General Condition Of Patient Research Articles

The safety and short-term efficacy of neoadjuvant chemotherapy in elderly patients with resectable locally advanced esophageal squamous cell carcinoma.

433 Background: The standard treatment for resectable locally advanced esophageal squamous cell carcinoma (LA-ESCC) is neoadjuvant chemotherapy followed by surgery. However, the efficacy and safety of neoadjuvant chemotherapy for patients aged 76 or older have not been established because the JCOG1109 trial, which established the current standard of care, was limited to patients younger than 76 years. In our hospital, even patients aged 76 or older are treated with docetaxel, cisplatin, and 5-FU (DCF) or 5-FU / leucovorin, oxaliplatin, and docetaxel (FLOT), if the patient's general condition and organ function are maintained, but there have been few reports on the efficacy and safety of these therapies for elderly population. Methods: The subjects were 76 years old or older resectable LA-ESCC patients diagnosed as cT1N1-3M0, cT2-3N0-3M0, and cT1-3N0-3M1 (UICC-TNM 8th), who received at least one cycle of neoadjuvant DCF or FLOT in our institution from 2014 to 2023. Adverse events (CTCAE ver. 5.0) and histopathological responses were evaluated. Results: Patients who received neoadjuvant DCF (D group) and FLOT (F group) were 19 and 25, respectively. Patients background in the D / F group was as follows; median age 76 / 78 (years), male 84% / 64%, PS1 37% / 64%, clinical, T3 74% / 84%, clinical N1 32% / 52%, N2 47% / 32%, clinical stage III 53% / 64%, stage IVB 21% / 28%. Of the 19 patients in the D Group, 17 completed 3 cycles of treatment (completion rate 89%), 18 underwent surgery, including 2 patients who discontinued during the treatment (1 with disease progression and 1 with adverse event), and 1 underwent CRT. Of the 25 patients in the F group, 16 completed 4 cycles of treatment (completion rate 64%), 22 underwent surgery, including 8 patients who discontinued during the treatment (1 with disease progression, 6 with adverse events, and 1 with other), 2 underwent CRT, and 1 was placed on best supportive care. In the D and F groups, hematological toxicities were more common in the F group, especially grade 3 or more neutropenia was 26% / 96%, but febrile neutropenia was similar at 5% and 12%, respectively. Nonhematological toxicities were more common in the F group for all grades (nausea 42% / 64%, anorexia 63% / 80%, and fatigue 52% / 88%, while grade 3 or more toxicity was not significantly different from the D group (nausea 0% / 4%, anorexia 0% / 4%, and fatigue 5% / 4%). In the 18 patients of the D group and 22 patients of the F group who underwent surgery, R0 resection was performed in 94% / 95%, and pathological complete response (pCR) was 11% / 23%, respectively. Conclusions: Neoadjuvant triplet chemotherapy was well tolerated and resulted in high R0 resection rates and pathological responses even in patients aged 76 or older. Further investigation with long-term follow up is warranted to elucidate the clinical benefit of neoadjuvant chemotherapy for elderly LA-ESCC patients.

Microbial analyses of infectious keloids on the anterior chest-a case-control study.

Some studies have confirmed that pathogens can cause infection through bacterial cultures on the surface of infectious keloids. However, further exploration of the comparison between infectious and non-infectious keloids and the bacterial flora of infectious foci is lacking. To investigate the differential flora of purulent secretions on the surface of infectious keloids compared to non-infectious keloids and to determine the microbial composition within the infectious foci. This case-control study involved 17 patients and obtained swab specimens from the surface of keloids in two groups, and from the infectious foci in the infectious group. Bacterial composition was analyzed using 16S ribosomal RNA sequencing. There were no statistical differences in the general condition of patients between the two groups. The presence of the phylum Actinobacteriota, and the orders Propionibacteriales and Corynebacteriales, as well as the genus Taibaiella, was greater on the surface of keloids in the infectious group. The most prevalent genera in infective sites were Staphylococcus, Peptoniphilus, and Cutibacterium. Microbial-associated gene pathways indicated a correlation with inflammation and tumor-like growth in keloids. There is a connection between infectious keloids and microorganisms, providing insights for predicting and treating keloid infections.

Epithelial-Mesenchymal Transition Suppression by ML210 Enhances Gemcitabine Anti-Tumor Effects on PDAC Cells.

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers in the world. Neoadjuvant chemotherapy (NAC) has become a standard treatment for patients scheduled for surgical resection, but the high rate of postoperative recurrence is a critical problem. Optimization of NAC is desirable to reduce postoperative recurrence and achieve long-term survival. However, if a patient's general condition deteriorates due to NAC toxicity, surgical outcomes may be compromised. Therefore, we aimed to identify drug(s) that can be used in combination with gemcitabine (GEM), a drug widely used for the treatment of PDAC, to inhibit distant metastatic recurrence, particularly after surgery. After several screening steps, ML210, a low molecular weight chemical, was found to suppress the epithelial-mesenchymal transition (EMT) in PDAC cells in combination with GEM. Specifically, low dose ML210 in combination with GEM was sufficient for cell migration without apparent toxicity or cell death. Mechanistically, ML210, which was developed as a glutathione peroxidase 4 (GPX4) inhibitor to induce lipid peroxidation, increased the oxidized lipid concentrations in PDAC cells. The oxidization of the cell membrane lipids may suppress EMT, including cell migration. Since EMT is a major malignant phenotype of PDAC, our findings may lead to the advancement of PDAC therapy, especially in the prevention of postoperative recurrence.

Gastric cancer liver metastases in China: a real-world, multicentre, prospective, observational cohort study protocol

IntroductionGastric cancer liver metastases (GCLM) is a highly heterogeneous disease with a poor prognosis. The multidisciplinary diagnosis and treatment model is applied throughout the entire treatment process. In addition to...

The Role of Metabolic Therapy in the Treatment of Chronic Coronary Syndrome. Results of Own Research

Ischemic heart disease (IHD) and stroke are the main causes of mortality and disability worldwide. One of the most controversial issues in modern cardiology is the feasibility of using metabolic drugs for the treatment of patients with angina. The main directions in metabolic therapy are optimization of energy production and expenditure and normalization of the balance between the intensity of free radical oxidation and antioxidant processes. The objective: to determine the clinical effectiveness of combined metabolic therapy with domestic drugs meldonium, ethylmethylhydroxypyridine succinate and armadin in the complex treatment of military personnel with IHD. Materials and methods. The study included 36 military personnel with coronary artery disease with stable angina pectoris of functional class II–III. Patients were treated in the cardiology department of the Military Medical Clinical Treatment and Rehabilitation Center (Irpin). All examined patients were male, the average age was 43.7 ± 2.7 years, the duration of the disease was 4.2 ± 2.3 years, the onset of angina attacks was 39.6 ± 2.8 years. All patients received standard therapy in accordance with the ESC recommendation. Additionally intravenous drip infusions of meldonium (100 mg/ml, 5 ml per 100.0 saline), ethylmethylhydroxypyridine succinate (50 mg/ml, 2 ml intravenously in a 1:2 dilution in saline, slowly in a jet) and armadin (300 mg, 1 tablet in the evening for 2 weeks, then 1 tablet solution twice a day for 4 weeks) were prescribed. The effectiveness of the prescribed complex was monitored based on the dynamics of clinical status, bicycle ergometry indicators, and Holter ECG monitoring before the start of treatment and after 14–16 days. Results. The use of metabolic therapy significantly improved the general condition of patients, reduced the number of angina attacks, and reduced the need for nitroglycerin tablets. Analysis of the sample with dosed physical activity before the start of therapy revealed a significant percentage of patients with ST segment depression of 2 mm at the height of physical activity, and the total relative number of patients with ST segment depression of 1.5–2 mm was 72.2%. During the repeated examination ST segment depression was not determined in 94.4% of patients. Before treatment, rhythm disturbances in the form of supraventricular and ventricular extrasystoles were recorded on the background of maximum exercise, and after treatment, no rhythm disturbances were detected. In the dynamics of the therapy, it was possible to achieve a decrease in blood pressure (BP) indicators during exercise, the level of systolic BP decreased by 16.4%, and diastolic BP – by 9.4% (p < 0.05). Recovery time significantly decreased by 35.2%, but oxygen consumption and tolerance index significantly increased. Conclusions. The results of the study demonstrated that combination therapy with domestically produced metabolic drugs (meldonium, ethylmethylhydroxypyridine succinate and armadine) with a combination of injectable and tablet forms showed high effectiveness in the treatment of military personnel with coronary artery disease. The combination of drugs that patients received during the study demonstrated good tolerability and the absence of adverse reactions.

Clinical Presentation and Integrated Management of Pressure Injuries in the Emergency Hospital Setting: A Plastic Surgeon’s Perspective

Background: Pressure injuries are localized areas of tissue damage or necrosis that occur when pressure is applied to the skin for prolonged periods, often over bony prominences, often the sacrum, heels, ischial tuberosities, and greater trochanters. The pathophysiology is complex, involving a combination of mechanical forces, ischemia, and tissue hypoxia. Methods: We conducted a 2-year retrospective study aiming to assess the clinical characteristics, risk factors, and management of pressure injuries in patients admitted to an emergency hospital who underwent a plastic surgery examination. Results: This study included 176 patients with clinically diagnosed pressure ulcers, with findings showing 28.52% of cases as stage III and 35.57% as stage IV. Common sites included the sacrum (40.94%), ischium (15.1%), and heel (14.43%). The median patient age was 76 years, with 47.15% between 60 and 80 years and 36.93% ≥ 80 years, often presenting with comorbidities increasing the risk of pressure injuries, such as cardiovascular disease (71.59%), diabetes (18.18%) and obesity (9.66%). Important risk factors included neurological diseases (46.02%), spinal cord injuries (14.7%), and nutritional deficiencies, as indicated by anemia (10.43g/dL; 95% CI [10.04; 10.82]), low serum albumin (2.56 g/dL; 95% CI [2.43; 2.69]) and proteins (5.54 g/dL; 95% CI [5.34; 5.73]). Mortality was significant, at 36.93%, with 23.3% occurring within the first 7 days of hospitalization due to the patients’ critical condition. Decision-making for surgical intervention considered the patient’s general status, comorbidities, and ulcer severity. Surgical treatment consisted of seriate debridement, negative pressure vacuum therapy, and/or coverage using skin grafting, local advancement, or rotation flaps. Conclusions: The key question for a plastic surgeon to consider is how pressure ulcers should be managed. Various debridement and covering techniques should be tailored to the wound’s characteristics, considering patient comorbidities and general health condition.

The role of the dentist in the multidisciplinary palliative care team: a comprehensive review of the literature

Palliative care is defined as an approach that aims to improve the quality of life of patients and their families, faced with problems associated with life-threatening illnesses, through the prevention and relief of suffering through early identification, assessment and treatment of pain. The incorporation of dentists into palliative care teams is a significant advance from the perspective of patient care. Professionals with their specialized skills can significantly improve the quality of life of patients suffering from serious and limiting illnesses. Therefore, the present study aims to identify studies in the literature that deal with the integration of dentists and their importance in the palliative care team. The association between the descriptors was used in the main databases: (Dentists) AND (palliative care). After selecting 19 articles that met the inclusion criteria, a summary table was prepared with the main findings of the selected articles. Most studies showed that the dentist plays a fundamental role in the palliative care team, being an important part of it. It is clear that its actions help prevent oral health conditions that harm the general condition of patients undergoing palliative care. It is concluded that the inclusion of this professional leads to a crucial advance in guaranteeing comprehensive and humanized care for terminally ill patients.

Pneumopericardium, a Heart in a Trap.

Background: The text discusses the case of a patient who experienced pneumopericardium because of a traumatic incident. It discusses pneumopericardium's causes, symptoms, and complications, including tamponade symptoms and imaging modalities, to confirm the diagnosis and assess complications. Present various treatment options emphasize the importance of ongoing monitoring and damage control principles. Methods: Retrieved pneumopericardium cases with complete clinical databases (Pubmed, Medline) and summarised the clinical symptoms and prognosis of different treatment schemes. Results: A 33-year-old male patient, after a suicide attempt, fell from a height estimated at 15 m. The patient was intubated at the scene and mechanically ventilated. Initial assessment revealed signs of tension pneumothorax, which was decompressed and stabilized. Subsequent deterioration led to the discovery of pneumopericardium through diagnostic imaging. Conclusions: The case highlights the need for a comprehensive and multidisciplinary approach to address the complex nature of injuries associated with pneumopericardium. It examines the principles of damage control, which focus primarily on the patient's general condition, leaving some injuries for later treatment.

Significance of Multidisciplinary Teams for Patients with Oral and Maxillofacial Surgical Diseases: An Observational Retrospective Study in a General Hospital in China.

The multidisciplinary team (MDT) approach is increasingly being utilized in the management of complex head and neck diseases. This study analyzed the benefits of MDT for patients with head and neck diseases as primary or secondary conditions and categorized MDT meetings into two types: head and neck surgery initiation (HNI) and head and neck surgery participation (HNP). The study further explored the characteristics of these MDT meetings and the factors influencing patient compliance, aiming to optimize MDT treatment models to maximize patient benefits. Retrospective analysis. MDT meetings from January 2021 to December 2023 were reviewed. The meetings and patients were classified into the HNI group and the HNP group. Various factors, including general patient conditions, disease characteristics et al were analyzed using chi-square tests and point biserial correlation tests. P-values < 0.05 were considered statistically significant. A total of 292 MDT cases were analyzed, comprising 127 cases in the HNI group and 165 cases in the HNP group. In the HNI group, the initial diagnosis was modified in 11 cases (8.7%), with 92 patients (72.4%) receiving major recommendations for their treatment plans. In the HNP group, the initial diagnosis was modified in 28 cases (17.0%). The head and neck surgeons had a major impact on treatment plans in 47 cases (28.5%). Notably, patients with head and neck tumors received more major recommendations (p<0.05) in the HIN group, and patients who had tumors (p<0.05) and from outpatient departments (p<0.05) exhibited poor compliance with recommendations. The MDT approach in general hospitals has improved the rationality of medical decision-making, especially in rare diseases, tumors, and systematic conditions compared to MDT in a single center, with head and neck surgeons playing vital roles. MDT models can be further explored and established.

Lateral forehead flap in oral reconstruction: A case report

Introduction: Lateral Forehead flap is very versatile as it represents a good choice for reparation of different types of nose and oral cavity defects and provides an optimal, aesthetic, and functional outcome. In era of free transfer tissue, the use of loco-regional flaps, alone or in combination may prove to be the only practical solution in the absence of resources or other options. Case presentation: A-65 years old male with multiple comorbidities underwent a wide resection with adequate margin of the lower lip and small segment of the upper lip due to a locally advanced squamous carcinoma. After long consideration, the last resort was the pedicled lateral forehead flap. Information was sourced from patient’s case notes and operating theatre report. Results: The donor defect was covered with a split-thickness skin graft harvested from the right thigh area. The flap survived and both functional and aesthetic outcome were satisfactory. The site of the donor defect result was also acceptable. No complications were noted in our case study beside a small tip necrosis and breakdown of the suture line. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in cases with previous history of radiotherapy or surgery. Decision making of a particular reconstructive option should be done taking in consideration the available resources, surgical team expertise along with the patient's general condition. The pedicled forehead flap still useful when other options are inappropriate or have not been successful.

Purulent-Necrotic Complications After Amputation of The Lower Extremities: Issues of Treatment and Prevention

Transfemoral amputation of a limb performed by a patient with obliterating atherosclerosis with irreversible ischemia is a difficult, traumatic operation and is accompanied by high mortality. High mortality after amputation of a limb at the hip level is associated with the severity of the general condition of patients and complications of the postoperative period. As our studies have shown, the most common complication after limb amputation is an infection of the femoral stump wound, its development is directly related to metabolic disorders in patients, a decrease in the immune status, ischemia of the stump tissues and foci of secondary infection. The clinical picture of infection of the femoral stump wound is variable. It depends, first, on the patient's general condition, the process's spread, the trophism of the stump tissues, and the nature of the microflora. Improving the treatment results of patients who have undergone limb amputation is possible by performing all the necessary preventive measures regarding ischemia and stump infection in the prescribed volume and the development of infectious complications, as well as treatment by the requirements of modern purulent surgery.

Surgical Treatment of Simultaneous Common Femoral and Profunda Femoris Artery Aneurysms

Profunda femoris artery aneurysms (PFAAs) are rare because of the histo-anatomical characteristics of the profunda femoris arteries. We present a case of simultaneous PFAA and common femoral artery aneurysm (CFAA) incidentally detected on computed tomography in a 58-year-old man with diverticular bleeding. Images revealed a 37-mm right PFAA and a 24-mm right CFAA. According to the report, PFAAs >20 mm are a surgical indication, and surgery should be decided based on the patient's general condition. We resected the aneurysms and reconstructed the arteries using vascular prostheses. The postoperative course was uneventful, and the patient was discharged 8 days postoperatively.

Pneumoniae: A Comprehensive Overview of Public Awareness and Scientific Knowledge

The illness manifests as mild to severe symptoms such as cough, fever, chest discomfort, and breathing difficulties. In order to determine the cause of the illness, the diagnosis often entails a clinical assessment, imaging tests such chest x-rays, and microbiological analysis. Depending on the pathogen and the patient's general condition, different treatment approaches are used. However, supportive care, antiviral drugs for viral forms of the illness, and antibiotics are frequently used for bacterial pneumonia. Vaccinations, proper hygiene habits, and addressing risk factors like smoking are examples of preventive actions. Pneumonia is still a serious worldwide health concern despite advancements in treatment, particularly in susceptible demographics like the young, the old, and those with underlying medical issues. Serious episodes of pneumonia can result in organ failure, sepsis, and severe respiratory distress, all of which call for emergency medical attention. A combination of the patient's medical history, physical examination, chest x-ray, and microbiologic tests are often used in the diagnosis process to determine the etiologic agent. Antibiotics are frequently used to treat bacterial pneumonia, antiviral drugs are used to treat viral pneumonia, and antifungal compounds are used to treat fungus pneumonia. Treatment strategies are based on the organism that is causing the illness. In addition, supportive care—which includes oxygen treatment and hydration—is crucial, particularly in more serious situations. Vaccination (e.g., against influenza and pneumococcal pneumonia), quitting smoking, and better hygiene habits are examples of preventive measures. Pneumonia continues to be a serious public health concern despite advancements in medicine, particularly for high-risk populations including the elderly, small children, and those with chronic conditions. To effectively treat pneumonia, a multimodal approach is needed a strategy that includes prompt diagnosis, suitable treatment, and effective prevention measures.

The effectiveness of antidepressant therapy against anhedonia in patients with alcohol dependence

The article presents the results of a scientific study aimed at determining the effectiveness of the drug Vortioxetine (Brintellix) in the treatment of affective spectrum disorders in patients with alcohol dependence in a drug treatment hospital, since the drug is promising for widespread use in the drug therapy of a number of mental disorders and in the future could be included in the standard of medical care in the field of psychiatry-addictology. It is known that anhedonia is one of the mental disorders in withdrawal syndrome, which provokes relapses of an addictive disorder and negatively affects the duration and quality of remissions of patients with an addiction profile. At the same time, the study of antidepressant therapy in the treatment of alcohol dependence remains relevant, since poor tolerance, side effects, and deterioration of the patient's general condition may affect adherence to drug therapy. In the present study, anhedonia was assessed on the Snaith-Hamilton SHAPS scale, anxiety-depressive manifestations using the HADS hospital anxiety and depression scale and quality of life according to the SF-36 questionnaire during 24 weeks of follow-up.The result of drug therapy with Vortioxetine was the relief of affective disorders in alcohol dependence, which contributed to the improvement of overall subjective well-being, the degree of satisfaction with the quality of life and a decrease in anxiety-depressive tendencies and anhedonia. In addition, minimal and minor adverse reactions when taking Vortioxetine affected the increased adherence of the examined patients to medical prescriptions and recommendations.Conclusions. The use of Vortioxetine in the treatment of affective disorders among patients suffering from alcohol dependence provides new opportunities to help people suffering from alcohol addiction. Vortioxetine can be recommended both at the stage of inpatient care and outpatient treatment, since when it was taken, stable positive dynamics of antidepressant, anti-anxiety and antiangedonic effects were recorded.

Iron deficiency conditions in gynaecology: Effective management of perioperative anaemia

Iron deficiency anaemia is one of the most common diseases among women, and is most often caused by posthemorrhagic conditions. Gynaecological diseases requiring surgical treatment play a determinant role in the genesis of heavy iron loss in women. Anaemia can prevent from the timely surgery, and failure to eliminate local causes of blood loss can deteriorate the patients’ condition and quality of life. Anaemia is currently regarded as a serious risk factor for the outcomes of surgical treatment, which can and should be eliminated. At the same time, substitution transfusion that was previously often used to manage anaemia in less time is not only ineffective and has a temporary effect, but can itself cause such serious complications as haemolysis, infection, anaphylaxis. Therefore, it is recommended to apply an approach that combines diagnosis and treatment of anaemia, reduces blood loss and improves the general condition of patients. This approach can lead to about 40% reduction in the incidence of complications. The review summarizes the main features of iron deficiency anaemia in gynaecology and the most effective approaches to therapy. Early onset of modern oral ferrotherapy allows to assign treatment courses of required duration without side effects and prevents severe iron deficiency. Parenteral administration of iron carboxymaltose has significantly reduced the duration of treatment and improved its effectiveness in severe recurrent and perioperative anaemia. Timely management of anaemia allows not only to perform surgical intervention in time, when indicated, but also to reduce the likelihood of complications and improve the women’s quality of life.

Neuronutrition and Its Impact on Post-Stroke Neurorehabilitation: Modulating Plasticity Through Diet.

The recovery of neurological deficits after ischemic stroke largely depends on the brain's ability to reorganize its undamaged neuronal circuits and neuronal plasticity phenomena. The consolidated evidence highlights the involvement of the patient's impaired nutritional conditions in post-stroke recovery and unsatisfying rehabilitative outcomes. Standardized nutritional protocols usually applied in hospitalized patients in a rehabilitation setting aim mainly to improve the general health conditions of patients, do not consider the high inter-individual variability in neurorehabilitation outcomes, and are not sufficiently modifiable to provide neuroprotective and restorative dietary patterns that could promote neuronal plasticity and functional recovery during neurorehabilitation. Neuronutrition, an emergent scientific field of neuroscience, represents a valid model of a personalized nutritional approach, assuring, for each patient, nutrients having antioxidant and anti-inflammatory properties, ensuring a balanced microbiota composition, and providing adequate neurotrophic support, essential for improving neuronal plasticity, brain functional recovery, and rehabilitative outcomes. In the present narrative review, we provide an overview of the current knowledge on neuronutrition as an adjuvant strategy of a personalized nutritional approach potentially effective in improving post-stroke neuroplasticity and neurorehabilitation by counteracting or at least limiting post-stroke oxidative/nitrosative stress, neuroinflammation, and gut-brain axis disturbance.

Psychological resilience and post-traumatic stress disorder as chain mediators between personality traits and cognitive functioning in patients with breast cancer

BackgroundPersonality is a unique behavioral trait; cognition is how an individual knows and understands things. It is essential for everyday daily living. In patients with breast cancer, despite the growing body of research on personality and cognitive functioning, exploration of the underlying mechanisms is still relatively scarce. Therefore, this study aimed to investigate the impact of Big Five personality traits on cognitive functioning and the mediating role of psychological resilience and post-traumatic stress disorder(PTSD) between personality traits and cognitive functioning in patients with breast cancer.MethodsConvenience sampling was used, and a cross-sectional survey of 288 patients clinically diagnosed with breast cancer was conducted in the Department of Breast Surgery of the First Hospital of Jinzhou Medical University. The general information questionnaire, the Ten-Item Personality Inventory in China, the 10-item Connor-Davidson Resilience Scale, the Post-traumatic Stress Disorder Checklist-Civilian Version, and the Montreal Cognitive Assessment were used to measure the patient's general condition, personality traits, psychological resilience, PTSD, and cognitive function, respectively. Descriptive and correlation analyses were performed using SPSS 26.0 software, and mediation effect tests using SPSS PROCESS macro 3.3 software.Results(1) Psychological resilience, PTSD, Big Five personality traits, and cognitive functioning were significantly correlated. (2) The effects of the Big Five personality traits (extraversion, conscientiousness, agreeableness, emotional stability, and openness) on cognitive functioning can be mediated through three indirect pathways: the separate mediating effects of psychological resilience and PTSD and the chain mediating effects of psychological resilience and PTSD, with a chain mediation effect of 0.014, 0.018, 0.014, 0.018, and 0.014, respectively. None of the 95% CI contained 0.ConclusionPersonality traits can indirectly influence cognitive functioning in patients with breast cancer through the separate mediating roles of psychological resilience and PTSD and their chained mediating roles. This result suggests we pay more comprehensive attention to patients' cognitive function. Workers can be guided to assess patients' personality, psychological, and spiritual characteristics promptly in their work and adopt personalized care to safeguard good cognitive functioning.

Biomarkers in early and late period after radiofrequency and pulsed field catheter ablation of atrial fibrillation

Abstract Introduction Biomarkers are routinely used parameters for disease diagnosis, treatment control and risk stratification. In connection with atrial fibrillation (AF), the importance of GDF-15 (growth differentiation factor 15), NT-proBNP (N-terminal fragment brain natriuretic factor) and hs-TnT (high sensitivity cardiac troponin T) is discussed. Catheter ablation is an established treatment method in selected population with AF. However, biomarker response to radiofrequency catheter ablation (RFCA) and pulsed field ablation (PFA) of AF has not been precisely described. Purpose Purpose of the study was to describe early and late dynamics of GDF-15, hs-TnT and NT-proBNP in different ablation technologies. Methods We prospectively enrolled 48 patients (median (IQR) age 62 (55; 70) years, 30 males) undergoing RFCA, which we compared with 30 patients (median (IQR) age 64 (56; 71) years, 18 males) undergoing PFA. All patients underwent 6 sequential blood takes: before ablation (baseline), right after ablation (0h), 24 and 48 hours after procedure (24h and 48h), 90 and 180 days after procedure. Levels of GDF-15, hs-TnT and NT-proBNP were analyzed. Results Out of all patients, 19 (40 %) and 20 (67 %) patients had paroxysmal AF in RFCA and PFA group, respectively. Additional ablation lesions over pulmonary vein isolation were done in 26 (54 %) patients in RFCA group and 11 (43 %) patients in PFA group. Median procedural time was significantly longer in RFCA than in PFA group (155 (130; 190) vs. 80 (70; 90) min; p &amp;lt; 0.01). Early dynamics of GDF-15 and cardiac hs-TnT are visualised in Figure 1 and 2. GDF-15 level peak was registered 48 hours after ablation with median (IQR) 1183 (824; 1988) ng/l. Compared to baseline, GDF-15 values sustained elevated up to 90 days after ablation in both groups and decreased to baseline levels after 180 days. No significant differences were found in GDF-15 levels between patients treated with RFCA and PFA. Maximal values of hs-TnT were significantly higher in PFA group than in RFCA group (1001±589 vs. 458±202 ng/l; p &amp;lt; 0.001). We have recognised decrease of NT-proBNP between baseline and 90 days after procedure in both groups: 338 (112; 613) vs. 209 (101; 545) ng/l; p &amp;lt; 0.05. Conclusion Eventhough GDF-15 is considered as a nonspecific biomarker reflecting general condition of patient, the levels are significantly affected by catheter ablation of AF for several months irrespective to ablation technology. PFA is associated with advanced elevation of hs-TnT.Dynamics of GDF-15 (median; IQR)Dynamics of hs-TnT (median; IQR)

Revascularization of myocardial infarction without ST segment elevation in multivessel coronary artery disease

Many patients with non-ST elevation myocardial infarction have multivessel coronary artery disease, which complicates the course of the disease and is associated with fatal outcomes. Most patients with non-ST elevation myocardial infarction undergo coronary angiography and revascularization during initial hospitalization. However, the decision to perform total or incomplete revascularization and whether to perform total revascularization on admission or at the stage of its implementation is complex and must be adapted to the age, general condition of the patient and comorbidities. Sincethe majority of patients with non-STelevation myocardial infarction have multivessel disease, treatment and timing are critical components to ensure favorable outcomes. Early revascularization is associated with improved long-term patient outcomes, but the optimal approach to revascularization in patients with non-ST elevation myocardial infarction with multivessel disease remains poorly understood. However, in this patient population, a multidisciplinary cardiac approach is recommended to determine revascularization options. Published data suggest that evaluation of the risk-benefit associated with future invasive procedures should be based on an analysis of the patient's general condition and cardiovascular risk factors, the ability to identify the culprit artery, the technical feasibility of performing multivessel revascularization, and the location, degree of stenosis, and severity of lesions.Whether multivessel percutaneous coronary intervention or coronary artery bypass grafting provides better outcomes in patients with non-ST elevation myocardial infarction remains largely debatable. In this connection, it is relevant to conduct prospective studies to study the optimal revascularization strategies.

Analysis of risk factors for intraoperative bleeding in patients with Siewert type II esophagogastric junction adenocarcinoma treated by two minimally invasive surgeries and its influence on prognosis: a retrospective study.

The present study aimed to analyze the independent risk factors for intraoperative bleeding in Siewert II adenocarcinoma of the esophagogastric junction (AEG) using two minimally invasive surgical approaches, namely, the laparoscopy-assisted abdominal trans-hiatal (LTH) method and transthoracic-laparoscopic esophagectomy (TLE). The clinical data of 100 patients with SiewertII AEG admitted to our hospital from October 2017 to October 2020 were retrospectively analyzed. According to the type of surgery, the patients were divided into LTH approach group and TLE approach group. The differences between the clinical characteristics of the patients in different groups and the differences in the intraoperative bleeding and prognosis between different surgical procedures were analyzed and compared using the t-test and chi-squared test. Multiple linear regression was used to identify the independent risk factors affecting the amount of intraoperative bleeding in patients. The results of this study showed that patients in the LTH group had significantly less intraoperative bleeding and operative time and significantly better postoperative recovery than the TLE group. The results of multivariate linear regression showed that the combined trans-thoracic-abdominal approach (P=0.000), advanced age (P=0.014), larger BMI (P=0.000), and larger tumor diameter (P=0.001) were the independent risk factors influencing the increase in intraoperative bleeding. In addition to the conventional factors that affect intraoperative bleeding, such as the patient's general condition, operation time, and tumor size, LTH surgery is another way to avoid intraoperative bleeding for Siewert type II AEG patients and can significantly improve postoperative recovery.