Long-term Management Of Patients Research Articles

Long-term results of coronary bypass grafting supplemented with surgical stimulation of extracardiac myocardial vascularization in patients with diffuse coronary artery disease

Highlights. In recent decades, the number of patients with diffuse, multivessel coronary artery disease has increased due to widespread use of endovascular methods of treatment, long-term conservative management of patients, and the expansion of indications for surgical revascularization. In order to improve the results of treatment, in 2007 academician Yu. L. Shevchenko developed and began using the method of stimulation of extracardiac angiogenesis – «YurLeon». The present article demonstrates the long-term results of supplementing coronary bypass surgery with this method in patients with diffuse coronary artery disease.Aim. To evaluate long-term results of coronary bypass surgery supplemented by extracardiac myocardial revascularization.Methods. The prospective, randomized study included 205 patients with diffuse, multivessel coronary artery disease who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic, National Medical and Surgical Center named after N.I. Pirogov. The majority of patients were men – 75% (n = 153), whereas women accounted for 25% (n = 52), all patients were 60 to 78 years old (67.3±5.74 years). The group I consisted of patients with coronary bypass surgery supplemented with the «YurLeon» technique, the group II consisted of patients with coronary bypass grafting only. All patients provided consent to participate in the study. The clinical condition of patients, echocardiography, myocardial scintigraphy and coronary angiography data, quality of life indicators (the 36-Item Short Form Health Survey) were assessed.Results. In the long-term postoperative period (36 months), the group I, compared with the group II, presented with a statistically significant decrease in the functional class of angina pectoris (1[1–2] vs. 2[1–2], p = 0.02); fewer adverse events: myocardial infarction (4.5% vs. 11.6%, p = 0.011), recurrent angina pectoris (10% vs. 17.9%, p = 0.038); an increase in the left ventricular ejection fraction (59.0±5.15% vs. 53.2±6.13%, p = 0.001); a decrease in the Summed Rest Score (SRS) (4.5±3.5 vs. 8.4±5.7, p = 0.012) according to myocardial scintigraphy with technetril; a decrease in the Summed Thickening Score (STS) (6.1±3.3 vs. 10.7±2.9, p = 0.012); a decrease in the hibernating myocardium (3.5±2.2% vs. 7.4±5.1%, p = 0.03); additional extracardiac sources were found in the group I according to coronary graft angiography, there were no statistically significant differences between the groups by occluded autogenous venous bypass grafts (in the group I – 23 out of 46 venous conduits (49%), in the group II – 30 out of 49 venous conduits (51%), p = 0.089); The groups differed in terms of quality of life (the 36-Item Short Form Health Survey): physical functioning (87.3±10.32 vs. 75.3±14.15 points, p = 0.001); role-based functioning due to physical condition (90.1±10.50 vs. 79.7±7.01 points, p = 0.012); pain (93.10±6.37 vs. 80.5±5.21 points, p = 0.03); the total physical component of health (57.9±5.4 vs. 45.8±6.1 points, p = 0.012).Conclusion. We have accumulated 15 years of experience in conducting complex myocardial revascularization in patients with coronary artery disease and diffuse coronary atherosclerosis, which allowed us to prove the effectiveness and safety of the YurLeon technique.

Technological advances and digital solutions to improve quality of life in older adults with chronic obstructive pulmonary disease: a systematic review

Several technological advances and digital solutions have been proposed in the recent years to face the emerging need for tele-monitoring older adults with Chronic Obstructive Pulmonary Disease (COPD). However, several challenges have negatively influenced an evidence-based approach to improve Health-Related Quality of Life (HR-QoL) in these patients. To assess the effects of tele-monitoring devices on HR-QoL in older adults with COPD. On November 11, 2022, PubMed, Scopus, Web of Science, and Cochrane were systematically searched for randomized controlled trials (RCTs) consistent with the following PICO model: older people with COPD as participants, tele-monitoring devices as intervention, any comparator, and HR-QoL as the primary outcome. Functional outcomes, sanitary costs, safety, and feasibility were considered secondary outcomes. The quality assessment was performed in accordance with the Jadad scale. A total of 1845 records were identified and screened for eligibility. As a result, 5 RCTs assessing 584 patients (423 males and 161 females) were included in the systematic review. Tele-monitoring devices were ASTRI telecare system, WeChat social media, Pedometer, SweetAge monitoring system, and CHROMED monitoring platform. No significant improvements in terms of HR-QoL were reported in the included studies. However, positive effects were shown in terms of the number of respiratory events and hospitalization in patients telemonitored by SweetAge system and CHROMED platform. Although a little evidence supports the role of tele-monitoring devices in improving HR-QoL in older patients, positive effects were reported in COPD exacerbation consequences and functional outcomes. Tele-monitoring solutions might be considered as sustainable strategies to implement HR-QoL in the long-term management of older patients with COPD.

Influence of morphology and hemodynamics on thrombosis in kawasaki disease patients

Kawasaki Disease (KD) patients with co-occurrent coronary artery aneurysms (CAAs) are prone to thrombosis. This study explores the thrombotic influence of morphology and hemodynamics in KD patients with CAAs. Patient-specific computed tomography angiogram images of 9 patients were used to rebuild coronary models (including 23 aneurysms; 10 in thrombosed group, and 13 in non-thrombosed group) and perform computational simulations to obtain the hemodynamic parameters. The thrombosed and non-thrombosed groups were compared in terms of six parameters, namely, the maximum diameter (Dmax), aspect ratio (Rl/d), shape, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT). The results showed that: (1) In thrombosed aneurysms, there were several vortex structures (eddy zone), of which the position changed continuously in a cardiac cycle. In non-thrombosed aneurysms, the streamlines showed a large streaming zone. (2) Abnormal hemodynamic areas of aneurysms with thrombosis tended to appear in the same region (especially the proximal and near myocardial side of aneurysms). (3) In the non-thrombosed group, there was a correlation between the morphological and hemodynamic parameters. In thrombosed aneurysms, the flow pulsatility has a significant impact on the flow pattern. The thrombosed coronary aneurysms exhibited more risk factors and the co-location of hemodynamic abnormalities was consistent with the position of thrombosis. A score of risk factors could provide the thrombotic information of coronary aneurysms, which might be helpful for long-term clinical management of KD patients.

Long-Term Spasticity Management in Post-Stroke Patients: Issues and Possible Actions-A Systematic Review with an Italian Expert Opinion.

Spasticity is a well-known motor dysfunction occurring after a stroke. A group of Italian physicians' experts in treating post-stroke spasticity (PSS) reviewed the current scientific evidence concerning the state-of-the-art clinical management of PSS management and the appropriate use of botulinum toxin, aiming to identify issues, possible actions, and effective management of the patient affected by spasticity. The participants were clinicians specifically selected to cover the range of multidisciplinary clinical and research expertise needed to diagnose and manage PSS. When evidence was not available, the panel discussed and agreed on the best way to manage and treat PSS. To address the barriers identified, the panel provides a series of consensus recommendations. This systematic review provides a focused guide in the evaluation and management of patients with PSS and its complications. The recommendations reached by this panel of experts should be used by less-experienced doctors in real life and should be used as a guide on how to best use botulinum toxin injection in treating spasticity after a stroke.

Long-term efficacy of spinal cord stimulation for chronic primary neuropathic pain in the contemporary era: a systematic review and meta-analysis.

Spinal cord stimulation (SCS) is a modern neuromodulation technique extensively proven to be an effective modality for treatment of chronic neuropathic pain. It has been mainly studied for complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS) and recent data almost uniformly establishes its statistically significant positive therapeutic results. It has also been compared with other available treatment modalities across various studies. However, long term data on maintenance of its efficacious potential remains less explored. Few studies have reported data on long follow-up times (>= 12 months) and have compared its efficacy with other treatment options for chronic pain, respectively. Our study pools and analyzes the available data and compares SCS with other treatment options. It also analyzes the efficacy of SCS in long term management of patients with chronic pain. We reviewed all the data available on MEDLINE, Embase and Cochrane CENTRAL using a search strategy designed to fit our pre-set inclusion and exclusion criteria. Both single-arm and double-arm studies were included. The primary outcome was defined as decrease of visual analogue scale (VAS) by >50% at 6, 12 and/or 24 months after SCS. According to the pooled data of double-arm studies, SCS has unanimously proven its superiority over other treatment options at 6 months follow-up; however it fails to prove statistically significant difference in results at longer treatment intervals. Dorsal root ganglion stimulation, a relatively recent technique with the same underlying physiologic mechanisms as SCS, showed far more promising results than SCS. Single-arm studies show around 70% patients experiencing greater than 50% reduction in their VAS scores at 6 and 12 months. SCS is a viable option for management of chronic neuropathic pain secondary to FBSS and CRPS. However, data available for its long term efficacy remains scarce and show no further statistically significant results.

Liver Transplantation: A Right or a Privilege? Sustainable Liver Transplant Financing With an Innovative Model for the Developing World

Living donor liver transplant in addition to its lifesaving therapy is a cost-effective alternate to long-term disease management in patients with chronic liver disease. Financial constraint is the biggest hurdle faced by patients in developing countries in availing the liver transplantation. So, we conducted this study to report a government-funded financial support system for liver transplant services. A total of 198 patients who underwent living donor liver transplant with at least 90 days follow-up were included in the study. According to proxy means test score, 52.2% patients were from low and middle socioeconomic groups and 64.6% of patients underwent liver transplantation through government support. Out of 198 patients who underwent liver transplantation 29.6% had monthly income below 25,000 Pakistani rupees ($114). In recipients, 90-day mortality was 7.1% and morbidity was 67.1%. Donor morbidity was 23.2% without any mortality. This financial model can serve as a valuable source for middle and low income group countries to overcome the financial challenge and make liver transplant an accessible, affordable, and economically viable option.

Biological equivalent dose is associated with radiological toxicity after lung stereotactic ablative radiation therapy

IntroductionStereotactic ablative radiation therapy (SABR) is the standard of care for inoperable early-stage non-small-cell lung cancer. Although the probability of grade ≥ II toxicities is low, many patients present radiological subclinical toxicities usually associated with long-term patient management challenges. We evaluated radiological changes and correlated them with the received Biological Equivalent Dose (BED). MethodsWe retrospectively analyzed chest CT scans of 102 patients treated with SABR. An experienced radiologist evaluated the radiation-related changes 6 months and 2 years after SABR. The presence of consolidation, ground-glass opacities, organizing pneumonia pattern, atelectasis and the extent of affected lung were recorded. Dose-volume histograms of the lung healthy tissue were transformed to BED. Clinical parameters such as age, smoking habits, and previous pathologies were registered and correlations between BED and radiological toxicities were drawn. ResultsWe observed a positive and statistically significant correlation between lung BED over 300 Gy and the presence of organizing pneumonia pattern, the degree of lung affectation and the 2-year prevalence and/or increase of these radiological changes. Radiological changes in patients receiving BED > 300 Gy to a healthy lung volume ≥ 30 cc increased or remained in the 2 years follow-up scan. We found no correlation between radiological changes and the analyzed clinical parameters. ConclusionsThere seems to be a clear correlation between BEDs higher than 300 Gy and radiological changes both short and long term. If confirmed in an independent patient cohort, these findings could lead to the first radiotherapy dose constraints for grade I pulmonary toxicity.

Behavioral Interpretation of Willingness to Use Wearable Health Devices in Community Residents: A Cross-Sectional Study

Wearable health devices (WHDs) have become increasingly advantageous in long-term health monitoring and patient management. However, most people have not yet benefited from such innovative technologies, and the willingness to accept WHDs and their influencing factors are still unclear. Based on two behavioral theories: the theory of planned behavior (TPB) and the diffusion of innovation (DOI), this study aims to explore the influencing factors of willingness to use WHDs in community residents from the perspective of both internal and external factors. A convenience sample of 407 community residents were recruited from three randomly selected Community Health Service Centers (CHSCs) in Nanjing, China, and were investigated with a self-developed questionnaires. The mean score of willingness to use WHDs was 17.00 (range 5-25). In the dimensions of TPB, perceived behavioral control (β = 1.979, p < 0.001) was the strongest influencing factor. Subjective norms (β = 1.457, p < 0.001) and attitudes (β = 0.651, p = 0.016) were also positively associated with willingness. In innovation characteristics of DOI, compatibility (β = 0.889, p < 0.001) and observability (β = 0.576, p = 0.003) had positive association with the willingness to wear a WHD. This study supports the applicability of the two behavioral theories to interpret the willingness to use WHDs in Chinese community residents. Compared with the innovative features of WHDs, individual cognitive factors were more critical predictors of willingness to use.

Inhaled corticosteroids administration/withdrawal as a therapeutic continuum for patients with chronic obstructive pulmonary disease in real clinical practice

Chronic obstructive pulmonary disease (COPD) is a progressing disease. Each exacerbation impairs the patient’s prognosis and increases burden for the healthcare system. The most common maintenance treatment options for COPD include long-acting bronchodilators – β2-agonists (LABA) and long-acting antimuscarinic agents (LAMA), and inhaled glucocorticosteroids (ICS), in fixed/opened double and triple combinations. Triple therapy in subjects with exacerbation history is the most effective way to prevent negative outcomes of the disease. It can reduce the frequency of exacerbations, slow down the disease progression, improve quality of life, and reduce mortality in the long run. On the other hand, the response to triple therapy may change over the time depending on airways inflammation level, infection activity, and exacerbation frequency. Current COPD guidelines propose different indications for therapy escalation and de-escalation (ICS addition/withdrawal) for more personalized and safe treatment. At the same time, many practical issues of this process are still unclear, e.g. how often treatment regimens should be reviewed and what escalation/de-escalation criteria should be prioritized. The authors strongly believe that COPD therapy should adapt a holistic treatment approach (continuum) with quick responses to any changes in the patient’s condition.The aim of our work was to create an algorithm for ICS administration/ withdrawal for COPD patients on long-acting dual bronchodilators maintenance therapy and to establish a therapeutic continuum that takes into account exacerbation history, symptoms severity, blood eosinophilia level, and concomitant asthma.Conclusion. This instrument can be a useful and convenient tool for long-term patient management when access to specialized medical care might be restricted. It takes into account the main current recommendations for COPD management and is easy to apply in real clinical practice.

Long-term risk, clinical management, and healthcare resource utilization of stable patients with coronary artery disease and post-myocardial infarction in Greece - TIGREECE study

BackgroundIn light of the scarcity of evidence, TIGREECE evaluated the clinical management and long-term outcomes of patients at high risk for an atherothrombotic event who have suffered a myocardial infarction (MI), managed by cardiologists/internists in routine hospital and private office settings in Greece. MethodsTIGREECE, a multicenter, 3-year prospective cohort study, enrolled patients ≥50 years old, with a history of MI 1–3 years before enrollment and with at least one of the following risk factors: age ≥65 years, diabetes mellitus requiring medication, second prior MI, multivessel coronary artery disease, and creatinine clearance 15–60 mL/min. The primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death. ResultsBetween 5 June 2014 and 25 July 2015, 305 eligible consented patients (median age: 67.3 years; 81.3% males; 14.8% active smokers; 80.7% overweight/obese) were enrolled; 52.5% had ≥2 qualifying risk factors. The median time from the index MI [ST-segment elevation myocardial infarction (STEMI) in 51.1%, non-STEMI in 33.1%] to enrollment was 1.7 years. Of the patients, 65.9% had been discharged on dual antiplatelet therapy. At enrollment, 94.4% were receiving antiplatelets: 60.0% single [acetylsalicylic acid (ASA): 43.3%; clopidogrel: 15.7%] and 34.4% dual (ASA + clopidogrel: 31.8%) therapy. The Kaplan–Meier estimated 3-year primary composite event rate was 9.3% [95% confidence interval (CI): 6.4–13.0), and the ischemic composite event rate was 6.7% (95% CI: 4.2–9.9). ConclusionsStudy results indicate that in the routine care of Greece one in ten patients experience a recurring cardiovascular event or death, mainly of ischemic origin, 1–3 years post-MI.

P441 Long-term CD treatment failure and dose modification rates with vedolizumab and other biologics: Results from a large prospective observational study

Abstract Background Durable treatment effectiveness is an important consideration in the long-term management of patients with Crohn’s disease (CD) receiving biologic therapy. The aim of this analysis was to evaluate rates of failure and dose modification for biologic treatment over time in patients with CD using data from a large long-term observational study evaluating secondary outcomes in patients initiating treatment on vedolizumab (VDZ) and other biologics. Methods We analysed data from a multicentre, prospective, observational, post-authorisation safety study (PASS; NCT02674308, EUPAS6469) following VDZ or other biologic treatment cohorts under routine standard of care. Longitudinal data on treatment failure (including biologic discontinuation†, IBD non-surgical hospitalization, primary IBD surgery and corticosteroid initiation) up to 36 months and dose modification at any time during the study were analysed in biologic-naïve and biologic-experienced patients with CD in the treatment cohorts. Results The cohort comprised 1338 biologic-naïve patients (pts) (VDZ, n=312; other biologics, n=1026) and 1543 biologic-experienced pts (VDZ, n=829; other biologics, n=714). Baseline pt characteristics (Table 1) were broadly similar across different treatment cohorts, although there were some notable differences with respect to fistulising disease and age at CD diagnosis. Treatment failure rates for biologic-naïve and biologic-experienced pts cumulatively over time at specific time points are shown in Table 2. The proportion of pts continuing biologic treatment with dose modification at any time during the study period for biologic-naïve pts was 13/312 (4.2%) in VDZ-treated pts vs 502/1026 (48.9%) in the group treated with other biologics and 34/829 (4.1%) vs 433/714 (60.6%), respectively for biologic-experienced pts. Conclusion This large observational study reported rates of treatment failure, hospitalization, and IBD-related surgeries during long-term follow-up of biologic-naïve and biologic-experienced pts with CD. Dose modification occurred less frequently in biologic-naïve and biologic-experienced pts treated with VDZ compared with pts receiving other biologic treatments during the study.

Long-term follow-up of patients in fracture liaison services: problems and solutions (literature review and own data)

To reduce the frequency of fragility fractures, Fracture Liaison Services are being created worldwide. One of the most difficult parts in their organization is considered to be the creation of an effective system of long-term patient management. Many factors are involved in this process, concerning the patient, the team of specialist, the peculiarities of the organization of primary health care, and many others. On the one hand, it has been shown that the inclusion of patients in FLS increases their commitment to the implementation of doctor’s recommendations. On the other hand, there are a number of barriers depending both on the characteristics of the patient himself (polymorbidity, severity of the condition, decreased cognitive function, fear of side effects, low motivation to treat osteoporosis) and on various aspects in the medical care organization. The article analyzes the importance of training patients and medical personnel, approaches to the choice of therapeutic tactics, optimization of the process of succession management of patients, the availability of a system of information exchange between medical institutions. Using the example of the Yaroslavl’ FLS, the possibilities of improving various aspects of medical care are analyzed, as well as local problems that arose at various stages of the development of this service, and the measures that were applied to resolve them.

Developing a long-term follow up service for bariatric surgical patients in the community: Patient and professional perspectives.

In the UK, bariatric surgical patients are followed up for 2years post-operatively in hospital settings, before being discharged into General Practice for long-term follow-up. Presently, there is ambiguous guidance as to what should be included in a community-based bariatric surgical follow-up service. The aim of the study was to understand, from both patient and professional perspectives, what is needed to support the long-term management of bariatric surgical patients in community-based settings. Post-surgical bariatric patients and General Practice staff were recruited from an area in the UK which has an National Health Service (NHS) hospital providing a high-volume and established bariatric surgical service. Data was collected through semi-structured interviews. A thematic analytic framework was used to construct eight themes which illuminated the participants' experiences. The study took place between March and December 2021. Thirty participants (14 patients and 16 healthcare professionals) were recruited to the study. The study revealed the lack of a framework for delivery of a long-term follow up service was frustrating to both patients and professionals. Patient participants reported needing more support, especially dietetic and psychological input, and professionals stated they had little knowledge about bariatric surgical care, and what was needed to provide optimal care, but wanted to provide quality patient care. Long-term follow up of bariatric surgical patients is an important issue which needs addressing. This study illuminates both the patient and professional perspectives on developing a pragmatic, community-based service which meets the needs of patients and considers the need to incorporate such a service into existing infrastructures without adding additional demands on General Practice.

Гіпонатріємія у хворих з декомпенсованою серцевою недостатністю

Лекція присвячена гіпонатріємії (ГН), найпоширенішому електролітному розладу в госпіталізованих пацієнтів, який пов’язаний з ризиком небезпечних ускладнень і погіршанням прогнозу. Розглянуто етіологічні фактори та патофізіологічні механізми розвитку ГН, зокрема у хворих з декомпенсованою серцевою недостатністю (СН), клінічні прояви гострої і хронічної ГН. Наведено алгоритм клінічної інтерпретації ГН, діагностики й диференційної діагностики, принципи початкового та довготривалого лікування хворих із СН відповідно до визначеного типу гіпонатріємії. На конкретному клінічному прикладі хворої з тяжкою декомпенсованою СН, ускладненою розвитком ГН, розглянуто практичне ведення пацієнта з ГН.

PS-C20-3: MOBILE MEDICAL APP CAN BE MORE EFFECTIVE IN LONG-TERM MANAGEMENT OF HYPERTENSION PATIENTS

Objective: The application of mobile medical application, APP, to manage patients with hypertension makes the contact between doctors and patients more convenient, saves the economic cost and time cost of patients, and also makes it easier for doctors to manage patients and improve their compliance. This study investigated the effect of APP on long-term management of hypertension patients. Design and method: This trial was a randomized, single-blind, parallel, controlled study. A total of 302 patients with hypertension were included in this study and observed for one year. All the enrolled patients received antihypertensive treatment of nifedipine controlled release tablets with or without telmisartan in outpatient or ward. The APP of the experimental group could be used to push health education information, remind patients to measure their own blood pressure and take medication, and consult doctors online. Blood pressure, improvement of hypertensive target organ injury, and sodium intake were assessed in both groups after one year treatment. Results: There were no significant differences in blood pressure, urinary microalbumin and 24-hour urinary sodium levels between the two groups at baseline. APP information push was more helpful to the control of blood pressure, systolic and diastolic blood pressure decreased significantly, after treatment, systolic blood pressure of experimental group vs control group 133 ± 6mmHg vs 141 ± 11mmHg, P &lt; 0.05; Diastolic pressure 83 ± 7mmHg vs 89 ± 9mmHg, P &lt; 0.05. APP information push was more helpful to improve target organ injury (decrease of microalbuminuria), and microalbuminuria after treatment was 31 ± 12 mg/L vs 47 ± 14 mg/L, P &lt; 0.05. APP information push helped control sodium intake, and the urine sodium level at 24 hours after treatment was 123 ± 31 mmol/24 h vs 148 ± 28 mmol/24 h, P &lt; 0.05. Conclusions: Using mobile medical APP for patient management can help control patients’ blood pressure level, improve the degree of renal damage caused by hypertension, and help control sodium intake. APP can be used as an auxiliary means for long-term management of hypertension patients, which can improve the quality of blood pressure management of patients more effectively, conveniently and economically.

Metabolic and Renal Protective Benefits of Magnesium Supplementation in the Long-Term Management of Patients with Type 2 Diabetes Mellitus

Metabolic and Renal Protective Benefits of Magnesium Supplementation in the Long-Term Management of Patients with Type 2 Diabetes Mellitus

Targeting Skeletal Muscle Dysfunction With L-Carnitine for the Treatment of Patients With Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is a major medical problem and the world's third leading cause of death. COPD is a chronic disease with heterogeneous clinical symptoms, disease progression, and treatment responses. Besides pulmonary symptomatology, the common systemic clinical manifestations are cachexia, muscle weakness, and widespread comorbidities such as cardiovascular diseases, diabetes, osteoporosis, and infections. The adverse effects of pharmaceutical therapies contribute to the difficulty of health risk assessment and management of COPD patients. This review shows how skeletal muscle dysfunction and metabolic abnormalities contribute significantly to COPD patients' symptoms, functional activities, quality of life, and overall disease outcomes. Based on the clinical evidence of L-carnitine and derivatives as metabolic and muscle bioenergetic enhancers, we propose broader research and implementation of this nutraceutical agent as an effective, inexpensive, and safe adjuvant therapeutic for the long-term management of COPD patients. Moreover, we believe the management of COPD as a chronic disease should be shifted from symptomatic reactive pharmaceutical intervention to more constructive and non-toxic approaches using a single or combination of natural and nutritional agents with potential muscle metabolic enhancing and immunomodulating activities to achieve a better overall outcome for the patients in terms of morbidity, mortality, and medical cost-reduction.

Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.

Statin therapy is the standard of care for patients with carotid artery stenosis given its proven cardiovascular benefits. However, the impact of statin therapy on outcomes in patients undergoing carotid revascularization in the Vascular Quality Initiative has not yet been evaluated. Therefore, our aim was to investigate the association of statin therapy with outcomes following carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), and transcarotid artery revascularization (TCAR). We identified all patients who underwent CEA, tfCAS, or TCAR in the Vascular Quality Initiative registry from January 2016 to September 2021. To compare outcomes, we stratified patients by procedure type and created 1:1 propensity score-matched cohorts of patients who received no preoperative statin therapy (within 36hours of procedure) versus those who received preoperative statin therapy. Propensity scores incorporated demographic characteristics, comorbidities, carotid symptom status, preoperative medications, and physician and hospital procedural experience. The primary outcome was a composite end point of in-hospital stroke and/or death. As a secondary analysis, we performed repeat propensity score-matching by postoperative statin use (prescribed at discharge) and assessed 5-year mortality. Relative risks (RR) and hazard ratios (HR) were calculated using log binomial regression and Cox regression, respectively. Among 97,835 CEA, 20,303 tfCAS, and 22,371 TCAR patients, 15%, 17%, and 10% of patients did not receive preoperative statin therapy, respectively. Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death among 13,434 matched CEA patients (no statin, 1.7% vs statin, 1.4%; RR, 1.2; 95% confidence interval [CI], 1.02-1.5) and among 2707 matched tfCAS patients (4.8% vs 2.8%; RR, 1.7; 95% CI, 1.3-2.3). However, there was no difference for this outcome by statin use among 2089 matched TCAR patients (1.8% vs 1.6%; RR, 1.1; 95% CI, 0.7-1.8). At5years, no statin therapy at discharge was associated with higher 5-year mortality after CEA (15% vs 10%; HR, 1.8; 95% CI, 1.6-2) and tfCAS (18% vs 14%; HR, 1.5; 95% CI, 1.2-1.8), but there was no difference after TCAR (14% vs 11%; HR, 1.3; 95% CI,0.9-1.8). Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death and 5-year mortality among CEA and tfCAS patients. Although there was no significant difference in outcomes among TCAR patients, this may in part be due to lower statistical power in this cohort. Overall, statin therapy is essential in the short- and long-term management of patients undergoing carotid revascularization. Our findings not only support current Society for Vascular Surgery recommendations for statin therapy in patients undergoing carotid revascularization, but they also highlight an important opportunity for quality improvement.

Predictive models for endoscopic disease activity in patients with ulcerative colitis: Practical machine learning-based modeling and interpretation.

Endoscopic disease activity monitoring is important for the long-term management of patients with ulcerative colitis (UC), there is currently no widely accepted non-invasive method that can effectively predict endoscopic disease activity. We aimed to develop and validate machine learning (ML) models for predicting it, which are desired to reduce the frequency of endoscopic examinations and related costs. The patients with a diagnosis of UC in two hospitals from January 2016 to January 2021 were enrolled in this study. Thirty nine clinical and laboratory variables were collected. All patients were divided into four groups based on MES or UCEIS scores. Logistic regression (LR) and four ML algorithms were applied to construct the prediction models. The performance of models was evaluated in terms of accuracy, sensitivity, precision, F1 score, and area under the receiver-operating characteristic curve (AUC). Then Shapley additive explanations (SHAP) was applied to determine the importance of the selected variables and interpret the ML models. A total of 420 patients were entered into the study. Twenty four variables showed statistical differences among the groups. After synthetic minority oversampling technique (SMOTE) oversampling and RFE variables selection, the random forests (RF) model with 23 variables in MES and the extreme gradient boosting (XGBoost) model with 21 variables in USEIS, had the greatest discriminatory ability (AUC = 0.8192 in MES and 0.8006 in UCEIS in the test set). The results obtained from SHAP showed that albumin, rectal bleeding, and CRP/ALB contributed the most to the overall model. In addition, the above three variables had a more balanced contribution to each classification under the MES than the UCEIS according to the SHAP values. This proof-of-concept study demonstrated that the ML model could serve as an effective non-invasive approach to predicting endoscopic disease activity for patients with UC. RF and XGBoost, which were first introduced into data-based endoscopic disease activity prediction, are suitable for the present prediction modeling.

Mid-term follow-up chest CT findings in recovered COVID-19 patients with residual symptoms.

More than a year has passed since the initial outbreak of SARS-CoV-2, which caused many hospitalizations worldwide due to COVID-19 pneumonia and its complications. However, there is still a lack of information detailing short- and long-term outcomes of previously hospitalized patients. The purpose of this study is to analyze the most frequent lung CT findings in recovered COVID-19 patients at mid-term follow-ups. A total of 407 consecutive COVID-19 patients who were admitted to the Fondazione IRCCS Policlinico San Matteo, Pavia and discharged between February 27, 2020, and June 26, 2020 were recruited into this study. Out of these patients, a subset of 108 patients who presented with residual asthenia and dyspnea at discharge, altered spirometric data, positive lung ultrasound and positive chest X-ray was subsequently selected, and was scheduled to undergo a mid-term chest CT study, which was evaluated for specific lung alterations and morphological patterns. The most frequently observed lung CT alterations, in order of frequency, were ground-glass opacities (81%), linear opacities (74%), bronchiolectases (64.81%), and reticular opacities (63.88%). The most common morphological pattern was the non-specific interstitial pneumonia pattern (63.88%). Features consistent with pulmonary fibrosis were observed in 32 patients (29.62%). Our work showed that recovered COVID-19 patients who were hospitalized and who exhibited residual symptoms after discharge had a slow radiological recovery with persistent residual lung alterations. This slow recovery process should be kept in mind when determining the follow-up phases in order to improve the long-term management of patients affected by COVID-19.