Invasive Treatment For Patients Research Articles

Comparison between Invasive Intervention and Conservative Treatment in Patients with In-Hospital Myocardial Infarctions: Results from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA) Study.

Background/Objectives: In-hospital myocardial infarctions (AMIs) are less often treated with invasive intervention, compared to out-of-hospital AMIs. We aimed to identify the determinants of invasive intervention in patients with in-hospital AMIs and assess its association with mortality, compared to conservative treatment. Methods: This was a cross-sectional study of in-hospital AMIs in The Regional Myocardial Infarction Registry of Saxony-Anhalt. Patients' characteristics and outcomes were compared based on the treatment strategy (invasive intervention vs. conservative treatment). Logistic regression was performed to assess the determinants of invasive intervention (vs. conservative treatment) and its association with 30-day mortality. Results: Nearly 67% of the patients (259/386) received invasive intervention, and the rest were treated conservatively. Those who were treated with an invasive intervention were younger and had a lower proportion of chronic heart failure than those treated conservatively. Age > 75 years compared to younger patients, pre-existing heart failure, and higher heart rate upon presentation were associated with lower odds of receiving invasive intervention. Hypertension (OR = 2.86, 95% CI [1.45-5.62]) and STEMI vs. NSTEMI (1.96, [1.10-3.68]) were associated with higher odds of invasive intervention. The adjusted odds of 30-day mortality were lower with invasive intervention compared to conservative treatment (0.25, [0.10-0.67]). Conclusions: One-third of the patients with in-hospital AMIs received conservative treatment. Younger age, absence of heart failure, lower heart rate, hypertension, and STEMI were determinants of invasive intervention usage. Invasive intervention had lower odds of 30-day mortality, but longitudinal studies are still needed to assess the efficacy of conservative vs. invasive strategies in in-hospital AMIs.

Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies.

Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the technical efficacy of three minimally invasive techniques (cryoablation, electroporation, and microwave ablation) and their impact on quality of life in patients with prostate cancer. Studies between January 2020 and July 2023 were selected using PubMed, Embase, and The Cochrane Library and analyzed following PRISMA guidelines; they have not been registered. Twenty-three studies investigating three different sources of energy to deliver focal therapy were found. Thirteen studies evaluated the performance of the cryoablation therapy, seven studies of the irreversible electroporation, and three studies of microwave ablation option. The majority of studies were retrospective cohort studies. Cryoablation showed excellent oncological outcomes for low-grade prostate cancer, whether performed on the lesion, on the hemigland, or on the entire gland, with the best results obtained for patients with intermediate risk. Irreversible electroporation showed promising oncological outcomes with no significant changes in functional outcomes. Microwave ablation showed great early functional outcomes. The oncological effectiveness of minimally invasive treatment in comparison to standard of care is still under investigation, despite encouraging results in terms of functional outcomes improvement and adverse events reduction. More comprehensive research is needed to fully understand the function of minimally invasive treatment in patients with localized PCa.

Predicting the risk of in-hospital Asian NSTEMI patients using stacked ensemble learning

Abstract Background NSTEMI affects 60–75% of patients with MI and has a variety of clinical manifestations and prognoses. Ensemble learning (EL) utilizes the machine learning (ML) models on a classification task to make more accurate predictions than any single ML model. It has also been demonstrated to be superior to conventional risk scores in predicting mortality risk. However, no studies on the application of EL to ASIAN NSTEMI patients have been published. Purpose To identify factors associated with Asian in-hospital NSTEMI patients using ML and to develop a stacking EL-based NSTEMI risk score that is specifically tailored to the Asian population. Methods From 2006 to 2016, 10464 data were collected from the Malaysian National Cardiovascular Disease Database (NCVD-ACS) registry on hospitalized multiethnic Asian patients admitted with NSTEMI. This study utilized 39 variables, including demographic, cardiovascular risk, medication, and clinical variables. For stacked EL model development, four algorithms, Support Vector Machine (SVM), Random Forest (RF), eXtreme Gradient Boosting (XGB), and Naive Bayes (NB), are used as base learners, and Generalized Linear Model (GLM) is used as the meta learner. Significant variables were chosen and ranked using ML variable importance with backward elimination. As a predictive performance metric, the area under the curve (AUC) was used. Using a validation dataset, algorithms were validated against the TIMI for NSTEMI, and the net reclassification index (NRI) was calculated. Results The stacked EL models developed using SVM feature selection (13 predictors, AUC = 0.823, CI: 0.779 - 0.867) outperforms the conventional risk score, TIMI (AUC = 0.563, CI: 0.515 - 0.610). RF contributes the most to the EL model predictions, followed by NB, XGB and SVM (Figure 1). Common predictors between SVM feature selection and TIMI are; age, hypertension and ECG-type depression. SVM feature selection also identified gender, MI history, chronic lung disease, heart rate, systolic blood pressure, Killip class, fasting blood glucose, LMWH, beta-blockers and angiotensin II receptor blocker as predictors that improve mortality prediction in ASIAN NSTEMI patients. Our findings indicate that the TIMI score underestimates the mortality risk of NSTEMI patients. Stacked EL model using selected predictors classified 47.4% of nonsurvivors as high risk (risk probabilities > 50%), whereas TIMI (score > 5) classified only 3.3% of nonsurvivors as high risk (Figure 2). The NRI of NSTEMI patients using the EL model (SVM selected var) resulted in an NRI of 79.8% with a p-value < 0.00001 when compared to the TIMI for NSTEMI risk score. Conclusions The stacked EL algorithm classifies ASIAN NSTEMI patients more accurately than the single ML model and TIMI score. A precise prognosis is useful for selecting the appropriate level of care and pharmacological or invasive treatment for patients with Asian NSTEMI.Relative influence of each ML modelsStacked EL performance on validation set

Efficacy of Continuous-Wave Transscleral Cyclophotocoagulation Post-Pars Plana Vitrectomy in Glaucoma Patients: A Retrospective Study from Poland.

BACKGROUND Glaucoma, a vision-threatening condition, results from optic nerve damage and affects millions of people worldwide. Often asymptomatic, it is hereditary, with risk factors like hypertension, diabetes, and steroid use. Despite its link with intraocular pressure (IOP), not everyone with high IOP develops glaucoma. After pars plana vitrectomy (PPV), patients face increased IOP risks. Traditional treatment includes pharmacotherapy, and, when ineffective, surgical interventions. Continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) is an alternative for refractory glaucoma but can have complications. Our study compares the efficacy and safety of CW-TSCPC after PPV. MATERIAL AND METHODS The study group consisted of 18 patients diagnosed with glaucoma who underwent the CW-TSCP procedure as the first-choice therapy after conservative treatment of glaucoma proved ineffective. The comparison group consisted of 12 patients who underwent the CW-TSCP procedure after conservative drug treatment and in whom surgical treatment of glaucoma had been unsuccessful. All patients had inadequate control of IOP after PPV. RESULTS Study and comparison group patients showed a decrease in IOP during the follow-up, independent of the type of endotamponade used (P<0.05). When the indication for PPV was retinal detachment hemorrhage into the vitreous chamber, a significant decrease in IOP between 0 days and 180 days was only found in the study group (P<0.05). In contrast, when the indication for PPV was the state after uveitis or proliferative diabetic retinopathy, a significant decrease in IOP was found at 180 days in the study and comparison groups (P<0.05). CONCLUSIONS The analysis showed that the CW-TSCPC procedure can be recommended as the first-choice invasive treatment in patients with increased IOP after PPV.

Short-Term Outcomes Following Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry

BackgroundTranscatheter edge-to-edge repair (TEER) is a less invasive treatment for patients with mitral regurgitation (MR). Limited safety and efficacy data of TEER with MitraClip, including the fourth-generation (G4) system, in a large cohort, are available. ObjectivesThis study aimed to summarize the initial experience of the TEER system in patients with MR from a large registry in Japan. MethodsThe OCEAN (Optimized CathEter vAlvular iNtervention)-Mitral Registry is an ongoing, prospective, investigator-initiated, multicenter, observational registry for patients with primary and secondary MR undergoing transcatheter mitral valve therapies. A total of 21 centers participated in the registry. Patients undergoing TEER were enrolled, and their characteristics, procedural details, and clinical outcomes were recorded. ResultsIn total, 2,150 patients including 1,605 patients (75.0%) with secondary MR, were enrolled between April 2018 and June 2021. The median age was 80 years, and 43.7% were women. The median device and fluoroscopy times were 60 and 26 minutes, respectively. Those with the G4 system (618/2,150 [28.7%]) were significantly shorter than those with the second generation (G2) system (1,532/2,150 [71.3%]). Overall, 94.6% met acute procedural success without significant differences between the 2 systems (G2 94.7% vs G4 94.6%; P = 0.961). ConclusionsThe OCEAN-Mitral registry has demonstrated the short-term outcomes of TEER systems, including the G4 system, in symptomatic patients with primary and secondary MR. The acute procedural success rate in the G2 system was excellent, and that in the G4 system was expected to improve with the multidisciplinary heart valve team approach. (Japanese Registry study of valvular heart diseases treatment and prognosis; UMIN000023653)

Comparative analysis of unilateral and bilateral flexible ureterorenoscopy: a cohort multicentre study

Introduction. Flexible ureteroscopy (fURS) with laser lithotripsy is the «gold standard» for minimally invasive treatment in patients with kidney stones less than 20 mm. Currently, there are no objective data on the efficacy and safety of bilateral interventions.Objective. To study the results of bilateral flexible URS (B-fURS) versus unilateral flexible URS (U-fURS).Materials &amp; methods. Eighty patients prospectively enrolled in the study from July 2022 to December 2022 and was divided into 2 groups. Group 1 (n = 40) underwent U-fURS and Group 2 (n = 40) underwent B-fURS. A single stone up to 20 mm or multiple small calyx stones was an indication for the operation. The baseline values were comparable between the groups, but in the B-fURS group a 39.0% higher incidence (p &gt; 0.002) of multiple stones and a 28.0% higher incidence (p &gt; 0.001) of stones in the lower pole. Previous interventions were also more frequent in Group 1 (B-fURS) patients.Results. Stone-free rate did not differ (p &gt; 0.9) between the groups and was 95.0% and 97.5%, respectively. No serious complications (p &gt; 0.9) of Clavien III–V were observed in both groups.Conclusion. Bilateral flexible ureteroscopy is a safe and effective option for patients with bilateral kidney stones, allowing removal of stones in one anesthesia on both sides.

A.5 Neurovascular complications of veno-venous extracorporeal membrane oxygenation in critically ill COVID-19 patients

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an invasive intervention for patients with respiratory failure associated with COVID-19. This meta-analysis aims to determine the incidence of neurovascular complications in COVID-19 patients requiring VV-ECMO. Methods: Systematic literature search of MEDLINE, Embase, PsycINFO, and Cochrane databases was performed to identify studies that reported neurovascular complications of adult COVID-19 patients on VV-ECMO for respiratory failure. Case series and reports were excluded. Studies with 95% or more of its patients on VV-ECMO were pooled for meta-analysis. Results: Eighteen studies (n=1968) were included for meta-analyses. In COVID-19 patients requiring VV-ECMO, the incidences of intracranial hemorrhage and ischemic stroke were 11% [95% CI, 8–15%] and 2% [95% CI, 1–3%], respectively. Intraparenchymal and subarachnoid hemorrhages accounted for 73% and 8% of all intracranial hemorrhages, respectively. The risk ratio of mortality in COVID-19 patients with neurovascular complications on VV-ECMO compared to patients without neurovascular complications was 2.24 [95% CI, 1.46–3.46]. Conclusions: COVID-19 patients requiring VV-ECMO have a higher incidence of intracranial hemorrhage compared to historical data in non-COVID-19 patients (11% vs. 8%), while the incidence of ischemic stroke is similar (2%) in both cohorts. COVID-19 patients with neurovascular complications on VV-ECMO are at an increased risk of death.

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.

Prognostic significance of small vessel coronary artery disease in patients with acute coronary syndromes treated with percutaneous coronary interventions.

Small vessel disease (SVD) usually refers to atherosclerosis within vessels of diameter of < 2.5 mm. Conflicting data exist regarding the outcomes of its revascularization. To evaluate the outcome of invasive treatment in patients with acute coronary syndromes (ACS) and SVD and the predictors of angina recurrence after percutaneous coronary intervention (PCI). This was an observational, retrospective, single-center study. It covered consecutive 127 patients (26.77% women; median age: 69.74 ±8.97 years) with ACS who underwent PCI in the Upper-Silesian Medical Center in Katowice between 2018 and 2020. The study population was stratified by means of presence of SVD defined by PCI of the culprit artery with a diameter of ≤ 2.5 mm. The major adverse cardiac and cerebrovascular events (MACCE) and angina recurrence were analyzed in a 12-month follow-up period. Overall 99 (77.95%) patients were diagnosed with small-vessel coronary artery disease. MACCE were documented in 14 (11.02%) patients. Univariate analysis revealed the following factors associated with MACCE: left ventricle ejection fraction (LVEF) (OR = 0.95, p = 0.0212), left main (LM) stenting (OR = 18.17, p = 0.0216), number of former PCIs (OR = 1.48, p = 0.0235). According to logistic regression analysis the factors were LM stenting (OR = 20.04, p = 0.0216) and number of former PCIs (OR = 1.53, p = 0.0203). Patients with SVD had more often refractory or recurrent angina in symptomatic class III/IV on follow-up (52.53% vs. 10.71%, p < 0.001). Outcome of invasive treatment in patients with ACS is related to LM stenting and former PCIs but not to SVD occurrence. Patients with SVD have a high rate of recurrent/refractory angina despite successful PCI in this clinical setting.

The Safety and Long-Term Efficacy of Carotid Artery Stenting: An All-Comers Registry.

Background Carotid artery stenting (CAS) has emerged as a less invasive alternative to carotid endarterectomy (CEA) for the prevention of future cerebrovascular events in patients with carotid artery stenosis. Despite multiple randomized controlled trials (RCTs) comparing CAS and CEA for carotid disease, real-world data outside the rigorous environment of trials is scarce. Methods The present study is a prospectiveobservational study conducted at a tertiary care center, wherein all patients who underwent CAS between January 2007 and December 2019 were included. All patients were followed up for one year of the last enrolled patient at an interval of one, six, and 12 months and then yearly thereafter. The primary composite outcome was defined as a combination of periprocedural (until 30 days of procedure) major adverse cardiac and cerebrovascular events (MACCEs) and the long-term incidence of ipsilateralstroke. The secondary outcome included the rate of restenosis. Results A total of 115 patients (86 males and 29females) (147 lesions) who underwent CAS between 2007 and 2019 were followed up for a median of 80.5 months. Seventy-seven (67.27%) patients were symptomatic, and 38/115 (33%) were asymptomatic. PeriproceduralMACCEs were noted in six patients, and four patients had ipsilateral stroke on long-term follow-up; hence, the primary composite outcome was observed in 10 (8.7%) patients. Higher age was found to be significantly associated with the primary composite outcome (p-value = 0.005). Five (4.34%) patients were lost to follow-up, while four (3.48%) patients developed restenosis. Conclusion CAS is a safe and less invasive intervention in patients with significant carotid artery stenosis and is equally effective in preventing future strokes. The incidence of primary outcome rises with an increase in age.

Effectiveness of ultrasound-guided fascia hydrorelease on the coracohumeral ligament in patients with global limitation of the shoulder range of motion: a pilot study

We conducted a prospective single-arm interventional study of the treatment efficacy of ultrasound-guided fascia hydrorelease (US-FHR) on the coracohumeral ligament (CHL) of patients with global limitation of shoulder range of motion (ROM) without local inflammation. The primary outcome was the change in passive ROM (pROM) of external rotation (ER) after first US-FHR. Secondary outcomes included the change in pROM of other directions from baseline, the pain visual analogue scale (pVAS) at the timepoints after each procedure (first, second US-FHR and rehabilitation) as well as the change in the Shoulder Pain and Disability Index (SPADI) from the first to the second visit. Eleven patients underwent US-FHR. The pROM of ER after the 1st US-FHR changed by a median of 7.1° (p < 0.01). There was a statistically significant improvement in the pROM of flexion, extension, abduction, external rotation, and internal rotation from baseline to each timepoints. The pVAS at rest showed no significant improvement, although the pVAS at maximal ER showed a trend towards improvement. The SPADI score decreased by a median of 13.4 (p < 0.01). No adverse events were observed. US-FHR on the CHL with or without rehabilitation might be an effective, less invasive treatment for patients with global limitation of shoulder ROM.

Invasive treatment of patients with atrial fibrillation and high risk of bleeding

Invasive treatment of patients with atrial fibrillation and high risk of bleeding

Functional luminal imaging probe in the evaluation of esophago-gastric junction outflow obstruction.

Esophagogastric junction outflow obstruction (EGJOO) comprises a heterogeneous group of conditions that demonstrate impaired deglutitive relaxation of the esophagogastric junction (EGJ) with intact esophageal peristalsis on high-resolution manometry. Functional luminal imaging probe (FLIP) panometry is a powerful tool that can help to clarify the etiology of this manometric diagnosis. The aim of this review is to summarize the use of FLIP for the evaluation and management of EGJOO. FLIP panometry provides measures of esophageal compliance at the EGJ and information on esophageal body contractile responses to balloon distention that have important implications for the management of patients with EGJOO. After excluding anatomic causes of impaired EGJ distensibility, FLIP panometry is useful in differentiating true lower esophageal sphincter dysfunction from manometric artifact. FLIP panometry has been shown to be useful in determining the need for invasive treatment in patients with EGJOO, and in intraoperative tailoring of myotomy procedures. FLIP panometry is easy to perform during endoscopy and provides useful information for characterizing the EGJOO population. FLIP panometry can be used to guide treatment and improve outcomes in the management of patients with EGJOO.

Importance of Aberrant Right Subclavian Artery Detection During Second Trimester Ultrasound Examination in Low-Risk Population

OBJECTIVE: Aberrant right subclavian artery, which is detected in 1-1.5% of the population, is considered an anatomical variant. Aberrant right subclavian artery is usually not symptomatic, but can sometimes lead to dysphagia due to esophageal compression. On the other hand, it has been found that it has accompanied some fetal anomalies in the last two decades. Although aberrant right subclavian artery is seen at a rate of 1-1.5% in normal chromosomal fetuses, it is seen at a rate of 19-36%, especially in fetuses with Down syndrome. STUDY DESIGN: Our study was carried out in the Department of Obstetrics and Gynaecology at Ankara University Faculty of Medicine between the dates of January 2017-January 2020. Pregnant women have had their detailed ultrasonography at our clinic and who were between 18th-24th gestational weeks were included. Amniocentesis was performed on the patients who have accepted, and genetic results were followed up. The patients who did not accept were followed up until after birth, and genetic testing was requested for babies suggestive of anomaly. RESULTS: Our study included 6205 patients who underwent detailed ultrasonography in our clinic between January 2017 and June 2020. Our detailed ultrasonography application week was between 16-24 weeks. During this period, aberrant right subclavian artery was detected in 47 of our patients. The detection rate of ARSA in the normal population in our study was 0.7% (46/6205). While aberrant right subclavian artery was the only ultrasonographic finding in 28 patients, extra anomalies were observed in 18 patients. Down syndrome was detected in four fetuses, CONCLUSION: We did not find any chromosomal anomalies in any of the patients with isolated aberrant right subclavian artery. Therefore, we do not recommend invasive intervention in patients with isolated aberrant right subclavian artery. On the other hand, our study confirmed that aberrant right subclavian artery screening should be a part of a detailed fetal ultrasonographic examination. Further studies with larger patient groups are needed.

Ruta Graveolens in Homeopathic Dilution Has In Vitro Antitumor Activity in Osteosarcoma Cells (U2OS) and Low Effect on Canine Mesenchymal Stem Cells (CTM)

Ruta graveolens belongs to the family Rutaceae, and it is used to treat inflammatory diseases and some cases of cancer due to its anti-inflammatory and analgesic properties. Osteosarcoma (OS) is a bone cancer that mainly affects children and adolescents and has a high index in dogs. The treatment of this cancer consists of high doses of chemotherapy, and resection of the area affected by cancer, thus making it a painful and invasive treatment for patients. Under this perspective, it is necessary to search for new forms of treatment that are less invasive and, at the same time, effective, considering that homeopathy is used as a complementary therapy and benefits the patient's quality of life. This study aimed to compare the in vitro action of the homeopathic medicine Ruta D35 on U2OS osteosarcoma cells and canine mesenchymal stem cells (MSC). Our results demonstrate that Ruta D35 has a toxic effect on U2OS cells (IC50 16.38µL/mL), reducing cell viability compared to MSC (IC50 67.38µL/mL). Therefore, Ruta D35 showed positive results in treating the OS U2OS line, demonstrating a potential activity in treating this cancer.

Clinical presentation and therapeutic outcome of patients with jackhammer esophagus—a multicenter cohort study in Japan

BackgroundJackhammer esophagus (JE) is a hypercontractile esophageal motility disorder diagnosed using high-resolution manometry (HRM). We sought to determine the clinical presentation and therapeutic data of patients with JE in Japan.MethodsThe study included patients with JE, diagnosed through HRM performed for suspicious esophageal motility disorders. Demographics, esophagogastroduodenoscopy, radiology, and therapy data were collected from patient charts.ResultsAmong the 4,412 HRM tests performed, 89 patients (61.6 ± 13.4 years; 64 males, 25 females) were diagnosed with JE (2.0%). Dysphagia was the most frequent symptom (80%), followed by chest pain (40%) and heartburn (25%). Esophagogastroduodenoscopy showed abnormal findings in 32% of patients: corkscrew/rosary beads appearance in 26%, narrowing in 11%. Eosinophilic infiltration (> 15 eosinophils/high power field) was diagnosed in 21%. Esophagography showed abnormal findings in 9% of the patients. For the initial therapy, 47 patients received medical treatment followed by peroral endoscopic myotomy (21 patients) and laparoscopic myotomy (two patients). Thirteen patients did not receive any treatment and 10 of those (77%) reported spontaneous resolution of symptoms. Patients who required invasive treatment experienced severe disability in their quality of life and greater maximal distal contractile integral than those who did not.ConclusionsHRM showed that the prevalence of JE was very low (2%). Esophagogastroduodenoscopy revealed some characteristic features of JE in patients. Some patients showed improvement of symptoms without invasive treatments. Follow-up with/without medical treatment should be considered before performing invasive treatment in patients whose distal contractile integral is relatively low and the quality of life is not impaired.

EVALUATION OF QUALITY OF LIFE INDICATORS IN NSTEMI PATIENTS DEPENDING ON PLASMA LEVEL ST2, NATURE OF CORONARY ARTERIES LESION AND OTHER CLINICAL CHARACTERISTICS

Introduction. The prevalence of myocardial infarction and its leading role in the structure of overall and cardiovascular mortality encourages the search for predictors of adverse disease and the search for optimal means to prevent adverse events and improve the quality of life of this category of patients. The aim of the study – to evaluate quality of life in NSTEMI patients based on plasma ST2 levels, the nature of coronary artery disease, and other clinical characteristics. Research Methods. The study involved 200 patients with NSTEMI aged 38 to 80 years. All patients were examined according to the current treatment protocol for patients with acute myocardial infarction without ST segment elevation, plasma ST2 levels were determined and quality of life was assessed using the MIDAS-35 questionnaire. Results and Discussion. Spearman's rank correlation showed that the level of physical activity (the first subscale of MIDAS-35) of patients with NSTEMI is directly correlated with the presence of frequent ventricular extra­systoles and paroxysms of ventricular tachycardia recorded during ECG monitoring on day 1 of NSTEMI, the seve­rity of coronary artery lesions and plasma ST2 levels determined on the 1st day of hospitalization. Similar patterns are found in subscales 2, 4, 5. Subscale 6 revealed the presence of a correlation only with the presence of frequent ventricular tachycardia. Subscales 3 and 7 did not show correlations with the studied parameters. Conclusions. Elevated ST2 levels, hemodynamically significant coronary artery lesions and the presence of acute arrhythmias in the early period of NSTEMI have been found to significantly affect quality of life as determined by the MIDAS-35 questionnaire. The impact on remodeling processes and the strategy of early invasive treatment in patients with NSTEMI will not only reduce the likelihood of complications, but also improve the quality of life of this category of patients.

New Trends and Evidence for the Management of Renal Angiomyolipoma: A Comprehensive Narrative Review of the Literature.

Treatment of renal angiomyolipoma (AML) seeks to reduce related complications and preserve kidney function. The purpose of this article was to perform an updated literature review on the diagnosis, therapeutic options, and criteria for invasive intervention in patients with renal AML. Computerized tomography is the standard diagnostic method for renal AML, while definitive diagnosis is made by histopathology. The management of choice in most cases is active surveillance (AS), with a clinical and imaging follow-up protocol. In high-risk cases, therapeutic management should be considered, with alternatives such as selective arterial embolization (SAE), nephron-sparing surgery (NSS), and mTOR inhibitors in selected patients. Renal AML in women of childbearing age, those with growth >0.25 cm/year, intralesional aneurysms >5 mm, and clinically significant symptoms may qualify for active treatment. Despite the limitations derived from the available evidence, it is possible to consider SAE, NSS, and the use of mTOR inhibitors as management alternatives for selected patients.

Intracranial electroencephalographic biomarker predicts effective responsive neurostimulation for epilepsy prior to treatment.

Despite the overall success of responsive neurostimulation (RNS) therapy for drug-resistant focal epilepsy, clinical outcomes in individuals vary significantly and are hard to predict. Biomarkers that indicate the clinical efficacy of RNS-ideally before device implantation-are critically needed, but challenges include the intrinsic heterogeneity of the RNS patient population and variability in clinical management across epilepsy centers. The aim of this study is to use a multicenter dataset to evaluate a candidate biomarker from intracranial electroencephalographic (iEEG) recordings that predicts clinical outcome with subsequent RNS therapy. We assembled a federated dataset of iEEG recordings, collected prior to RNS implantation, from a retrospective cohort of 30 patients across three major epilepsy centers. Using ictal iEEG recordings, each center independently calculated network synchronizability, a candidate biomarker indicating the susceptibility of epileptic brain networks to RNS therapy. Ictal measures of synchronizability in the high-γ band (95-105Hz) significantly distinguish between good and poor RNS responders after at least 3 years of therapy under the current RNS therapy guidelines (area under the curve = .83). Additionally, ictal high-γ synchronizability is inversely associated with the degree of therapeutic response. This study provides a proof-of-concept roadmap for collaborative biomarker evaluation in federated data, where practical considerations impede full data sharing across centers. Our results suggest that network synchronizability can help predict therapeutic response to RNS therapy. With further validation, this biomarker could facilitate patient selection and help avert a costly, invasive intervention in patients who are unlikely to benefit.

Abstract 11210: Trends in Invasive Treatment of Patients Hospitalized with Acute Decompensated Aortic Stenosis and Cardiogenic Shock

Background: Prior to 2012, balloon aortic valvuloplasty (BAV) was the only potential intervention for patients with decompensated aortic stenosis (AS) and cardiogenic shock. Emergent transcatheter aortic valve replacement (TAVR) is now an option and has shown acceptable outcomes compared with elective TAVR. We explored how treatment patterns for AS and cardiogenic shock have shifted since TAVR was introduced. Methods: We identified hospitalizations of patients with AS and cardiogenic shock within the National Readmissions Database, the proportion treated with BAV or TAVR, and in-hospital mortality over the study period by treatment. Due to challenges in determining the timing of surgery vs. onset of shock, patients who underwent surgical AVR were excluded. Results: From 2010-2018, there were 17,297 hospitalizations for AS and cardiogenic shock, which have increased over time (Figure A legend). The proportion of hospitalizations where either BAV or TAVR was used has also increased (BAV 3.9%-&gt;7.1%; TAVR 3.8%-&gt;10.1%; Figure A). In-hospital mortality was very high but has significantly decreased over time for all treatment strategies (no invasive: 46.9%-&gt;35.5%; BAV: 45.7%-&gt;34.2%; TAVR 18.8%-&gt;8.9%; Figure B), with much lower mortality rates the TAVR group at all time points. Compared with BAV, patients treated with TAVR were less likely to require mechanical ventilation (TAVR 34.6% vs BAV 49.1%) or mechanical circulatory support (TAVR 19.9% vs BAV 30.6%; p&lt;0.001 for both). Age and comorbidity burden were similar among groups. Conclusions: Over the past decade, hospitalizations for AS and cardiogenic shock have increased as has the proportion in which BAV or TAVR are emergently used. Although in-hospital mortality has declined over time, it remains very high, particularly among patients treated with BAV or those without intervention. This is likely in part due to the lower severity of cardiogenic shock of the patients treated with TAVR.