Results Of Procedure Research Articles

Clinical and peri procedural outcomes using reduced dose prasugrel vs standard dose ticagrelor in elderly patients of acute coronary syndrome undergoing PCI

Abstract Introduction The novel antiplatelet agent prasugrel is generally not indicated in elderly(>75-years) patients in standard dose(60 mg loading and 10 mg maintenance) however, there is a scarce data on safety and efficacy of reduced dose prasugrel(30 mg loading and 5 mg maintenance dose) among elderly patients undergoing elective PCI. Some previous studies have raised concerns regarding the differences in pharmacodynamic and pharmacokinetic responses to prasugrel in asian ethnicities. The efficacy and safety of reduced dose prasugrel in elderly patients has not been investigated. Therefore, in this study we have compared the efficacy and safety of a reduced dose prasugrel with standard dose ticagrelor in elderly Indian patients undergoing elective PCI for acute coronary syndrome (ACS). Purpose To study the periprocedural and intermediate term clinical outcomes using reduced dose prasugrel versus standard dose ticagrelor in elderly Indian patients of acute coronary syndrome undergoing PCI. Methods This was a single centre, randomised, prospective cohort study. Based on the previous reference studies, at 95% level of significance and 80% of power, the sample size was calculated as 73 in each group. Study was conducted from May 2021 to October 2022 (18 months). Patients >75 years of age with ST-segment–elevation (STE) or Non ST elevation (NSTE) ACS treated with PCI were included. The study was approved by the institutional ethics review board. Participants were assigned to receive a standard dose of ticagrelor (180 mg loading followed by 90 mg twice daily, n=73) or a reduced dose prasugrel (30 mg loading followed by 5 mg once daily, n=73). The primary efficacy end point of the study was a composite of major adverse cardiac events (MACE) including cardiovascular mortality , non fatal MI and stroke. The secondary safety end points were major and minor bleeding events. Patients were followed up at 15 days, 3 months and 6 months. Results The baseline clinical and demographic characteristics were comparable in the both groups. The composite of primary efficacy end points at 6 months occurred significantly more in ticagrelor group vs reduced dose prasugrel group(13.7% vs 4.1% P value=0.05) and composite of secondary safety end point were comparable in both the groups(21.9% vs 16.4% respectively, p=0.44). Dyspnoea was seen more frequently in standard dose ticagrelor group as compared to reduced dose prasugrel group (15.1% vs. 6.8% respectively, p value=0.133). Conclusion The results of our study indicate that the reduced dose prasugrel is safe in elderly patients, has similar bleeding events as compared to standard dose ticagrelor group and is better tolerated. The reduced dose prasugrel is significantly more efficacious as compared to standard dose ticagrelor in elderly patients in terms of reduced MACE events. Although large scale randomized studies may be warranted in such populations to draw a broader conclusion.Baseline characteristicsEnd results

Impact of the thin-walled sheath on the distal radial artery occlusion: a randomized trial

Abstract Background Distal transradial access (dTRA) has been increasingly accepted as an alternative to the transradial access (TRA) for coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Although the dTRA has been significantly associated with better patient comfort, shorter haemostasis time, and fewer vascular access-related complications, such as haematoma and proximal radial artery occlusion (pRAO), it has also been associated with an increased risk of distal radial artery occlusion (dRAO). Purpose The aim of the present study was to investigate whether the 6-Fr thin-walled sheath was superior to the conventional radial sheath with respect to the incidence of distal radial artery occlusion (dRAO) at 24 h after CAG and/or PCI via dTRA. Methods A prospective, single-centre trial of patients who were randomized to undergo CAG and/or PCI with either a 6-Fr thin-walled sheath or a 6-Fr conventional sheath. The primary endpoint was the incidence of dRAO at 24 h postoperatively, as evaluated by Doppler ultrasound. The second endpoints included the puncture success rate, puncture time, the incidence of pRAO, pain during the sheath placement, and other vascular-associated complications. Results A total of 620 patients were included in the study. The mean age of the patients was 66.6± 9.7 years (median age 69.0 years [interquartile range 60.0- 74.0 years]), and 66.3% were men. The baseline patient and procedural characteristics were similar between the two groups. For the primary endpoint, the incidence of dRAO at 24 h after the procedure was 1.0% (3/314) in the thin-walled sheath group and 3.6% (11/306) in the conventional sheath group (RR= 0.266, 95%CI= 0.075-0.943, P= 0.027) according to the intention-to-treat (ITT) analysis. For secondary endpoints, the incidence of pRAO was 0.3% (1/314) in the thin-walled sheath group and 2.3% (7/306) in the conventional sheath group (P= 0.029). No significant difference was observed between the thin-walled sheath and the conventional sheath groups regarding the puncture success rate (92.4% vs. 92.5%, P= 0.952). The severity of pain experienced during the sheath placement was similar between the two groups (VAS 2 vs. 2 P=0.426). Other secondary endpoints, including procedural outcomes and other puncture-related outcomes and access-related complications, were not significantly different between the two groups. Conclusion A thin-walled sheath can reduce the incidence of early-term dRAO in patients who underwent CAG and/or PCI via the dTRA.The primary endpoint of the trial

CHARACTERISTICS AND OUTCOME OF LEFT MAIN STEM PCI AMONG WOMEN

Left main stem disease is a severe condition affecting a major coronary artery, traditionally treated with coronary artery bypass grafting. Recent advancements in percutaneous coronary intervention have made it a viable option, particularly for women who face unique risks and outcomes compared to men. Objective: This study aims to evaluate the characteristics and outcomes of percutaneous coronary intervention for left main stem disease in female patients, focusing on procedural outcomes and changes in laboratory parameters before and after the intervention. Methods: A prospective observational study was conducted from January to July 2024 with 68 female patients, aged 18 and above, from Fauji Foundation Hospital Rawalpindi. Various percutaneous coronary intervention techniques were used, and data on ejection fractions, access methods, and procedural specifics were collected. Pre- and post-procedural laboratory outcomes including haemoglobin, creatinine, platelet counts, and alanine aminotransferase levels were analyzed. Results: The mean age of participants was 63.6 years. Diabetes, hypertension, and dyslipidemia were common comorbidities. Laboratory results showed stable haemoglobin levels, slight increases in creatinine, and consistent platelet counts and ALT levels post-procedure. Statistical analysis revealed no significant changes in these parameters, indicating minimal impact on anaemia, renal function, and platelet or liver function. Conclusion: percutaneous coronary intervention for the left main stem in females generally results in stable laboratory outcomes with minimal impact on anaemia, renal function, and platelet or liver function. The procedure is safe with a low mortality rate. Continuous monitoring is recommended to manage any potential complications effectively.

Clinical effect of secondary LEEP combined with transcervical resection of endocervical tissue for cervical precancerous lesions with positive internal margin after the first LEEP

Objective: To preliminarily investigate the clinical outcomes of secondary loop electrosurgical excision procedure (LEEP) combined with transcervical resection of endocervical tissue (i.e., second combined surgeries) in patients with positive endocervical margins following the initial LEEP for high-grade squamous intraepithelial lesion (HSIL) or adenocarcinoma in situ (AIS) of the cervix. Methods: Patients who underwent second combined surgeries due to positive endocervical margins after the initial LEEP for cervical HSIL or AIS at Obstetrics and Gynecology Hospital, Fudan University between August 2015 and September 2023 were included. Postoperative cytological examinations, high-risk human papillomavirus (HR-HPV) testing, colposcopic biopsy results, and cervical canal length were followed up to evaluate the clinical efficacy of second combined surgeries. Results: (1) General clinical data: a total of 67 patients were enrolled, including 34 with cervical HSIL (HSIL group) and 33 with AIS (AIS group). In the HSIL group before the time of initial LEEP, the mean age was (41.3±5.3) years, with all patients positive for HR-HPV preoperatively. Preoperative cytology results revealed ≤low-grade squamous intraepithelial lesion (LSIL) in 13 cases and ≥HSIL in 21 cases. The preoperative cervical canal length was (3.71±0.17) cm. Patients in the AIS group before their the first LEEP were at an average age of (39.1±8.7) years old, with preoperative HR-HPV positive. Among them, 16 cases showed preoperative cytological results of ≤LSIL, while 17 cases showed ≥HSIL. The preoperative cervical canal length was (3.64±0.21) cm. (2) Pathological findings and postoperative follow-up of the HSIL group following second combined surgeries:in the HSIL group, the residual rate of HSIL in the endocervical canal tissue (ECT) was 24% (8/34). Out of the 34 HSIL patients, 10 cases (29%, 10/34) remained with positive endocervical margins post-second combined surgeries. Among these 10 patients, 5 cases (5/10) had no lesion detected in ECT, while the remaining 5 cases (5/10) exhibited HSIL in their ECT. Conversely, 24 patients (71%, 24/34) had negative endocervical margins after second combined surgeries. Of these 24 patients, 3 cases (12%, 3/24) were found to have HSIL in ECT, and 21 cases (88%, 21/24) had no lesion in ECT. During follow-ups conducted at 6 and 12 months post-second combined surgeries, the clearance rates of HR-HPV were 91% (31/34) and 100% (34/34), respectively. Notably, among the 29 patients (85%, 29/34) who were followed up for a period of 2 years or longer, all cases maintained a consistently negative HR-HPV status, highlighting the effectiveness of second combined surgeries in achieving long-term HR-HPV clearance (100%, 29/29). (3) Pathological findings and postoperative follow-up of the AIS group following second combined surgeries: the residual rate of AIS in the ECT following second combined surgeries among AIS patients was 15% (5/33). Out of the 33 AIS patients, 11 cases (33%, 11/33) had positive endocervical margins post-operation, among whom AIS was detected in the ECT of 2 cases (2/11), while 1 case (1/11) was diagnosed with adenocarcinoma in the cervical canal tissue (subsequently underwent radical surgery and was excluded from this study). In contrast, 22 patients (67%, 22/33) had negative endocervical margins post-operation, with AIS found in the ECT of 2 cases (9%, 2/22) and no lesions detected in the remaining 20 cases (91%, 20/22). Follow-up evaluations conducted at 6 and 12 months postoperatively revealed HR-HPV clearance rates of 91% (29/32) and 97% (31/32), respectively. All 32 (100%, 32/32) AIS patients were followed up for a duration of ≥2 years post-second combined surgeries, during which HR-HPV remained consistently negative. (4) Complications and cervical length following second combined surgeries: neither the HSIL group nor the AIS group experienced significant complications such as hemorrhage, infection or cervical canal adhesion. At the 6-month follow-up, the cervical length of both HSIL and AIS patients exceeded 3 cm. By the 12-month follow-up, the cervical length had recovered to 96.5% and 97.5% when compared to the original length, respectively, for the HSIL and AIS groups. Conclusions: For patients with HSIL or AIS who exhibit positive endocervical margins following the initial LEEP procedure, undergoing second combined surgeries presents as an optimal choice. This surgical intervention guarantees thorough excision of the lesion, and subsequent colposcopic follow-up evaluations consistently demonstrate an absence of residual disease or recurrence. Moreover, it augments the rate of sustained HR-HPV negativity, thereby contributing to more favorable clinical outcomes.

Influence of surgeon learning on outcomes in new ophthalmic procedures: quantified nationwide evidence in endothelial corneal transplantation

AimsTo investigate the impact of surgeon learning on endothelial keratoplasty (EK) procedure outcomes.MethodsA prospective nationwide registry study of EK grafts in patients aged at least 21 years with Fuchs endothelial...

Procedural Volume and Outcomes After Septal Reduction Therapies in Hypertrophic Obstructive Cardiomyopathy.

Septal myectomy and alcohol septal ablation (ASA) are septal reduction therapies for patients with symptomatic obstructive hypertrophic cardiomyopathy. Operator and hospital volume may influence outcomes, but contemporary data on this relationship are limited. This retrospective cohort study used data from the Vizient Clinical Data Base (2016-2022). Patients with undergoing septal myectomy and ASA were identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and stratified into low-, medium-, and high-volume groups based on annualized operator and hospital volumes. The outcomes were 30-day in-hospital mortality and 90-day readmission, analyzed using multivariable adjusted logistic and Cox models. Among 5725 patients with hypertrophic cardiomyopathy (3990 septal myectomy; 1735 ASA), most operators and hospitals performed <10 procedures annually. For septal myectomy, low-volume operators were associated with higher odds of 30-day mortality (adjusted odds ratio [aOR], 1.86 [95% CI, 1.11-3.15]) and greater risk for 90-day readmission (aOR, 1.51 [95% CI, 1.22-1.88]), and medium-volume operators had higher odds of 30-day mortality (aOR, 1.93 [95% CI, 1.05-3.55]). Medium-volume hospitals had higher 30-day mortality (aOR, 2.29 [95% CI, 1.32-3.99]), with low-volume hospitals showing greater risk for 90-day readmission (aOR, 1.60 [95% CI, 1.14-2.23]). For ASA, low- and medium-volume operators had increased 30-day mortality (aOR, 2.99 [95% CI, 1.15-7.75] and aOR, 3.86 [95% CI, 1.30-11.46]), but the risk of 90-day readmission was similar. Hospital volumes did not significantly impact outcomes for ASA. Low operator and hospital volumes were associated with worse outcomes for septal reduction therapies, emphasizing the need to refer patients with hypertrophic cardiomyopathy to high-volume centers with experienced operators.

Comparison Between Total Hip and Knee Arthroplasty on Short-Term Performance-Based Outcomes and Factors Associated with the Improvement of Gait Function During Post-Acute Inpatient Rehabilitation

Background: Data on the differences in functional recovery between inpatient rehabilitation for total hip arthroplasty (THA) and total knee arthroplasty (TKA) are lacking, and the factors influencing the improvement of short-term functional mobility remain unknown. In this study, we compared the short-term functional outcomes of both procedures and identified early postoperative predictors of physical function gain during post-acute rehabilitation. Methods: A total of 435 patients who underwent THA and TKA were included. The main outcomes were knee extension strength, the motor component of the Functional Independence Measure, Numerical Rating Scale, 10 Meter Walk Test, Timed Up and Go (TUG) test, and the Berg Balance Scale. The recovery process and rehabilitation outcomes were compared between patients with THA and TKA. Additionally, predictors related to physical performance improvement were examined for each procedure. Results: Patients with THA and TKA achieved significant short-term functional recovery after multidisciplinary rehabilitation (time; p &lt; 0.001). However, the pain score was higher at discharge in patients with TKA (p &lt; 0.001). Age (β: −0.264, p = 0.009) and TUG test (β: −0.884, p &lt; 0.001) in THA, and non-operated knee extension strength (β: 0.234, p = 0.016) and TUG test (β: −0.783, p &lt; 0.001) in TKA were significant early postoperative predictors of functional mobility. Conclusions: Multidisciplinary rehabilitation was beneficial for functional improvement in patients with THA and TKA despite persistent pain at discharge after TKA. Baseline functional levels in both groups and non-operated knee extension strength in TKA can be useful performance-based predictors of short-term gait function improvement.

Experiences in robotic colorectal surgery: comprehensive insights from a multi-center analysis using the Senhance Robotic System.

Robotic-assisted surgery has revolutionised minimally invasive approaches, particularly in colorectal surgery. While many single-center studies on colorectal surgeries exist in present literature, including experiences with Senhance® Robotic Systems, comprehensive multi-center studies are lacking. This study, conducted through the TransEnterix European Patient Registry ("TRUST"), aims to assess the safety and feasibility in this context. The present study explored procedural times, complications, robotic malfunction and limitations, adverse events and pain management outcomes for colorectal procedures, including sigmoid resection, right hemicolectomy and rectal surgery collected in two European centers. Data from 355 colorectal surgeries showed that the median duration of surgery was 147.2min (IQR: 124.3-183.0), the docking time was reported with a median of 3.4min (IQR: 2.0-5.4) and the console time was found at a mean of 84.4min (SD: 33.6). Despite minimal blood loss, pain scores, and robotic malfunction, 2.9% of the cases (10 instances) required conversions to either an open or laparoscopic approach. Further, most robotic limitations were attributed to limited motion (18.9%, 67 cases) and collisions (11.5%, 41 cases). Adverse events (24 cases, 6.8%) were effectively managed, with 23 instances judged completely unrelated to the robotic system. This study underscores the positive outcomes and safety profile of Senhance® Robotic Systems in colorectal surgery, contributing valuable insights for future research and clinical practice.

Chest Tubes and Pleural Drainage: History and Current Status in Pleural Disease Management

Thoracostomy and chest tube placement are key procedures in treating pleural diseases involving the accumulation of fluids (e.g., malignant effusions, serous fluid, pus, or blood) or air (pneumothorax) in the pleural cavity. Initially described by Hippocrates and refined through the centuries, chest drainage achieved a historical milestone in the 19th century with the creation of closed drainage systems to prevent the entry of air into the pleural space and reduce infection risk. The introduction of plastic materials and the Heimlich valve further revolutionized chest tube design and function. Technological advancements led to the availability of various chest tube designs (straight, angled, and pig-tail) and drainage systems, including PVC and silicone tubes with radiopaque stripes for better radiological visualization. Modern chest drainage units can incorporate smart digital systems that monitor and graphically report pleural pressure and evacuated fluid/air, improving patient outcomes. Suction application via wall systems or portable digital devices enhances drainage efficacy, although careful regulation is needed to avoid complications such as re-expansion pulmonary edema or prolonged air leak. To prevent recurrent effusion, particularly due to malignancy, pleurodesis agents can be applied through the chest tube. In cases of non-expandable lung, maintaining a long-term chest drain may be the most appropriate approach and procedures such as the placement of an indwelling pleural catheter can significantly improve quality of life. Continued innovations and rigorous training ensure that chest tube insertion remains a cornerstone of effective pleural disease management. This review provides a comprehensive overview of the historical evolution and modern advancements in pleural drainage. By addressing both current technologies and procedural outcomes, it serves as a valuable resource for healthcare professionals aiming to optimize pleural disease management and patient care.

Rotational, orbital atherectomy and intravascular lithotripsy for coronary calcified nodules: insights from optical coherence tomography.

The optimal treatment strategy for coronary calcified nodules (CN) remains uncertain. We aimed to evaluate the efficacy and safety of different calcium modification strategies, including rotational atherectomy (RA), orbital atherectomy (OA), and intravascular lithotripsy (IVL) for managing CN with optical coherence tomography (OCT) guidance. Consecutive patients undergoing OCT-guided percutaneous coronary intervention (PCI) for severely calcified lesions using RA, OA, or IVL between January 2017 and December 2022 were included. Primary endpoint was minimum stent area (MSA) post-PCI. Secondary endpoints included MSA at CN site and 1-year target vessel failure (TVF), defined as a composite of cardiac death, target-vessel myocardial infarction, or target vessel revascularization. Among 154 patients and 158 lesions, CN was identified in 54 lesions (34.2%) and managed with RA (39%, n = 21), OA (33%, n = 18), or IVL (28%, n = 15). The IVL group exhibited a larger minimal lumen diameter, maximum calcium arc, and maximum calcium thickness. Post-PCI OCT demonstrated comparable MSA (RA: 6.23 ± 0.34 mm², OA: 5.75 ± 0.39 mm², IVL: 6.24 ± 0.46 mm²; p = 0.62) and MSA at CN site (7.17 ± 0.43 mm², 6.46 ± 0.49 mm², 7.86 ± 0.56 mm², respectively; p = 0.55) after adjusting for morphologic factors. The incidence of TVF at 1 year was similar among the group (RA: 19.0%, OA: 22.2%, IVL: 13.3%, p = 0.81). In patients undergoing PCI for CN, similar procedural and clinical outcomes can be achieved using RA, OA, or IVL. These findings warrant further investigation in larger, prospective trials.

Early adoption of triamcinolone acetonide suprachoroidal injection for uveitic macular edema: a physician survey

ObjectiveTo obtain physicians’ “real-world” perspectives on early experiences with triamcinolone acetonide suprachoroidal injection (SCS-TA) for treatment of patients with uveitic macular edema (UME).ResultsTwelve retina/uveitis specialists in the United States were surveyed about SCS-TA injection procedure and patient outcomes. Survey participants administered ≥ 291 SCS-TA injections to 243 patients with UME with various disease characteristics (etiologies, chronicity, and anatomical subtypes). Commonly reported reasons for SCS-TA adoption included potential for lowering the risk of steroid-associated intraocular pressure elevations versus intravitreal injections or implants (100%), potential for longer duration of action versus intravitreal steroid injections or implants (92%), and desire to use a new delivery modality (83%). Nearly all participants (92%) found injection procedure relatively easy post-training, with most (75%) procedurally comfortable after completing 2–5 injections. 58% of participants indicated that their patients gained 2–3 lines of vision by first follow-up visit, and 92% reported having patients who experienced 100–150 μm or greater reduction in central subfield thickness. Overall, 92% of participants were satisfied with SCS-TA treatment outcomes. Findings from this survey of early adopters of SCS-TA indicate that the suprachoroidal injection technique was easy to learn and resulted in favorable patient outcomes consistent with clinical trial data.

Effectiveness of Telemedicine in Managing Health-Related Issues in the Pediatric Population: A Systematic Review.

Healthcare delivery is made more convenient and effective via telemedicine, which enables physicians to conduct virtual consultations and evaluations with pediatric patients. The purpose of this systematic review was to evaluate the efficacy of telemedicine as compared to physical appointments in the pediatric population. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for the available literature using pre-specified inclusion and exclusion criteria. These databases provided 968 relevant research articles, which Endnote software screened for duplicates. Fourteen studies were considered relevant for full-text evaluation. After complete text evaluation, only 11 of these articles were found to be relevant. The Newcastle-Ottawa Scale (NOS) was used for the risk of bias assessment of all included studies. Eleven articles in all satisfied the requirements for inclusion and were added to the review. Every study was classified as either a cluster randomized trial (27%) or a randomized controlled trial (RCT) (73%). There were between 22 and 400 participants in each trial. Medical conditions evaluated included obesity (27%), mental health disorders (9%), asthma (18%), otitis media (9%), skin disorders (9%), type 1 diabetes (9%), attention deficit hyperactivity disorder (ADHD) (9%), and pancreatic insufficiency associated with cystic fibrosis (1/11). Telemedicine strategies employed included telemedicine-based screening visits (9%), smartphone-based therapies (27%), phone counseling (18%), and videoconferencing visits between patients and doctors (45%). The outcomes of the telemedicine procedures in every included study were on par with or superior to those of the control groups. Medication adherence, appointment completion rates, life satisfaction, symptom management, and disease progression were all outcomes associated with these findings. Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, healthcare professionals, and caregivers may benefit from using both telemedicine services and traditional in-person healthcare services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.

Clinical Impact of Baseline Frailty Status and Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry.

The Clinical Frailty Scale (CFS) is a useful frailty marker for predicting clinical outcomes in patients undergoing invasive therapy. However, the clinical impact of CFS after transcatheter edge-to-edge repair in patients with mitral regurgitation (MR) remains unclear. This study aimed to elucidate the association between the baseline frail status defined by the CFS and clinical outcomes with or without postprocedural MR ≥2+ (post-MR ≥2+) after transcatheter edge-to-edge repair. Based on a Japanese multicenter registry (OCEAN [Optimized Catheter Valvular Intervention]-Mitral), data from 2078 patients with MR who underwent transcatheter edge-to-edge repair were analyzed. The patients were classified into 5 groups: CFS 1 to 3, 4, 5, 6, and ≥7. The procedural and clinical outcomes and post-MR ≥2+ were compared among the groups. All-cause mortality for up to 2 years was explored using Cox proportional hazards regression analysis. Although the rates of acute procedural success and post-MR ≥2+ were similar, all-cause mortality at 2 years was significantly increased across the 5 CFS categories (15.5%, 23.8%, 27.7%, 34.6%, and 48.8%, respectively, P<0.001). The incremental CFS categories and post-MR ≥2+ were independent predictive risk factors of all-cause mortality (all P<0.05). Among the patients with 5 CFS categories, the incidence of all-cause mortality was higher in those with post-MR ≥2+ than in those without (all P<0.05). Although prognosis was poor in patients with higher CFS grade after transcatheter edge-to-edge repair, minimizing modifiable factors of residual MR is warranted to improve the clinical outcomes. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000027188; Unique identifier: UMIN000023653.

Impact of burden and distribution of aortic valve calcification on the hemodynamic performance and procedural outcomes of a self-expanding, intra-annular transcatheter aortic valve system.

Aortic valve calcification (AVC) has been explored as a powerful predictor of procedural complications in patients undergoing transcatheter aortic valve implantation (TAVI). However, little evidence exists on its impact on intra-annular devices' performance. We aimed to investigate the impact of AVC burden and distribution pattern on the occurrence of paravalvular leak (PVL), conduction disturbances requiring permanent pacemaker implantation (PPI) and 30-day clinical outcomes in patients undergoing TAVI with a self-expanding, intra-annular device. According to AVC, 103 patients enrolled in a single medical centre from November 2019 to December 2022 were divided into tertiles. Valve Academic Research Consortium (VARC)-3 definitions were used to classify procedural complications and outcomes. Patients in the highest AVC tertile showed an increased occurrence of mild or more PVL and conduction disorders (p < 0.001 and p = 0.006). AVC tertiles (highest tertile) emerged as an independent predictor of PVL (OR 7.32, 95%CI 3.10-17.28, p < 0.001) and post-TAVI conduction disturbances (OR 3.73, 95%CI 1.31-10.60, p = 0.013) but not of PPI (OR 1.44, 95%CI 0.39-5.35, p = 0.579). Considering calcium distribution, ROC analyses revealed that annular AVC but not left ventricle outflow tract (LVOT) calcium burden significantly indicated the development of PVL (AUC 0.863, 0.77-0.93, p < 0.001) and conduction disorders/PPI (AUC 0.797, 0.70-0.89, p < 0.001 and 0.723, 0.58-0.86, p = 0.018, respectively). After adjustment for age and sex, the highest tertile remained an independent predictor of the 30-day composite outcome (death, myocardial infarction, stroke, major vascular complications, type 3/4 bleedings, acute kidney injury, PPI and ≥ moderate PVL) (OR 3.26; 95%CI 1.26-8.40, p = 0.014). A higher AVC is associated with an increased risk of PVL and conduction disturbances after TAVI with a self-expanding, intra-annular device. However, our findings suggest a minor role for LVOT calcification compared with annular AVC in the performance of this specific prosthesis.

Clinical and functional outcome of total transanal endorectal pull-through procedure for the management of Hirschsprung’s disease

ObjectiveThe aim of the study is to evaluate the complications and long-term bowel function in Hirschsprung’s disease (HD) patients following total transanal endorectal pull-through (TERPT) surgery operated in a tertiary hospital in Oman.MethodsA retrospective data retrieval was done for patients diagnosed with Hirschsprung’s disease and underwent total transanal endorectal pull-through procedure during the period from December 2008 to June 2019 with concomitant prospective phone call questionnaire interview to assess the long-term functional outcome of children aged 3 years and older.ResultsTotal transanal endorectal pull-through was performed in 61 patients. The mean age at the time of operation was 7.71 ± 8.26 months. The most common late complication was anal excoriation (19.7%). Of the patients, 61.5% had a normal to fair score, and the remaining 38% had a poor score in their functional outcome questionnaire. The majority had no social problems (65.4%), while 15.4% had problems causing varying degrees of social restrictions.ConclusionThe short-term outcomes of total transanal endorectal pull-through are found to be acceptable. In addition, the long-term functional outcome post total transanal endorectal pull-through was found to be satisfactory; however, longer follow-up studies with larger sample sizes are needed for more accurate functional outcome evaluation.

Implications of Long-Term Double Eyelid Tape Use.

The widespread adoption of double eyelid tapes (DET) to achieve thedesired double eyelid aesthetic has prompted investigations into their long-term effects. Given the delicate and complex anatomy of the eyelid, concerns have emerged about the impact of DETs on eyelid structure and the outcomes of subsequent surgical procedures. A cohort of 267 outpatients from our department was recruited between January 2022 and January 2024 to participate in a survey assessing the usage of double eyelid tape (DET). Eyelid laxity was subsequently tested in all outpatients using the Vertical Lid Pull and Parallel Lid Pull methods. Among all participants, 33 underwent double eyelid surgery, with 22 having a history of excessive DET usage and 11 with no DET usage. Post-operative outcomes, including operation duration, satisfaction levels, and complications were recorded. Additionally excised eyelid skin tissues during surgery underwent Masson's staining and EVG staining to analyze collagen and elastic fibers. Among surveyed outpatients (mean age: 23.79 ± 3.71years, 99.63% female, mean BMI: 21.56 ± 1.75kg/m2), 56.55% had oculopathy with ametropia being predominant (53.93%). Hooded eyelids were the most prevalent congenital condition (62.54%). Nearly half (49.44%) used Double Eyelid Tapes (DET) for 1-2years, with 70.04% experiencing discomfort and 70.79% reporting permanent eyelid shape change. Lid pull measurements showed no significant difference in vertical pulls between DET users and non-users, but parallel pulls varied significantly (p<0.05). Complications like asymmetry, numbness, and hypertrophic scars were exclusive to DET users. Physician evaluations favored non-DET users significantly (p<0.05). Histological analysis revealed an interesting finding that individuals using DET have higher collagen levels and notable changes in skin structure when compared to non-users. Prolonged use of double eyelid tape (DET) may result in eyelid laxity, impacting ocular health and complicating blepharoplasty procedures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

IN-HOSPITAL OUTCOMES AMONG PATIENTS PRESENTED WITH ST-ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Primary Percutaneous Coronary Intervention (PCI) is considered the gold standard treatment for patients with ST-elevation myocardial Infarction (STEMI). Prompt intervention, aimed at restoring blood flow, plays a critical role in improving survival and minimizing complications in these patients. Objective: The objective of this study was to evaluate in-hospital outcomes among patients diagnosed with STEMI and treated with Primary PCI. Methods: This cross-sectional study was conducted in the Cardiology Department over one year. The study included patients aged 50 years and older who were diagnosed with STEMI based on electrocardiographic criteria and presented within 12 hours of symptom onset. Demographic information, clinical characteristics, comorbidities, and in-hospital outcomes were recorded. Statistical analyses were performed using relevant descriptive measures. Results: A total of 150 patients were included in the study. The mean age of patients was 60.89 ± 5.65 years, with 64.4% being male. The average door-to-balloon time was 89.93 ± 18.12 minutes. Successful reperfusion, defined as achieving a TIMI grade 3 flow, was observed in 87.8% of the patients. In-hospital mortality was recorded at 4.4%, while 3.3% of patients developed infections during their hospital stay. Conclusion: The study demonstrated favourable in-hospital outcomes for STEMI patients treated with Primary PCI, with a high success rate in achieving TIMI grade 3 flow and a relatively low in-hospital mortality rate. These findings underscore the efficacy of timely PCI in improving survival and procedural outcomes in STEMI patients, particularly when door-to-balloon time is minimized.

Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Disrupt PAD III Observational Study.

Intravascular lithotripsy (IVL) has shown promising safety and effectiveness in calcified peripheral artery disease (PAD) in large trials and small real-world experiences. Real-world evidence from a larger cohort is lacking, so we aimed to evaluate the real-world acute performance of IVL in the treatment of calcified PAD. The Disrupt PAD III Observational Study (OS) is a prospective, multicenter, single-arm study. Patients with claudication or critical limb-threatening ischemia (CLTI) and at least moderate calcification were eligible. Independent predictors of procedural outcomes were assessed by multivariable analysis. Between November 2017 and June 2021 across 30 global sites, 1373 patients with 1677 lesions (1531, 91.3% core lab evaluable) were enrolled. Diameter stenosis and lesion length was 80.6±17.6% and 93.5±74.3 mm, respectively. Target vessels included femoropopliteal (61%), iliac (15.8%), common femoral (10.7%), and infrapopliteal arteries (12.8%). Lesion characteristics included 31.1% chronic total occlusions (CTOs) and 19.3% long lesions (≥15 cm). At final assessment, residual stenosis was 23.8±11.3%, with 0.9% serious angiographic complications, no abrupt closures, distal embolization, no flow, or thrombotic events. Independent predictors of ≤30% residual stenosis were lesion length ≥15 cm (odds ratio [OR]=0.384), female sex (OR=1.850), age ≤75 years (OR=1.625), IVL balloon to artery ratio ≥1.0 (OR=1.538), and CTO lesions (OR=0.638). Lesion length ≥15 cm (OR=16.076) was an independent predictor of procedural complications. The Disrupt PAD III OS represents the largest assessment of IVL periprocedural outcomes in calcified PAD. It confirmed excellent procedural safety and effectiveness in complex lesions across multiple peripheral vascular beds. This final analysis of the PAD III OS represents the largest report of peripheral IVL utilization in daily clinical practice. The outcomes of this study indicate that previously reported procedural results in clinical trial settings can be translated to a broader patient population. Treatment with peripheral IVL in severely calcified stenotic lower limb lesions demonstrated consistent acute safety and stenosis reduction, even in complex patients across multiple vessel beds. In addition, the importance of proper IVL balloon sizing to achieve excellent acute stenosis reduction was confirmed by multivariate analysis.

Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry

BACKGROUND Mechanical thrombectomy has changed the landscape of acute ischemic stroke treatment, offering improved outcomes for patients with large vessel occlusions. The interplay between reperfusion techniques and occlusion sites remains a critical consideration in treatment decisions. This study investigates the impact of primary reperfusion techniques—stent retriever classic, stent retriever combination with aspiration, and direct aspiration—on procedural and clinical outcomes at different occlusion sites. METHODS Using data from the ASSIST registry, a prospective multinational initiative, patients with anterior circulation acute ischemic stroke with large vessel occlusions (n = 1477) were included. Three primary occlusion sites—M1 segment of the middle cerebral artery, M2 segment of the middle cerebral artery, and the internal carotid artery—were studied. Univariate tests and multivariable logistic regression models were used to assess associations between reperfusion techniques and procedural and clinical outcomes, including the expanded thrombolysis in cerebral infarction score and the modified Rankin Scale, stratified by occlusion site. RESULTS Achieving expanded thrombolysis in cerebral infarction ≥2c after first pass was lower in internal carotid artery occlusions (18.2%, P &lt;0.0001) with direct aspiration alone compared with stent retriever classic (38.2%) or stent retriever combination with aspiration (43.3%), while no differences were seen for M1 segment of the middle cerebral artery ( P = 0.77) and M2 segment of the middle cerebral artery ( P = 0.29) occlusions. Bailout maneuvers, which were more frequent in the direct aspiration group for all occlusion sites, did not result in longer procedure times or different final recanalization outcomes in direct aspiration compared with stent retriever classic or stent retriever combination with aspiration. Overall, there were no differences in the rate of patients with modified Rankin Scale scores of 0–2 at 90 days. No differences in safety outcomes were observed. CONCLUSIONS This study provides insight into the complex relationship between reperfusion techniques and occlusion sites in patients with acute ischemic stroke and shows that certain techniques have advantages in certain occlusion sites. As the field evolves, further research is warranted to refine our understanding of these dynamics and inform clinical practice.

Comparison of Abdominal and Vaginal Hysterectomy: A Comparative Clinical Study at A Tertiary Hospital of Southern Part of Bangladesh

Background: Hysterectomy is indicated in several common gynecologic problems and is one of the commonly performed operations in many hospitals of Bangladesh. Though Hysterectomy is a reasonably safe operative procedure but at times minor to major complications may occur. Current study was undertaken to compare the feasibility and safety of abdominal hysterectomy (AH) and vaginal hysterectomy (VH) procedures in the treatment of benign uterine diseases, and to determine the outcomes of both procedures. Objectives: To compare outcomes of vaginal and abdominal hysterectomy procedures in women with benign gynaecological diseases. Materials and Methods: This was a prospective study of outcomes of consecutive patients who underwent AH or VH for benign gynaecological diseases. Patient characteristics before, during, and after the operations were reviewed. Patients were followed up for three months to evaluate postoperative complications. Results: This study included a total of 305 patients. 199 patients underwent AH and 106 patients underwent VH. Baseline characteristics were similar between the two groups. Mean operative time was 95.78±18.46 minutes for AH group and 76.26±19.24 minutes for VH group (p&lt;0.006). Mean hospital stay was 5.32±0.67 days for AH group and 4.08±0.19 days for VH group with p-value &lt;0.047. There was a significant lesser total operation cost in VH group than AH group (VH: 12058±386 BDT, AH: 14275±276 BDT; P &lt; 0.05). Furthermore there was no wound infection; paralytic ileus and no need to reopening any patient in case of VH group compared to AH group. Conclusion: This study showed that vaginal hysterectomy was associated with less intraoperative complications and postoperative morbidities and complications as compared to abdominal hysterectomy. KYAMC Journal Volume: 15, No: 01, April 2024: 40-45.