In-hospital Period Research Articles

Left Atrioventricular Transvalvular Pressure Gradients Derived from Intraoperative and Postoperative Echocardiograms following Atrioventricular Septal Defect Repair.

Left atrioventricular valve (LAVV) stenosis following an atrioventricular septal defect (AVSD) repair is a rare but potentially life-threatening complication. While echocardiographic quantification of diastolic transvalvular pressure gradients is paramount in the evaluation of a newly corrected valve function, it is hypothesized that these measured gradients are overestimated immediately following a cardiopulmonary bypass (CPB) due to the altered hemodynamics when compared to postoperative valve assessments using awake transthoracic echocardiography (TTE) upon recovery after surgery. Out of the 72 patients screened for inclusion at a tertiary center, 39 patients undergoing an AVSD repair with both intraoperative transesophageal echocardiograms (TEE, performed immediately after a CPB) and an awake TTE (performed prior to hospital discharge) were retrospectively selected. The mean (MPGs) and peak pressure gradients (PPGs) were quantified using a Doppler echocardiography and other measures of interest were recorded (e.g., a non-invasive surrogate of the cardiac output and index (CI), left ventricular ejection fraction, blood pressures and airway pressures). The variables were analyzed using the paired Student's t-tests and Spearman's correlation coefficients. The MPGs were significantly higher in the intraoperative measurements when compared to the awake TTE (3.0 ± 1.2 vs. 2.3 ± 1.1 mmHg; p < 0.01); however, the PPGs did not significantly differ (6.6 ± 2.7 vs. 5.7 ± 2.8 mmHg; p = 0.06). Although the assessed intraoperative heart rates (HRs) were also higher (132 ± 17 vs. 114 ± 21 bpm; p < 0.001), there was no correlation found between the MPG and the HR, or any other parameter of interest, at either time-point. In a further analysis, a moderate to strong correlation was observed in the linear relationship between the CI and the MPG (r = 0.60; p < 0.001). During the in-hospital follow-up period, no patients died or required an intervention due to LAVV stenosis. The Doppler-based quantification of diastolic transvalvular LAVV mean pressure gradients using intraoperative transesophageal echocardiography seems to be prone to overestimation due to altered hemodynamics immediately after an AVSD repair. Thus, the current hemodynamic state should be taken into consideration during the intraoperative interpretation of these gradients.

Increased Serum Sodium at Acute Kidney Injury Onset Predicts In-Hospital Death.

Over the last decades, acute kidney injury (AKI) has been identified as a potentially fatal diagnosis which substantially increases in-hospital mortality in the short term and morbidity/mortality in the long term. However, reliable biomarkers for predicting AKI-associated outcomes are still missing. In this study, we assessed whether serum sodium, measured at different time points during the in-hospital treatment period, provided prognostic information in AKI. This was a retrospective, observational cohort study. AKI subjects were identified via the in-hospital AKI alert system. Serum sodium and potassium levels were documented at five pre-defined time points: hospital admission, AKI onset, minimum estimated glomerular filtration rate, minimum and maximum of the respective electrolyte during the treatment period. In-hospital death, the need for kidney replacement therapy (KRT) and recovery of kidney function were defined as endpoints. Patients who suffered in-hospital death (n = 37, 23.1%) showed significantly higher serum sodium levels at diagnosis of AKI (survivors: 145.7 ± 2.13 vs. non-survivors: 138.8 ± 0.636 mmol/L, P = 0.003). A logistic regression model was significant for serum sodium levels in patients with in-hospital death (X2, P = 0.003; odds ratio = 1.08 (1.022 - 1.141); R2 = 0.082; d = 0.089). This suggests an increase of the relative risk for in-hospital death by 8% with every unit of serum sodium increase. Patients with a sodium above the upper normal range at AKI diagnosis were also more likely to suffer in-hospital death (P = 0.001). In summary, we present evidence that serum sodium, measured at time of AKI diagnosis, potentially serves as a predictor for in-hospital death in patients with AKI.

CLINICAL, INSTRUMENTAL AND BIOCHEMICAL ASSOCIATIONS OF THE DEGREE OF PHYSICAL RECOVERY IN PATIENTS SUFFERED FROM ACUTE CORONARY SYNDROME AT THE COMPLETION OF IN-HOSPITAL REHABILITATION PERIOD.

The aim: To determine the clinical, instrumental and biochemical factors associated with the degree of physical recovery in patients suffered from acute coronary syndrome (ACS) at the completion of in-hospital rehabilitation period. Materials and methods: We enrolled 88 patients (all were males); 77 patients had ACS/STEMI and 11 with ACS/unstable angina. The mean age was (median, interquartile range) was 58 (49-64) years. We analyzed clinical, laboratory (including the circulating proprotein convertase subtilisin/kexin type 9 (PSK9) level in blood serum), transthoracic echocardiography and (urgent or delayed) coronary angiography data. Symptom-limited exercise tolerance (ET) test was performed predominantly at the second week of in-hospital stay. According to ET-test results, patients were subdivided into the groups with low (G1; 43 [48,9 %]) and high ET (G2; n=45 [51,1 %]). Results: G1 (vs. G2) was characterized by older age, lower estimated glomerular filtration rate (eGFR) and higher left atrial (LA) dimension. The cases of any left anterior descending artery (LAD) lesion were more frequent in G1 (25 % vs. 2 % in G2, respectively; p=0,004). We revealed a decrease in PSK9 level after ET-test (pre-ET vs. post-ET: 824,0 (371,0-1073,0) vs. 676,0 (441,9-995,9) ng/ml, respectively; p=0,004 [N=35]). Conclusions: At the completion of in-hospital rehabilitation period, the insufficient physical recovery in patients suffered from ACS associated with older age, lower eGFR, higher LA dimension, and more frequent any LDA lesion cases. Physical exercises favored the decrease in PCSK9 levels in blood serum.

Minimally invasive treatment of a giant pancreatic pseudocyst

The authors present minimally invasive treatment of a giant infected pancreatic pseudocyst. Throughout in-hospital period, the patient underwent endosonography-guided transgastric drainage of the pseudocyst, 7 endoscopic debridement of the cavity with sequestrectomy, laparoscopy for enzymatic peritonitis and external percutaneous drainage of the pseudocyst. Effectiveness of minimally invasive treatment was assessed considering laboratory data (CRP, white blood cell count), clinical data (hyperthermia, complaints) and follow-up ultrasound and computed tomography data (cyst dimension, sequestration). We observed with positive dynamics with decrease of intoxication syndrome, serum CRP and white blood cell count after two debridement procedures. After the seventh endoscopic debridement and sequestrectomy, granulations occurred in the cyst cavity and there was no further sequestration. At discharge, CT revealed dry residual small cavity 1.5×3 cm. There were no any complaints.

Simultaneous transfemoral endovascular procedures for aortic valve replacement (TAVI) and percutaneous coronary intervention (PCI) in old patients with aortic valve atherosclerotic stenosis (AVAS) and coronary artery disease (CAD)

Aim: To evaluate the effectiveness of simultaneous TAVI and coronary stenting in elderly and old patients with AVAS and CAD at high surgical risk. Methods: The study comprised 121 patients who underwent TAVI. They were assigned to two groups: I–patients who underwent TAVI with simultaneous coronary stenting (n = 30); II–patients with AVAS without severe stenotic changes in the coronary arteries. They underwent only TAVI (n = 91). The in-hospital period and the mid-term results have been studied. Results: The success of simultaneous TAVI and PCI was 100%. There were no intra- or perioperative deaths, acute myocardial infarction, acute brain stroke, or acute renal failure requiring dialysis. During the 6-month followup, one patient died from cancer. There were no other serious complications. The left bundle branch block occurred in 23.3% of cases and regurgitation (leakage) on the aortic valve in 6.6% of cases. Conclusion: Simultaneous TAVI and coronary stenting in elderly and old patients with severe aortic stenosis and CAD are feasible and safe. Within the first 30 days after the procedure, there were no significant differences in mortality and severe complication rates between the two groups.

Simultaneous Transfemoral Endovascular Procedures for Aortic Valve Replacement (TAVI) and Percutaneous Coronary Intervention (PCI) in Old Patients With Aortic Valve Atherosclerotic Stenosis (AVAS) and Coronary Artery Disease (CAD)

Aim: To evaluate the effectiveness of simultaneous TAVI and coronary stenting in elderly and old patients with AVAS and CAD at high surgical risk. Methods: The study comprised 121 patients who underwent TAVI. They were assigned to two groups: I – patients who underwent TAVI with simultaneous coronary stenting (n = 30); II – patients with AVAS without severe stenotic changes in the coronary arteries. They underwent only TAVI (n = 91). The in-hospital period and the mid-term results have been studied. Results: The success of simultaneous TAVI and PCI was 100%. There were no intra- or perioperative deaths, acute myocardial infarction, acute brain stroke, or acute renal failure requiring dialysis. During the 6-month follow-up, one patient died from cancer. There were no other serious complications. The left bundle branch block occurred in 23.3% of cases and regurgitation (leakage) on the aortic valve in 6.6% of cases. Conclusion: Simultaneous TAVI and coronary stenting in elderly and old patients with severe aortic stenosis and CAD are feasible and safe. Within the first 30 days after the procedure, there were no significant differences in mortality and severe complication rates between the two groups.

Preoperative lymphocyte to C-reactive protein ratio: A new prognostic indicator of post-primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.

The lymphocyte-to-C-reactive protein ratio (LCR) is a novel inflammatory biomarker for many diseases. This study aimed to examine the association between LCR and major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention. A total of 382 patients with STEMI were included in this study; these patients were enrolled from January 2014 to January 2016 at a single center, and the LCR was calculated for each patient. During the in-hospital and long-term follow-up period, MACEs included cardiovascular death, new-onset non-fatal myocardial infarction, heart failure, malignant arrhythmias, revascularization in unstable angina, and new-onset atrial fibrillation. Using receiver operating characteristic curves, we assessed the predictive impact for MACEs using a combination of six inflammatory markers in patients with STEMI and focused on LCR to elucidate its prognostic value. Univariate and multivariate Cox proportional hazard models were used to define the factors associated with MACEs. Among the assessed variables, preoperative LCR showed the highest accuracy in predicting hospitalized (AUC:0.71) and long-term follow-up(AUC:0.602) MACEs in patients with STEMI. Decreased preoperative LCR was significantly associated with the Gensini score (P<0.05) and no-reflow (P<0.05). Multivariate Cox analysis showed that a high preoperative LCR (cutoff threshold=112.4) was an independent protective factor for hospitalized MACEs in patients with STEMI (hazard ratio, 0.409; 95% confidence interval, 0.283-0.590; P<0.001). A high preoperative LCR (cutoff threshold=106.3) was an independent protective factor for long-term follow-up MACEs in patients with STEMI (hazard ratio, 0.552; 95% confidence interval, 0.369-0.740; P<0.001). Preoperative LCR is a novel and valuable prognostic marker to determine the occurrence of MACEs in hospitals and long-term follow-up after primary percutaneous coronary intervention in patients with STEMI.

214 THE IMPACT OF ARRHYTHMIA ON PROGNOSIS IN HOSPITALIZED COVID-19 PATIENTS. A CARDIAC TELEMETRIC MONITORING STUDY

Abstract Background Cardiovascular abnormalities have been largely reported in patients with COVID-19. Among these, myocardial injury and rhythm disorders represent one of the most important complications in patients affected by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Moreover, a poorer prognosis has been documented in COVID-19 patients when complicated by arrhythmias, independently by age and sex. Objectives The aims of the present study were to identify some of non-cardiac and cardiac comorbidities and some myocardial electrical features (including QT dispersion) associated with arrhythmia in hospitalized COVID-19 patients. Moreover, another objective was to contribute in analyzing the impact of arrhythmias on outcome in this setting of patients. Methods At admission, each patient underwent cardiac telemetry monitoring through entire hospitalization period. In all the subjects, laboratory analyses, standard 12-lead electrocardiogram (both at admission and on discharge), and lung imaging examination (by means of both ultrasound scans and computed tomography) were performed. Patients exhibiting arrhythmia during in-hospital period were divided into three groups: i, with brady-arrhythmias; ii, with tachy-arrhythmias; and, iii, with tachy- and brady-arrhythmias. Results Two-hundred patients completed the study (males, 123; mean age, 70.1 years); of these, 80 patients (40%) exhibited rhythm disorders on cardiac telemetry. Patients with arrhythmia resulted to be older (p&amp;lt;0.0001) than patients without arrhythmia. Moreover, patients with arrhythmia showed: i, greater number of comorbidities (p&amp;lt;0.0001); ii, higher values of creatinine (p=0.007), B-type natriuretic peptide (p&amp;lt;0.0001), troponin (p&amp;lt;0.0001), c-reactive protein (p=0.01), ferritin (p=0.001), d-dimer (p&amp;lt;0.0001), and procalcitonin (p=0.0008); iii, QT interval (p=0.002), QTc interval (p=0.04), and QTc dispersion (p=0.01); and, iiii, lower values of sodium (p=0.03), magnesium (p=0.04), glomerular filtration rate (p&amp;lt;0.0001), and hemoglobin (p=0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. Multivariate analysis showed that age (OR=1.14 [95% CI: 1.07-1.22]; p=0.0004), coronary artery disease (OR=12.7 [95% CI: 2.38-68.01]; p=0.005), and circulating troponin (OR=1.05 [95% CI: 1.003-1.10]; p=0.04) represented risk factors independently associated with arrhythmia. By analyzing all-cause in-hospital mortality, it resulted a ∼forty-fold higher among patients with arrhythmia (OR=39.66 [95% CI: 5.20-302.51]; p=0.0004) when compared to patients without rhythm disorders. Conclusion In the present study, arrhythmias have been to be associated with ageing, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and abnormalities in myocardial electrical impulse propagation in patients affected by SARS-CoV-2 infection. In alignment with previous reports, the presence of arrhythmia seems to be associated with a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetric monitoring should be encouraged in COVID wards.

A new clinical classification and reconstructive strategy for post-sternotomy surgical site infection.

Post-sternotomy surgical site infection (SSI) is a serious complication of cardiovascular surgery. Here, we proposed a new clinical classification and reconstructive strategy for this condition. A retrospective study based on medical records was performed on 100 consecutive cases requiring wound management by plastic surgeons for post-sternotomy SSI at Kobe University Hospital between January 2009 and December 2021. We classified 100 cases into four categories according to the anatomical invasiveness of the infection (type 1, superficial SSI; type 2, sternal osteomyelitis; type 3, mediastinitis; and type 4, aortic graft infection). The standard treatment plan comprised initial debridement, negative pressure wound therapy with continuous irrigation, and reconstructive surgery. Reconstructive methods and their outcomes (in-hospital mortality rate, follow-up period, and infection recurrence rate) were investigated for each SSI category. There were nine SSI cases in type 1, 28 in type 2, 25 in type 3, and 38 in type 4. The pectoralis major (PM) muscle advancement flap was mainly selected in types 1 and 2 (100 and 70.4%, respectively), while the omental flap or latissimus dorsi (LD) myocutaneous flaps were mainly selected in types 3 and 4 (77.3 and 81.8%, respectively) for reconstructive surgery. The in-hospital mortality rates for types 1, 2, 3, 4 were 44.4, 3.6, 12.0, and 15.8%, respectively. The mean follow-up periods for types 1, 2, 3, 4 were 542.8, 1514.5, 1154.5, and 831.1 days, respectively. Infection recurrence rates for types 1, 2, 3, 4 were 0, 11.5, 13.3, and 19.2%, respectively. All of these recurrent cases, except for 4 cases of type 4 that required surgical intervention, were treated with conservative wound management. A volume-rich flap (omental or LD flap) was required to fill the dead space after debridement in mediastinitis (type 3) or aortic graft infection (type 4), whereas superficial SSI (type 1) or sternal osteomyelitis (type 2) received a less-invasive flap (PM muscle advancement flap). Our new classification method was based on the anatomical invasiveness of the infection, providing both a simple and easy diagnosis and definitive treatment strategy.

Différences sexuelles dans la mortalité par accident vasculaire cérébral en Thaïlande : une étude de cohorte nationale

BackgroundOver half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients. MethodAll stroke admissions between 2004–2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders. Results608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17–1.23; 1 month: HR: 1.17; 95% CI: 1.15–1.20; 1 year: HR: 1.10; 95% CI: 1.09–1.12 and 5 years: HR: 1.02; 95% CI: 1.01–1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00–1.04; 1 month: HR: 1.08; 95% CI: 1.06–1.10; 1 year: HR: 1.04; 95% CI: 1.03–1.06 and 5 years: HR: 1.09; 95% CI: 1.08–1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03–1.06; 1 month: HR: 1.20; 95% CI: 1.14–1.27; 1 year: HR: 1.14; 95% CI: 1.09–1.18 and 5 years: HR: 1.06; 95% CI: 1.03–1.10). ConclusionsCompared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.

The predictive role of systemic inflammation response index in the prognosis of traumatic brain injury: A propensity score matching study.

We aimed to evaluate the predictive power of systemic inflammation response index (SIRI), a novel biomarker, to predict all-cause mortality in patients with traumatic brain injury (TBI) in the intensive care unit (ICU). Clinical data were retrieved from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Kaplan-Meier (KM) methods and cox proportional hazard models were performed to examine the association between SIRI and all-cause mortality. The predictive power of SIRI was evaluated compared to other leukocyte-related indexes including neutrophils, lymphocytes, monocytes and white blood cells (WBC) by the Receiver Operating Characteristic (ROC)curve for 30-day mortality. In addition, propensity score matching (PSM) was conducted to reduce confounding. A total of 350 TBI patients were enrolled overall in our study. The optimal cutoff point of SIRI was determined at 11.24 × 109/L. After 1:1 PSM, 66 matched pairs (132 patients) were generated. During the 30-day, in-hospital and 365-day follow-up periods, patients with low SIRI level were associated with improved survival (p < 0.05) compared with patients with high SIRI level. Cox regression analysis identified that higher SIRI values was an independent risk factor for all-cause mortality and results were stable on multiple subgroup analyses. Furthermore, ROC analysis indicated that the area under the curve of SIRI [0.6658 (95% Confidence Interval, 0.5630-0.7687)] was greater than that of neutrophils, monocytes, lymphocytes and WBC. The above results were also observed in the matched cohort. It was suggested that TBI patients with high SIRI level would suffer from a high risk of 30-day, in-hospital and 365-day mortality. SIRI is a promising inflammatory biomarker for predicting TBI patients' prognosis with relatively better predictive power than other single indicators related to peripheral differential leukocyte counts.

Evaluating systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST elevation myocardial infarction patients

Abstract Introduction This investigation aimed to evaluate the predictive value of systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST elevation myocardial infarction (NSTEMI). Methods In this retrospective investigation, 314 consecutive elderly patients who were diagnosed with NSTEMI in a tertiary center were included. The SII was computed as neutrophils x platelets/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes. Results Patients in the T3 group had lower chances to survive both in the in-hospital and long-term periods as compared to those in the T2 and T1 groups. The SII was independently related with in-hospital (HR: 1.001, 95% CI: 1.000–1.1003, p=0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002–1.006, p&amp;lt;0.001) according to the multivariable Cox regression models. To predict long-term mortality, the optimal value of the SII was &amp;gt;2174 with 80% sensitivity and 85.4% specificity. When the AUC values of the SII, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were assessed to predict long-term mortality, the SII had the greatest value (AUC: 0.862), followed by the NLR (AUC: 0.731) and the PLR (AUC: 0.698). Additionally, combining SII with the traditional risk factors and the Charlson Comorbidity Index revealed a significant improvement in C-statistics. Conclusion This might be the first investigation to demonstrate that the SII was independently linked with in-hospital and long-term mortality in elderly NSTEMI patients. Funding Acknowledgement Type of funding sources: None.

مستوى D-dimer كمشعر إنذاري في المرضى الذين يعانون من الهجمة الحادة للداء الرئوي الانسدادي المزمن عند الدخول إلى المستشفى

Introduction: D-dimer is a marker of thrombin and plasmin activation that has been used in the diagnostic workup of venous thromboembolism in patients with chronic obstructive pulmonary disease (COPD) admitted for acute respiratory distress. The prognostic role of elevated D-dimer levels for hospital course and in-hospital mortality in patients with AECOPD in whom deep venous thrombosis/ pulmonary embolism is excluded has rarely been evaluated. Aim: This study was designed to investigate the effect of D-dimer obtained upon admission on in-hospital mortality, the need for intensive care unit ICU admission, and the need for mechanical ventilation after acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Materials and Methods: 125 participants were investigated at admission for an acute exacerbation of COPD, The age of them was between 40 and ≥70. This was an observational analytical prospective study conducted at Pulmonology Department in Tishreen University Hospital, Lattakia, Syria, during the period between June 2020 and June 2021. Clinical and laboratory data were evaluated in 108 patients (77 males,31 females) admitted for AECOPD in whom D-dimer levels were obtained upon admission and in whom (17 patients) Deep vein thrombosis/Pulmonary embolism DVT/ PE was excluded. Results: 28 (25.9%) patients needed ICU admission, 22 (20.3%) patients needed mechanical ventilation, and 19 (17.6%) patients died in the in-hospital period. D-dimer ≥ 0.5 mg/l was a risk factor for ICU admission (Relative Risk: RR 5, 95%CI: Confidence interval 1.97-12.6), for mechanical ventilation (RR 5.77, 95%CI 2.1 – 15.7), and in-hospital mortality (Relative Risk: RR 6.76, 95%CI 2.32 – 19.6). The mean age of patients with elevated D-dimer was significantly higher than patients with normal D-dimer (69.2 ± 10 VS 64 ± 12 years, P=0.037). D-dimer levels were higher in patients with renal dysfunction and congestive heart failure. A significant correlation was found between D-dimer level with hemoglobin, creatinine, and C – reactive protein (CRP). Conclusion: Elevated D-dimer is a reliable prognostic marker for short-term outcomes in patients admitted for AECOPD.

Prophylactic and Therapeutic Fasciotomy for Acute Compartment Syndrome after Revascularization for Acute Lower Limb Ischemia—Renal and Wound Outcomes

Acute Compartment Syndrome (ACS) is a significant complication after revascularization for acute lower limb ischemia (ALI). High risk patients sometimes undergo prophylactic fasciotomy (PF) to prevent ACS. Patients that develop ACS undergo therapeutic fasciotomy (TF). The optimal timing of fasciotomy has been debated. The aim of this study was to describe and compare renal and wound outcomes in patients undergoing PF and TF. A retrospective cohort study including 76 patients undergoing PF (n=40) or TF (n=36) after revascularization for ALI between 2006 and 2018. Estimated glomerular filtration rate (e-GFR) was used to evaluate renal function and compare within (paired-samples t-test) and between (analysis of variance) groups. Wound complications and healing time were compiled from the complete wound healing period and compared between groups with Pearson's chi-squared-and log-rank test, respectively. E-GFR improved over the in-hospital period with 8.2ml/min/1.73m2 (95% confidence interval [CI] 2.4-14.1, P=0.007) in the PF group and 4.4ml/min/1.73m2 (95% CI 1.2-7.7, P=0.010) in the TF group, with no significant difference between the 2 groups (0.3ml/min/1.73m2, 95% CI -6.7 to 7.4, P=0.93). The wound infection rate was higher after TF (PF=60.6 % and TF=82.4 %, P=0.048), whereas rate of other wound complications (PF=61.3 % and TF=35.3%, P=0.036) was higher after PF. Overall wound complications were high, whereas renal function improved during in-hospital stay. A more conservative approach to fasciotomy could avoid unnecessary fasciotomies and reduce wound complications, while holding the potential to sufficiently preserve renal function if fasciotomy is needed for ACS. This would be possible and safe if an early diagnosis and treatment of ACS can be ensured.

Conditional cumulative incidence of postoperative complications stratified by complexity classification for laparoscopic liver resection: Optimization of in-hospital observation

BackgroundThe optimal in-hospital observation periods associated with minimal risks of complications and unplanned readmission after laparoscopic liver resection are unknown. The purpose of this study was to assess changes in the risks of postoperative complications over time. MethodsSurgical complexity of laparoscopic liver resection was stratified into grades I (low complexity), II (intermediate), and III (high) using our 3-level complexity classification. The cumulative incidence rate and conditional probability of postoperative complication and risk factors for complication Clavien-Dindo grade ≥II (defined as treatment-requiring complications) were assessed. ResultsThe cumulative incidence of treatment-requiring complications was higher in patients undergoing grade III resection than in patients undergoing grade I resection (32.3% vs 10.4%, P < .001) and grade II resection (32.3% vs 20.7%, P = .019). The conditional probability of postoperative complication stratified by our complexity classification decreased over time and was <10% for patients undergoing grade I resection on postoperative day 1, grade II resection on postoperative day 4, and grade III resection on postoperative day 10. ConclusionThe conditional cumulative incidence of treatment-requiring complications for patients undergoing laparoscopic liver resection is well stratified based on the 3-level complexity classification. Conditional complication risk analysis stratified by the 3 complexity grades may be useful for optimizing in-hospital observation after laparoscopic liver resection.

Early Carotid Endarterectomy for Symptomatic Internal Carotid Artery Stenosis in the Acute Ischemic Stroke

Objective: To research the results of the microsurgical treatment of symptomatic internal carotid artery stenosis by Carotid Endarterectomy in the acute period of a stroke that were performed in the Neurosurgery Department of IMSP IMU. Materials and Methods: A retrospective data collection was conducted on all consecutive patients surgically treated for an extra-cranial internal carotid artery (ICA) hemodynamic stenosis in the Neurosurgery Department of the Emergency Medicine Institute,in Chisinau (Rebublic of Moldova),between February 2019 and March 2021.All patients undergoing ICA endarterectomy for symptomatic carotid stenosis (SCS) within 48 hours and 14 days after the acute neurologic onset were included in the present study.Outcomes were evaluated by a prospective follow-up. Primary outcomes were the rate of postoperative ipsilateral stroke, myocardial infarction (MI), peripheral nerve injury, hematoma in the operating area and death.Secondary outcomes were the rate of local and systemic complications.The results were stratified according NIHSS score and comorbidities 30 days after surgery,and a multivariate analysis were performed in order to define any correlation between preoperative data and postoperative outcomes. Results: A total of 40 patients (10 %, n 4 bilateral and 90%, n 36 unilateral) underwent carotid endarterectomy (CEA) for hemodynamically significant ICA stenosis. According to inclusion criteria (22% women vs 78% men; median age 64 years, range: 54-76; median preoperative NIHSS score 4, range 0-18) all patients affected by SCS were enrolled in the present study. Median delay for surgery was 6 days (range: 2-14).During in-hospital post-operative period the combined death/stroke/MI rate was 0%.In-hospital NIHSS score improved post-operatively of more than 2 points (range 0-12) in 45.7% of cases.Microsurgical CEA is accompanied,in most cases by the regression of neurological symptoms and it is not correlated with the increased risk for a hemorrhagic transformation.No local and systemic complications were registered.The stratification of outcomes according to NIHSS status, sex, comorbidities did not show any statistical relation neither at 30 days nor at the long term-follow up. Conclusion: In properly selected patients with a SCS, affected by an acute ischemic stroke, early carotid endarterectomy can be performed without any complications or worsening of neurological status in comparison with similar cases in a longer period after a stroke.

Thrombosis in unvaccinated and Gam-COVID-Vac-vaccinated patients with COVID-19

Aim. To analyze the incidence of thrombotic events in unvaccinated and GamCOVID-Vac-vaccinated patients with coronavirus disease 2019 (COVID-19).Material and methods. This prospective study included 316 patients (group 1) vaccinated with two doses of Sputnik V (Gam-COVID-Vac) hospitalized between November 20, 2020 and June 1, 2021 for COVID-19. Group 2 included 754 unvaccinated patients with a positive polymerase chain reaction test for SARSCoV-2.Results. During inhospital period, deaths were recorded only in unvaccinated patients (group 1 — 0%; group 2 — 10,7% (n=87); p&lt;0,0001). Among unvaccinated patients, the following thrombotic events were more common: upper- extremity deep vein thrombosis (group 1 — 0,63% (n=2); group 2 — 5,4% (n=41); p=0,0003), lower-extremity deep vein thrombosis (group 1 — 2,21% (n=7); group 2 — 11,4% (n=86); p&lt;0,0001), pulmonary embolism (PE) (group 1 — 0%; group 2 — 3,4% (n=26); p=0,0008), lower limb arterial thrombosis followed by thrombectomy (group 1 — 0,31% (n=1); group 2 — 12% (n=91); p &lt;0,0001), lower limb arterial retrombosis after retrombectomy (group 1 — 0,31% (n=1); group 2 — 8,7% (n=66); p&lt;0,0001), lower limb amputation (group 1 — 0%; group 2 — 8,7% (n=66); p&lt;0,0001), composite endpoint (group 1 — 3,8% (n=12); group 2 — 55,2% (n=416); p&lt;0,0001). In the long-term follow-up period (125,5±26,5 days), recurrent COVID-19 developed significantly more often in unvaccinated patients (group 1 — 0,63% (n=2); group 2 — 3,6% (n=24); p=0,007). All arterial and venous thromboses, limb amputations were diagnosed only among unvaccinated patients.Conclusion. Vaccination with Sputnik V (Gam-COVID-Vak) prevents the severe COVID-19 with the development of deaths, pulmonary embolism, venous and arterial thrombosis.

Systematic review and meta-analysis of serum amyloid a prognostic value in patients with COVID-19

INTRODUCTION: This study was designed to assess the levels of human serum amyloid A (SAA) among COVID-19 patients. MATERIAL AND METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A comprehensive literature search was performed (PubMed, Web of Science, Scopus, and Cochrane network), and studies comparing SSA levels in: (A) with non-severe vs severe COVID-19; (B) severe vs critical COVID-19 condition; (C) survived vs died due to COVID-19 in-hospital treatment period — were included. Random-effects meta-analyses were performed to obtain pooled estimates. RESULTS: Thirty studies met the criteria and were included in the meta-analysis. Pooled analysis showed that SAA levels were statistically significantly lover in non-severe group 58.7 ± 53.9 mg/L compared to 154.5 ± 169.6 mg/L for patients with severe condition (MD = –120.29; 95% CI: –135.35 to –105.22; p &lt; 0.001). SAA levels among patients with critical condition were 89.5 ± 90.4 mg/L compared to 195.3 ± 206.2 mg/L (MD = –56.66; 95% CI: –101.81 to –11.51; p = 0.01). SAA levels in patient who survived were 108.7 ± 157.3 mg/L, and 206.8 ± 58.8 mg/L for patients who not survived (MD = –85.04; 95% CI: –145.78 to –24.29; p = 0.006). CONCLUSIONS: In conclusion, this updated meta-analysis suggests that SAA concentrations are positively correlated with the severity of the COVID-19. Therefore, SAA can be considered a biomarker for predicting the severity and prognosis of COVID-19. Measurement of this parameter might assist clinicians in monitoring and evaluating the severity and prognosis of COVID-19.

Optimal Indicator of Death for Using Real-World Cancer Patients' Data From the Healthcare System.

Background: Information on patient’s death is a major outcome of health-related research, but it is not always available in claim-based databases. Herein, we suggested the operational definition of death as an optimal indicator of real death and aim to examine its validity and application in patients with cancer. Materials and methods: Data of newly diagnosed patients with cancer between 2006 and 2015 from the Korean National Health Insurance Service—National Sample Cohort data were used. Death indicators were operationally defined as follows: 1) in-hospital death (the result of treatment or disease diagnosis code from claims data), or 2) case wherein there are no claims within 365 days of the last claim. We estimated true-positive rates (TPR) and false-positive rates (FPR) for real death and operational definition of death in patients with high-, middle-, and low-mortality cancers. Kaplan−Meier survival curves and log-rank tests were conducted to determine whether real death and operational definition of death rates were consistent. Results: A total of 40,970 patients with cancer were recruited for this study. Among them, 12,604 patients were officially reported as dead. These patients were stratified into high- (lung, liver, and pancreatic), middle- (stomach, skin, and kidney), and low- (thyroid) mortality groups consisting of 6,626 (death: 4,287), 7,282 (1,858), and 6,316 (93) patients, respectively. The TPR was 97.08% and the FPR was 0.98% in the high mortality group. In the case of the middle and low mortality groups, the TPR (FPR) was 95.86% (1.77%) and 97.85% (0.58%), respectively. The overall TPR and FPR were 96.68 and 1.27%. There was no significant difference between the real and operational definition of death in the log-rank test for all types of cancers except for thyroid cancer. Conclusion: Defining deaths operationally using in-hospital death data and periods after the last claim is a robust alternative to identifying mortality in patients with cancer. This optimal indicator of death will promote research using claim-based data lacking death information.

Clinical outcomes in patients with infrapopliteal arterial occlusive disease treated by lower extremity bypass surgery: a comparison of atherosclerosis and thromboangiitis obliterans.

Surgical bypasses are commonly utilized for the treatment of infrapopliteal arterial occlusive disease resulting from atherosclerosis (ASO) and thromboangiitis obliterans (TAO), especially when endovascular procedures fail. The aim of this study is to compare the in-hospital and follow-up outcomes of ASO and TAO patients treated with infrapopliteal bypass surgery. A total of 32 infrapopliteal bypasses were analyzed in 18 TAO patients and 14 ASO patients. Preoperative and postoperative arterial Doppler ultrasonography was performed in all patients. The ankle-brachial index (ABI) was calculated preoperatively and postoperatively in all cases. All patients were followed-up for at least one year and clinical outcomes were recorded. Within 1-7 days postoperatively, 4 grafts in TAO patients occluded; nevertheless, 1 graft occlusion occurred in ASO patients. Patency rates at in-hospital were 77.8% and 92.9% in TAO and ASO patients, respectively. In 27 patients with successful infrapopliteal bypass, ABIs and crural peak arterial flow velocities significantly increased at 1-7 days postoperatively. During the period of follow-up, 6 graft occlusions occurred in TAO patients, and one ASO patient died of myocardial infarction. Patency rates at follow-up were 44.5% and 85.7% in TAO and ASO patients. For TAO patients with graft failure, ABIs at follow-up did not statistically differ from those postoperatively; however, they were significantly higher than those preoperatively. Infrapopliteal bypass surgery is a feasible and effective procedure for ASO and TAO patients. Patency rates are lower in TAO than those in ASO during the in-hospital and follow-up period. However, TAO patients had the ischemic symptom relief and the improvement in ABI despite graft occlusion one year postoperatively.