Long-term Outcomes Research Articles

The impact of the Naples prognostic score in long-term outcomes after percutaneous coronary intervention for chronic total occlusions.

Chronic total occlusions (CTOs) of coronary arteries present a significant challenge in cardiology, with long-term outcomes following percutaneous coronary intervention (PCI) for CTOs remaining variable and unpredictable. The Naples prognostic score (NPS), which incorporates markers of nutritional status and systemic inflammation, has shown potential in predicting outcomes in various cardiovascular settings. This study evaluates the NPS as a predictor of long-term outcomes after PCI for CTOs. A retrospective analysis was conducted on 287 patients who underwent coronary angiography. Patients were categorized into non-CTO-PCI and CTO-PCI groups. Patients were further stratified based on survival status. Cox regression and Kaplan-Meier survival analyses were used to evaluate the association between NPS and long-term outcomes. The mean age of the study population was 63.5 ± 10.6 years, with 28.6% being female. The NPS was significantly higher in the CTO-PCI group compared to the non-CTO-PCI group ( P = 0.004) and was also elevated in the non-survival group ( P = 0.004). Multivariable Cox regression analysis identified NPS as an independent predictor of mortality ( P = 0.015). Kaplan-Meier analysis demonstrated significantly higher mortality in patients with an elevated NPS ( P = 0.009). The NPS is a valuable independent predictor of long-term mortality in patients undergoing CTO-PCI. Incorporating NPS into existing risk stratification models could improve predictive accuracy and guide individualized patient management. Further prospective studies are warranted to validate these findings and explore interventions targeting inflammation and nutrition in this high-risk population.

Myocardial Revascularization in Heart Failure With Reduced Ejection Fraction.

Heart failure (HF) patients with reduced ejection fraction (HFrEF) now more commonly die of non-cardiovascular causes than they did in the past. In patients with both HFrEF and ischemic cardiomyopathy (as the cause of HFrEF or as an accompanying condition), the effect of myocardial revascularization-i.e. percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)-on long-term outcome is unclear. This review is based on publications that were retrieved by a selective search of the literature for pertinent clinical studies and current guidelines. Drug treatment for HFrEF has markedly prolonged these patients' survival. In a comparative study, HF pharmacotherapy was found to add an average of 8.3 years to the lifespan of a 55-year-old patient with HFrEF. Three of the four randomized controlled trials on revascularization procedures were conducted prior to the major pharmacotherapy improvements leading to better outcomes in HF patients over the past decade. These trial data indicate a long-term benefit from CABG compared to medical treatment alone in patients with HFrEF and severe coronary heart disease. For example, in the STICH trial, the hazard ratio for death from any cause after a follow-up time of nearly 10 years was 0.84 (95% confidence interval, [0.73; 0.97]). The role of pre-procedural myocardial viability and ischemia testing remains to be fully determined. The choice of method for myocardial revascularization should be discussed within an interdisciplinary cardiac team in consideration of the patient's symptoms and ischemic burden, the complexity of the coronary findings, as well as the patient's perioperative risk and current medical HF therapy. No RCTs comparing CABG to PCI are yet available. Optimal guideline-directed medical therapy is a key determinant of long-term survival in patients with HFrEF.

Incidence and Outcomes of Cataract in Eyes with Ocular Cicatricial Pemphigoid

ABSTRACT Purpose To identify the incidence of cataract and the outcomes of cataract surgery in eyes with ocular cicatricial pemphigoid (OCP) Methods Phakic eyes were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study and followed for the incidence of visually significant cataract defined as: newly reduced visual acuity 20/50 or worse attributed to cataract; and/or incident cataract surgery. Secondarily, all eyes with OCP that underwent cataract surgery and had a year of follow up thereafter, were included in an analysis of visual outcome. Results Three hundred fifty-five phakic eyes (200 patients) with OCP were at risk. Eighty eyes developed visually significant cataract over 1064 eye years (incidence rate = 7.5%/eye-year, 95% confidence interval [CI] = 5.6 to 10.1). Higher age was associated with increased incidence of cataract (adjusted hazard ratio [aHR] = 4.47; 95% CI, 1.95–10.23 for age 60–75 inclusive and aHR = 8.37; 95% CI, 3.60–19.42 for age > 75, each compared with age <60 years). Seventy-nine eyes of 61 patients were monitored for > = 1 year following cataract surgery. Cataract surgery was associated with an improvement of vision around 4 lines, which was sustained through at least 48 months. Poorer pre-operative visual acuity was associated with poorer long-term visual outcome. Conclusions The incidence of cataract was high in this older population. No factors predictive of cataract such as duration of OCP or use of corticosteroids were identified. Visual acuity improved after surgery by a median of 4 lines’ gain at one year; poorer long-term outcome among those with initially poorer visual acuity may be secondary to corneal scarring.

Advances and challenges in peroral endoscopic myotomy: Safety, precision, and post-procedure management

Peroral endoscopic myotomy (POEM) has revolutionized the treatment of upper gastrointestinal tract motility disorders, particularly achalasia. This editorial explores the efficacy, safety, and challenges of POEM, emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events. The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration, especially regarding anesthetic considerations. Despite significant advances, challenges remain in standardizing safety protocols and managing complications. As POEM applications expand, precision endoscopy continues to enhance therapeutic outcomes, promising a transformative impact on gastrointestinal motility disorder management.

Elucidating the need for inclusion of burn in graduate and continuing dermatologic medical education.

The management of acute burn wound and chronic burn scar typically involves burn specialists, yet patients often rely on dermatologists to address post-burn sequelae associated with burn injury and scar. However, there is a lack of burn-specific education, exposure, and overall confidence in managing burn within the field of dermatology. This research correspondence provides a brief review of published literature pertaining to themes such as the lack of burn resources and a potential increased risk of skin cancer after a burn injury. Additionally, this correspondence explains the rationale for why increased burn-related training within dermatology is necessary to optimize care and to improve patient outcomes. Challenges regarding the integration of burn education into dermatology will also be explored. All in all, the development of a greater number of burn-specific Graduate Medical Education (GME) and Continuing Medical Education (CME) opportunities will adequately address resource disparity through an expanded awareness of burn pathogenesis, treatment, and long-term outcomes.

Clinical and Radiological Outcome of Posterior Cervical Fusion Using Philips AlluraXper FD20 Angiography Suite

Background: Posterior cervical fusion (PCF) is widely used for cervical spinal cord decompression with/without fusion. In our hybrid operating room, intraoperative computed tomography (iCT) is routinely used to verify screw placement. This study analyzed clinical and radiological outcomes after PCF and evaluated iCT benefits for detecting screw misplacement. Methods: Nineteen patients underwent PCF between March 2012 and April 2016 for degenerative (n = 6), neoplastic (n = 7), and traumatic (n = 6) conditions. Seven patients had primary PCF, while twelve underwent PCF following anterior fusion due to segmental instability with cervical malalignment (n = 11) or tumor progression (n = 1). Results: The mean patient age was 59 ± 11 years, with 63% male patients. The median follow-up was 21 months. PCF averaged 4.74 segments (range: 1–9). At follow-up, 79% reported pain improvement and normal sensorimotor function. Of six patients with preoperative paresis, five showed improved muscle strength. No persistent gait disturbances occurred. Complications requiring revision occurred in four patients (21%): three surgical site infections and one cerebrospinal fluid leak. One perioperative death occurred (5%). iCT detected incorrect screw placement in seven patients (36%), allowing the immediate repositioning of eight screws, preventing later revision surgeries. The overall fusion rate was 92%. Conclusions: PCF with iCT is safe and effective for various cervical spine pathologies, yielding good long-term clinical outcomes. iCT effectively detects and enables immediate correction of screw malposition, reducing revision surgery needs. This imaging modality demonstrates high sensitivity and specificity for identifying clinically relevant screw malpositions.

Paradox in the research of gestational diabetes mellitus and twin pregnancies: Perspective and future directions.

Gestational diabetes mellitus (GDM) is well known to be associated with fetal overgrowth and short- or long-term adverse outcomes in singleton pregnancies; however, its relationship with twin pregnancies remains controversial, posing challenges for clinical management. Despite the heterogeneity in GDM diagnosis and racial differences among populations, two critical issues remain unaddressed. The first issue is methodological, specifically whether data on twins have been analyzed using appropriate approaches. The second issue is the underlying pathophysiology'. Given that both glucose demand and insulin resistance are elevated in twin pregnancies, the optimal level of maternal insulin secretion remains uncertain. In this paper, we summarize the current knowledge on GDM in the context of twin pregnancies, their perinatal outcomes, glucose control, and gestational weight gain management. We then propose methodological considerations for future improvements. Ultimately, we underscore the importance of delving into the glucose requirements of twin pregnancies to gain a profound understanding of their gestational glucose and insulin metabolism. All these questions are key issues in this area, and by answering them we will accelerate the development of high-quality, evidence-based clinical guidelines for GDM management in twin pregnancies.

Update on long-term outcomes of a cohort of patients with TCF3::HLF positive acute lymphoblastic leukemia treated with blinatumomab and stem cell transplantation.

Not available.

The importance of the posterior osteoligamentous complex of the lumbar spine: dogma changing biomechanical insights.

During full flexion of the spine, the paraspinal muscles are largely inactive. This suggests that passive structures like the posterior osteoligamentous complex (POLC), consisting of interspinous and supraspinous ligaments and the spinous processes, play a key role in spinal stability and protection of the spinal column. The POLC, however, is often resected or damaged during spinal decompression surgeries, whereas the biomechanical implications of this resection or damage are not yet fully understood. A stepwise reduction study was performed on three fresh frozen cadaveric torsi (aged 30-78 years) using a custom setup which only allows sagittal plane motion. After preloading and locking in full flexion, the posterior lumbar structures were gradually resected in the following order: Skin, fascia, musculature, facet joints, ligamentum flavum, posterior ligamentous complex, and posterior longitudinal ligaments. Load cells measured force increase on the fixation frame after each resection step. The load increased sequentially with each resection, demonstrating load transfer from the passive structures onto the fixation frame. The POLC, including the supraspinous and interspinous ligaments at L2-L5, accounted for 69 - 74% of the measured passive load resistance in full flexion, representing the largest contribution. Facet joints with their capsules contributed 10-18%, while muscular contributions were negligible (< 2%). The experiment indicates that the POLC is the primary passive stabilizer of the fully flexed lumbar spine. Surgical resection of this structure can redistribute loads and increase stresses on remaining spinal tissues, potentially leading to spinal instability, accelerated degeneration, and poor clinical long-term outcomes.

Derivation and Validation of Risk Score Including Nutritional Status Among Patients With Chronic Limb-threatening Ischemia: Insight From I-PAD NAGANO Registry.

Geriatric nutritional related index (GNRI) is a simple and well-established screening method of nutritional status. We aimed to develop and validate a scoring system including GNRI to predict long-term outcomes in patients with chronic limb-threatening ischemia (CLTI) undergoing endovascular treatment (EVT). Patients undergoing EVT for symptomatic LEAD from August 2015 to August 2016 were enrolled into the I-PAD NAGANO registry, a prospective, multicenter, observational registry. We identified predictors of amputation-free survival (AFS) at 5 years using Cox proportional hazards regression and developed a risk scoring system. The predictive performance of the risk score was assessed. A total of 126 patients with CLTI were analyzed. Cox multivariate analysis revealed GNRI score <92 points, ≥72 years of age, hemodialysis, heart failure, and anemia to be significant predictors. We developed a 5-item risk score (I-PAD CLTI score) assigning points to each factor based on the magnitude of association with AFS at 5 years. The I-PAD CLTI score showed a c-index of 0.80 for 5-year AFS. Patients with high score (≥7 points, n=50) had an increased risk of AFS at 5 years compared with those with low score (<7 points, n=68) (26.5% vs 72.1%, p<0.001). A simple 5-item risk score including nutritional status showed reasonable discriminative and prognostic ability for long-term AFS among patients with CLTI. The I-PAD CLTI score, a simple five-item risk score including nutritional status determined by geriatric nutritional related index, showed reasonable discriminative and prognostic ability for long-term amputation free survival among patients with chronic limb-threatening ischemia. This risk score may be useful for clinicians to accurately predict patient's prognosis and thus identify high-risk patients who may derive the greater clinical benefit from more intensive risk modification. Further research is required to test the clinical utility of risk-score-based treatment approach to improve the prognosis of patients with chronic limb-threatening ischemia.

Coil or Plug-Assisted Retrograde transvenous obliteration (CARTO/PARTO) for treating portal hypertensive variceal bleeding: A multi-center, real-world 10-year retrospective study

Background &amp; Aims: CARTO and PARTO are well-accepted treatment for gastric variceal (GV) bleeding. However, long-term (&gt;2 years) clinical outcomes have yet to be studied. In this study, we investigated long-term clinical outcomes, including overall survival (OS) in 10 years Methods: We performed a multi-national, multi-center, retrospective study of CARTO/PARTO in GV treatments between 05/2012 and 07/2024. The primary study outcomes were a long-term OS and prognostic factors of CARTO/PARTO. The secondary outcomes were long-term clinical/technical success, complications, clinical changes including portal hypertensive symptoms. Results: A total of 311 patients (41% female; 69% CARTO) from 13 centers in five countries were included. The cumulative 1-, 3-, 5-, 7-, and 10-year OS rates were 98, 80, 68, 52, and 33%, respectively, with a median OS of 99 months. Prophylactic CARTO/PARTO showed a better OS than CARTO/PARTO for active bleeding (p=0.00035). The independent prognostic factors of OS were having high pre-MELD, concurrent HCC, treating GOV2, history of esophageal variceal bleeding, high pre-TBili, and ammonia levels. Notably, a high pre-MELD score &gt;27 had a significantly higher mortality rate (92.6%) than a lower pre-MELD score (p&lt;0.001). The overall cumulative 1-, 3-, 5-, 7-, and 10-year recurrent GV bleeding rates were 0.9, 3.2, 4.0, 4.5, and 5.4%, respectively. The overall technical and clinical success rates were 96.5% and 95.3%, respectively, with a 4.5% major complication rate over 10 years. Conclusions: CARTO and PARTO have excellent long-term survival and clinical outcomes. However, these are negatively affected by high MELD scores, concomitant HCC, and coexisting esophageal varices.

A Markov model assessing the cost-effectiveness of various anti-vascular endothelial growth factor drugs and panretinal photocoagulation for the treatment of proliferative diabetic retinopathy.

Proliferative diabetic retinopathy (PDR) may lead to vision loss and blindness. The cost-effectiveness of various anti-vascular endothelial growth factor (anti-VEGF) drugs and panretinal photocoagulation (PRP) was assessed to supplement the NICE guideline for treating PDR. A Markov model including eight levels of visual acuity (ranged between >85 and ≤25 letters) was developed to compare the cost-effectiveness of ranibizumab, aflibercept and bevacizumab with PRP (alone or in combination). Clinical inputs in the model were based on literature, while a published network meta-analysis (NMA) informed visual outcomes. Costs were estimated from a UK NHS perspective. Assuming initial treatment effects from the NMA continued to be applied for the remainder of lifetime, the probabilistic analysis resulted in bevacizumab plus PRP producing the highest net monetary benefit (NMB [95% CI]) of £221,374 [£203,941-£238,388] at £20,000 per quality-adjusted life-year. However, assuming initial treatment effects stabilised over time resulted in PRP alone producing the highest NMB of £223,416 [£209,318-£236,866]. Results were associated with large uncertainty due to wide confidence intervals around vision-based treatment effects of anti-VEGFs versus PRP, particularly for bevacizumab as data were drawn from trials with small sample size and high risk of bias. Using confidential prices for aflibercept and ranibizumab did not change the overall findings. PRP is likely to be more cost-effective than anti-VEGFs for PDR. However, the results should be interpreted with caution given the scarcity of long-term visual outcomes with anti-VEGFs in this population. Further research on long-term visual outcomes may resolve these uncertainties.

A systematic review and meta-analysis investigating gender differences in in-hospital, short-term and long-term outcomes among patients who underwent primary PCI.

To assess how gender disparities impact major adverse cardiovascular events during hospitalization, as well as in the short and long term, among patients with ST-elevation myocardial infarction who undergo primary PCI. PubMed, Scopus and Cochrane database were searched for relevant studies. Studies were included if all comers with STEMI, reported gender specific patient characteristics, treatments and outcomes. Odds ratio and 95% confidence interval were calculated using random effect model. A total of 23 studies were included for the pooled meta-analysis. Average age of female at presentation was 68.61±3.91 years while in male was 60.83±2.48 years. In unadjusted analysis, female patients were at higher risk for mortality (OR=1.98, 95% CI: 1.71-2.30, P<0.0001, I2=35%) at hospitalization, (OR=2.25, 95% CI=1.75-2.88, P≤0.00001) at short term and (OR=1.76, 95% CI: 1.41-2.21, P<0.000, I2=68%) at long term. The adjusted analysis of major adverse cardiovascular events for short term (OR=1.09, 95% CI: 0.91-1.31, P=0.37, I2=76%) and long term (OR=1.05, 95% CI: 0.98-1.12, P=0.17, I2=37%) were not found significant between both genders. However, it remained significant during hospitalization (OR=1.12, 95% CI: 1.03-1.22, I2=15%, Tau2=0.00). The findings of this comprehensive meta-analysis indicate higher major adverse cardiac events among women with STEMI who underwent PPCI. After adjusting for comorbidities, the difference between women and men showed insignificant at short term and long term but remained significant at in-hospital. Female patients exhibited a higher prevalence of cardiovascular risk factors than men. Implementing intensive cardiovascular risk reduction strategies in women may offer a pathway to address this gender disparity.

Multimodality Therapy Including Pleurectomy/Decortication in Pleural Mesothelioma: Long-Term Outcomes in 152 Consecutive Patients A Retrospective Cohort Study.

Evaluate the long-term outcomes of pleurectomy decortication, systemic chemotherapy and prophylactic radiotherapy in pleural mesothelioma (PM). There is no known cure for PM and cytoreductive surgery remains controversial. Retrospective analysis of a cohort of patients treated consecutively between October 2004 and October 2019. Patients with PM were referred to our clinic and those with favorable prognostic factors and with completely resectable disease were selected for trimodality therapy. Our treatment protocol involved total pleurectomy decortication (P/D) and hyperthermic intrapleural povidone-iodine, prophylactic chest wall radiotherapy and systemic chemotherapy. 18FDG-PET-CT was used routinely to diagnose disease recurrence. Further systemic therapies were administered when appropriate. Survival and prognostic factors were analyzed using the Kaplan-Meier method and univariate and multivariate Cox regressions. 152 consecutive patients had P/D performed with curative intent. Median age was 64 years and the male/female ratio was 123/29. Thirty-one patients (20.4%) had received chemotherapy preoperatively. Thirty-five patients (23%) underwent extended resections. Sixty-four patients (42%) suffered a postoperative complication, but 90-day mortality was nil. Histological types were epithelioid in 107 patients (70.4%) and non-epithelioid in 45 (29.6%). Pathological stages were: I:88, II: 0, III: 63, and IV:1 (8th TNM classification). Six patients (4%) did not receive systemic chemotherapy and three (2%) no radiotherapy, postoperatively. Seventy-four patients (48.7%) received further systemic therapies for relapse. Median overall survival was 31.7 months, 35.0 months for epithelioid and 18.3 months for non-epithelioid histology. Histological type was the only predictor of overall survival, independent of resection status, pathological stage, or lymph node status, on multivariate analysis. P/D is a safe and well-tolerated procedure resulting in no mortality and acceptable morbidity. Most patients can receive radiotherapy and systemic chemotherapy in due time and receive further therapies on relapse, resulting in prolonged survival mainly in those with early-stage epithelioid mesothelioma.

Laparoscopic-assisted colostomy with anorectal malformation: friend or foe?

Abstract Purpose The standard management of anorectal malformations (ARM) without perineal fistula involves fecal diversion via a sigmoid colostomy. This report aims to describe our initial experience and evaluate the feasibility and benefits of laparoscopically-assisted loop colostomy in a neonate with ARM without perineal fistula, addressing the question of whether this minimally invasive approach offers advantages over traditional open techniques. Methods We report the case of a full-term male newborn with an imperforate anus. A laparoscopic-assisted loop colostomy was performed on the second day of life. Three trocars were used: a 5 mm umbilical port for the laparoscope and two 3 mm ports on the flanks. The surgical technique, including trocar placement, bowel mobilization, stoma creation, and closure, is described. The postoperative course and long-term outcomes were monitored over 17 months, including subsequent anorectoplasty and stoma closure. Results The laparoscopic approach provided superior visualization of pelvic anatomy, enabling accurate identification of the fistula and optimal stoma placement. Postoperatively, the patient exhibited early stoma function, rapid recovery, and no complications such as urinary tract infections or stomal issues. Follow-up procedures, including anorectoplasty and colostomy closure, were performed without incident. The patient remains healthy and complication-free at 17 months of age Conclusion Laparoscopic-assisted colostomy offers distinct advantages over the open technique, including reduced complications, improved recovery, and favorable cosmetic outcomes. This minimally invasive method represents a promising alternative for ARM management, aligning with modern pediatric surgical advancements.

Clinical presentation of bone tumours in children and young people: a systematic review and meta-analysis.

Children and young people (CYP) with bone tumours often experience lengthy intervals prior to diagnosis that can lead to increased morbidity and mortality. Early diagnosis is key to optimising treatment options and long-term outcomes. This review aims to describe symptomatology at diagnosis, in order to develop interventions to accelerate diagnosis. A literature search of MEDLINE and EMBASE was conducted for studies published between January 2008 and May 2023, reporting signs and symptoms in CYP with bone tumours. Pooled proportions of symptoms and signs were calculated. 16 studies (1452 patients; 492 osteosarcoma and 932 Ewing's sarcoma) were included in the analysis. The most prevalent symptoms were pain (64%, 95% CI 52% to 75%) and swelling (22%, 95% CI 6% to 42%). Other symptoms included fever, pain and swelling, history of trauma, pathological fracture, palpable mass, functional limitation, increased volume and limp. Subanalysis identified differences in symptom clusters: osteosarcoma more frequently presented with a history of trauma, pathological fracture, pain on weight-bearing, pain worse at night, pain at rest and weight loss. Ewing's sarcoma was associated with fever, functional limitation and a palpable mass. These data highlight the differences in presentations between osteosarcoma and Ewing sarcoma, which may account for differences in survival and outcome. This will be used to inform professional and public health interventions through the Child Cancer Smart campaign to accelerate diagnosis for all. This review also highlights the need for a renewed research focus to identify patients earlier in the disease development as a strategy to improve the current static outcomes.

Home Environment as a Therapeutic Target for Prevention and Treatment of Chronic Diseases: Delivering Restorative Living Spaces, Patient Education and Self-Care by Bridging Biophilic Design, E-Commerce and Digital Health Technologies

A high prevalence of chronic diseases exposes diverse healthcare pain points due to the limited effectiveness of pharmaceutical drugs and biologics, sedentary lifestyles, insufficient health literacy, chronic stress, unsatisfactory patient experience, environmental pollution and competition with commercial determinants of health. To improve patient care and long-term outcomes, the impact of the home environment is overlooked and underutilized by healthcare. This cross-disciplinary work describes perspectives on (1) the home environment as a therapeutic target for the prevention and treatment of chronic diseases and (2) transforming health-centric household goods e-commerce platforms into digital health interventions. We provide a rationale for creating therapeutic home environments grounded in biophilic design (multisensory, environmental enrichment) and supporting physical activities, quality sleep, nutrition, music, stress reduction, self-efficacy, social support and health education, hence providing clinical benefits through the modulation of the autonomic nervous system, neuroplasticity and behavior change. These pleiotropic “active non-pharmacological ingredients” can be personalized for people living with depression, anxiety, migraine, chronic pain, cancer, cardiovascular and other conditions. We discuss prospects for integrating e-commerce with digital health platforms to create “therapeutic home environment” interventions delivered through digital therapeutics and their combinations with prescription drugs. This multimodal approach can enhance patient engagement while bridging consumer spending with healthcare outcomes.

Retraction Note: Pediatric skull fractures: neurosurgical approaches and long-term outcomes.

Retraction Note: Pediatric skull fractures: neurosurgical approaches and long-term outcomes.

Risk Factors and Long-Term Outcomes of Acute Kidney Disease in Hematopoietic Stem Cell Transplant—Cohort Study

Background: Acute kidney disease (AKD) is a recent definition reflecting ongoing physiopathological processes of an acute renal injury (AKI). Information on AKD in hematopoietic stem cell transplant (HSCT) is scarce and there is no available data on long-term outcomes. We aimed to determine the cumulative incidence of AKD in the first 100 days after HSCT; to identify risk factors for AKD in HSCT; and to determine the impact of AKD in 3-year overall survival and relapse-free survival in HSCT. Methods: A retrospective cohort study was conducted, considering AKD when AKI was present and the patient continued to meet the KDIGO criteria (creatinine and/or urinary output criteria) for 7 days or more. Survival analysis methods considering competing events were used for risk factors and disease-free survival, Cox proportional regression for overall survival, and stepwise regression methods for multivariable models. Results: We enrolled 422 patients. AKD incidence was 22.9% (95% CI: 19.2–27.4%). Higher body mass index (HR: 1.05, 95% CI 1.01–1.10; p = 0.034), HCT-CI score ≥ 2 (HR: 1.83, 95% CI 1.11–3.13; p = 0.027), allogeneic transplantation (HR:2.03, 95% CI 1.26–3.33; p = 0.004), higher C-reactive protein (HR:1.01, 95% CI 1.01–1.02; p &lt; 0.001), and exposure to nephrotoxic drugs (HR: 4.81, 95% CI 1.54–4.95; p = 0.038) were independently associated with AKD. AKD had a significant impact on overall survival (HR: 1.75; 95% CI 1.27–2.39; p = 0.001). Conclusion: An awareness of the risk factors for AKD allows the identification of high-risk patients, enabling the timely implementation of preventive measures to alleviate the progression and impact of the disease.

Stent as a bridge to surgery for malignant colonic obstruction: a retrospective study on survival and outcomes

BackgroundIn cases of malignant colonic obstruction (MCO), self-expandable metallic stents (SEMS) are used as a bridge to surgery, offering an alternative to emergency surgery. However, the long-term oncologic outcomes remain debated, particularly in developing countries where the cost of SEMS is a concern. This study aimed to evaluate overall survival (OS) and outcomes associated with SEMS as a bridge to surgery (SBTS) compared to direct emergency surgery (ES) in patients with acute MCO.MethodsA retrospective study was conducted, including patients with potentially curable obstructed colon cancer who were treated with either SBTS or ES at a university hospital in Thailand from 2015 to 2022. We compared OS, 5-year OS rate, disease-free survival (DFS), postoperative morbidity, and complications between the SBTS and the ES groups.ResultsA total of 106 patients were eligible, 29 underwent SBTS, and 77 underwent ES. Baseline characteristics were similar except for ASA classification and chemotherapy rates. The median OS was 56.1 months, with no significant differences in OS (51.4 vs. 61.0 months, p = 0.67) or 5-year DFS (53.8% vs. 59.9%, p = 0.32) between the two groups. The SBTS group had higher rates of minimally invasive surgery (MIS) (65.5% vs. 16.9%, p < 0.001) and shorter postoperative stays (POS) (7 vs. 9 days, p = 0.026). Stage IV cancer and low serum albumin were poor prognostic factors for OS.ConclusionSEMS placement as a bridge to surgery had no significant impact on OS compared to ES, but it was associated with shorter hospital stays and higher rates of MIS.