mortality (spearman r: 0.579). Multivariate analysis revealed male gender (OR: 0.78) and smoking (OR: 0.91) predicting better prognosis, whereas age, renal failure, CPR, extent of CAD, left main PCI were marker of poorer prognosis. Conclusions: In this large Belgian multicenter registry on PCI procedures in the setting of cardiogenic shock, the Crude 30-day hospital mortality underestimates Kaplan-Meier event rates by approximally 30%. The available inhospital data seem of limited value to perform quality control or benchmarking. These observations emphasize the need for 30-day survival status in all cases after invasive procedures, ideally by automate feedback from the national institute for statistics.

Arthroscopic repair of subscapularis tears: Preliminary data from a prospective multicentre study

Until the introduction of arthroscopic-assisted surgery for rotator cuff repair, the frequency of subscapularis tears was underestimated. These tears remain challenging to treat even with arthroscopy. The absence of a specific classification system has hampered communication about the treatment and outcomes of the various types of subscapularis tears. The objective of this prospective multicentre study was to validate the relevance of arthroscopic subscapularis tendon repair based on an assessment of short-term outcomes according to the initial extent of the anatomic lesions. A prospective multicentre study sponsored by the French Society for Arthroscopy was conducted from March 2010 to January 2011 in 208 patients with subscapularis lesions that were either isolated or associated with limited anterosuperior tears. The Constant and UCLA scores were used to assess clinical outcomes. Anatomic and prognostic results were evaluated based on the physical examination, preoperative and postoperative imaging study findings, and anatomic lesions. Clinical data were available for 103 patients after at least 1 year of follow-up and radiological data for 129 patients after at least 6 months. The preliminary clinical results in 103 patients with at least 1 year of follow-up showed overall statistically significant improvements in the Constant and UCLA scores, with resolution of the clinical manifestations. The degree of improvement seemed to increase over time. The clinical results varied significantly across patient groups based on a classification system distinguishing four lesion types. Postoperative imaging studies to assess the anatomic results in all patients with at least 6 months of follow-up (n=129) showed tendon healing in 92% of cases but also indicated muscle wasting of the upper subscapularis muscle in 18.6% of cases and increased fatty degeneration of the muscle belly. Our study confirms the good clinical and radiological results reported in the literature. Our classification system distinguishing four lesion patterns was applicable during the imaging workup. The main finding from this classification system was the difference in results between Type 2 and Type 3 lesions. The trend towards improvements over time requires confirmation by longer-term studies, which will also have to establish that the increased wasting of the upper subscapularis muscle and fatty degeneration of the muscle belly have no adverse effects.

Die akute Nierenschädigung

Acute kidney injury plays a pivotal role in intensive care medicine and exerts crucial adverse effects on the course of the disease and overall prognosis of the critically ill patient. Intensive renal support, including initiation of earlier dialysis or maximal uremic toxin removal by higher dosage and frequency of renal replacement therapy, and individualized selection of modality were not able to decrease excessive mortality in this population. Systemic acute inflammation, mediated, at least in part, by cytokines, and not secondary uremic side effects, seems to have a major impact on nonrenal organ damage. Assessment of short-term outcome in critically ill patients who develop acute kidney injury may underestimate the true burden of disease. The overall survival at 5 years in patients discharged alive after severe acute kidney injury necessitating renal replacement therapy is only 20-30%, comparable to cancer patients. In addition, acute renal damage was identified as an independent risk factor for progression of chronic renal insufficiency. Current research focuses on strategies for the prevention of acute kidney injury and on the establishment of effective biomarkers for the early recognition and accurate diagnosis of subclinical renal damage.

Surgical Therapy for Epidermoid Carcinoma of the Anal Canal: A NSQIP Assessment of Short-term Outcomes

Surgical Therapy for Epidermoid Carcinoma of the Anal Canal: A NSQIP Assessment of Short-term Outcomes

Assessment of short-term outcomes following unintentional ingestions of “oral contraceptive pills” by toddlers

Background. Cases of unintentional pediatric ingestions of oral contraceptive pills are commonly reported to Poison Information Centers (PICs). No study had examined clinical outcomes in the past 30 years, although the hormone content of these preparations has been substantially reduced. We assessed short-term outcomes to determine the relevance of advice provided, particularly that vaginal bleeding can occur. Methods. Prospective observational study of cases reported to a state PIC were followed up over a 5-month period. Results. There were 63 cases with complete follow-up, average age was 2 years and 10 months; 65% of the patients were female. Median number of pills ingested was 5.0 [Interquartile Range (IQR) 3–16.5]. Minor symptoms including vomiting and irritability were reported in 44% of cases. No case of vaginal bleeding was reported. Conclusion. No major clinical effects and no instances of vaginal bleeding were reported.

LONG-TERM OUTCOME AFTER ACUTE KIDNEY INJURY IN CRITICALLY-ILL PATIENTS

Assessment of short-term outcome in criticallyill patients who develop acute kidney injury (AKI) may underestimate the true burden of disease. It is important to focus on long-term survival, renal recovery and quality of life beyond hospital discharge. Although the majority of critically-ill patients with AKI die during hospital stay, there is only a minor increase in mortality after hospital discharge among AKI patients treated in the intensive care unit (ICU). Estimates of mortality rates at 1 year following hospital discharge range from 57% to 78% with an absolute difference between hos-pital mortality and 1-year mortality ranging from 4% to 18%.Renal recovery is another important measure of outcome since chronic renal replacement therapy (RRT) does not only significantly affect health-related quality of life (HRQoL), it is also costly. Fortunately, renal recovery occurs in most AKI survivors leading to independence of RRT at 1 year following hospital discharge. Potential factors associated with reduced recovery of renal function are female sex, high comorbidity, older age, a parenchymal aetiology of AKI, late initiation of RRT, and use of intermittent haemodialysis (IHD).HRQoL in survivors of critical illness and severe AKI is perceived as acceptable and good, despite the fact that HRQoL scores are lower than these of the general population.

Short Term Follow Up of Whiplash-associated Disorder Patients Treated with Pulsed Radiofrequency Thermocoagulation

Background: Whiplash associated disorder (WAD) is one of the most common causes of neck pain and cervicogenic headache. One proposed method of treating neck pain and cervicogenic headache is the ablation of cervical medial branch with pulsed radiofrequency thermocoagulation (PRFT). This study was a retrospective evaluation of the effect of the PRFT in patients with WAD who did not show any responses to the various conservative treatments. Methods: Short term outcome was ascertained among 7 patients with the PRFT of cervical medial branches, who had shown positive response to the diagnostic block. During the PRFT under the guidance of C-arm image, impedance and sensory electrical nerve stimulation threshold were assessed. After obtaining appropriate stimulation, PRFT was performed to the cervical medial branches at for 120 seconds. Three out of 7 patients were treated unilaterally. For the assessment of short term outcome, the 4 point Likert scale was adopted. The result was regarded as favorable if pain reduction were more than 50% on the scale. Results: Mean duration of pain was 415.3 233.4 days. Average follow-up interval was 76.4 10.1 days. Two patients did not respond favorably to the PRFT. In 5 patients who showed favorable response to the PRFT, the effect lasted on average 76.4 10.1 days. Conclusions: The PRFT of cervical medial branches might be an effective treatment modality in patients with WAD and who did not show any responses to the conservative managements.