High Risk Of Complications Research Articles

Impact of Disability on Postoperative Outcomes After Gastrointestinal Cancer Surgery

Abstract Introduction Approximately 61 million individuals in the United States have a disability and face unique challenges, resulting in healthcare disparities. Objective We aimed to evaluate the impact of disability on postoperative outcomes and number of healthy days at home (HDAH). Methods Patients who underwent surgery for gastrointestinal (GI) cancer between 2017 and 2020 were identified using the Medicare database. Multivariable regression models were used to examine the association between disability and postoperative complications, discharge disposition, and the number of HDAH. Results A total of 72,452 individuals underwent GI cancer surgery (pancreas: n = 7614, 10.5%; hepatobiliary: n = 4994, 6.9%; colorectal: n = 59,844, 82.6%). Median patient age was 75 years (interquartile range 71–81) with most patients being female (n = 37,167, 51.3%). Overall, 5432 individuals (7.2%) had a disability. Following surgery, patients with a disability were more likely to experience complications (4.6% vs. 3.3%), be discharged to a skilled nursing facility (SNF; 26.6% vs. 12.3%), and experience hospital readmission (20.0% vs. 13.5%) [all p < 0.001]. Consequently, individuals with disabilities were more likely to spend fewer (<20th percentile) HDAH (33% vs. 19.2%) [all p < 0.001]. On multivariable analysis, disability was associated with higher odds of complications (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.19–1.56) and hospital readmission (OR 1.55, 95% CI 1.44–1.66). Additionally, disability was associated with higher odds of spending fewer HDAH (OR 1.88, 95% CI 1.77–1.99). Conclusion Following GI cancer surgery, individuals with disabilities had a higher risk of complications and spent fewer HDAH. There is a need for targeted interventions to improve the care of patients with disabilities and ensure equitable oncological and surgical outcomes.

Successful thrombolysis in an elderly patient with a large-scale hemispheric brain infarction

Currently, one of the primary methods of reperfusion in ischemic stroke is systemic thrombolytic therapy (TLT) using recombinant tissue plasminogen activators (rtPA). Despite TLT’s effectiveness demonstrated in several large multicenter randomized placebo-controlled clinical trials, the use of rtPA at standard dosages carries a high risk of hemorrhagic complications, especially in patients with certain aggravating factors. This article presents a clinical case of early thrombolysis in a patient with ischemic stroke, utilizing an individualized dosage of rtPA despite the presence of relative contraindications for reperfusion therapy.

Impact of Preoperative Glucagon-Like Peptide-1 Receptor Agonist on Outcomes Following Major Surgery.

Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly being used for the management of diabetes mellitus and obesity. We sought to define the impact of preoperative GLP-1RA use on outcomes following major surgical procedures. Patients who underwent a major surgical procedure between 2013 and 2021 were identified using the IBM MarketScan database. Patients who took GLP-1RA within a year before surgery were categorized as "exposed." After propensity score matching (PSM), multivariable regression analysis was used to define the association of GLP-1RA exposure with postoperative complications. Among 138,980 patients (coronary artery bypass graft: n=39,516, 28.4%; pneumonectomy: n=4,881, 3.5%; abdominal aortic aneurysm repair: 4,459, 3.3%; pancreatectomy: n=15,873, 11.4%; and colectomy: n=74,251, 53.4%), most individuals were male (n=80,871, 58.2%) with a median age of 58 (IQR 53-61) years. 2944 (2.2%) individuals had GLP-1RA exposure before surgery. Overall incidence of complications was 36.5% (n=50,724); complications included sepsis (n=6,385, 4.6%), surgical site infections (n=7,431, 5.3%), thromboembolism (n=3,609, 2.6%), pneumonia (n=4,783, 3.4%), renal (n=9,017, 6.5%), or cardiopulmonary failure (n=26,661, 19.2%). On unmatched analysis, patients on GLP-1RA had a higher risk of complications (no GLP-1RA: 36.3% vs. GLP-1RA: 44.5% p<0.001); however, after PSM to account for measured confounders, GLP-1RA exposure was not associated with the odds of surgical complications (OR 0.99 95% CI 0.91-1.08; p>0.05). Among patients using GLP-1RA during the 2 weeks before surgery (n=522, 17.7%), there was no association of GLP-1RA with risk of complications (nonrecent GLP-1RA: 44.7% vs. recent GLP-1RA: 44.1%; p=0.992). GLP-1RA use was not associated with an increased risk of complications following major surgical procedures.

Chronic Liver Disease as a Risk Factor For Post-ERCP Complications: A Nationwide Retrospective Analysis.

Endoscopic retrograde cholangiopancreatography (ERCP) is indicated for multiple pancreatic and biliary pathologies and carries a heightened risk profile compared with other endoscopic procedures. Considerable research has been directed towards discerning risk factors associated with complications such as post-ERCP pancreatitis and post-ERCP bleeding. Despite this, data on chronic liver disease (CLD) as a risk factor for complications is limited. We aimed to assess the outcomes of patients with CLD who underwent therapeutic or diagnostic ERCP to determine whether these patients had different outcomes relative to patients without CLD. We used the National Inpatient Sample (NIS) database to inquire for all adult patients who underwent ERCP between 2016 and 2019 using the International Classification of Disease, Tenth Revision (ICD-10) coding. The group was stratified into 2 groups: patients with CLD and those without. The main outcome we looked at was the rate of post-ERCP pancreatitis, post-ERCP hemorrhage, and perforation between the 2 groups. The secondary outcomes were in-hospital mortality and length of stay. A multivariate regression model was used to estimate the association of CLD with ERCP outcomes. We identified a total of 883,825 patients who underwent ERCP between 2016 and 2019. Among these, 21,212 (2.4%) had CLD and 862,613 (97.6%) did not have CLD. The mean age for patients in liver disease group was 61.66 years and in group without liver disease was 60.46 years. The predominant ethnicity in both groups was whites. Additional admission-related factors are outlined in Table 1. The rate of post-ERCP pancreatitis (8.8% vs. 6.7%, P < 0.001) with adjusted odds ratio (aOR) 1.3; and post-ERCP hemorrhage (8.8% vs. 6.69%, P < 0.001) with aOR 1.35, was higher in the patient group with CLD. The rate of post-procedure perforation was not significantly different in both groups. For secondary outcomes; the in-hospital mortality (3.03% vs. 1.58%, P < 0.001) and length of stay (7 days vs. 3 days, P < 0.001) were higher in the patients with chronic liver disease. The outcomes are mentioned in Table 2. Although ERCP is considered a safe procedure, it is one of the endoscopic procedures associated with the highest risk of complications. As a result, risk stratification is crucial. Certain demographics, conditions like end-stage renal disease, liver cirrhosis, and procedural factors have been identified as risk factors for post-ERCP complications. Our study represents newer data, with use of revised ICD codes, to demonstrate increased risk in patients with liver disease. On the basis of these results, ERCP should be used judiciously in this population and further studies are required for identifying reversible risk factors to improve outcomes.

Improving Sternal Closure Outcomes in Cardiac Surgery: Polyethylene Suture Tapes vs. Steel Wires.

Background: Steel wires are often inadequate for sternal closure for patients at high risk of sternal complications. This study compares a novel sternal closure system to conventional steel wires to assess its potential to reduce sternal complication rates and improve clinical outcomes. Methods: A retrospective study was conducted on 300 consecutive patients undergoing cardiac surgery via median sternotomy. A total of 150 patients underwent steel wire sternal closure, while 150 underwent suture tape closure. Preoperative, intraoperative, and postoperative data were collected and analyzed for both groups. Results: Rates of sternal wound infections (1% vs. 5%, p = 0.0363) and sternal dehiscence (0% vs. 5%, p = 0.0297) were lower in the suture tape group. Suture tape patients had significantly less pain at 14 and 30 days (p = 0.0002 and 0.0071). The requirement for sternal protection adjuncts was eliminated with suture tape closure. Sternal closure time was significantly shorter in the suture tape group (11 vs. 19 min, p < 0.0001). Conclusions: Suture tapes proved safe, feasible, and effective for sternal closure, demonstrating significant advantages for sternal closure over steel wires, with reduced rates of sternal dehiscence, infection, postoperative incisional pain, and closure time. These superior outcomes and the elimination of sternal protection adjuncts can potentially reduce healthcare costs. Our experiences suggest that this novel sternal closure system has significant potential, with larger prospective studies warranted to optimize sternal closure strategies.

The Correlation between Serum Procalcitonin and C-Reactive Protein and Main Complications After Endoscopic Retrograde Cholangiopancreatography.

The aim of this study was to explore the clinical value of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in evaluating complications after endoscopic retrograde cholangiopancreatography (ERCP) in patients with common bile duct (CBD) stones. Patients who were diagnosed with CBD stones and underwent ERCP from December 2021 to December 2023 were selected as the study subjects. According to whether postoperative complications occurred, they were divided into complication group (n = 28) and non-complication group (n = 132). The general clinical data, biochemical indexes, serum PCT, and CRP levels before ERCP and 4 hours and 24 hours after ERCP were compared. The changes of serum PCT and CRP levels in patients with different types of complications at 4 hours and 24 hours after ERCP were analyzed. The value of serum PCT, CRP levels, and combined indicators in distinguishing postoperative complications was analyzed. The proportion of previous pancreatitis and complications (hypertension and diabetes) in the complication group was higher than that in the non-complication group. Serum PCT and CRP levels of patients in the complication group were significantly higher than those in the non-complication group at 24 hours after ERCP (p < 0.001). Stratified according to the main types of complications, CRP level of patients with postoperative pancreatitis continued to increase at 4 hours and 24 hours after ERCP, while serum PCT increased only after 24 hours. When serum PCT and CRP levels were higher than 2.61 μg/mL and 68.18 mg/mL, respectively, at 24 hours after ERCP, the patients with postoperative complications could be well distinguished. The combination of the two indicators had a higher value in distinguishing patients with postoperative complications than the serum indicators alone. The increase of serum PCT and CRP levels after ERCP is related to the complications after ERCP in patients with CBD stones. For patients with a high risk of complications after ERCP, the possibility of complications occurring can be evaluated by combined examination of serum PCT and CRP levels, and prevention and treatment measures can be taken as soon as possible.

Different measures of ventilatory efficiency in preoperative cardiopulmonary exercise testing are useful for predicting postoperative complications in abdominal cancer surgery.

Ventilation as a function of elimination of CO2 during incremental exercise (VE/VCO2 slope) has been shown to be a valuable predictor of complications and death after major non-cardiac surgery. VE/VCO2 slope and partial pressure of end-tidal carbon dioxide (PetCO2) are both affected by ventilation/perfusion mismatch, but research on the utility of PetCO2 for risk stratification in major abdominal surgery is limited. We aimed to determine the correlation between VE/VCO2 slope and PetCO2 measured during preoperative cardiopulmonary exercise testing (CPET) and its association with major cardiopulmonary complications (MCPCs) or death following oesophageal and other major abdominal cancer surgeries. In a retrospective cohort of 116 patients undergoing preoperative CPET 2008-2023, VE/VCO2 slope and PetCO2 (kPa) were recorded. The main outcome was MCPC during hospitalisation or death ≤90 days of surgery. We determined threshold values for each measure, corresponding to 90% specificity, using receiver operating characteristics analysis. A strong negative correlation was found between PetCO2 after a 5-minute warm-up and VE/VCO2 slope (Pearson r = -.88). In oesophagus cancer, VE/VCO2 slope >38 and PetCO2 < 4.1 kPa (30.8 mmHg) were both significant thresholds for the main outcome. For other major abdominal surgery patients, threshold analyses were non-significant. The area under the curve to predict outcome was similar using VE/VCO2 slope (0.70, 95% confidence interval 0.51-0.89) as compared to PetCO2 (0.71, 0.53-0-90). Both preoperative VE/VCO2 slope and PetCO2 could identify subjects with a very high risk of complications following oesophageal resection, with similar prognostic utility. PetCO2 can be measured with simpler equipment and could therefore be useful when CPET is not available.

Cambridge risk score, new hyperglycemia, and complications in surgical patients without diabetes

AimsOur study examined the association between the Cambridge Risk Score (CRS), new hyperglycemia (NH), and complications in patients undergoing elective surgery. MethodsIn this retrospective cross-sectional study, adult surgical patients, without diabetes, with NH (blood glucose ≥140 mg/dL) were identified, and the CRS was calculated. We used univariate regression models to evaluate the relationship between CRS and NH with 30-day readmission, length of stay (LOS), and complications. Models were stratified by surgical specialty (cardiac/vascular, general, orthopedic, neurologic). ResultsOf 10,531 patients in the study, 24 % had NH. After adjusting for covariates, the CRS was associated with increased odds of complications [OR 2.09; 95%CI:1.69, 2.59] and NH [OR 1.95; 95%CI:1.66, 2.29]. NH was associated with increased odds of 30-day readmission [β 1.60; 95%CI:1.31, 1.96], and increased LOS [β 0.64; 95%CI:0.59, 0.68]. When stratified by surgery type, the CRS was associated with increased LOS in neurosurgery, decreased LOS in orthopedics, and increased odds of complications and NH in neurosurgery and orthopedics. ConclusionThe CRS is associated with NH, complications, and LOS in patients undergoing elective neurosurgery, orthopedic surgery, and general surgery. This suggests that CRS may have potential to help identify surgical patients at high risk for NH and complications.

Using Time in Tight Glucose Range as a Health-Promoting Strategy in Preschoolers With Type 1 Diabetes.

Children who develop diabetes in their first years of life risk being exposed to many decades of hyperglycemia, hence having a high risk of early complications and premature death. An additional age-dependent risk is that dysglycemia, especially hyperglycemia, negatively affects the developing brain. In evaluating the outcome of insulin treatment at an individual and group level, cutoff thresholds for glucose values are needed. Time in tight range (TITR) was defined as a measurement of time spent in a state of normoglycemia. The International Society of Pediatric and Adolescent Diabetes recommended that for preschoolers with type 1 diabetes (T1D), either >70% of time with glucose in range 70-180 mg/dL (3.9-10 mmol/L) or >50% of time in a tighter range 70-140 mg/dL (TITR) can be used as continuous glucose monitoring targets. In Sweden, over the past two decades, pediatric diabetes teams set glycemic targets to 70-140 mg/dL (3.9-7.8 mmol/L). Swedish registry data show that >50% of children <7 years old have >50% TITR. The purpose of this review is to share and discuss international knowledge and experiences of working with TITR as a health-promoting strategy in preschoolers with T1D on a structural and individual level. We conclude that as insulin treatment improves, a reasonable goal is to strive for as much time in a state of normoglycemia as possible, and this can easily be explained to families of children with diabetes. For children with access to an experienced health care team and diabetes technologies a currently realistic target can be at least half of the time in normoglycemic range, i.e., TITR >50%.

The Neurocardiogenic Impact of Ischemic Stroke: Intricacies of Cardiac Enzymes and the Vegetative System

There is a potential lateralization of vegetative influences at the cerebral level. We sought to understand the impact of these influences in the setting of ischemic stroke. We conducted a prospective study on 110 who presented with acute ischemic stroke (symptom onset maximum 24 hours before admission). We investigated correlations between stroke subtype, insular location or lateralization, stroke severity, hospital mortality, and the dynamic of enzymes (Tn, TnT, CK, CK-MB). We demonstrated that a higher cardiac enzyme value is associated either with stroke severity or with a higher risk of death in the short term, this growth being a marker for a more severe prognosis of a large stroke rather than an independent cause of mortality. Cardiac monitoring in the acute phase of ischemic stroke can prevent cardiac morbidity and mortality, which is why it is important to identify patients at high risk of heart complications after stroke.

Paracentesis exceeding three liters increases risks of acute kidney injury even in cirrhotic patients with albumin infused refractory ascites.

Cirrhotic patients with refractory ascites exhibit severe portal hypertension and hemodynamic disturbances. The risks associated modest-volume paracentesis (<5L) for refractory ascites remains unclear. We aimed to explore the impact of modest-volume paracentesis in refractory ascites. Cirrhotic patients with refractory ascites undergoing paracentesis <5L with albumin infusion were retrospectively enrolled. Patients were categorized into two groups based on the volume of paracentesis: ≥3L and <3L. Logistic regression analyses were used to determine risk factors for post-paracentesis complications, while Kaplan-Meier analysis was used to assess 28-day survival rates. Among 116 patients, 40 (34.5%) experienced post-paracentesis complications within one week, predominantly acute kidney injury (AKI) (19.8%). Twenty patients had paracentesis ≥3L and 96 patients had <3L. Overall complications were comparable between two groups (50% vs. 31.3%, p=0.109), but ≥3L group had more AKI (40% vs. 15.6%, p=0.013). Additionally, paracentesis ≥3L is an independent risk factor for AKI [Odds ratio (OR)=4.15, p=0.012], while higher MELD scores (OR=1.14, p=0.001) and older age (OR=1.03, p=0.047) are risk factors for overall complications. Furthermore, patients with post-paracentesis complications had significantly poorer 28-day survival. Cirrhotic patients with refractory ascites face a high risk of complications from modest-volume paracentesis, even with albumin infusion. Paracentesis ≥3L increases AKI risks, while higher MELD scores are linked to greater overall complications, leading to poor short-term survival.

Safety assessment of microwave ablation in sheep vertebral bodies

Background Spine is the most common location for bone metastases. Microwave ablation (MWA) is a technique for minimally invasive tumor treatment. The aim of the current study was to determine whether MWA is a safe option for treatment in vertebral bodies and to gain data on the amount of cortical insulation in the spine. Method MWA was applied with different settings for power and time in both in- and ex-vivo sheep vertebral bodies. Safety was evaluated by temperature measurements at critical surrounding structures (e.g. spinal cord, nerve root). Furthermore, the distribution of heat through the bone at 5 mm from the ablation needle was measured and compared to the temperature at the posterior wall. Results An effect of cortical insulation in the spine was found, for ablations with 20–30 and 50 W (p < 0.01). Ablations with wattage levels of 40–50 W almost instantly led to temperatures over 60 °C at the posterior wall. The temperature remained below 60 °C for 4 min in ex-vivo ablations with 20 and 30 W. However, in the in-vivo experiment paralysis was frequently seen (10/12 sheep) in lower wattages (20–30 W) as well and the experiment was therefore terminated. Conclusion MWA is an effective approach for local bone destruction in the spine. However, given the high risk of complications, caution is advised for treatment in vertebral bodies without better local distribution accuracy. Since cortical insulation appears insufficient to protect the spinal canal from excess heat, MWA involves a risk of paralysis.

Does the Administration of Intravenous Fluid Matter in the Context of the Incidence of Postoperative Complications After Radical Cystectomy?

Introduction: Intravenous fluid management is integral to perioperative care, particularly under enhanced recovery after surgery (ERAS) protocols. In radical cystectomy (RC), which carries high risks of complications and mortality, optimizing fluid management poses a significant challenge due to the absence of definitive guidelines. Aim: the purpose of this study was to investigate the effects of intravenous fluid administration on postoperative complications in patients undergoing RC. Material and methods: This study involved 288 patients who underwent laparoscopic RC and urinary diversion from 2018 to 2022. ERAS protocols were implemented for all patients. Participants were divided into four groups based on the type of urinary diversion (ureterocutaneostomy vs. ileal conduit) and the intraoperative fluid volume input (less than 1000 mL vs. more than 1000 mL). Postoperative complications were evaluated at 30 and 90 days post-surgery using the Clavien-Dindo scale. The fluid management effectiveness was measured using the absolute Vascular Bed Filling Index (aVBFI) and the adjusted Vascular Bed Filling Index (adjVFBI). Results: The UCS is associated with a lower risk of increased severity of postoperative complications. The administration of more than 1000 mL of fluids was associated with a higher risk of complications (p = 0.035). However, after adjusting for the duration of the surgery and BMI, this association did not hold statistical significance, indicating that fluid volume alone is not a direct predictor of postoperative complications. At aVBFI values between zero and eight, urinary diversion using the UCS method is associated with a lower risk of complications compared to the IC. When aVBFI equals eight, the differences in the severity of complications between the UCS and the IC are minimal. However, when aVBFI exceeds eight, the IC is associated with fewer complications during the 30 days post-operation compared to the UCS. The correlation between the adjVFBI (B = -0.27; 95% CI: -0.45 to -0.08; p = 0.005) and the severity of complications up to 30 days postoperatively is similar to that seen with the aVBFI. Similarly, the correlation of the adjVFBI with the method of urinary diversion (B = 0.24; 95% CI: 0.06 to 0.43; p = 0.011) resembles that of the aVBFI. The volume of fluids administered and the indices aVBFI and adjVFBI did not influence the occurrence of complications 90 days postoperatively. Conclusions: The volume of fluids administered is not a factor directly affecting the occurrence of complications following RC when the ERAS protocol is used. The amount of intraoperative fluid administration should be adjusted according to the intraoperative blood loss. Our findings endorse the utility of aVBFI and adjVFBI as valuable tools in guiding fluid therapy within the framework of ERAS protocols. However, further multicenter randomized trials are needed to definitively determine the best fluid therapy regimen for patients undergoing RC.

RISK FACTORS FOR MORBIDITY AND MORTALITY IN PROXIMAL FEMORAL FRACTURES

Proximal femoral fractures (hip fractures) are a major public health concern, particularly in the elderly, due to their high morbidity and mortality rates. This retrospective descriptive study, conducted at the Mohammed V Military Teaching Hospital between January 2018 and June 2021, aimed to identify risk factors for short- and long-term morbidity and mortality in patients over 50 years of age undergoing surgery for proximal femoral fractures. A total of 125 patients were included in the study. The analysis revealed several significant risk factors for morbidity and mortality, including age over 70, anemia, preoperative renal insufficiency, and delayed treatment beyond 48 hours. Multivariate analysis indicated that treatment delay was the only statistically significant factor associated with postoperative morbidity and mortality (p=0.015). Postoperative complications were found to be associated with neurological, cardiovascular, respiratory, thromboembolic, and chronic pain, with significant relationships to anesthesia techniques, prolonged hospitalization, and pre-existing comorbidities. In-hospital mortality was 4%, with a 3-month mortality rate of 8.8% and a 1-year mortality rate of 20.8%. The study highlighted the impact of early surgical intervention, revealing that a delay in treatment by more than 48 hours was associated with a higher risk of complications and mortality. Furthermore, the study explored the influence of anesthesia techniques on patient outcomes, noting a slightly higher incidence of mortality in patients receiving general anesthesia compared to spinal anesthesia, though the difference was not statistically significant. The findings emphasize the importance of early intervention, identification of risk factors, and the need for multidisciplinary care to improve patient outcomes and reduce the burden of these fractures on healthcare systems.

Aortic root and total arch replacement for a patient with severe cerebrovascular stenosis due to Arg179His ACTA2 mutation

ACTA2 mutations are causative for familial thoracic aortic aneurysms Additionally a specific ACTA2 missense mutation Arg179His causes severe cerebrovascular disorders and may lead to a high risk of intraoperative complications

Survival analysis of early initiation of antenatal care visits and associated factors among pregnant women in Ethiopia.

Early initiation of antenatal care visits creates an opportunity for early detection of high-risk pregnancies, pregnancy complications, health education, and counseling about successful care and nutrition of the mother and the fetus. Thus, the main objective of this study was to identify the factors associated with the early initiation of antenatal care visits in Ethiopia. The study was conducted based on the children's data set of the 2019 Ethiopia mini-demographic and health survey. The study employed a retrospective cohort study design using the data downloaded from the Measure Demographic and Health Survey website. The study included a random sample of 2922 pregnant women who had complete information about their first antenatal care visits. A gamma-accelerated failure time model was employed to identify the factors associated with the early initiation of antenatal care visits in Ethiopia. In Ethiopia, 62% of the pregnant women started their first antenatal care visit early. The higher birth order of the current pregnancy (ϕ = 2.215, 95% CI: 1.8901, 2.5966), mothers being rural residents (ϕ = 1.239, 95% CI: 1.1633 1.3195), mothers aged 25-34 (ϕ = 1.692, 95% CI: 1.5588, 1.8369), and mothers aged above 34 (ϕ = 1.826, 95% CI: 1.6392, 2.0336) were associated with an accelerated time to initiation of antenatal care visits. However, mothers attained higher education (ϕ = 0.830, 95% CI: 0.7345, 0.9373) and rich wealth index (ϕ = 0.869, 95% CI: 0.8156, 0.9259) were associated with a shorter time to initiation of antenatal care visits. A higher proportion of urban and educated pregnant women initiated their antenatal care visits earlier than the other groups. We recommend that stakeholders at the federal and regional levels should focus on providing special concern for information, education, and communication regarding the importance of early antenatal care visits initiation.

Abnormal Venous Flow in Pregnant Women with Mild Right Ventricular Dysfunction in Repaired Tetralogy of Fallot: A Clinical Model for Organ Dysfunction in Preeclampsia.

Background: Pregnant women with congenital heart disease carry a high risk of complications, especially when cardiac function is suboptimal. Increasing evidence suggests that impaired right ventricular (RV) function has a negative effect on placental function, possibly through venous congestion. We report a case series of hepatic and renal venous flow patterns in pregnant women with right ventricular dysfunction after repaired Tetralogy of Fallot (ToF), relative to those observed in normal pregnancy and preeclampsia. Methods: At 20-24 weeks pregnancy, RV function was measured by echocardiography and by cardiovascular magnetic resonance in women with repaired ToF. Combined Doppler-ECG of the hepatic and renal interlobular veins were performed in three women with asymptomatic right ventricular dysfunction. Venous impedance index and pulse transit time were measured and classified as abnormal at >75th and <25th reference percentile, respectively. Results: All three women showed dilated RV and mildly impaired RV function. Both hepatic and intrarenal Doppler flow waves were abnormal and very much resembled the patterns seen in preeclampsia. One of the three women had complications including ventricular tachycardia, intrauterine growth restriction, antenatal bleeding, emergency cesarean section and acute heart failure 2 days postpartum. Conclusions: Pregnant women with mild right ventricular dysfunction after repaired ToF show abnormal venous Doppler flow waves in the liver and kidneys, similar to those observed in preeclampsia. These findings are in line with reported observations on the association between impaired RV function, abnormal return of venous blood, venous congestion and organ dysfunction. The parallel with venous Doppler flow observations in preeclampsia suggest that the venous compartment might play an important role in the etiology of preeclampsia-induced organ dysfunction. Whether this phenomenon directly affects the uteroplacental circulation is to be assessed in future research.

The short term impact of radiofrequency ablative techniques and peripheral nerve block on thermoregulation in mouse models

This study investigated the impact of multiple nerve block methods (local anesthesia, conventional radiofrequency thermocoagulation [CRF], and pulsed radiofrequency [PRF]) on thermoregulation. Focusing on hypothalamic function, the effects of local anesthesia, CRF, and PRF on central and peripheral temperatures were analyzed and compared. Our findings revealed that all three nerve block groups cause a decrease in central temperature, with the CRF group exhibiting the most pronounced effect. Furthermore, immunostaining analysis showed decreased neural activity in the preoptic area, suggesting that nerve blocks may influence central thermoregulatory mechanisms. This study provides valuable insights into the effects of peripheral nerve blocks on thermoregulation and may contribute to the development of therapeutic strategies to managing perioperative hypothermia and enhancing pain management, especially in patients undergoing surgeries with high risks of thermoregulatory complications, such as on-pump surgery and laparoscopic surgery.

Maternal Mortality in the Context of the Aging Female Population in Moscow

Background. Maternal mortality is a key indicator characterizing the status of the healthcare system and the social well-being of the population. Most of the countries, especially developing countries, still face the problem of maternal mortality. Maternal age at birth is one of the main factors affecting maternal mortality. The studies show that women under 20 and over 35 are at high risk of pregnancy and delivery complications. During the past decades, the changes in social, economic, and cultural settings have resulted in an increase of the average maternal age in many countries, including Russia.Objective. To analyze maternal mortality in the context of the aging maternal age structure using the case of Moscow.Material and methods. The research used the official data from the Federal State Statistics Service of the Russian Federation (Rosstat).Results. The study investigated the correlation between changes in the age structure of women at birth and maternal mortality dynamics. The majority of maternal deaths is observed in women aged 30–40, especially in the 30-34 age group. The study confirmed the global trend towards an increasing age of first-time mothers. The aging of maternal age structure presents challenges for healthcare. The study results could be used to develop effective measures for reducing maternal mortality in the context of the aging maternal age structure.

Multimodal Screening for Pulmonary Arterial Hypertension in Systemic Scleroderma: Current Methods and Future Directions

Systemic sclerosis (SSc) is an immuno-inflammatory rheumatic disease that can affect both the skin and internal organs through fibrosis. Pulmonary arterial hypertension (PAH) is one of the most severe secondary complications. Structural changes in the vascular bed lead to increased pressures in the pulmonary circulation, severely impacting the right heart and significantly affecting mortality. The gold standard for diagnosing PAH is right heart catheterization (RHC), an invasive method for measuring cardiac pressure. Due to the high risk of complications, procedural difficulties, and significant costs, non-invasive screening for SSc-PAH has garnered significant interest. Echocardiography is likely the most important screening tool, providing structural and functional information about the right heart through measurements that have proven their utility over time. In addition to imagistic investigations, serum biomarkers aid in identifying patients at risk for PAH and can provide prognostic information. Currently, well-known serum biomarkers (NT-proBNP, uric acid) are used in screening; however, in recent years, researchers have highlighted new biomarkers that can enhance diagnostic accuracy for SSc patients. Pulmonary involvement can also be assessed through pulmonary function tests, which, using established thresholds, can provide additional information and help select patients requiring RHC. In conclusion, given the invasiveness of RHC, non-invasive screening methods are particularly important for SSc patients.