Patients In Long Term Research Articles

Prevalence of Physical comorbidities among Long-Term Psychiatric Inpatients: A Single Centre Study from South India

Background: Physical comorbidities are the most common causes of early mortality among patients with mental disorders. Prevention and early treatment of physical comorbidities would lead to better outcomes. Hence, the aim to the study was to estimate the prevalence of physical health disorders present as comorbidities among long-term stay psychiatric inpatients and to compare the difference in the physical comorbidities among male and female patients. Materials and Methods: The study was conducted at Institute of Mental Health, Madras Medical College, Chennai. It was a descriptive study combining data from clinical files and nursing records related to the physical health of the long-term inpatients. The clinical records of long-term inpatients, defined as the duration of stay in the care facility for more than 5 continuous years between 1stJanuary and 30thJune, 2019 were assessed. Results: The estimated prevalence was74.2% (95% CI: 69.5-78.6) for at least one physical disorder comorbidity and 38.8% (95% CI: 33.8-43.9) had more than one physical comorbidities. Female in-patients have 2.7 times higher risk than males to have diabetes mellitus, hypertension and thyroid disorders. They also have 0.92 times higher risk than males to have anaemia. Conclusion: There is a high prevalence of physical comorbidities among long term psychiatric inpatients. Systems for the early detection and better clinical management of these physical comorbidities are essential in any long-term psychiatric facility.

Prevalence of Physical comorbidities among Long-Term Psychiatric Inpatients: A Single Centre Study from South India

Background: Physical comorbidities are the most common causes of early mortality among patients with mental disorders. Prevention and early treatment of physical comorbidities would lead to better outcomes. Hence, the aim to the study was to estimate the prevalence of physical health disorders present as comorbidities among long-term stay psychiatric inpatients and to compare the difference in the physical comorbidities among male and female patients. Materials and Methods: The study was conducted at Institute of Mental Health, Madras Medical College, Chennai. It was a descriptive study combining data from clinical files and nursing records related to the physical health of the long-term inpatients. The clinical records of long-term inpatients, defined as the duration of stay in the care facility for more than 5 continuous years between 1stJanuary and 30thJune, 2019 were assessed. Results: The estimated prevalence was74.2% (95% CI: 69.5-78.6) for at least one physical disorder comorbidity and 38.8% (95% CI: 33.8-43.9) had more than one physical comorbidities. Female in-patients have 2.7 times higher risk than males to have diabetes mellitus, hypertension and thyroid disorders. They also have 0.92 times higher risk than males to have anaemia. Conclusion: There is a high prevalence of physical comorbidities among long term psychiatric inpatients. Systems for the early detection and better clinical management of these physical comorbidities are essential in any long-term psychiatric facility.

Transcranial magnetic stimulation in treatment of motor and nonmotor symptoms of Parkinson’s disease

This review highlights topical issues of the use of transcranial magnetic stimulation as a non‑drug method for treating motor and non‑motor symptoms of Parkinson’s disease. The method of transcranial magnetic stimulation has a wide therapeutic potential since it has the ability to induce neuronal plasticity by modulating neuronal connections in the human brain, and in particular in patients with Parkinson’s disease. Several areas of application of transcranial magnetic stimulation in patients with Parkinson’s disease are currently being considered. Its effect on the severity of motor symptoms, such as tremor, rigidity, bradykinesia and gait disturbances, the manifestation of non‑motor symptoms, such as cognitive impairment and depressive disorders, is described. It is proved that patients with Parkinson’s disease have a wide range of disorders of neurophysiological parameters in the primary motor cortex, which are positively correlated with the severity of clinical symptoms of Parkinson’s disease and can be used for objectification of transcranial magnetic stimulation treatment results. According to the analysis of literature data, transcranial magnetic stimulation significantly improves the function of the upper extremities, the ability to walk and score III of UPDRS not only in the short term but also in the long term in patients with Parkinson’s disease. Today, a topical issue is the discussion of possible mechanisms of therapeutic action of transcranial magnetic stimulation on the level of cytokines associated with neuroinflammation in patients with Parkinson’s disease. The results of studies on the treatment of Parkinson’s disease by the method of transcranial magnetic stimulation are promising and encouraging, but many questions and controversies remain, which require additional study.

Retrospective investigation of anticoagulant complications in long term after mechanical heart valve replacement surgery in Turkey

Background: Patients with mechanical heart valve replacement surgery (MHVRS) should be followed up in terms of prosthetic valve-related and open heart surgery complications. This study aimed to determine the anticoagulant complications in long term in patients with MHVRS. Methods: This retrospective and descriptive study was conducted in a university hospital, İzmir, Turkey. The data were collected from July to December 2019. In total, 73 patients referring for regular check-ups to the hospital with intervals not exceeded more than 90 days, and those who had international normalized ratio (INR) measurements for January-April-July-October 2018 were included in this study. Results: The mean age of the patients was obtained at 58.98±12.89 years, and 53.4% (n=39) of the cases were male. Moreover, the mean follow-up period was estimated at 65.98±28.47 months. According to the results, complications developed in 60 patients (82.2%). The first hospitalized unit was the emergency department. The factors affecting the development of complications after MHVRS were evaluated, and a difference was found regarding gender (X2=6.18, P=0.013), comorbidities (X2=25.58, P=0.018), and monthly referral for regular check-ups to the hospital (X2=5.20, P=0.023). There was no relationship between the INR levels and the development of complications. Furthermore, the results of evaluating the factors affecting the number of hospitalizations after MHVRS revealed that monthly referral to hospital for check-ups (t=3.18, P=0.002) and history of previous valve surgery (Z=201.00, P=0.03) affected the number of hospitalizations. Conclusions: It was observed that patients frequently refer to the emergency department and struggled with various complications. Moreover, it was found that the patients had frequent bleeding and refer to the emergency service repeatedly. Accordingly, there is a need for interventional studies to reduce postoperative complications and provide the therapeutic INR level.

Оценка состояния роговицы у пациентов в отдаленные сроки после передней радиальной кератотомии

Оценка состояния роговицы у пациентов в отдаленные сроки после передней радиальной кератотомии

Catheter Ablation Versus Medication in Atrial Fibrillation and Systolic Dysfunction: Late Outcomes of CAMERA-MRI Study.

This study sought to determine the long-term outcomes of restoring sinus rhythm with catheter ablation (CA). The CAMERA-MRI (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and HeartFailure-An MRI-Guided Multicenter Randomized Controlled Trial) study demonstrated that restoration of sinus rhythm with CA significantly improved left ventricular ejection fraction (LVEF) compared with medical rate control (MRC) at 6months in persistent atrial fibrillation and otherwise unexplained systolic heart failure. However, the long-term outcomes have not been reported. Patients enrolled in the CAMERA-MRI study were followed for 4 years with echocardiogram and cardiac magnetic resonance. CA involved pulmonary vein isolation and posterior left atrial wall isolation in 94%. Patients crossed over to CA after 6-month study duration. Arrhythmia burden was determined with implanted cardiac monitors or cardiac devices. Sixty-six patients (age 62 ± 10 years, atrial fibrillation duration of 22 ± 16months, and LVEF 33 ± 9%) were randomized 1:1 to CA versus MRC. Eighteen of 33 patients crossed over from MRC group to CA group. At 4.0 ± 0.9 years, atrial fibrillation recurred in 27 patients (57%) in the CA group with a mean burden of 10.6 ± 21.2% after 1.4 ± 0.6 procedures. There was an absolute increase in LVEF with CA of 16.4 ± 13.3% compared with 8.6 ± 7.6% in MRC (p=0.001). In the CA group, the absence of ventricular late gadolinium enhancement was associated with a greater improvement in absolute LVEF (19 ± 13% vs. 10 ± 11% in the late gadolinium enhancement-positive group; p=0.04) and LVEF normalization in 19 patients (58%) versus 4 patients (18%) in the late gadolinium enhancement-positive group (p=0.008) at 4.0 ± 0.9 years follow-up. CA is superior to MRC in improving LVEF in the long term in patients with atrial fibrillation and systolic heart failure. The greatest recovery in systolic function was demonstrated in the absence of ventricular fibrosis on cardiac magnetic resonance.

Short- and Long-term Effectiveness of Sacral Nerve Stimulation in Patients with Overactive Bladder

BACKGROUND: Sacral nerve stimulation (SNS) approved for use in North America since 1997 despite the fact that the concept of using SNS to treat patients with voiding dysfunction discussed first almost 50 years ago.
 AIM: The objectives of the study were to assess the effectiveness of SNS the short and long term for patients with overactive bladder (OAB) dysfunction and its relation to age, gender, and causes.
 PATIENTS AND METHODS: This is a clinical prospective study that involved 50 cases (32 females and 18 males) with OAB. It was carried out at Ibn Sina Hospital, and the neurosciences hospital in Baghdad/Iraq from April 2015 to April 2018. All the patients were assessed preoperatively and certain inclusion criteria were used. The patients went through the 2 stage implantations of the Medtronic InterStim®. The patients were assessed at 6 months (short term) and 2 years (long term) postoperatively.
 RESULTS: The results of our patients were analyzed with respect to age, gender, causes of OAB, and post-operative complications. We found that younger age patients, female patients, and patients with neurogenic causes of OAB showed a better response in both the short- and long-term follow-up.
 CONCLUSION: Considerable progress has been made in the surgical management of OAB. Proper selection of patients is the key to the success of SNS, and female patients have better results compared to male patients. Furthermore, younger patients and patients with neurogenic causes did better than older patients and patients with idiopathic causes. SNS is a safe minimally invasive surgery with a low complication rate, and the 2 stages procedure has better results than the percutaneous nerve evaluation.

Number of long-term inpatients in Japanese psychiatric care beds: trend analysis from the patient survey and the 630 survey

BackgroundThe number of psychiatric care beds and the mean length of stay in psychiatric care beds in Japan have decreased over the past 10 years. However, as has long been indicated here and elsewhere, Japan lags behind other countries in terms of deinstitutionalization. Furthermore, the population of inpatients in psychiatric care beds is aging dramatically. In addition to the diversification of mental illness, the question of what measures to implement going forward regarding current psychiatric bed resources has emerged as a new challenge.MethodsUsing data from the Patient Survey and the 630 Survey, we examined trends in the number of long-term inpatients in psychiatric care beds in Japan through 2040. Population estimation was used for estimating long-term hospital bed demand because of small fluctuations in the admission and discharge of long-term inpatients.ResultsIn 2017, nearly one-third of all long-term hospitalized patients were aged ≥75 years, and an estimated 47% of the total are expected to die by 2040. Thus, the overall demand for long-term hospitalization is forecast to decrease sharply due to aging of currently hospitalized long-term inpatients. The number of long-term inpatients in 2017 was 167,579, and this is projected to decrease to 103,141 in 2040.ConclusionsWe believe it is necessary to adopt a multifaceted approach to promote hospital discharge and transition to the community, and to address the diversification of mental illness and the issue of psychiatric care bed supply/availability, which are forecast to decrease due to the natural decrease in long-term inpatients.

PRN Medication Events in a Forensic Psychiatric Hospital: A Document Analysis of the Prevalence and Reasons

The aim of this study was to describe and explain the prevalence and reasons for as needed medication (pro re nata, PRN) in a forensic psychiatric hospital. We reviewed the documents of 67 long-term inpatients (87% male) over the one-year study period and identified 8626 PRN events. Virtually all of the patients received PRN for physical reasons, just over half for psychiatric reasons, and just over one-third for insomnia. The number of PRN events per patient was unevenly distributed. The prevalence of PRN events for both psychiatric reasons (26%) and insomnia (14%) were associated with the female gender, more severe psychiatric symptoms, and lower daily functioning. Half of the patients did not receive PRN for psychiatric reasons. It is likely that the use of such medication was successfully mitigated with scheduled medication and psychosocial approaches. The high number of PRN events for physical reasons (60%) was not explained by the patient characteristics and urgent research is needed on this aspect. Protracted PRN use should be recognized in clinical practice, and consider more structured solutions to develop PRN protocols and evidence-based care. Future research should examine how PRN is integrated with patients’ regular treatment and non-pharmacological methods.

The French Integrative Psychosocial Rehabilitation Assessment for Complex Situations (FIPRACS): Modelization of an Adapted Assessment Method Toward Long-Term Psychiatric Inpatients With Disabling, Severe and Persistent Mental Illness.

For the past forty years, the generalization of community-based approaches has prompted psychiatry into promoting a deinstitutionalization movement and a psychosocial rehabilitation approach (PSR) for individuals with schizophrenia and related difficulties. Unfortunately, this approach generally does not involve the most severe cognitive and psycho-affective clinical situations among this population despite an increasing number of publications advocating that all individuals should be included in PSR and deinstitutionalization programs. In this context, considering the absence of an assessment battery designed for French individuals with particularly disabling, severe, and persistent mental illness (IDSPMI), we constructed an integrative assessment model adapted to this specific population. To select the most suitable tools for this population, a literature review (inspired by the PRISMA protocol) and a systematic review were combined with a clinical assessment study. The literature review first identified the cognitive and psycho-affective functions which mainly influence the day-to-day life adaptation of individuals engaged in a PSR/deinstitutionalization program. The systematic review then gathered all of the useable French validated tools to assess the initially selected dimensions (n = 87). To finish, for each dimension, the selected 87 tools were included in a clinical assessment study performed within a French psychiatric hospital. The authors collected and verified the characteristics of each tool (validity, French norms, French version, the average speed of the test, ease of use, ability to assess other dimensions). Their suitability was also assessed when applied to IDSPMI. Based on this final clinical evaluation, the authors selected one tool per function to create the French Integrative Psychosocial Rehabilitation Assessment for Complex Situations (FIPRACS). This battery is an assessment tailored to the neurocognitive and psycho-affective potentials of IDSPMI. While further validation studies of this battery are ultimately required, the practical/clinical implications of this battery are presented and discussed.

Radiocirugía estereotáctica con Gamma Knife® como tratamiento del temblor esencial y parkinsoniano: experiencia a largo plazo

IntroductionUnilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. MethodsWe reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months’ follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. ResultsThirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. ConclusionsThis is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants.

Acupuncture treatment for carotid atherosclerotic plaques: study protocol for a pilot randomized, single blinded, controlled clinical trial

BackgroundCarotid atherosclerosis disease (CAD) is generally associated with the occurrence of cardiovascular and cerebrovascular accidents. However, CAD has not been taken seriously enough in the clinic, which, coupled with the single treatment and prevention of CAD, has led to a generally low level of patient compliance. Therefore, acupuncture is expected to be a safe and effective therapy that can be maintained in the long term for patients with CAD. The study objective is to evaluate the efficiency and reliability of acupuncture to relieve CAD and provide a new therapeutic idea for the clinical treatment of CAD.MethodsThis is a three-arm randomized clinical trial in China. Three groups (TA, SA, and MC) will be randomly allocated at a 1:1:1 ratio. The study will enrol 105 cervical atherosclerosis plaque patients in total on a voluntary basis, with 35 patients in each group. The treatment will last for 12 weeks, with two treatments per week for twenty-four treatments in total.ResultsTwo 3D ultrasound indicators will be measured as the primary outcomes: the total plaque volume (PV) of the carotid artery on each side and the grey-scale median (GSM). The secondary outcomes will include intima-media thickness (IMT), lipid levels, apolipoprotein A-IV level, platelet count (PLT), fibrinogen (FIB), and platelet aggregation rate (PAR). All the outcomes will be assessed before treatment, after treatment, and after a 12-week follow-up period. This study will utilize per-protocol (PP) and intention-to-treat (ITT) analysis principles.ConclusionsThis trial is to evaluate the efficacy and reliability of acupuncture in relieving carotid atherosclerotic plaques by establishing acupuncture (TA), sham acupuncture (SA), and medication (MC) groups.Ethics and disseminationThis study was approved by the Institutional Ethics Committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (no. YF2018-107-01). All data and findings will be provided by the principal investigator via email.Trial registrationChiCTR, ChiCTR1800019259. Registered on 1 November 2018—retrospectively registered, http://www.chictr.org.cn/index.aspx

Need for Prescription Suggestions for Long-term Inpatients in the Psychiatric Ward

Additional fees for ward pharmacists' services have been valued for hospitals in Japan. However, the calculation period for services provided to inpatients in the psychiatric ward is limited to 8 weeks. This study aimed to reveal the need for the services of pharmacists in the hospital ward for inpatients hospitalized for >8 weeks in the psychiatric ward. Patients who were hospitalized in the psychiatric ward from September 2016 to February 2017 were analyzed retrospectively. The pharmacists suggested prescriptions for inpatients admitted for >8 weeks, similar to those admitted for <9 weeks, and this supported pharmacotherapy without exacerbating patient outcomes. Moreover, significant decreases in benzodiazepine doses were found between the prior and post prescription suggestions of the pharmacist for inpatients >8 weeks of admission. Healthcare expenditures were also reduced. These results suggest that the prescriptions suggested by pharmacists for inpatients admitted for >8 weeks in the psychiatric ward were useful. In conclusion, our findings show that ward pharmacists' services were necessary not only for the inpatients hospitalized for <9 weeks, but also for those hospitalized for >8 weeks.

Open modified puestow procedure in an advanced endoscopic era for chronic pancreatitis with dilated pancreatic duct and stones

Background: Chronic pancreatitis has been defined as a continuing inflammatory disease of the pancreas characterized by irreversible morphological changes. These changes typically cause pain and loss of exocrine and endocrine pancreatic function. The most common symptom of chronic pancreatitis is pain, which can be severe and intractable in some patients. Although it is itself benign, chronic pancreatitis can significantly affect quality of life and can cause significant distress with its complications [1]. The initial treatment for pain in most cases is to start of enzyme replacement, control of diabetes with insulin, and administration of oral analgesics. Surgical intervention is required in patients with intractable pain that is resistant to conventional nonsurgical therapy, in patients with associated or suspected malignancy, and in patients who have developed complications such as biliary or duodenal obstruction, pancreatic fistulae, pancreatic ascites/pleural effusion, pseudocyst, or rare hemosuccus pancreaticus [2]. The aetiology of pain in chronic pancreatitis is unclear. Some evidence has suggested that perineural inflammation may be the cause of pain. A dilated pancreatic duct, secondary to obstruction, may cause increased intraductal pressures, resulting in pain [3]. The primary aim of therapy is the achievement of primary pain relief and an improvement in quality of life. This could be achieved by means of endoscopic, open or laparoscopic /robotic lateral pancreaticojejunostomy [4, 13]. Methods: We selected 41 cases of chronic pancreatitis of both genders with moderate to intractable pain hampering routine life. All patients tried conservative treatment for more than 6 months. All selected patients underwent haematological and radiological work up. MRCP of all patients showing dilated pancreatic duct more than 7mm. in size. All of these patients operated for longitudinal pancreaticojejunostomy (Modified Puestow’s). Follow up done for one year to ten years Results: All 41 patients in long term follow up were recovered well from pain and abdominal discomfort. Appetite were improved and weight gain noted in the patients after surgery. Conclusions: Longitudinal pancreaticojejunostomy is still safe, simple and timely approved procedure for pain associated with chronic pancreatitis.

Higher baseline serum lactate dehydrogenase level is associated with poor effectiveness of dupilumab in the long term in patients with atopic dermatitis.

Dupilumab shows high efficacy and tolerable safety for the treatment of atopic dermatitis (AD). However, the extent of its effectiveness varies in individual patients. To date, practical predictors of later effectiveness of dupilumab in AD patients have not been reported. To explore practical predictors of later effectiveness of dupilumab in AD, we retrospectively investigated the correlation of baseline demographics and baseline laboratory results with the percentage reduction in Eczema Area and Severity Index (EASI) scores at 1, 3, 6 and 12months after initiating dupilumab. Furthermore, multiple regression analyses were conducted. Data were collected from patients' charts. Data on 54 Japanese adult patients (43 men and 11 women) with moderate to severe AD were analyzed. Baseline serum lactate dehydrogenase (LDH) level was negatively correlated with the percentage reduction in EASI score at 3, 6 and 12months after initiating dupilumab but not at 1month. Multiple regression analyses also revealed that effectiveness of dupilumab at 3 and 6months was associated with lower baseline serum LDH level. AD patients with allergic diseases tended to have lower percentage reduction in EASI at 1month, but had higher percentage reduction in EASI in the long term than patients without allergic diseases. In conclusion, higher baseline serum LDH level was associated with poor effectiveness of dupilumab in the long term in patients with AD. Furthermore, it tended to take a longer time for AD patients with allergic diseases to respond to dupilumab, and these patients responded better to dupilumab in the long term than patients without allergic diseases.

Differences in Social and Clinical Characteristics between Readmission and Dehospitalization in Long-Term Inpatients with Schizophrenia

Differences in Social and Clinical Characteristics between Readmission and Dehospitalization in Long-Term Inpatients with Schizophrenia

Prevention and Management of the Post-Thrombotic Syndrome.

The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate–severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials.

A short bout of high-intensity intermittent exercise before moderate-intensity prolonged exercise as a mean to potentiate fat oxidation ?

ABSTRACTModerate-intensity continuous exercise (MICE) improves fat oxidation. High-intensity intermittent exercise (HIIE) is thought to have a greater potential for fat oxidation but it might be too demanding in the long term for patients. We hypothesized that an initial bout of HIIE could maximize fat oxidation during MICE and the following passive recovery. Eighteen healthy participants performed two acute isocaloric exercise sessions at random. MICE consisted of 45-min cycling at 50% of maximal aerobic power (Pmax). COMB began with five 1-min bouts of HIIE at Pmax (interspaced with 1-min recovery periods) followed by 35-min MICE. Gas exchange allowed substrate oxidation rate assessment.Expressed as a % of energy expenditure, fat oxidation (%) increased during in the passive recovery following COMB (Recovery: 36.0 ± 19.4 vs 23.0 ± 20.3%; ES: 0.66; p < 0.0001). An initial bout of HIIE preceding a prolonged moderate-intensity exercise may potentiate fat oxidation during the following recovery. This might be relevant for health management of overweight/obese persons.

Elevated circulating metalloproteinase 7 predicts recurrent cardiovascular events in patients with carotid stenosis: a prospective cohort study

BackgroundMajor adverse cardiovascular events are the main cause of morbidity and mortality over the long term in patients undergoing carotid endarterectomy. There are few reports assessing the prognostic value of markers of inflammation in relation to the risk of cardiovascular disease after carotid endarterectomy. Here, we aimed to determine whether matrix metalloproteinases (MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10), tissue inhibitor of MMPs (TIMP-1) and in vivo inflammation studied by 18F-FDG-PET/CT predict recurrent cardiovascular events in patients with carotid stenosis who underwent endarterectomy.MethodsThis prospective cohort study was carried out on 31 consecutive patients with symptomatic (23/31) or asymptomatic (8/31) severe (> 70%) carotid stenosis who were scheduled for carotid endarterectomy between July 2013 and March 2016. In addition, 26 healthy controls were included in the study. Plasma and serum samples were collected 2 days prior to surgery and tested for MMP-1, MMP-2, MMP-7, MMP-9, MMP-10, TIMP-1, high-density lipoprotein, low-density lipoprotein, high-sensitivity C-reactive protein and erythrocyte sedimentation rate. 18F-FDG-PET/CT focusing on several territories’ vascular wall metabolism was performed on 29 of the patients because of no presurgical availability in 2 symptomatic patients. Histological and immunohistochemical studies were performed with antibodies targeting MMP-10, MMP-9, TIMP-1 and CD68.ResultsThe patients with carotid stenosis had significantly more circulating MMP-1, MMP-7 and MMP-10 than the healthy controls. Intraplaque TIMP-1 was correlated with its plasma level (r = 0.42 P = .02) and with 18F-FDG uptake (r = 0.38 P = .05). We did not find any correlation between circulating MMPs and in vivo carotid plaque metabolism assessed by 18F-FDG-PET. After a median follow-up of 1077 days, 4 cerebrovascular, 7 cardiovascular and 11 peripheral vascular events requiring hospitalization were registered. Circulating MMP-7 was capable of predicting events over and above the traditional risk factors (HR = 1.15 P = .006). When the model was associated with the variables of interest, the risk predicted by 18F-FDG-PET was not significant.ConclusionsCirculating MMP-7 may represent a novel marker for recurrent cardiovascular events in patients with moderate to severe carotid stenosis. MMP-7 may reflect the atherosclerotic burden but not plaque inflammation in this specific vascular territory.

Efficacy of Doppler-guided hemorrhoidal artery ligation with mucopexy, in the short and long terms for patients with hemorrhoidal disease.

Several studies comparing Doppler-guided hemorrhoidal artery ligation (DG HAL) with or without mucopexy with hemorrhoidopexy and hemorrhoidectomy techniques show no difference in short-term efficacy. The aim of this study was to evaluate efficacy of DG HAL with mucopexy (DG HAL+m) in the long term (beyond 5years) for patients with hemorrhoidal disease. A retrospective observational study was conducted on patients with symptomatic hemorrhoidal disease of any stage treated with DG HAL m at our outpatient colorectal surgery unit in April 2009-April 2013. Patients were followed clinically for 1month and with a questionnaire until 5years after surgery or until they underwent a second surgery for recurrent hemorrhoids. Of 150 patients who underwent DG HALm during the study period 50 (33.3%) were lost to follow-up. A total of 100 patients (47 women, 53 men) were analysed. The average age was 50 (± 12) years. Twenty-six patients (17.3%) had had one or more prior procedures. The mean length of hospital stay was 2.2days (median = 2days; range = 1-8days). No major complications were described. There were no deaths. At 5years the mean bleeding, local discomfort and pain scores were significantly improved. Thirty-six patients (35.6%) had a recurrence during the follow-up period, and 20 (19.8%) of them underwent reoperation. The mean time between the operation and the second procedure was 36months (median 27.4months). The majority (61.4%) of patients were satisfied with the procedure. Despite the low invasiveness of DG HALm the low morbidity associated with the procedure and the satisfactory functional outcomes, the long-term recurrence rate can be very high. However, only about half of the patients who experienced a recurrence needed a second operation.