Preprocedural Levels Research Articles

Association and Prognostic Implication of C-Reactive Protein with Risk of 1-Year Death or Disabling Stroke After Transcatheter Aortic Valve Replacement

ABSTRACT Background : Recent data suggest that serum biomarkers may predict worse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). We examined the association and predictive value of preprocedural levels of C-reactive protein (CRP) with clinical outcomes after TAVR. Methods : We evaluated 243 patients who had undergone successful TAVR and had a valid measurement of baseline CRP level between March 2010 and February 2017. The primary endpoint was the composite of death from any cause or disabling stroke at 12 months. Results : During follow-up (median, 13.7 months), primary outcome events occurred in 18 patients (8.2%), including 14 deaths (6.7%) and 5 disabling strokes (2.1%). Patients with high serum levels of CRP (≥3.0 mg/L) had a significantly higher 1-year rate of death or disabling stroke compared to those with normal CRP levels (16.7% vs. 5.5%, P = 0.009). In the multivariate Cox-proportional hazard model, an elevated level of CRP was identified as an independent predictor of 1-year death or disabling stroke (hazard ratio, 2.84; 95% confidence interval, 1.10–7.34; P = 0.03). After the addition of information about CRP concentration to the Society of Thoracic Surgeons (STS) score model, the C-index for the prediction of death or disabling stroke substantially increased from 0.655 to 0.710, and a continuous net reclassification improvement of 0.529 (0.054–1.004) was noted. And there was no significant relationship between the primary outcome and other biomarkers, included B-type natriuretic peptide (BNP) and troponin I, in our study. Conclusions : In patients undergoing TAVR, elevated CRP levels were significantly associated with an increased risk of death or disabling stroke and also augmented event prediction, suggesting that CRP could be used as biomarker into a risk prediction model for TAVR.

Predictive value of preprocedural procalcitonin for short- and long-term mortality after transfemoral transcatheter aortic valve implantation.

Current risk scores used for patients undergoing transcatheter aortic valve implantation (TAVI) do not reliably predict adverse events after TAVI. Procalcitonin (PCT) is associated with increased atherosclerotic burden and adverse outcomes in patients with cardiovascular disease. The aim of our study is to assess the predictive value of preprocedural serum PCT levels in comparison with established risk scores in TAVI patients. A total of 243 patients undergoing transfemoral TAVI at our institution were included prospectively in the study and 230 of these patients participated in the follow-up 1 year after TAVI. The primary endpoints were mortality at 30days and 1year. Multivariable analysis revealed that preprocedural PCT was the only independent predictor of 30-day mortality (HR 2.84; 95% CI 1.59-5.06; p < 0.001) and 1-year mortality (HR 1.90; 95% CI 1.17-3.11; p = 0.01), whereas high-sensitivity C-reactive protein showed no association with procedural outcomes. The results of ROC analysis showed good predictive power of PCT for both outcomes (AUC 0.75; p = 0.0003 for 30-day mortality and AUC 0.71; p < 0.0001 for 1-year mortality). An optimal cut-off value for PCT of 0.06ng/ml for short- and long-term mortality was determined with the Youden index. A significantly higher mortality rate was observed in the high-PCT group (≥ 0.06ng/ml) based on Kaplan-Meier analysis (log rank = 12.1; p = 0.001 at 30days and log rank = 14.2; p = 0.0002 at 1year). Patients in the high-PCT group also had a considerably worse clinical pro6file. In conclusion, preprocedural PCT is an independent predictor of 30-day and 1-year mortality after TAVI. In particular, a cut-off value of 0.06ng/ml discriminates patients at higher risk of mortality within 30days and 1year of TAVI.

Circulating Galectin-3 and Atrial Fibrillation Recurrence after Catheter Ablation: A Meta-Analysis.

Background Galectin-3 (Gal-3) is involved in fibrosis and heart failure. However, epidemiological studies evaluating the association between Gal-3 and atrial fibrillation (AF) recurrence after catheter ablation showed inconsistent results. We conducted a meta-analysis to comprehensively evaluate the relationship between baseline circulating Gal-3 levels and AF recurrence in patients undergoing catheter ablation. Methods Relevant studies were identified by systematically searching the PubMed and Embase databases. A random-effect model was used to synthesize the results. Sensitivity analyses, performed by omitting one study at a time, were used to evaluate the robustness of the results. Results Seven prospective cohort studies including 645 AF patients were included. Within a follow-up duration of up to 18 months, 244 patients developed AF recurrence. Pooled results showed that baseline circulating Gal-3 levels were significantly higher in patients with AF recurrence compared to those without (standardized mean difference: 0.74; 95% confidence interval (CI): 0.21 - 1.27; p = 0.007; I2 = 89%). Moreover, higher baseline Gal-3 levels were independently associated with a significantly higher risk of AF recurrence after catheter ablation (risk ratio: 1.17 per unit of Gal-3; 95% CI: 1.01 - 1.35; p = 0.03; I2 = 40%), which was independent of age, gender, and left atrial dimension. Sensitivity analyses did not significantly affect the results. However, there was a significant publication bias for predicting efficacy of associating preprocedural Gal-3 levels with AF recurrence. Conclusions Higher preprocedural Gal-3 levels may be associated with increased risk of AF recurrence in patients undergoing catheter ablation.

Higher preprocedural fibrinogen levels are associated with aneurysm sac regression after EVAR.

Background: The aim of our study was to determine the diameter of the aneurysm sac 24 months after endovascular abdominal aortic aneurysm repair (EVAR); to identify factors associated with sac regression, and to determine the impact of sac regression on all-cause mortality during long-term follow-up. Patients and methods: We conducted a retrospective review of prospectively collected data from patients treated with EVAR between January, 2010 and July, 2016. Sac regression was defined as at least 5mm decrease in aneurysm diameter in relation to the preprocedural diameter seen on computed tomography angiography. Sociodemographic information, comorbidities, treatment, laboratory parameters, selected anatomical and genetic factors were all analysed to determine their impact on sac regression. Results: During the study period, 124 patients with mean age of 71.2±7.2 years met the inclusion criteria. Sac regression was found in 45.2% of patients. Higher preprocedural fibrinogen was found in patients with sac regression in comparison with patients with stable sac or sac expansion (3.84g/l vs 3.47g/l; p= 0.028). In multivariate analysis after adjustment for age, hypertension, sex, smoking, dyslipidaemia, volume and percentage of intraluminal thrombus higher fibrinogen was associated with an increased probability of sac regression (OR 2.47; 95%CI 1.29-4.72; p= 0.006). Persistent typeII endoleak was associated with significantly lower probability of sac regression in univariate and multivariate analysis after adjustment for age, hypertension, sex, smoking and dyslipidaemia (OR 0.26; 95% CI 0.10-0.66; p=0.004). Higher age was a significant predictor of sac regression in multivariate analysis after adjustment for hypertension, sex, smoking and dyslipidaemia (OR 1.07; 95% CI 1.02-1.14; p= 0.012). No difference was found between patient subgroups with and without sac regression in all-cause mortality during follow-up. Conclusions: Higher preprocedural fibrinogen, absence of persistent type II endoleak and higher age were predictive factors of aneurysm sac regression post-EVAR.

Free fatty acids as a marker for predicting periprocedural myocardial injury after coronary intervention

BackgroundPrevious studies have revealed that plasma levels of free fatty acids (FFAs) are related to cardiovascular risk. However, whether FFAs could predict periprocedural myocardial injury (PMI) following percutaneous coronary intervention...

Prediction role of a novel biomarker ST2 in risk assessment of adverse cardiovascular events in chronic heart failure with preserved and intermediate ejection fraction after myocardial revascularization

Aim. To evaluate prediction role of the biomarkers soluble ST2 (sST2) and natriuretic hormone N-terminal propeptide (NT-proBNP) in risk assessment of adverse cardiovascular events (ACVE) in coronary heart disease patients (CHD) with chronic heart failure (CHF) after myocardial revascularization.Material and methods. Totally, 87 patients included (72 males) with CHD and CHF I-III functional class by NYHA with ejection fraction of the left ventricle (LVEF) 63 [55; 65]%, mean age 63 [57; 69] y.o. Levels of sST2 and NT-proBNP in plasma were measured by immune enzyme assay before myocardial revascularization.Results. In 12 months of prospective follow-up, patients were selected to 2 groups according to clinical course of CHF. To the group I the patients included (n=35) with ACVE, group II (b=52) — with none. It was found that in the group I the level of sST2 was higher by 41,5% (p&lt;0,001) and reached 46,78 [37,88; 64,96] ng/mL, and in the group II — 27,39 [23,02; 35,4] ng/mL. Concentration of NT-proBNP in the group with ACVE was 2,5 times (p=0,004) higher comparing with group II and reached 189,21 [74,46; 580,79] and 73,58 [26,64; 155,77] pg/mL, respectively. In ROC-analysis it was found that the level of sST2 ≥34,18 ng/mL (sensitivity — 90,6%, specificity — 75,0%, AUC — 0,88, р&lt;0,0001) and level of NT-proBNP ≥276,96 pg/mL (sensitivity — 88,4%, specificity — 43,7%, AUC — 0,64, р&lt;0,004) can be regarded as markers of ACVE during 12 months in CHD and CHF patients after revascularization. Also, together these two markers increase predictive significance of the analysis (sensitivity — 92,6%, specificity — 77,1%, AUC — 0,90, р&lt;0,0001).Conclusion. Therefore, the preprocedural level of sST2 can be regarded as non-invasive marker for prediction of ACVE. Combination of sST2 and NT-proBNP shows higher diagnostic sensitvity and specificity for prediction of adverse CHF course.

Hemoptysis as a side effect of cryoballoon pulmonary vein isolation in atrial fibrillation: a retrospective case-control study.

Hemoptysis and pulmonary hemorrhage are rarely described as complications of cryoballoon ablation for pulmonary vein isolation (CB PVI). This study evaluated a large cohort to determine the frequency and risk factors for manifestation of these complications and assess the clinical relevance of hemoptysis after CB PVI. Seven hundred fifteen consecutive patients (351 female) from a single-center database were evaluated to identify those who developed hemoptysis after CB PVI. A total of 31 patients with hemoptysis (4.3%; 2 female, age 60.5 ± 11.5years) were matched with a control group (n = 31). Hemoptysis developed within 72h after CB PVI. Cases versus controls had significantly lower ablation temperatures in the right inferior pulmonary vein (PV) (- 56.2 ± 26.6 vs - 49.1 ± 13.2°C; p = 0.004) and left inferior PV (- 56.4 ± 11.9 vs - 47.2 ± 7.6°C; p = 0.001). A trend to lower temperatures not reaching the level of significance was also found for the superior PV. All other procedural parameters were not significantly different between cases and controls. Although pre-procedural hemoglobin levels were comparable, post-procedural hemoglobin was lower in cases versus controls (12.9 ± 1.6 vs 13.7 ± 1.5g/dL; p < 0.05). Twenty-six patients presenting with hemoptysis underwent chest CT scan, which showed perivenous infiltration at either the right (n = 23) or left inferior PV (n = 2) or no infiltrate (n = 1). No negative long-term effects were reported after 3, 6, and 12months' follow-up. Post-procedural hemoptysis after CB PVI is a relatively frequent finding and was associated with low freezing temperatures and pulmonary tissue infiltration predominantly located at the right inferior PV. Hemoptysis resolved without long-term sequelae.

Ambulatory colonoscopy under sedoanalgesia in adult patients with and without irritable bowel syndrome: A prospective, cross-sectional, and double-blind comparison.

It is unclear whether patients with irritable bowel syndrome (IBS) require a high dose of sedatives during colonoscopy. In this study, we investigated the pre-procedural anxiety levels, sedative consumption, procedure times, complications, and patient's satisfaction between patients with IBS and controls for ambulatory colonoscopy under sedation. Rome III criteria were used in the diagnosis of IBS. Anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI). Patients received a fixed dose of midazolam (0.02 mg/kg), fentanyl (1 μg/kg), ketamine (0.3 mg/kg), and incremental doses of propofol under sedation protocol. Demographic data, heart rate, blood pressure, and oxygen saturation were measured. Procedure times, recovery and discharge times, drug doses used, complications associated with the sedation, and patient's satisfaction scores were also recorded. The mean Trait (p=0.015), State (p=0.029), Beck anxiety scores (p=0.018), the incidence of disruptive movements (p=0.044), and the amount of propofol (p=0. 024) used were significantly higher in patients with IBS. There was a decline in mean systolic blood pressure at the 6th minute in patients with IBS (p=0.026). No association was found between the sedative requirement and the anxiety scores. Patients with IBS who underwent elective colonoscopy procedures expressed higher pre-procedural anxiety scores, required more propofol consumption, and experienced more disruptive movements compared with controls. On the contrary, the increased propofol consumption was not associated with the increased pre-procedural anxiety scores.

Effectiveness of Two Different Methods for Pain Reduction During Insulin Injection in Children With Type 1 Diabetes: Buzzy and ShotBlocker.

Repeated injections may prevent children from performing insulin administration (skip dosing) and may cause anxiety. To compare the effect of ShotBlocker and the combination of vibration and cold application (Buzzy) in reducing pain during insulin administration in children. This research was designed as a randomized controlled experimental study. The study sample consisted of 60 children aged between 6 and 12years who were diagnosed as having type 1 diabetes and received insulin from the Child Endocrinology Department of the medical faculty in Eskisehir Osmangazi University between May 2015 and June 2017. The children were randomized into the Buzzy (n=20), ShotBlocker (n=20), and control (n=20) groups. Three instruments were used to obtain the research data: Interview and Observation Form, Children's Anxiety and Pain Scale (CAPS), and Faces Pain Scale-Revised (FPS-R). The mean age of the children was 9.43±2.18years (range 6-12years). There were no significant differences among preprocedural anxiety levels of the study groups in terms of self-, parent-, and observer-reported levels (p=.935, p=.374, and p=.680, respectively). Children in the control group had higher levels of pain than children in the Buzzy and ShotBlocker groups (p=.008, p=.007, and p>.001, respectively). There was a significant difference between the groups with procedural anxiety levels reported by the family and observer (p=.006 and p=.002, respectively), favoring the intervention groups. Nurses should be aware of pain during insulin injection and use methods for pain relief accordingly. ShotBlocker is recommended as a helpful option in cases where a pain control method is required.

A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures.

Insufficient preparation for children who are undergoing bone marrow aspiration can cause anxiety and negative outcomes. Nonpharmacological therapies have been proven to reduce fear in children who are undergoing painful procedures. We have therefore developed a mobile application to help reduce these patients' anxiety by providing them with procedural information and coping skills. This single-blinded, randomized controlled trial included 60 patients age 5 to 12 years old who were undergoing bone marrow aspiration procedures in Thailand that were conducted between May 2015 and May 2016. Sixty participants were randomly assigned to the intervention group (mobile application added to usual care) or the control group (usual care only). Preprocedural anxiety levels were evaluated by visual analog scales (child anxiety visual analog scale); this was repeated in the intervention group immediately after patients used the mobile application. On the day of the procedure, the patients' cooperation levels were assessed by using the modified Yale Preoperative Anxiety Scale. The total amount of sedative drugs that were used was also recorded. The paired t test and the Wilcoxon signed rank test were used to analyze within-person change, whereas the t test and the Wilcoxon rank sum test were used for group comparisons. The child anxiety visual analog scale score of patients in the intervention group decreased significantly after they used the mobile application (P < .0012). The modified Yale Preoperative Anxiety Scale score of patients in the intervention group was significantly lower than that in the control group (P < .01). There was no difference in sedative use between the 2 groups. This mobile application possibly had effectiveness in routine use for reducing anxiety and increasing patients' cooperation in bone marrow aspiration procedures.

Mean platelet volume and long-term cardiovascular outcomes in patients with stable coronary artery disease

Background and aimsAlthough an elevated mean platelet volume (MPV) has been associated with poor clinical outcomes after acute coronary syndrome (ACS), the association between MPV and long-term outcomes in patients with stable coronary artery disease (CAD) remains uncertain. We aimed to investigate the impact of pre-procedural MPV levels in patients following elective percutaneous coronary intervention (PCI). MethodsWe studied 2872 stable CAD patients who underwent their first PCI and who had available data on pre-procedural MPV between 2002 and 2016. Patients were divided into quartiles based on their MPV. The incidences of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, were evaluated. ResultsThe median MPV was 10.4 fL (interquartile range: 9.8–11.0). During a median follow-up of 5.6 years, 498 (17.3%) MACE were identified, with a cumulative incidence significantly higher in the lowest MPV group than in other groups (p < 0.01). After adjustment for platelet count and the other cardiovascular risk factors, the lowest MPV group had a significantly higher risk of MACE compared with the highest MPV groups (hazard ratio: 1.43, 95% confidence interval 1.10–1.86, p = 0.009). Decreasing MPV as a continuous variable was associated with the incidence of MACE (hazard ratio: 1.16 per 1 fL decrease, 95% confidence interval 1.04–1.30, p = 0.007). ConclusionsContrary to previous studies on ACS patients, this study showed that a low MPV was associated with worse clinical outcomes among stable CAD patients.

Nonsurgical Medical Penile Girth Augmentation: A Retrospective Study of Psychological and Psychosexual Outcomes.

Although interest in penile augmentation procedures is increasing, there is a significant lack of research into the psychological and psychosexual outcomes of these procedures. To investigate the psychological and psychosexual outcomes of nonsurgical medical penile girth augmentation. This retrospective study involved a mixed method approach. Twenty-five men who had undergone a nonsurgical medical penile girth augmentation between 1 and 12 months prior (mean, 6.6 months) completed an online questionnaire containing measures of procedure motivation, procedure satisfaction, genital self-image, penile-focused body dysmorphic disorder symptoms, self-esteem, and sexual relationship satisfaction. Six of these men elected to complete in-depth one-to-one semi-structured phone interviews to further explore the psychological impacts of the procedure. In the online questionnaire, most men were satisfied with their penile size, appearance, and function after penile girth augmentation. The men also reported statistically significant improvements in their genital self-image (P < 0.001) and self-esteem (P = 0.008), and a reduction in penile-focused body dysmorphic disorder symptoms (P = 0.002) at the time of completing the questionnaire compared to recalled pre-procedural levels. The in-depth interviews yielded 3 themes surrounding penile augmentation outcomes: (1) high satisfaction with increased penis girth; (2) increased self-confidence, particularly in situations in which the penis would be seen, such as a locker room; and (3) increased sexual confidence, but some mixed impacts on sexual relationships. Most men appear to be satisfied with their nonsurgical medical penile girth augmentation results, and they also seem to experience improvements in their overall self-esteem.

SINGLE AND MULTIPLE ISCHEMIC BRAIN MICROLESIONS AFTER CAROTID ARTERY STENTING

Aim. To identify most probable cardiovascular predictors of periprocedural ischemic brain microlesions after carotid artery stenting (CAS) accounting its presumable pathogenesis. Material and methods. 84 patients with carotid artery stenosis undergoing CAS in a specialized medical center were examined. Diffusion-weighted imaging (DWI) magnetic resonance imaging was performed in all patients before and after intervention. Results. Among selected patients aged 40 to 83 years (mean age of 60.6Ѓ}3.9 years, male 80.95%) 39 (46.4%) patients had new ischemic brain microlesions after CAS, differently located. Among all patients (n=84) microlesion count correlated with age (γ=0.243; p<0.01), preprocedural hemoglobin level (γ=-0.278; p<0.01), systolic blood pressure (SBP) level before CAS (γ=0.190; p<0.05) and diastolic blood pressure (DBP) level 1 hour after CAS (γ=-0.201; p<0.05). In patients with microlesions their count (n=39) correlated with SBP and DBP levels 15 min after CAS (γ=-0.370; p<0.01 and γ=-0.369; p<0.01, respectively), percentage of SBP and DBP levels decrease during CAS (γ=0.404; p<0.01 and γ=0.458; p<0.001, respectively), SBP level 24 h after CAS (γ=-0.272; p<0.05) and body mass index (γ=-0.260; p<0.05). Patients with multiple microlesions (n=25) differed from patients without lesions (n=45) older age (67.0 [64.0; 77.0] vs 64.0 [60.0; 70.0], p<0.05), lower preprocedural hemoglobin level (130.9Ѓ}14.5 vs 139.5Ѓ}13.6, p<0.01), lower percentage of smokers (32.0% vs 57.8%, p<0.05), previous ipsilateral stroke (36.0% vs 13.3%, p<0.05) and persistent periprocedural arterial hypotension (12.0% vs 2.2%, p<0.05). These patients with multiple microlesions had more significant DBP level decrease (17.0 [10.0; 25.0] vs 6.5 [1.3; 11.8], p<0.05) compared with patients with single lesions (n=14). In the group of patients with single brain microlesion, unstable (71.4% vs 40.0%, p<0.05) and calcified (64.3% vs 28.0%, p<0.05) atherosclerotic plaques were seen more often compared with patients with multiple lesions. Patients with single brain microlesion differed from patients without lesions greater frequency of calcified atherosclerotic plaques (64.3% vs 31.1%, p<0.05), usage of proximal embolic protection devices (21.4% vs 0.0% p<0.01) and predilatation (35.7% vs 13.3%, p<0.05), perioperative neurological symptoms (21.4% vs 4.4%, p<0.05, and higher SBP levels during 24 h after CAS (mean values 137-122 mm Hg vs 120-112 mm Hg, p<0.05). Conclusion. Single microlesion is associated with unstable or calcified plaques and CAS technical complexities. Multiple microlesions may be associated with periprocedural hemodynamic instability and cerebral hypoperfusion risk factors.

Association of prealbumin levels with contrast-induced acute kidney injury in elderly patients with elective percutaneous coronary intervention.

PurposeInflammatory factors play a critical role in contrast-induced acute kidney injury (CI-AKI). Prealbumin, a nutritional and inflammatory indicator, is a well-established predictor of short- and long-term outcomes in numerous clinical conditions. The current study investigated the association of pre-procedural prealbumin levels with CI-AKI and long-term outcomes in geriatric patients after elective percutaneous coronary intervention (PCI).Patients and methodsA total of 558 patients aged≥75 years, who underwent elective PCI between January 2012 and December 2015, were selected for the current study. Pre-procedural prealbumin levels were measured before PCI. Multivariable logistic regression and Cox proportional hazard regression analyses were performed to identify the independent risk factors for CI-AKI and long-term mortality.ResultsOut of 558 patients, 54 developed CI-AKI. The optimal cutoff value of prealbumin for detecting CI-AKI was 185.5 mg/L with 62.7% sensitivity and 70.4% specificity based on the receiver operating characteristic analysis (C-statistic=0.710; 95% confidence interval [CI] 0.673–0.751). Multivariable analysis demonstrated that prealbumin≤185.5 mg/L was significantly associated with CI-AKI (odds ratio [OR] 0.397; 95% CI 0.195–0.808; P=0.011). Cox regression analysis demonstrated that prealbumin≤185.5 mg/L was associated with long-term mortality (adjusted hazard ratio [HR] 0.525; 95% CI 0.289–0.952; P=0.034) during the follow-up.ConclusionPre-procedural levels of prealbumin were independently associated with an increased risk of CI-AKI and long-term mortality in elderly patients undergoing elective PCI.

THE INCIDENCE OF THE ISCHEMIC BRAIN MICROLESIONS AFTER CAROTID ARTERY STENTING

Aim. To estimate incidence of periprocedural ischemic brain microlesions after carotid artery stenting (CAS) and to identify most probable predictors. Material and methods. 84 patients with carotid artery stenosis undergoing carotid angioplasty with stenting (CAS) in a specialized medical center, between 2013 and 2016, were examined. All patients had diffusion-weighted magnetic resonance imaging before and after treatment for the detection of new periprocedural ischemic brain microlesions. Statistical analysis was performed using non-parametric methods. Results. Among the selected patients aged 40 to 83 years (mean age of 60.6±3.9 years) there were 68 men (80.95%) and 16 women (19.05%). 39 (46.4%) of 84 patients had new ischemic brain microlesions after CAS both ipsilateral (37.8%) and non-ipsilateral location. 17.95% of them (n=7) had the transient or persistent neurological symptoms and the rest patients were asymptomatic. Patients with ischemic brain microlesions compared with patients without them were older and had lower hemoglobin level before CAS, history of previous strokes and as well as perioperative arterial hypotension persisting up to 24 hours (p<0.05). Statistically significant differences in atherosclerotic plaques characteristics and CAS technical features were not detected. Conclusion . Ischemic brain microlesions after CAS, mostly asymptomatic, were detected in about half of patients. Microlesion appearance may be associated with older age, preprocedural lower hemoglobin level, previous strokes and periprocedural hemodynamic instability.

Evaluation of Preprocedural Laboratory Parameters as Predictors of Drug-Eluting Stent Restenosis in Coronary Chronic Total Occlusion Lesions.

This retrospective, single-center study assessed the prognostic value of several emerging inflammatory markers as predictors of in-stent restenosis (ISR) after drug-eluting stent implantation for coronary chronic total occlusion (CTO) lesions. Consecutive patients (n = 416) who underwent successful percutaneous coronary intervention (PCI) for documented CTO lesions and with follow-up angiography were enrolled. Preprocedural high-sensitivity C-reactive protein (hsCRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) were analyzed. At mean follow-up of 14.4 ± 3.3 months, ISR occurred in 72 patients. Compared with the non-ISR group, preprocedural hsCRP level, PLR, NLR, and RDW were significantly higher in the ISR group. The ISR group also had significantly greater proportions of patients with diabetes and smoking history, lower estimated glomerular filtration rate, higher low-density lipoprotein cholesterol (LDL-C) level and neutrophil count, longer stent length, and higher rate of severe dissection. In multivariate analysis, NLR (odds ratio [OR]: 3.110; 95% confidence interval [CI], 2.102-4.063; P < .001) and PLR (OR: 1.029; 95% CI, 1.016-1.143; P < .001) were independent predictors of ISR, along with LDL-C level and stent length. In conclusion, higher preprocedural NLR and PLR levels were independent risk factors for the development of ISR in patients who underwent PCI for CTO lesions.

Preprocedural Anxiety and Pain Perception Following Root Surface Debridement in Chronic Periodontitis Patients.

Background:The aim of this study was to evaluate and compare preprocedural dental anxiety levels and postprocedural pain perception in chronic periodontitis patients during conventional-staged root surface debridement (RSD) and single-stage RSD.Materials and Methods:Thirty-seven adult generalized chronic periodontitis patients requiring RSD were recruited in this study. Preprocedural anxiety levels were assessed using a self-reported questionnaire and postprocedural pain perceptions were assessed using 0–10 cm visual analog scale. The subject population was divided into two groups: staged RSD (n = 18) and single-stage RSD (n = 19). Staged RSD patients visited four times as opposed to single-stage RSD patients. Data were subjected to Pearson Chi-square test, Mann–Whitney U-test, and Spearman's rank correlation.Results:There was no statistically significant difference in dental anxiety levels or pain perceptions in both the groups. Within Group 1, there was statistical significant difference in dental anxiety levels between visit 4 and visit 3 (P = 0.037) and pain perception between visit 3 and visit 1 (P = 0.005), visit 4 and visit 1 (P = 0.002), and visit 4 and visit 2 (0.04) was statistically significant. There was a positive correlation of anxiety questionnaire (Q1–Q4) to the pain score in Group 1 which was statistically significant and in single-stage RSD.Conclusion:Conventional quadrant-wise RSD tends to cognitively condition the anxiety experience thus influencing pain experience.

Preprocedural Mean Platelet Volume Level Is a Predictor of In-Stent Restenosis of the Superficial Femoral Artery Stents in Follow-Up.

Background The mean platelet volume (MPV), the most commonly used measure of the platelet size, is a cheap and easy-to-use marker of the platelet activation. We aimed to evaluate the relationship between preprocedural MPV and other hematologic blood count parameters and in-stent restenosis in patients with superficial femoral artery (SFA) stenting. Methods and Results The consecutive 118 patients who successfully underwent endovascular stenting of the SFA were enrolled retrospectively in the study. The mean follow-up was 23 ± 12 months. The in-stent restenosis was observed in 42 patients (35.6%). There were no statistically significant differences between the restenosis group and no-restenosis group in terms of age, gender, and smoking (p=0.116, p=0.924, and p=0.428, resp.). In the restenosis group, the MPV level was markedly higher than that in the no-restenosis group, and it was statistically significant (p < 0.001). According to the ROC curve analysis, the optimal cutoff value of the MPV to determine the restenosis was >8.7 fL, and the level of the MPV >8.7 fL was a strong predictor of the restenosis (p < 0.001) in logistic regression analysis. Conclusions The measurement of the preprocedural MPV levels may help to identify high-risk patients for development of the in-stent restenosis. These patients may benefit from an aggresive antiplatelet therapy and close follow-up.

Impact of anxiety on sedative medication dosage in patients undergoing esophagogastroduodenoscopy.

IntroductionEsophagogastroduodenoscopy (EGD) is a diagnostic method used in the investigation of upper gastrointestinal system diseases. A high level of anxiety of patients who undergo EGD increases the duration of the procedure and the sedation and analgesic requirements. Sedation is used to increase patient comfort and tolerance by reducing the anxiety and pain associated with endoscopic procedures.AimIn this study, the effect of anxiety scores on medication doses was investigated in patients who underwent EGD under sedation.Material and methodsA psychiatrist, an endoscopist and an anesthesiologist conducted a prospective observational study blindly to investigate the effect of pre-procedural (before EGD) anxiety level on medication doses for sedation. Patients were divided into two groups, with and without additional medication doses.ResultsThe study included 210 consecutive patients who underwent EGD under sedation. The average STAI-S score was 40.28 and the average STAI-T score was 40.18. There was no relationship between anxiety scores and gender (p = 0.058, p = 0.869). Statistically significant results were obtained for anxiety scores with additional sedation dosing (p < 0.05). It was observed that an additional dose of medication was affected by age, body mass index and anxiety scores (p < 0.005). Patients who were young, had a low body mass index and had high anxiety scores had significantly higher additional dose requirements.ConclusionsThe medications used for sedation during EGD may be inadequate or an additional dose of medication may be needed for patients who have higher anxiety scores, younger age, and lower body mass index.

Acute Biliary Obstruction After Gastroduodenal Covered Self-Expanding Metallic Stent Placement in Patients with Previous Biliary Stent Placement for Periampullary Cancer: Frequency and Protective Factors.

We aimed to evaluate the frequency and protective factors of acute biliary obstruction in patients with biliary stent placement followed by gastroduodenal covered self-expandable metallic stent (SEMS) placement owing to progression of periampullary cancer. We retrospectively reviewed 58 patients. Total bilirubin and alkaline phosphatase (ALP) levels before and after gastroduodenal covered SEMS placement were evaluated. The incidence of acute biliary obstruction correlated to age, sex, biliary stent length and type, and longitudinal and axial locations of the lower end of the biliary stent was evaluated. Postprocedural total bilirubin and ALP levels were significantly higher than preprocedural levels (2.30±2.53 vs. 1.53±1.48mg/dL; P=0.008, 331.0±248.8 vs. 258.4±195.2IU/L; P=0.008, respectively). The increase in bilirubin levels was not statistically significant in female patients or patients with a biliary stent length≥6cm or longitudinal location of the lower end of the biliary stent distal to the lower end of the gastroduodenal stent (P>0.05). Seven patients (12.1%) developed acute biliary obstruction. No patients with the lower end of the biliary stent located distal to the lower end of the gastroduodenal stent developed acute biliary obstruction (P=0.012). The incidence of acute biliary obstruction was 12.1% among patients with biliary stent placement followed by gastroduodenal covered SEMS placement. Longitudinal location of the lower end of the biliary stent distal to the lower end of the gastroduodenal stent was a protective factor.