Favorable Outcome Research Articles

Preliminary insights into high-intensity focused ultrasound ablation for symptomatic uterine fibroids: a first look in Egypt

BackgroundUterine fibroids are common gynecological conditions that affect a significant number of women of reproductive age and may necessitate surgical intervention for their removal. However, there is a rising trend toward minimally invasive procedures, such as magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) ablation. This report provides the first experience in Egypt and North Africa on the use of MRgHIFU ablation as a therapeutic option for uterine fibroids.ResultsThis study demonstrates a correlation between post-operative NPV% and symptom improvement. Following a three-month follow-up period, a significant reduction in pain scores and excessive bleeding was observed. Importantly, there was no significant elevation in hemoglobin levels (11.23 ± 2.23 to 11.25 ± 1.71 g/dL) after treatment. Furthermore, the mean non-perfused volume ratio in the treated fibroids was 46 ± 27.3% (SD) among the 20 participants. These findings suggest a favorable therapeutic outcome of MRgHIFU, with no serious adverse effects reported.ConclusionMRgHIFU is a noninvasive therapeutic approach for the treatment of uterine myomas, offering significant benefits in terms of pain reduction and improved quality of life. This particular study represents the pioneering clinical experience of this innovative therapy in Egypt.

Prognostic implication of heart failure stage and left ventricular ejection fraction for patients with in-hospital cardiac arrest: a 16-year retrospective cohort study.

The 2022 AHA/ACC/HFSA guidelines for the management of heart failure (HF) makes therapeutic recommendations based on HF status. We investigated whether the prognosis of in-hospital cardiac arrest (IHCA) could be stratified by HF stage and left ventricular ejection fraction (LVEF). This single-center retrospective study analyzed the data of patients who experienced IHCA between 2005 and 2020. Based on admission diagnosis, past medical records, and pre-arrest echocardiography, patients were classified into general IHCA, at-risk for HF, pre-HF, HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction or HF with reduced ejection fraction (HFmrEF-or-HFrEF) groups. This study included 2,466 patients, including 485 (19.7%), 546 (22.1%), 863 (35.0%), 342 (13.9%), and 230 (9.3%) patients with general IHCA, at-risk for HF, pre-HF, HFpEF, and HFmrEF-or-HFrEF, respectively. A total of 405 (16.4%) patients survived to hospital discharge, with 228 (9.2%) patients achieving favorable neurological recovery. Multivariable logistic regression analysis indicated that pre-HF and HFpEF were associated with better neurological (pre-HF, OR: 2.11, 95% confidence interval [CI]: 1.23-3.61, p = 0.006; HFpEF, OR: 1.90, 95% CI: 1.00-3.61, p = 0.05) and survival outcomes (pre-HF, OR: 2.00, 95% CI: 1.34-2.97, p < 0.001; HFpEF, OR: 1.91, 95% CI: 1.20-3.05, p = 0.007), compared with general IHCA. HF stage and LVEF could stratify patients with IHCA into different prognoses. Pre-HF and HFpEF were significantly associated with favorable neurological and survival outcomes after IHCA. Further studies are warranted to investigate whether HF status-directed management could improve IHCA outcomes.

Diagnosis and Management of Esophageal Fistulas After Lung Transplantation: A Case Series.

Lung transplantations are highly complex procedures, often conducted in frail patients. Through the addition of immunosuppressants, healing can be compromised, primarily leading to the development of bronchopleural fistulas. Although esophageal fistulas (EFs) after lung transplantation remain rare, they are associated with significant morbidity. We aimed to investigate the clinical presentation, diagnostic approaches, and treatment strategies of EF after lung transplantation. All patients who developed EF after lung transplantation at the University Hospitals Leuven between January 2019 and March 2022 were retrospectively reviewed and the clinical presentations, diagnostic approaches, and treatment strategies were summarized. Among 212 lung transplantation patients, 5 patients (2.4%) developed EF. Three patients were male and median age was 39 y (range, 34-63). Intraoperative circulatory support was required in 3 patients, with 2 needing continued support postoperatively. Bipolar energy devices were consistently used for mediastinal hemostasis. All EFs were right-sided. Median time to diagnosis was 28 d (range, 12-48) and 80% of EFs presented as recurrent respiratory infections or empyema. Diagnosis was made through computed tomography (n = 3) or esophagogastroscopy (n = 2). Surgical repair with muscle flap covering achieved an 80% success rate. All patients achieved complete resolution, with only 1 patient experiencing a fatal outcome during a complicated EF-related recovery. Although EF after lung transplantation remains rare, vigilance is crucial, particularly in cases of right-sided intrathoracic infection. Moreover, caution must be exercised when applying thermal energy in the mediastinal area to prevent EF development and mitigate the risk of major morbidity. Timely diagnosis and surgical intervention can yield favorable outcomes.

Curative effect analysis of robot-assisted drainage surgery in treatment of spontaneous hypertensive brainstem hemorrhage.

Spontaneous hypertensive brainstem hemorrhage (HBSH) is characterized by sudden onset, rapid progression and poor prognosis. There has been a growing tendency of surgical treatment for HBSH. This study aimed to investigate outcomes and potential factors associated with the prognosis of robot-assisted drainage surgery for HBSH treatment. Patients with HBSH from July 2016 to March 2023 at a single neurosurgery center were included and divided into conservative group and surgical groups. Baseline and clinical data, radiographic characteristics, complications, and outcome evaluations were recorded and analyzed. A total of 125 patients, with 74 in the conservative group and 51 in the surgical group, were enrolled in the study. Mortality at 6 months was 59/74 (79.7%) in the conservative group and 9/51 (17.6%) in the surgical group. Twenty-four patients (47.1%) achieved favorable outcomes in the surgical group, whereas this rate in the conservative group was only 5.4% (4/74). There was a significant difference in NIHSS, GCS, and mRS at 6 months between surviving patients in the conservative and surgical groups. In prognostic analysis in the surgical subgroup, initial GCS score [5 (IQR 4-7) vs. 3 (IQR 3-4), p < 0.001], NIHSS [36 (IQR 32-38) vs. 40 (IQR 38-40), p < 0.001], smoking history [45.8% (11/24) vs. 74.1% (20/27), p = 0.039], hematoma volume [6.9 (IQR 6.2-7.6) vs. 9.6 (IQR 7.3-11.4), p = 0.001], and hemorrhage location (p = 0.001) were potential risk factors for poor 6-month prognosis after robot-assisted surgery for HBSH. Based on the results of this study, robot-assisted minimally invasive drainage of brain stem hematoma may significantly reduce mortality and improve prognosis. Surgery should be conducted for selected patients.

Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience.

Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas. We describe our use of the Heald anal stent and its potential impact in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery. We performed a single-center retrospective analysis of patients in whom a Heald anal stent had been used to "protect" a colorectal anastomosis or a rectal stump, in an elective or emergency context, for benign and malignant pathology. Intraoperative and postoperative outcomes were reviewed using clinical and radiological records. The Heald anal stent was used in 93 patients over 4 years. Forty-six cases (49%) had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. No anastomotic or rectal stump leaks were recorded. We recommend the Heald anal stent as a simple and affordable adjunct that may decrease anastomotic and rectal stump leak by reducing intraluminal pressure through drainage of fluid and gas.

Promoting Healthier Futures: A Six-Month Program for Childhood Obesity Reduction and Lifestyle Enhancement

Objective: This study aimed to evaluate the impact of a six-month family-based intervention and follow-up intervention on the body mass index and children's lifestyle in Erbil City among 5 to 19 years old. The intervention specifically targeted parents to the educational program and intended to reduce the Body Mass Index of children and change sedentary behavior. On the other hand, the educational program included minimizing the consumption of high-fat and carbohydrate-containing, increasing the consumption of fruits and vegetables, and soft drinks. In addition, it assessed exposure to multi-screen devices and evaluated sleep quality. Methods: Weight, height, waist circumference, and hip circumference were measured by portable stadiometer and weight-calibrated electronic scales and BMI was calculated at the baseline and after six months of intervention. The research employed various methodologies and conducted a family-based educational program through a printed booklet. The questionnaire was used at baseline and after six months of intervention, and IBM SPSS Statistics version 25 was used for data analysis, paired sample t-test and MacNemar Chi-square were used. Results: The BMI was reduced after six months of intervention. The mean difference was 0.435, however, there were no more differences for hip and waist circumference, on the other hand, the sedentary behaviour lifestyle was changed from poor daily lifestyle practice to good practice. Conclusion: The results of this research suggest that the implementation of a complete intervention produces favourable outcomes in terms of lifestyle modifications and a decrease in BMI among children who are obese or overweight. Although, daily practice was notable changed from poor daily practice to good practice.

Delayed symptomatic cerebral vasospasm following vestibular schwannoma resection: illustrative case.

Symptomatic cerebral vasospasm following posterior fossa extraaxial tumor resection is a rare phenomenon, with only 13 cases previously reported in the literature. The condition appears similar to vasospasm following supratentorial tumor resection, intraaxial posterior fossa tumor resection, and aneurysmal subarachnoid hemorrhage (aSAH). The majority of patients were not evaluated for vasospasm prior to symptom onset, leading to a delay in diagnosis. The authors present their experience in a 56-year-old female who developed delayed cerebral vasospasm after excision of a solid-cystic vestibular schwannoma. Routine postoperative brain computed tomography showed evidence of subarachnoid hemorrhage in the basal cisterns. She was discharged on the 9th postoperative day. On the 11th day after tumor excision, she developed left hemiparesis, dysarthria, and dysphagia and was readmitted. Angiography confirmed bilateral diffuse cerebral vasospasm. The patient responded to standard hyperdynamic therapy used for vasospasm secondary to aSAH. Symptomatic distant cerebral vasospasm after posterior fossa extraaxial tumor excision is a rare but challenging complication with a very high morbidity rate in reported cases. A high index of suspicion is required for early diagnosis and prompt management for a favorable outcome.

Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry.

Recent randomized controlled trials demonstrated superiority of mechanical thrombectomy compared to medical therapy in acute basilar artery occlusions, however, little data is available to guide clinicians in functional prognosis and risk stratification. Data from the retrospectively established PC-SEARCH Thrombectomy registry, which included patients with basilar artery occlusion from eight sites from January 2015 to December 2021, was interrogated. Outcomes were dichotomized into 90-day favorable (mRS ⩽ 3) and unfavorable (mRS > 3). Multivariate logistic regression analysis was performed with respect to the outcome groups and were adjusted for potential confounding baseline characteristics. Four-hundred-forty-four patients were included in this analysis. Mean age was 66 [SD 15], with 56% male, and comprised of 76% Caucasian. Patients presented with an initial median NIHSS of 18 and 199 patients (44.8%) achieved favorable 90-day functional outcomes. Independent predictors of favorable outcomes included younger age, pc-ASPECTS > 8 (OR 2.30 p < 0.001), and TICI ⩾ 2b (OR 7.56 p < 0.001). Unfavorable outcomes were associated with increasing number of passes (OR 1.29 p = 0.004) and sICH (OR 4.19 p = 0.015). IA-tPA was an independent risk factor for sICH (OR 7.15 p = 0.002) without improving favorable functional outcomes. PC-ASPECTS > 8, successful recanalization (TICI ⩾ 2b), first-pass recanalization, and younger age are independent predictors of favorable 90-day functional outcome in thrombectomy treated patients with acute basilar artery occlusion. Conversely, sICH were independent predictors of unfavorable outcomes. IA-tPA and unsuccessful recanalization are independently associated with sICH.

Ganglia-Induced Tarsal Tunnel Syndrome.

Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel. Between August 2020 and July 2022, we operated on 117 sides with TTS. This retrospective study examined data from 8 consecutive patients (8 sides: 5 men, 3 women; average age 67.8 years) with an extraneural ganglion in the tarsal tunnel. We investigated the clinical characteristics and surgical outcomes for these patients. The mass was palpable through the skin in 1 patient, detected intraoperatively in 1 patient, and visualized on MRI scanning in the other 6 patients. Symptoms involved the medial plantar nerve area (n = 5), lateral plantar nerve area (n = 1), and medial and lateral plantar nerve areas (n = 2). The interval between symptom onset and surgery ranged from 4 to 168 months. Adhesion between large (≥20 mm) ganglia and surrounding tissue and nerves was observed intraoperatively in 4 patients. Of the 8 patients, 7 underwent total ganglion resection. There were no surgery-related complications. On their last postoperative visit, 3 patients with a duration of symptoms not exceeding 10 months reported favorable outcomes. Because ganglia eliciting TTS are often undetectable by skin palpation, imaging studies may be necessary. Early surgical intervention appears to yield favorable outcomes.

A Study of the Effects of Alum and PAC on the Coagulation Process of Dug Well Water

The local population of Pal IX Village in West Kalimantan heavily depends on dug wells as their main source of obtaining clean water. The prolonged consumption of elevated concentrations of manganese (Mn) and iron (Fe) in water sourced from dug wells have neurotoxic effects on both adults and children. Therefore, it is imperative to employ alum and PAC coagulants for the treatment of dug well water in order to comply with the established national quality standard. However, the utilization of both coagulants resulted in elevation in the levels of iron (Fe), hence restricting the capacity to satisfy the quality standards. An augmentation in the mass of the coagulant is associated with a decline in the reduction efficiency. It is indicated that utilizing a mass of 0.5 grams of alum coagulant is the most favorable choice, resulting in a reduced of 50.14% for total dissolved solids (TDS), 86.25% for color, 97.70% for turbidity, and 94.48% for the concentration of Mn metal. By PAC coagulant, it has been determined that an ideal coagulant mass of 0.5 gram produces favorable outcomes with a TDS reduction of 45.08%, a color reduction of 97.71%, a turbidity reduction of 97.22%, and a Mn reduction of 95.04%.

Recovery from deep coma with roving eye movement: A case report and prognostic review

AbstractRoving eye movement (RoEM), commonly seen in unconscious patients with significant cortical dysfunction but without apparent brainstem damage, has unclear prognostic significance. We describe a case of presumed hypoglycemic encephalopathy with RoEM, where the patient emerged from a 4‐day coma. While previous reports often associate RoEM cases with poor prognosis, cases with favorable outcomes exist, particularly among young patients or those with reversible conditions. Our findings highlight the variable neurological prognosis of RoEM, suggesting the possibility of improved consciousness and neurological recovery in certain pathologies, thus enhancing our understanding of RoEM's implications.

Short and long-term outcomes of decompressive craniectomy among patients with non-traumatic acute intracranial hypertension; A 5-year retrospective analysis of a referral center

BackgroundDecompressive craniectomy (DC) is performed for the management of the patients with acutely elevated intracranial pressure (ICP). Considering the paucity of the evidence regarding the outcome predictors in patients with non-traumatic raised ICP, we aimed to assess short- and long-term outcome related factors in DC subjects. MethodsIn this cross-sectional study, health records of the patients who underwent DC for non-traumatic etiologies over the five years were interrogated and demographic data, clinical features, operative findings, and follow-up notes were collected. The primary short- and long-term outcomes were in-hospital mortality and functional status, respectively. Functional status was evaluated using Glasgow Outcome Scale (GOS) at 6-month follow-up. ResultsOf the 223 eligible patients, 113 (50.7 %) were male and the mean age was 48.68 ± 13.97 years. In-hospital mortality rate was 48.4 % (n = 108). Of the survivors, 28 (30.4 %) had favorable outcomes (GOS 4–5). The most common post-operative complications were infection with respiratory source (n = 52, 23 %) and external cerebral herniation (n = 61, 27.4 %). Presence of diabetes mellitus (DM) (OR = 6.09; 95 % CI = 2.0–18.51; P = 0.001), subarachnoid hemorrhage (SAH) (OR = 5.61; 95 % CI = 1.47––21.3; P = 0.01), and prolonged duration of ICU-stay (OR = 1.37; 95 % CI: 1.03, 1.24; P = 0.006) were associated with in-hospital mortality. Also, preexisting DM was two times more prevalent among the subjects deceased in the hospital than those who survived. ConclusionsConcomitant SAH, DM, and prolonged ICU stay were associated with increased in-hospital mortality. In addition, preexisting DM may increase mortality rates, likely irrespective of age factor.

Defining benchmark outcomes for mesial temporal lobe epilepsy surgery: A global multicenter analysis of 1119 cases.

Benchmarking has been proposed to reflect surgical quality and represents the highest standard reference values for desirable results. We sought to determine benchmark outcomes in patients after surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). This retrospective multicenter study included patients who underwent MTLE surgery at 19 expert centers on five continents. Benchmarks were defined for 15 endpoints covering surgery and epilepsy outcome at discharge, 1 year after surgery, and the last available follow-up. Patients were risk-stratified by applying outcome-relevant comorbidities, and benchmarks were calculated for low-risk ("benchmark") cases. Respective measures were derived from the median value at each center, and the 75th percentile was considered the benchmark cutoff. A total of 1119 patients with a mean age (range) of 36.7 (1-74) years and a male-to-female ratio of 1:1.1 were included. Most patients (59.2%) underwent anterior temporal lobe resection with amygdalohippocampectomy. The overall rate of complications or neurological deficits was 14.4%, with no in-hospital death. After risk stratification, 377 (33.7%) benchmark cases of 1119 patients were identified, representing 13.6%-72.9% of cases per center and leaving 742 patients in the high-risk cohort. Benchmark cutoffs for any complication, clinically apparent stroke, and reoperation rate at discharge were ≤24.6%, ≤.5%, and ≤3.9%, respectively. A favorable seizure outcome (defined as International League Against Epilepsy class I and II) was reached in 83.6% at 1 year and 79.0% at the last follow-up in benchmark cases, leading to benchmark cutoffs of ≥75.2% (1-year follow-up) and ≥69.5% (mean follow-up of 39.0 months). This study presents internationally applicable benchmark outcomes for the efficacy and safety of MTLE surgery. It may allow for comparison between centers, patient registries, and novel surgical and interventional techniques.

Spinal calcifying pseudoneoplasms of the neuraxis: A case report and review of the literature

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare, non-neoplastic, slow-growing tumors that can present anywhere throughout the central nervous system. While the etiology of these lesions remains unknown, the mainstay of treatment is surgical excision. We describe a case of CAPNON at our institution in a 66 year-old female patient who presented with 5 months of pain and burning sensation in her thigh. On MRI, an intradural extramedullary lesion was identified at the level of T11-T12. The mass was surgically excised and the patient reported resolution of her symptoms by her six week follow-up appointment. We reviewed 79 spinal CAPNON cases, covering all cases reported in the literature thus far. In summary, we find that spinal CAPNON are most commonly lumbar and extradural in location, with pain as the most common presenting symptom. Lesions are well-defined and hypointense on T1 and T2 MRI sequence. The majority of cases had favorable surgical outcomes with near complete resolution of pain and associated symptoms.

Luxury Fracture of the Sacrum [S1 S2] and [S2 S3

Introduction: Transverse fractures of the sacrum are rare and constitute less than 1% of all vertebral fractures. While the majority is longitudinal, only 3 to 5% are transverse fractures. Transverse fractures are usually seen following a fall by high-energy trauma, hence the name “Suicidal jumper’s fractures”. Neurological deficits involving the sacral roots are common and have been reported at rates of 96% to 100% in the literature. Material and Methods: We describe two uncommon cases of fracture-dislocation of the sacrum, the first at the S2-S3 level and the second at the S1-S2 level treated by isolated laminectomy without internal fixation with cauda equina syndrome, during the year 2020 in our department, including a review of the literature on the treatment of this type of fracture. Result: Our two patients on neurologically recovered at 7 months post laminectomy. Conclusion: Isolated decompression can be considered for patients who present a stable sacrum with non-displaced fracture or an old fracture that shows fracture healing. Favorable pelvic outcomes and neurological recovery, along with acceptable stability, can be acquired.

Unraveling the influence of biogenic volatile organic compounds and their constituents on ozone and SOA formation within the Yellow River Basin, China

Biogenic volatile organic compounds (BVOC) assume a pivotal role during the formation stages of ozone (O3) and secondary organic aerosols (SOA), serving as their primary precursors. We used the latest MEGAN3.1 model, updated vegetation data and emission factors, combined with MODIS data analysis to simulate and estimate the integrated emissions of BVOC from nine provinces in China's Yellow River Basin in 2018. Following an extensive evaluation of the WRF-CMAQ model utilizing diverse parameters, the simulated and observed values had correlation coefficients between them that ranged from 0.94 to 0.99, implying a favorable outcome in terms of simulation efficacy. The findings from the simulation analysis reveal that the combined BVOC emissions from the nine provinces in the Yellow River Basin reached a total of 6.51 Tg in 2018. Among these provinces, Sichuan, Henan, and Shaanxi ranked highest, with emissions of 1.28 Tg, 1.04 Tg, and 0.96 Tg, respectively. BVOC emissions led to concentrations of 36.72 μg/m³ in the daily maximum 8-h ozone and 0.59 μg/m³ in the average SOA in nine provinces of the Yellow River Basin in July. Isoprene contributed the most to the O3 production with 6.31 μg/m3, and monoterpenes contributed the most to SOA production with 0.45 μg/m3. ΔSOA and ΔOzone are mainly distributed in the belts of central Sichuan Province, southern Shaanxi Province, western Henan Province, northern Qinghai Province, central Inner Mongolia, and southern Shanxi Province, and most of these areas are located 50 km around the Yellow River. O3 and SOA in Taiyuan, Xi'an, Chengdu, and Zhengzhou cities are strongly influenced by the generation of BVOCs. This study provides a reliable scientific basis for the prevention and control of air pollution in the Yellow River Basin.

Beam quality and the mystery behind the lower percentage depth dose in grid radiation therapy

Grid therapy recently has been picking momentum due to favorable outcomes in bulky tumors. This is being termed as Spatially Fractionated Radiation Therapy (SFRT) and lattice therapy. SFRT can be performed with specially designed blocks made with brass or cerrobend with repeated holes or using multi-leaf collimators where dosimetry is uncertain. The dosimetric challenge in grid therapy is the mystery behind the lower percentage depth dose (PDD) in grid fields. The knowledge about the beam quality, indexed by TPR20/10 (Tissue Phantom Ratio), is also necessary for absolute dosimetry of grid fields. Since the grid may change the quality of the primary photons, a new kq,q0\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathbf{k}}_{\\mathbf{q},{\\mathbf{q}}_{0}}$$\\end{document} should be evaluated for absolute dosimetry of grid fields. A Monte Carlo (MC) approach is provided to resolving the dosimetric issues. Using 6 MV beam from a linear accelerator, MC simulation was performed using MCNPX code. Additionally, a commercial grid therapy device was used to simulate the grid fields. Beam parameters were validated with MC model for output factor, depth of maximum dose, PDDs, dose profiles, and TPR20/10. The electron and photon spectra were also compared between open and grid fields. The dmax is the same for open and grid fields. The PDD with grid is lower (~ 10%) than the open field. The difference in TPR20/10 of open and grid fields is observable (~ 5%). Accordingly, TPR20/10 is still a good index for the beam quality in grid fields and consequently choose the correct kq,q0\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathbf{k}}_{\\mathbf{q},{\\mathbf{q}}_{0}}$$\\end{document} in measurements. The output factors for grid fields are 0.2 lower compared to open fields. The lower depth dose with grid therapy is due to lower depth fluence with scatter radiation but it does not impact the dosimetry as the calibration parameters are insensitive to the effective beam energies. Thus, standard dosimetry in open beam based on international protocol could be used.

Impact of time to revascularization on outcomes in patients after out-of-hospital cardiac arrest with STEMI

BackgroundInternational guidelines recommend emergency coronary angiography in patients after out-of-hospital cardiac arrest (OHCA) with ST-segment elevation on 12‑lead electrocardiography. However, the association between time to revascularization and outcomes remains unknown. This study aimed to evaluate the association between time to revascularization and outcomes in patients with OHCA due to ST-segment-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI). MethodsThis multicenter, retrospective, nationwide observational study included patients aged ≥18 years with OHCA due to STEMI who underwent PCI between 2014 and 2020. The time of the first return of spontaneous circulation (ROSC) was defined as the time of first ROSC during resuscitation, regardless of the pre-hospital or in-hospital setting. The primary outcome was a 1-month favorable neurological outcome, defined as cerebral performance category 1 or 2. Multivariable logistic regression analysis was used to assess the association between the time to revascularization and favorable neurological outcomes. ResultsA total of 547 patients were included in this analysis. The multivariable logistic regression analysis showed that a shorter time from the first ROSC to revascularization was associated with 1-month favorable neurological outcomes (63/86 [73.3%] in the time from the first ROSC to revascularization ≤60 min group versus 98/193 [50.8%] in the >120 min group; adjusted OR, 0.26; 95% CI, 0.11–0.56; P for trend, 0.015). ConclusionsShorter time to revascularization was significantly associated with 1-month favorable neurological outcomes in patients with OHCA due to STEMI who underwent PCI.

Outcomes of Impella 5.0 and 5.5 for cardiogenic shock: A single-center 137 patient experience.

This study evaluated the outcomes of patients with cardiogenic shock (CS) supported with Impella 5.0 or 5.5 and identified risk factors for in-hospital mortality. Adults with CS who were supported with Impella 5.0 or 5.5 at a single institution were included. Patients were stratified into three groups according to their CS etiology: (1) acute myocardial infarction (AMI), (2) acute decompensated heart failure (ADHF), and (3) postcardiotomy (PC). The primary outcome was survival, and secondary outcomes included adverse events during Impella support and length of stay. Multivariable logistic regression was performed to identify risk factors for in-hospital mortality. One hundred and thirty-seven patients with CS secondary to AMI (n = 47), ADHF (n = 86), and PC (n = 4) were included. The ADHF group had the highest survival rates at all time points. Acute kidney injury (AKI) was the most common complication during Impella support in all 3 groups. Increased rates of AKI and de novo renal replacement therapy were observed in the PC group, and the AMI group experienced a higher incidence of bleeding requiring transfusion. Multivariable analysis demonstrated diabetes mellitus, elevated pre-insertion serum lactate, and elevated pre-insertion serum creatinine were independent predictors of in-hospital mortality, but the etiology of CS did not impact mortality. This study demonstrates that Impella 5.0 and 5.5 provide effective mechanical support for patients with CS with favorable outcomes, with nearly two-thirds of patients alive at 180 days. Diabetes, elevated pre-insertion serum lactate, and elevated pre-insertion serum creatinine are strong risk factors for in-hospital mortality.

Increased blood coagulation is associated with poor neurological outcome in aneurysmal subarachnoid hemorrhage

Background and purposePatients with aneurysmal subarachnoid hemorrhage (aSAH) have demonstrated increased blood coagulation which is thought to contribute to delayed cerebral ischemia (DCI) and to a worse outcome. Therefore, we sought to determine whether this increased blood coagulation, detectable with rotational thromboelastometry (ROTEM), was associated with DCI and neurological outcome. MethodsWe conducted a prospective observational study of 60 consecutive adult aSAH patients. ROTEM's EXTEM and FIBTEM assays and D-dimer were analyzed at admission and post-bleed days (PBDs) 2–3, 4–5, 7–8, and 11–12. ROTEM's clot formation time (CFT) represents the stabilization of the clot, and the maximum clot firmness (MCF) the maximum clot strength. Glasgow Outcome Scale extended (GOSe) at three months determined the neurological outcome. ResultsDCI incidence was 41.7%. EXTEM-CFT was significantly shorter in patients with unfavorable neurological outcome (GOSe 1–4) on PBDs 4–5 and 7–8, p < 0.05, respectively. FIBTEM-MCF was significantly higher in patients with unfavorable neurological outcomes on PBD 4–5 (p < 0.05), PBD 7–8 (p < 0.05), and PBD 11–12 (p < 0.05). EXTEM-CFT decreased, and FIBTEM-MCF rose during the study period in all patients. Patients with unfavorable neurological outcome had a higher D-dimer at all studied time points, p < 0.05. No difference was found in the ROTEM parameters or D-dimer when assessing patients with and without DCI. ConclusionsPatients were in a state of increased blood coagulation after aSAH, with those with unfavorable neurological outcome being more coagulable than those with favorable outcome. However, increased blood coagulation was not associated with DCI.ClinicalTrials.gov, NCT03985176