Invasive Treatment Group Research Articles

Abstract 4143258: Sex Differences in Health Status Outcomes: Analysis of the ISCHEMIA Randomized Clinical Trial

Background: Despite a lesser extent and severity of coronary artery disease (CAD), women had a higher burden of angina than men in the ISCHEMIA trial, suggesting that other factors may explain symptom severity in women. We aim to describe demographic and clinical characteristics, as well as differences in care patterns, associated with health status differences in women, as compared with men, in the conservative and invasive treatment groups of the ISCHEMIA trial. Methods: The ISCHEMIA trial randomized participants with moderate or severe ischemia to a routine invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with catheterization reserved for GDMT failure. Health status was a key secondary outcome. Using linear regression models we compared raw and adjusted Seattle Angina Questionnaire (SAQ) scores in women and men at baseline and at 1 year, stratified by randomized treatment strategy. Within the invasive strategy, sex differences were adjusted for completeness of revascularization among those with ≥1 coronary stenosis ≥70%. Results: Of 4,617 ISCHEMIA participants with valid SAQ data, women had lower (worse) baseline SAQ summary scores (SS) throughout follow up (Figure) after adjustment for demographics and clinical characteristics, including severity of CAD (difference 5.4 points, 95% CI 4.0-6.7). Women had lower SAQ SS after adjustment for post-randomization treatment (i.e., medical therapy, achievement of risk factor goals and, in the invasive strategy, complete revascularization), 2.4 points lower (95% CI 0.7-4.1) in the conservative group (Figure), and 1.9 points lower than in men (95% CI 0.1-3.7) in the invasive group. Findings were similar for all SAQ subscales. Conclusions: Women with chronic coronary disease in ISCHEMIA had worse health status than men at baseline and 1 year later, which was not explained by demographic or clinical characteristics, intensity of medical therapy, or completeness of revascularization.

Computerized tomography features acting as predictors for invasive therapy in the management of Crohn's disease-related spontaneous intra-abdominal abscess: experience from long-term follow-up.

Decision-making in the management of Crohn's disease (CD)-related spontaneous intra-abdominal abscess (IAA) is challenging. This study aims to reveal predictive factors for percutaneous drainage and/or surgery in the treatment of CD-related spontaneous IAA through long-term follow-up. Data were collected, including clinical manifestations, radiography and treatment strategies, in Chinese patients with CD-related IAA in a tertiary medical center. Univariate and Multivariate Cox analysis were conducted to identify predictors for invasive therapy. Altogether, 48 CD patients were identified as having IAA through enhanced CT scans. The median follow-up time was 45.0 (23.3, 58.0) months. 23 (47.9%) patients underwent conservative medical treatment, and 25 (52.1%) patients underwent percutaneous drainage and/or surgical intervention (invasive treatment group). The 1-, 2-, and 5-year overall survival rates without invasive treatment were 75.0%, 56.1%, and 46.1%, respectively. On univariate Cox analysis, the computerized tomography (CT) features including nonperienteric abscess (HR: 4.22, 95% CI: 1.81-9.86, p = 0.001), max abscess diameter (HR: 1.01, 95% CI: 1.00-1.02, p<0.001) and width of sinus (HR: 1.27, 95% CI: 1.10-1.46, p = 0.001) were significantly associated with invasive treatment. Nonperienteric abscess was significantly associated with invasive treatment on multivariate Cox analysis (HR: 3.11, 95% CI: 1.25-7.71, p = 0.015). A score model was built by width of sinus, location of abscess and max abscess diameter to predict invasive treatment. The AUC of ROC, sensitivity and specificity were 0.892, 80.0% and 90.9% respectively. More than half of CD-related IAA patients needed invasive therapy within 5-year follow-up. The CT features including nonperienteric abscess, larger maximum abscess diameter and width of sinus suggested a more aggressive approach to invasive treatment.

Factors affecting in-hospital clinical outcomes in patients with acute limb ischemia undergoing endovascular therapy or fogarty thrombectomy: a large-scale analysis based on the JROAD-DPC database

Abstract Background The etiology of acute limb ischemia (ALI) involves embolism as well as atherosclerotic thrombosis. Although endovascular therapy (EVT) or Fogarty thrombectomy (Fogarty TE) is the recommended revascularization method for ALI, treatment choice based on patient characteristics remains controversial. Purpose This study aimed to evaluate the differences in clinical outcomes between primary treatments and identify predictive factors affecting clinical outcomes in patients with ALI. Methods This retrospective study used data from the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database, from April 2012 to March 2020. We analyzed 18,701 patients with ALI and categorized them into medication and invasive treatment groups (EVT alone, Fogarty TE alone, bypass surgery alone, and hybrid treatment). The EVT-alone and Fogarty TE-alone groups were compared after propensity score matching, considering 19 clinically relevant covariates. The primary outcomes were in-hospital mortality, major amputation, and bleeding complications (anemia requiring transfusion or endoscopic hemostasis). The secondary outcomes were major adverse cardiovascular events (myocardial infarction, coronary intervention, heart failure, stroke, and cerebral hemorrhage), major amputation and/or death, hospitalization duration, and total cost during hospitalization. Results The EVT-alone group had more patients at a higher risk of atherosclerotic disease, including peripheral artery disease (PAD), chronic kidney disease (CKD), or hemodialysis. The Fogarty TE-alone group had more patients at a higher risk of embolism, including AF or AFL. After propensity score matching, in-hospital mortality (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.29–1.92, p&amp;lt;.0001), bleeding complications (OR: 1.28, 95% CI: 1.12–1.46, p=0.0002), and major amputation rates (OR: 1.44, 95% CI: 1.17–1.76, p=0.0004) were significantly higher in the EVT-alone group than in the Fogarty TE-alone group. Major amputation and/or death rates and total hospitalization costs were higher in the EVT-alone group than in the Fogarty TE-alone group. In interaction analyses, EVT demonstrated a favorable trend of lower risks of death and/or major amputation in patients with PAD, CKD, and diabetes mellitus (all risk factors for atherosclerotic disease), especially in those with PAD and CKD. Conclusions Fogarty TE may be the preferred primary treatment for patients with ALI, particularly those without PAD or CKD.Study flowchartForest plot analyzing interaction effect

Particularities of the course and treatment of non-ST elevation acute myocardial infarction: data from the REGION-IM registry

Aim. To characterize patients with acute non-ST elevation myocardial infarction (NSTEMI) hospitalized in Russian hospitals, study their anamnestic, demographic and clinical characteristics, treatment features and hospital outcomes, as well as compare data from previous Russian and foreign registries of acute coronary syndrome.Material and methods. Russian Registry of Acute Myocardial Infarction (REGION-IM) is a multicenter prospective observational study. The case report form contains demographic and anamnestic data, as well as the following information about the present MI: timing of symptom onset, first contact with medical personnel and admission to the hospital; data from coronary angiography (CAG) and percutaneous coronary intervention (PCI), therapy, hospitalization outcomes.Results. In total, for the period from November 1, 2020 to June 30, 2023, the study included 3253 patients with STEMI from 73 hospitals (30 vascular surgery departments, 17 of which are equipped with angiographic system, and 43 regional vascular surgery centers) from 45 constituent entities of the Russian Federation. There were 55% of high-risk patients. CAG was performed in 83,73% of patients. In 81%, CAG was performed ≤24 hours from hospitalization. PCI was performed in 62% of patients with NSTEMI. Median onset-to-balloon time was 27 hours [10;77]. The median door-to-balloon time was 5 hours [1;20]. Inhospital mortality was 3%. In the group with CAG, compared with the group without CAG, inhospital mortality was lower (2% and 6%, respectively; p&lt;0,05). In patients with a higher risk according to the GRACE, CRUSADE and ARC-HBR scales, CAG was performed less frequently.Conclusion. In patients with NSTEMI in Russian regions, there is a high frequency of CAG and PCI, including in the early stages. Inhospital mortality is low, especially in the invasive treatment group, and corresponds to data from international registries. In severely ill patients, revascularization is performed less frequently than in low-risk patients. There is room for increasing the prescription rate of modern effective anticoagulants and antiplatelet agents. In general, the quality of treatment for NSTEMI patients has improved in recent years.

Assessment of Dental Fear and Anxiety in Children Undergoing Nitrous Oxide-Oxygen Inhalation Sedation visiting BPKIHS

Introduction: Dental treatment of children is the most needed service that remains neglected because of a lack of skill to manage dental fear and anxiety (DFA). Both the non-pharmacological and pharmacological behavior management continuum should be followed to treat children. Objective: To assess and compare DFA levels in children before and after dental treatment using nitrous oxide-oxygen inhalation sedation (NOIS), to assess and compare the change in behavior in children undergoing NOIS, and to compare the level of DFA in children undergoing invasive and non-invasive dental treatment. Methods: DFA was measured using the Children's Fear Survey Schedule Dental Subscale (CFSS-DS), Modified Child Dental Anxiety Scale (MCDAS), and Facial Image Scale (FIS) before and after the dental treatment under NOIS. The change in children’s behavior during invasive and noninvasive treatment under NOIS was assessed by Frankl Behavior Rating Scale (FBRS). Results: A significant reduction in DFA was seen within each cohort as measured by 3 scales: CFSS-DS, MCDAS, and FIS (P≤0.001). There was also a positive change in behavior of children during the time of dental treatment under NOIS as measured by FBRS. However, there was no significant difference between invasive and non-invasive treatment groups with regard to DFA. Conclusions: Minimal sedation provided by NOIS significantly reduced DFA in children, and there was a positive change in their behavior during the time of treatment. NOIS was effective in decreasing DFA in both invasive and non-invasive dental treatment.

Analysis of outcomes in patients with ST-segment elevation myocardial infarction aged 90 years and older: a single center experience

Aim. To evaluate the effectiveness and safety of an invasive approach in patients with ST-segment elevation myocardial infarction (STEMI) aged 90 years and older.Material and methods. This retrospective single-center study was conducted at the V. P. Polyakov Samara Regional Clinical Cardiology Dispensary. In 20132020, 104 patients aged 90 years and older were hospitalized with a diagnosis of STEMI. The mean age of patients was 91,7 years (90-100), while the proportion of women was 67,3%. Patients included in the analysis were divided into groups of conservative treatment (n=81, mean age, 91,9 (90-100) years, women 70,4%) and invasive management (coronary angiography + percutaneous coronary intervention (PCI)) (n=23, mean age, 91,0 (90-94) years, women, 56,5%).Results. The groups were comparable in basic characteristics. In-hospital mortality in the conservative strategy group was 48,1% vs 17,4% in the invasive management group (p=0,009; odds ratio (OR) 3,35; 95% confidence interval (CI) 1,23-9,15). During the first year after discharge, 25,9% (n=21) died in the conservative strategy group and 30,4% (n=7) in the invasive strategy group (p=0,79; OR 0,85; 95% CI 0,42-1,75). In total (during the hospitalization period and within 1 year after discharge), 60 people (74,1%) died in the conservative strategy group, while in the invasive treatment group — 11 (47,8%) (p=0,02; OR 3,11; 95% CI 1,19-8,11). Life expectancy in patients with STEMI aged 90 years and older after discharge from hospital was 83,95 days for the conservative strategy group and 103,85 days for the invasive strategy group (p=0,67).Conclusion. The data obtained in our study support primary PCI as a treatment strategy for patients with STEMI aged 90 years and older.

Renal artery stenosis: a single center experience

Objectives: Renal artery stenosis (RAS) is among the most common causes of secondary hypertension. Prevalence of RAS are seen in end-stage renal disease (ESRD) patients with hypertension between 1-10%. In our study, we evaluated the data of patients with RAS who were followed up with medical treatment and stenting. Methods: In our study, patients who were thought to have renal artery stenosis (RAS) with renal artery doppler ultrasonography were scanned with contrast-enhanced Magnetic Resonance Angiography (MRA). Fifty-three patients (10 received medical therapy, 43 applied invasive procedure) who diagnosed with RAS evaluated. Results: Follow-up times were 15 (12-84) months in patients who received medical therapy, and 12 (10-96) months in patients who treated with invasive therapy (p = 0.583). Median ages were 56 (19-74) years in medical treatment group, and 60 (15-77) years in invasive therapy group (p = 0.955). Compared with the beginning of treatment, diastolic hypertension was decreased of 12.5% in invasive treatment group opposite medical therapy group (p = 0.040), so eGFR was increased of 5.94% in invasive treatment group. Conclusions: In recent years, several studies about survival in patients with RAS was observed that there was no significant difference between the medical and invasive treatment. Clinical, laboratory, and individual characteristics should be considered in treatment choice.

Trends of travel burdens to access cancer care among children with cancer: analysis of a population-based cancer registry data in Aichi, Japan.

Centralization of childhood cancer treatment in specialized hospitals is necessary for quality treatment and care, but imposes a time and cost burden for patients and their families. We investigated the 20-year trend in the patients' car travel burden to reach cancer-care hospitals in Aichi Prefecture, Japan. From the Aichi population-based cancer registry data, 1,741 cases diagnosed in 1998-2017 under 15 years of age were extracted and assigned to three treatment groups: invasive treatment (n = 697), radiotherapy (n = 371), or chemotherapy groups (n = 1,462), allowing for duplicate assignment. Their travels to access each treatment hospital were estimated and summarized as the estimated travel times (ETT), estimated travel distances (ETD), and direct distances (DD). The ETTs were compared using the Brunner-Munzel test. The average cases per year for each hospital were plotted. The annual trends during 1998-2017 on ETT, ETD, and DD were investigated using Joinpoint regression models. The ETTs were 0.38-0.45 hours on median for three periods (1998-2005, 2006-2012, and 2013-2017) in three treatment groups and increased by 0.02-0.07 hours from 2006-2012 to 2013-2017, with a statistically significant difference in the radiotherapy group (0.07 hours, P = 0.037). The average cases per year increased for the top hospital in each group, and regression model analyses showed no joinpoint on the annual median trend. In conclusion, the increases in travel times were small and not considered clinically significant, and treatment centralization was observed from 2006-2012 to 2013-2017.

The triglyceride-glucose index as a potential protective factor for hypertrophic obstructive cardiomyopathy without diabetes: evidence from a two-center study

ObjectiveThis study aimed to investigate the relationship between the TyG (Triglyceride-glucose index) and the prognosis of patients with HOCM (hypertrophic obstructive cardiomyopathy) without diabetes.Research design and methodsA total of 713 eligible patients with HOCM were enrolled in this study and divided into two groups based on treatment: an invasive treatment group (n = 461) and a non-invasive treatment group (n = 252). The patients in both two groups were then divided into three groups based on their TyG index levels. The primary endpoints of this study were Cardiogenic death during long-term follow-up. Kaplan–Meier analysis was used to study the cumulative survival of different groups. Restricted cubic spline was used to model nonlinear relationships between the TyG index and primary endpoints. Myocardial perfusion imaging/Myocardial metabolic imaging examinations were performed to assess glucose metabolism in the ventricular septum of the HOCM patients.ResultsThe follow-up time of this study was 41.47 ± 17.63 months. The results showed that patients with higher TyG index levels had better clinical outcomes (HR, 0.215; 95% CI 0.051,0.902; P = 0.036, invasive treatment group; HR, 0.179; 95% CI 0.063,0.508; P = 0.001, non-invasive treatment group). Further analysis showed that glucose metabolism in the ventricular septum was enhanced in HOCM patients.ConclusionsThe findings of this study suggest that the TyG index may serve as a potential protective factor for patients with HOCM without diabetes. The enhanced glucose metabolism in the ventricular septum of HOCM patients may provide a potential explanation for the relationship between the TyG index and HOCM prognosis.

Change in treatment preferences in pediatric diaphyseal forearm fractures: a Danish nationwide register study of 36,244 fractures between 1997 and 2016.

The choice between invasive and non-invasive treatment of diaphyseal forearm fractures in children can be difficult. We investigated the trends in choice of treatment of pediatric diaphyseal forearm fractures over a 20-year period. Patients and methods: This is a population-based register study with data from 1997 to 2016 retrieved from the Danish National Patient Registry. The primary outcome was choice of primary treatment within 1 week divided into non-invasive treatment (casting only or closed reduction including casting) and invasive (Kirshner wires, intramedullary nailing [IMN], and open reduction internal fixation [ORIF]). The secondary outcomes were further sub-analyses on invasive treatment and age groups. 36,244 diaphyseal forearm fractures were investigated, yielding a mean incidence of 172 per 105/year. The proportion of fractures treated invasively increased from 1997 to 2016, from 4% to 23%. The use of Kirschner wires increased from 1% to 9%, IMN increased from 1% to 14%, and ORIF decreased from 2% to 1%. The changes were evident in all age groups but smaller in the 0-3-year age group. We found an increase in invasive treatment of pediatric diaphyseal forearm fractures over the investigated period. A change in invasive methods was also found, as the rate of IMN increased over the investigated period and became the predominant surgical treatment choice.

Long-Term Outcomes of Exercise Therapy Versus Revascularization in Patients With Intermittent Claudication.

The aim was to analyze the risk of progression to chronic limb-threatening ischemia (CLTI), amputation and subsequent interventions after revascularization versus noninvasive therapy in patients with intermittent claudication (IC). Conflicting evidence exists regarding adverse limb outcomes after each treatment strategy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. MEDLINE, Web of Science, and Google Scholar were searched aided by a health sciences librarian through August 16, 2022. Randomized control trials (RCTs) comparing invasive (endovascular or surgical revascularization) and noninvasive treatment (exercise and/or medical treatment) were included. PROSPERO registration was completed (CRD42022352831). A total of 9 RCTs comprising 1477 patients (invasive, 765 patients; noninvasive, 712 patients) were eligible. During a mean of 3.6-year follow-up, progression to CLTI after invasive [5 (2-8) per 1000 person-years] and noninvasive treatment [6 (3-10) per 1000 person-years] were not statistically different [rate ratio (RR): 0.77; 95% CI, 0.35-1.69; P =0.51, I2 =0%]. Incidence of amputation (RR: 1.69; 95% CI, 0.54-5.26; P =0.36, I2 =0%) and all-cause mortality (hazard ratio: 1.26; 95% CI, 0.91-1.74; P =0.16, I2 =0%) also did not differ between the groups. However, the invasive treatment group underwent significantly more revascularizations (RR: 4.15; 95% CI, 2.80-6.16; P <0.00001, I2 =83%). The results were not changed by fixed effect or random-effects models, nor by sensitivity analysis. Although there is equivalent risk of progression to CLTI, major amputation and all-cause mortality compared with noninvasive treatment, invasive treatment for patients with IC led to significantly more revascularization procedures and should be used selectively in patients with major lifestyle limitation. Guideline recommendation of noninvasive treatment for first-line IC therapy is supported.

Current treatment strategies for primary upper extremity deep venous thrombosis; a retrospective observational multicenter case series.

Current treatment strategies for primary upper extremity deep venous thrombosis (pUEDVT) range from conservative treatment with anticoagulation therapy to invasive treatment with thoracic outlet decompression surgery (TOD), frequently combined with catheter directed thrombolysis, percutaneous transluminal angioplasty, or stenting. Due to a lack of large prospective series with uniform data collection or a randomized trial, the optimal treatment strategy is still under debate. We conducted a multicenter observational study to assess the efficacy and safety of both the conservative and invasive treatment strategies for patients with pUEDVT. We retrospectively collected data from patients treated in five vascular referral and teaching hospitals in the Netherlands between 2008 and 2019. Patients were divided into a conservative (Group 1), an invasive treatment group (Group 2) and a cross-over group (Group 3) of patients who received surgical treatment after initial conservative therapy. Follow-up consisted of outpatient clinic visits and an electronic survey. Primary outcome was symptom free survival defined as absence of any symptom of the affected arm reported at last follow-up regardless of severity, or extent of functional disability. Secondary outcomes were incidence of bleeding complications, recurrent venous thromboembolism, surgical complications, and reinterventions. A total of 115 patients were included (group 1 (N = 45), group 2 (N = 53) or group 3 (N = 27). The symptom free survival was 35.6%, 54.7% and 48.1% after a median follow-up of 36, 26 and 22 months in groups 1, 2 and 3 respectively. Incidence of bleeding complications was 8.6%, 3.8% and 18.5% and recurrent thrombosis occurred in 15.6%, 13.2% and 14.8% in groups 1-3 respectively. In this multicenter retrospective observational cohort analysis the conservative and direct invasive treatments for pUEDVT were deemed safe with low percentages of bleeding complications. Symptom free survival was highest in the direct surgical treatment group but still modest in all subgroups. Perioperative complications were infrequent with no related long term morbidity. Of relevance, pUEDVT patients with confirmed VTOS and recurrent symptoms after conservative treatment may still benefit from TOD surgery. However, symptom free survival of this delayed TOD seems lower than direct surgical treatment and bleeding complications seem to occur more frequently.

Invasive versus Conservative Treatment Approach among Older Adult Patients Admitted with Acute ST-Segment Elevation Myocardial Infarction.

Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy for patients with ST-elevation myocardial infarction (STEMI); however, its efficacy remains unclear in very older adult patients with STEMI. This retrospective single-center observational study included 530 patients aged &gt;75 years admitted to Tel Aviv Sourasky Medical Center with a diagnosis of acute STEMI. Primary PCI was performed for patients with symptoms ≤12 hours in duration, while the other patients were conservatively treated. We evaluated 30-day mortality and complications occurring during hospitalization based on data from patient records. Among the study patients, only 28/530 (5%) were conservatively treated. In-hospital complications, including the use of inotropes or intra-aortic balloon counterpulsation and the need for mechanical ventilation, did not differ significantly between the groups. The only parameter that showed a trend toward significance was the incidence of heart failure during hospitalization (p=0.042). The risk for 30-day mortality was substantially higher in the conservative treatment group than in the invasive treatment group (27% vs. 10%; p = 0.02). Our data suggested that despite concerns regarding the safety of the primary PCI strategy in the older adult STEMI population, this treatment strategy was associated with a survival benefit.

Identifying patients with complicated diverticulitis, is it that complicated?

Discriminating simple from complicated diverticulitis solely on clinical bases is challenging. The aim of this study was to identify clinical predictive factor for the need for invasive treatment for patients presenting with acute diverticulitis in the emergency room. The records of all patients, who were discharged from a university hospital between January 2010 and March 2018 with "diverticulitis" diagnosis, were reviewed. Data collected included clinical features, whether this was a first or recurrent episode, WBC, and Hinchey score. Patients were divided into conservative and invasive treatment groups. Groups were compared by age, sex, BMI, fever, WBC and CT findings. Hinchey score groups were also compared by age, sex, BMI, fever, WBC. A total of 809 patients were included. Mean age was 60.6 years, with 10% below 40 years. Most patients were treated conservatively (95.9%) while only 4.1% were treated invasively. WBC at presentation was significantly higher in those who required invasive treatment in comparison with the conservative group (13.72 vs. 11.46K/uL, p= 0.024). A statistically significant higher WBC was found among patients with a higher Hinchey score (13.16 vs 11.69, p <0.005). No difference between the groups was found in terms of age, sex, fever or BMI. This study showed that patients who present with acute diverticulitis and an elevated WBC are prone to a more severe disease and a higher Hinchey score. Prudence should be taken with these patients, and CT scan is warranted as there is a greater chance that invasive treatment will be required.

Usefulness of inflammatory markers in detecting esophagojejunostomy leakage

Introduction and aimTotal gastrectomy is utilized in different pathologies. Esophagojejunostomy leakage is a frequent complication. Our aim was to determine the association of the neutrophil-lymphocyte ratio (NLR) with esophagojejunostomy leakage that subsequently required invasive treatment. Materials and methodsA retrospective study included patients that underwent esophagojejunostomy within the time frame of 2002-2017. Patients were grouped into those with or without anastomotic leakage that had conservative treatment (group A) and those with anastomotic leakage that had invasive treatment (group B). ROC curves and the Youden index were used for the optimum cutoff values of the NLR. ResultsFifty-seven patients were included. Thirty-two (56.14%) were men, and mean patient age was 61.8 ± 13.4 years. Forty-five patients were assigned to group A and 12 to group B. Mean NLR was higher for group B on postoperative day 3 (group A 9.5 ± 7.5 vs. group B 13.9 ± 4.9) (p = 0.05). Mean total leukocytes was higher in group B on postoperative day 5 (group A 7.8 ± 3.4 × 103/mcl vs. group B 10.3 ± 4.4 × 103/mcl) (p = 0.03). NLR and total leukocyte accuracy on postoperative day 3 was calculated with ROC curves, at 0.78 and 0.63, respectively. For the NLR and leukocyte count, sensitivity was 91.7% and 58%, specificity was 64.4% and 60%, positive predictive value was 40% and 28%, and negative predictive value was 96% and 84%, respectively. ConclusionsPostoperatively, the NLR identified the total gastrectomy with esophagojejunostomy patients that subsequently required an invasive procedure secondary to esophagojejunostomy leakage.

The Evaluation Characteristics of Type B Aortic Intramural Hematoma and Ten Years Treatment Outcomes

Background: Type B aortic intramural hematoma (IMH-B) is recognized as a subset of aortic dissection. The evolution of uncomplicated IMH-B is very difficult to predict. How and when to deal with this disease is unclear. The present study constructed two models to explore this problem. One is the morphology evolution model, which explored the risk factors and predictors for the IMH-B patients. Another is the predictive model confirmed the predictors and the time for invasive treatment of uncomplicated IMH-B patients. Objective: To explore the evolution predictors and detect the time for invasive treatment of uncomplicated IMH-B patients. Methods: Themorphology evolution model demonstrated that all 81 patients were diagnosis with CTA images. The initial and follow-up data were retrospectively studied. The evolution data were collection and measurement from initial and follow-up CTA images data. The predictive model showed that predictors of progression were detected with cox regression analysis. Results: All 81IMH-B patients were followed-up ranged from 1.2 to 36 months (median, 22 months). 26 patients accepted invasive treatment (24 underwent TEVAR and 2 underwent Surgery). 55 patients received medical treatment. Invasive treatment (IT) group overall events are 1/26 (3.8%); medical treatment (MT) group overall events are 33/55 (60.0%); IT group vs. MT group: p . Moreover, we found that most events related aorta occurred within 30 days. Multivariate Cox regression analysis MDAD (hazard ratio, 3.58; 95% CI, 1.25- 5.78; p - 7.84; p - 5.63; p Conclusions: MDAD > 45 mm, MDAHT > 10 mm, and IMH with PAU may be the important predictors for uncomplicated IMH-B patients. Most adverse aorta related events occurred within 30 days. It would be careful follow-up, closely observe for these patients within 30 days, and take necessary treatment strategies in time.

Comparison between open reduction and internal fixation and minimally invasive surgery in management of Sanders type II calcaneal fracture: A randomized controlled trial protocol.

Background:The minimally invasive surgery possesses an essential and growing function in treating the calcaneal fractures, but the related literature on this topic is limited. For our study, the main purpose was to compare the early prognosis of a group of the patients with Sanders type II fracture of calcaneus treated via minimally invasive surgery and open reduction and internal fixation (ORIF).Methods:This is a prospective randomized controlled trial in the patients who suffer from displaced intra-articular calcaneal fractures. This current study was carried out in accordance with the guidelines of “CONSORT statement” for the randomized controlled studies. All patients were randomly assigned into 2 groups on the basis of a random number table, namely the minimally invasive treatment group and the ORIF group using conventional methods. Inclusion criteria included the followings: aged between 18 to 59 years old; closed and unilateral fracture; patients with displaced intra-articular calcaneal fracture (>2 mm) involving Sanders Type IIC and Type IIB; and patients have enough mental capacity to understand and answer questions in the evaluation scale. In the process of outpatient follow-up, the radiographs were taken at 1, 3, 6, and 12 months. The functional results involved the American Orthopaedic Foot and Ankle Score, Foot Function Index, and the pain score.Conclusions:This protocol will give us research directions in future work.Trial registration:This study protocol was registered in Research Registry (researchregistry6261).

Retrospective Comparison of Complications with Open versus Minimally Invasive Achilles Tendon Repair

Category:Sports; OtherIntroduction/Purpose:Despite the relatively high frequency of Achilles ruptures, there is no clear consensus on the optimal treatment method. The debate has traditionally been framed by the tension between the risk for rerupture seen with nonoperative treatment and the risk for wound issues seen with operative treatment. Studies have demonstrated conflicting results when comparing complications associated with each treatment. The current study analyzed complications of patients with Achilles tendon ruptures that received either minimally invasive repair or open standard repair by a single surgeon.Methods:We conducted a retrospective chart review of patients that had Achilles tendon repair performed by the senior author between July 1st 2011 and January 22nd 2020. The senior author’s preferred operative technique transitioned from an open standard procedure to a minimally invasive procedure within this time frame, and patients were divided accordingly. Patient demographics, medical history, social history, surgical details, and additional surgeries were recorded. Patient outcomes and any complications were also recorded. Complications included any wound related issues or infection, erythema, DVT, wound breakdown, drainage, equinus contracture, and calcaneus stress reaction. Pain, swelling and/or tenderness were not considered complications. Independent sample t-tests and chi-square analyses were conducted to assess for differences in patient demographics and operative outcomes between the minimally invasive and open procedure treatment groups.Results:Of the 127 included patients, 75.6% were male with an average age of 41.85 (+-14.02). 30 (23.6%) patients had the minimally invasive approach, while 97 (76.4%) had the open approach. 82.7% were non-smokers, and the average BMI was 31.47(+-29.84). A majority of injuries (63.8%) occurred while playing sports. There were 10 complications, all of which were wound-related and all of which were in the open group (p=0.06). There were no revision surgeries in the minimally invasive group, and 10 in the open group (p=0.06). There were no recorded reruptures in either group.Conclusion:This study sought to determine the complication profile of two operative treatments for Achilles tendon ruptures, open standard and minimally invasive repair. Recent literature has suggested that minimally invasive repair results in superior outcomes to open repair. Our study found that both repeat surgery and complications trended towards a higher rate following open repair compared to minimally invasive repair, although the difference was not statistically significant (p=0.06). It is notable, however, that there were fewer total patients in the minimally invasive group and that there was not a single wound complication in the minimally invasive group.

Utilidad de marcadores de inflamación para detectar fugas de anastomosis esofagoyeyunal

Total gastrectomy is utilized in different pathologies. Esophagojejunostomy leakage is a frequent complication. Our aim was to determine the association of the neutrophil-lymphocyte ratio (NLR) with esophagojejunostomy leakage that subsequently required invasive treatment. A retrospective study included patients that underwent esophagojejunostomy within the time frame of 2002-2017. Patients were grouped into those with or without anastomotic leakage that had conservative treatment (Group A) and those with anastomotic leakage that had invasive treatment (Group B). ROC curves and the Youden index were used for the optimum cutoff values of the NLR. Fifty-seven patients were included. Thirty-two (56.14%) were men, and mean patient age was 61.8±13.4 years. Forty-five patients were assigned to Group A and 12 to Group B. Mean NLR was higher for group B on postoperative day 3 (Group A 9.5±7.5 vs. Group B 13.9±4.9) (P=.05). Mean total leukocytes was higher in Group B on postoperative day 5 (Group A 7.8±3.4×103/μl vs. Group B 10.3±4.4×103/μl) (P=.03). NLR and total leukocyte accuracy on postoperative day 3 was calculated with ROC curves, at 0.78 and 0.63, respectively. For the NLR and leukocyte count, sensitivity was 91.7 and 58%, specificity was 64.4 and 60%, positive predictive value was 40 and 28%, and negative predictive value was 96 and 84%, respectively. Postoperatively, the NLR identified the total gastrectomy with esophagojejunostomy patients that subsequently required an invasive procedure secondary to esophagojejunostomy leakage.

Percutaneous coronary intervention in the very elderly with NSTE-ACS: the randomized 80+ study

Objective: The treatment strategy in the very elderly with NSTE-ACS is debated, as they are often under-represented in clinical trials. The aim of this multicenter randomized controlled trial was to compare invasive and conservative strategies in the very elderly with NSTE-ACS.Methods: We randomly assigned patients ≥ 80 years of age with NSTE-ACS to an invasive strategy with coronary angiography and optimal medical treatment or a conservative strategy with only optimal medical treatment. The primary outcome was the combined endpoint of major adverse cardiac and cerebrovascular events (MACCE). Sample size was powered for a 50% reduction of event rate in MACCE with an invasive strategy. We used intention-to-treat analysis.Results: Altogether, 186 patients were included between 2009 and 2017. The study was terminated prematurely due to slow enrollment. At 12-month follow-up, the primary outcome occurred in 31 (33.3%) of the invasive treatment group and 34 (36.6%) of the conservative treatment group, with a hazard ratio (HR) of 0.90 (95% CI 0.55‒1.46; p = 0.66) for the invasive group relative to the conservative group. The corresponding HR value for urgent revascularization was 0.29 (95% CI 0.10‒0.85; p = 0.02), 0.56 (95% CI 0.27‒1.18; p = 0.13) for myocardial infarction, 0.70 (95% CI 0.31‒1.58; p = 0.40) for all-cause mortality, 1.35 (95% CI 0.23‒7.98; p = 0.74) for stroke, and 1.62 (95% CI 0.67‒3.90; p = 0.28) for recurrent hospitalization for cardiac reasons.Conclusion: In the very elderly with NSTE-ACS, we did not find any significant difference in MACCE between invasive and conservative treatment groups at 12-month follow-up, possibly due to small sample size. ClinicalTrials.gov: NCT02126202