Rate Of Cardiovascular Complications Research Articles

Influence of risk factors on progression of atherosclerosis of brachiocephalic artery with un-derlying treatment with statins

Aim. Analysis of influence of risk factors (RF) on progression of atherosclerosis of brachiocephalic arteries after unilateral carotid endarterectomy (CEA) with the underlying treatment with statins.
 Materials and Methods. 262 Cases (262 patients) were analyzed. Influence of RFs on the frequency of cerebral circulation disorders (CCD), myocardial infarction (MI), survival rate, condition of the carotid arteries and on lipid profile with the underlying treatment with statins was evaluated. In the early period the results were evaluated in 100% of patients, in a long-term period – in 93.5%. Patients were arranged in groups: a group that received simvastatin – 41.6% in the preoperative period and 24.5% in the long-term period, a group of atorvastatin – 51.9% and 54.7%, a group of rosuvastatin – 6.5% and 20.8%, respectively. Predominating (83.2%) were patients with more than 3 RFs (according to SCORE scale).
 Results. Lethality rate in the analyzed sample group was 6.5%, the rate of fatal cardio-vascular complications (CVC) – 7 cases (2.3%), of non-fatal CCD – 5 cases (1.9%). A significant influence on the progression of alterations in the carotid artery was found in patients with 3 RFs (p=0.03). The length of atherosclerotic plaque (ASP) was maximal in patients with 5 RFs (0.01). In the presence of more than 3 RFs, elevation of the total cholesterol (CL) and of low density lipoproteins (LDLP) was noted, p=0.001. In the long-term period in the atorvastatin group the level of LDLP decreased by 19%, p=0.0001, in the rosuvastatin group the level of HDLP increased by 3.4%, p=0.02. In the rosuvastatin group, the recommended values of CL were achieved 64.7% more often in comparison with the simvastatin group, p=0.03. The rate of CVC increased in patients >68 years of age, р=0.04. The lethality rate increased in case of body mass index (BMI) ≥25-30 kg/m2 (р=0.05) and in case of type 2 diabetes mellitus (p=0.03). The influence of the following factors on long-term results was demonstrated: smoking (p=0.04), arterial hypertension (p=0.019), chronic cardiac insufficiency (p=0.01), a tendency to bradycardia (p=0.03), atherosclerotic lesions of more than one arterial pool (p=0.006). RFs influenced the rate of development of restenosis of the internal carotid artery (ICA) >50% on the side of the operation in 4 observations (1.5%). In the atorvastatin group the most significant positive influence on lipid spectrum was observed in comparison with other groups (by 47.1%, р=0.001).Therapy with atorvastatin stabilized the wall of ICA and of the contralateral common carotid artery (CCA) 17.6% (p=0.05) more frequently in comparison with simvastatin and rosuvastatin.
 Conclusion. A direct influence of RFs on the progression of atherosclerotic alterations in the carotid arteries and on the rate of development of cardiovascular complications in the perioperative and long-term periods, and also influence of underlying statin therapy on the parameters of lipid metabolism, and a higher effectiveness of synthetic statins were determined.

Metabolic effects of egg white enzymatic hydrolyzates: prospects of use in persons with metabolic syndrome (short review)

The metabolic syndrome (MS), which is characterized by significant prevalence, constant growth of patients' number and high rate of cardiovascular complications, is one of actual problems of modern medicine. A way for optimization of the dietary status of patients with MS is the use of specialized foods with optimized chemical composition in their complex treatment. These products allow to correct hyperglycemia, dyslipidemia and antioxidant status disorders. The publications of the last decade show high interest of scientists to the problem of use of enzymatic hydrolysates of food proteins in dietary preventive products for people with metabolic disorders. High biological value of chicken egg protein and its enzymatic hydrolysates define the prospects of their use in specialized foods aimed at correction and/or prevention of MS clinical implications. The hydrolysis of chicken egg protein leads to the formation of biologically active peptides with antioxidant, hypotensive, anticoagulant and some other effects. As functional food ingredient, the enzymatic hydrolysate of chicken egg protein has some advantages over native protein - higher water solubility, digestibility and absorption in gastrointestinal tract. The results of preclinical in vitro and in vivo studies on evaluation of hypolipidemic effects of chicken egg protein and its enzymatic hydrolysates are discussed in this review. The analysis of the presented publications shows, that introduction of chicken egg protein and its enzymatic hydrolysates into the diet of animals with induced metabolic syndrome had hypolipidemic and antihypertensive effects. The main mechanisms of hypolipidemic action of protein hydrolysates and peptides in gastrointestinal tract are briefly discussed in this review. The prospects of the production of enzymatic hydrolysates of chicken egg protein with defined hypolipidemic properties for their inclusion into dietary products for prevention and treatment of MS are proved in the review.

Nonalcoholic Fatty Liver Disease: Epidemiology, Liver Transplantation Trends and Outcomes, and Risk of Recurrent Disease in the Graft.

In parallel with the rising prevalence of metabolic syndrome globally, nonalcoholic fatty liver (NAFL) disease is the most common chronic liver disease in Western countries and nonalcoholic steatohepatitis (NASH) has become increasingly associated with hepatocellular carcinoma. Recent studies have identified NASH as the most rapidly growing indication for liver transplantation (LT). As a hepatic manifestation of the metabolic syndrome, NAFL disease can be histologically divided into NAFL and NASH. NAFL is considered a benign condition, with histological changes of hepatocyte steatosis but without evidence of hepatocellular injury or fibrosis. This is distinct from NASH, which is characterized by hepatocyte ballooning and inflammation, and which can progress to fibrosis and cirrhosis, hepatocellular carcinoma, and liver failure. As for any other end-stage liver disease, LT is a curative option for NASH after the onset of decompensated cirrhosis or hepatocellular carcinoma. Although some studies have suggested increased rates of sepsis and cardiovascular complications in the immediate postoperative period, the long-term posttransplant survival of NASH cases is similar to other indications for LT. Recurrence of NAFL following LT is common and can be challenging, although recurrence rates of NASH are lower. The persistence or progression of metabolic syndrome components after LT are likely responsible for NASH recurrence in transplanted liver. Therefore, while maintaining access to LT is important, concerted effort to address the modifiable risk factors and develop effective screening strategies to identify early stages of disease are paramount to effectively tackle this growing epidemic.

Impact of preoperative cardiology consultation prior to intermediate-risk surgical procedures.

Patients undergoing noncardiac, nonvascular surgery (NCNVS) are at risk of perioperative cardiovascular events. However, benefits of cardiology consultation (CC) in patients with known or suspected cardiac disease undergoing intermediate-risk NCNVS is unknown. The study group included 700 consecutive patients referred for CC before intermediate-risk NCNVS in a tertiary-care teaching hospital. The control group included 1200 age-matched and sex-matched consecutive patients proceeded to the intermediate-risk surgery without preoperative CC during the same period. Patients older than 18years who underwent an elective, NCNVS were enrolled. Requests for consultation were made either by surgeon or an attending anaesthesiologist. All patients underwent a complete preoperative clinical evaluation. Of the 700 patients who were referred for CC in the study group, 530 patients (75.7%) had no additional recommendations, and 170 patients (24.3%) underwent additional preoperative tests or had a change in preoperative therapy. Only 20 (2.8%) patients' NCNVS were delayed based on the cardiologists' recommendation and 680 patients eventually had their surgeries. Major cardiovascular and noncardiovascular complication rates were similar in the study and in the control groups (12.9% vs 13.6%, P=0.273 and 25.2% vs 26%, P=0.432 respectively). Preoperative CC in patients who underwent intermediate-risk NCNVS does not affect either perioperative management or outcome of surgery.

MANAGEMENT OF ERECTILE DYSFUNCTION IN CARDIOVASCULAR PATIENTS WITH COMORBIDITIES: REVIEW OF THE TRIALS ON CONTINUING THERAPY WITH PHOSPHODIESTERASE-5 MEDICATIONS

The review is focused on the issues of erectile dysfunction (ED) management by long term courses of continuous intake of the phosphodiesteraze-5 type (PDE5) inhibitors. ED is an actual problem of modern healthcare, prevalent and influencing negatively life quality and interpersonal relations. At early stages the management of ED by the PDE5 inhibitor drugs was regarded as symptomatic. However recently there are more and more publications that confirm continuous long term intake of PDE5 inhibitors. This can be explained by the mechanism of this drugs class action that includes the causation of the disorder, particularly, endothelial dysfunction. It is well konwn that in erectile dysfunction there is malfunction of nitric oxide synthesis by endothelium, and long term usage of PDE5 facilitates the increase of biochemical reactions that can be started by nitric oxide. Based on the review data, a proposition made that PDE5 inhibitors are not harmful for cardiovascular system, but may present with positive effects on cardiovascular system in general. The trials towards this direction continue. There is also a suggestion that intake of PDE5 inhibitors helps to restore normal endothelial function that may lead to better condition of cardiovascular system and decrease complications rate.

IP215. Population-Based Secular Trends in Lower Extremity Amputations for Diabetes and Peripheral Artery Disease

Rates of cardiovascular and diabetes-related complications are generally decreasing. Whether a similar decline has occurred with lower extremity amputations remains poorly characterized. The aim of this study was to examine secular trends in the rate of lower extremity amputations among patients with diabetes and peripheral artery disease (PAD), within a single-payer regional health care system. The study cohort included all individuals 40 years old who underwent diabetes- or PAD-related lower limb amputation in Ontario, Canada (population, 13.6 million), between April 2005 and March 2016. Patients and amputations were identified through deterministic linkage of administrative health databases including inpatient and outpatient records. Quarterly rates (per 100,000 individuals 40 years old) of minor or major amputation as well as of major amputation alone were established. Time-series analyses were conducted using exponential smoothing models to characterize secular trends. A total of 19,961 patients underwent minor or major lower extremity amputations, of whom 12,755 (64%) underwent a major amputation. A total of 18,745 (94%) patients had PAD, 16,366 (82%) had diabetes, and 15,150 (76%) had both PAD and diabetes. The rate of any amputation initially declined between 2005Q2 and 2010Q4 but increased again by 2016Q1 (Fig 1), with PAD-related minor or major amputations following a similar trend (Fig 1). A significant increase was observed in the rate of any amputation among patients with diabetes and those with diabetes and PAD (Fig 1). Whereas the rates of major amputations decreased, although not significantly, among PAD patients, diabetes-related major amputations did not decrease (Fig 2). Diabetes-related lower extremity amputations have increased during the last decade. These data support renewed efforts to prevent and to decrease the burden of limb loss among patients with diabetes.Fig 2Peripheral artery disease (PAD) or diabetes-related major lower extremity amputations in Ontario, Canada.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Ambulatory Blood Pressure and Endothelial Dysfunction in Hematopoietic Cell Transplantation Recipients

Hematopoietic cell transplantation (HCT) is a common treatment for many disorders. Albuminuria post-HCT, which may represent endothelial injury or inflammation from graft- versus-host disease, increases the risk of chronic kidney disease and nonrelapse mortality at 1 year. HCT recipients also have abnormal blood pressure (BP) and increased rates of cardiovascular complications. We sought to determine the relationships among albuminuria, endothelial dysfunction, and BP in HCT recipients. Patients age ≥12 years who underwent their first allogeneic HCT between 2012 and 2015 and survived through day 80 post-HCT were eligible. Peripheral endothelial function was assessed using the EndoPAT2000 device at day 80 along with 24-hour ambulatory BP monitoring (ABPM). Clinical and laboratory data were collected along with a urine sample for calculation of the albumin-to-creatinine ratio. Both logistic and linear regression analyses were used to identify associations between EndoPAT score and clinical variables. Sixty patients (median age, 48 years; range, 14 to 69 years) completed the study. The median EndoPAT score was 2.05 (range, 1.02 to 4.45), and 17 patients (28%) had abnormal endothelial function. Forty-two patients (72%) had ambulatory hypertension (HTN), and 38 (63%) had blunted nocturnal dipping. HTN on ABPM (P = .045) and blunted nocturnal dipping (P = .04) were associated with a lower EndoPAT score. Albuminuria was not associated with EndoPAT score. There was a lack of agreement between our clinical definition of HTN (office BP and/or use of medications) and ABPM results (P = .04). We did not find an association between lower EndoPAT scores and albuminuria, but did find an association between an abnormal nocturnal dip and HTN diagnosed by ABPM. This suggests that albuminuria may reflect local endothelial injury and inflammation rather than a systemic process. Office BP readings do not accurately reflect true BP, suggesting that 24-hour ABPM studies are needed to diagnose and treat HTN appropriately.

Impact of comorbidity burden on morbidity following thoracoscopic lobectomy: a propensity-matched analysis.

Given the positive effect of a thoracoscopic approach on improving postoperative outcomes, it is reasonable to speculate whether an increased comorbidity burden is related to higher morbidity following thoracoscopic lobectomy. We sought to evaluate the impact of comorbidity burden on adverse postoperative outcomes in this patient population. A retrospective review of our institutional database included 512 patients undergoing thoracoscopic lobectomy for early-stage non-small cell lung cancer (NSCLC) from 2009 through 2016. Comorbidity burden was assessed by the Charlson comorbidity index (CCI) and classified as high (CCI ≥3) or low (CCI <3) grade. Propensity score matching and random effects model were performed. Patients included 228 women and 284 men with a median age of 67 years. High and low comorbidity burdens were found in 193 and 319 patients, respectively. The postoperative mortality, pulmonary and cardiovascular complication rates and overall morbidity in patients with high comorbidity burden were comparable to those with low comorbidity burden (1.6% vs. 0.6%, 9.3% vs. 8.5%, 6.2% vs. 6.0%, 24.4% vs. 22.9%, respectively). Similar results were seen after propensity score matching, which balanced differences in demographics and preoperative characteristics between the comorbidity groups. On the analyses of propensity-matched data using generalized linear mixed model, a high comorbidity burden was not related to greater postoperative complication rates. Our results suggest that thoracoscopic lobectomy can be performed with low mortality and reasonable morbidity in lung cancer patients presenting with multiple comorbid diseases. The presence of a high comorbidity burden measured by CCI does not have a perceptible impact on adverse postoperative outcomes following thoracoscopic lobectomy.

Experimental evaluation of hypolipidemic properties of soy and rice proteins and their enzyme hydrolysates. A brief review

Metabolic syndrome (MS) is characterized with high prevalence, constant increase of people suffering from this disease and high rate of cardiovascular complications. The key factors, leading to the development of metabolism disorders during MS, are visceral fat mass growth and decrease in sensitivity of peripheral tissues to insulin, which are associated with disorders of carbohydrate, lipid, purine metabolism and arterial hypertension. The main results of in vivo studies of hypolipidemic properties of soy protein, rice bran protein and their enzymatic hydrolysates using laboratory rats and mice with experimentally induced or genetically associated dyslipidemia are presented in this review. The analysis of reviewed publications shows that consumption of soy protein provides body weight loss, normalizes lipid metabolism, reduces insulin resistance. The consumption of rice protein by laboratory animals, as well as soy protein, leads to decrease of serum cholesterol level and also provides steroid excretion, such as cholesterol and bile acids, with feces. Enzymatic hydrolysis of food proteins allows obtaining peptide mixtures with high biological value and improved functional properties, especially water solubility and intestinal absorption. In their turn, hypolipidemic peptides of hydrolysates can play a key role in endogenous cholesterol homeostasis by means of disturbing its micellar solubility, intestinal absorption, changing bile acids entherohepatic circulation, and also lowering the expression of some genes of proteins - mediators of lipid transport. It has been concluded, that hypolipidemic properties of obtained enzymatic hydrolysates of food proteins determine the prospects of their use in specialized food products for prevention of metabolic disorders.

Postoperative morbidity in elderly patients after gastric cancer surgery.

BackgroundElderly patients have a high risk of adverse outcomes after surgery. Therefore, it is essential to determine the predictive factors for postoperative morbidity in elderly patients undergoing gastric cancer surgery.MethodsA total of 544 patients who underwent elective gastrectomy for gastric cancer at Yodogawa Christian Hospital between January 2007 and December 2015 were divided into the elderly group (age ≥70 years, n=282) and a control group (age <70 years, n=262). Clinicopathological data from all patients were reviewed.ResultsThe overall morbidity rates were 24.8% in the elderly group and 13.4% in the control group, indicating a significant difference (P<0.001). The incidence rates of anastomotic leakage (4.6% vs. 1.5%, P=0.039) and cardiovascular complications (2.5% vs. 0%, P=0.01) were significantly higher in the elderly group. A multivariate analysis revealed that a blood loss of ≥320 mL was an independent predictive factor of overall morbidity (P=0.004). A blood loss of ≥219 mL (P=0.025) and American Society of Anesthesiologists (ASA) physical status of 3/4 (P=0.006) were associated with anastomotic leakage and postoperative cardiovascular complications, respectively.ConclusionsThe overall morbidity rate was significantly higher among elderly patients and an intraoperative blood loss of ≥320 mL was a significant predictive factor. In particular, anastomotic leakage and cardiovascular complications were seen with greater frequency among those with a higher blood loss volume and ASA physical status, respectively.

Rebleeding and Mortality After Lower Gastrointestinal Bleeding in Patients Taking Antiplatelets or Anticoagulants

Patients who develop lower gastrointestinal bleeding (LGIB) while receiving anticoagulants oranti-platelets have increased severity of bleeding and risk of rebleeding. We compared outcomes of patients receiving antiplatelets, anticoagulants, or direct oral anticoagulants (DOACs) who develop LGIB, as well as the effects of withholding these drugs on their course of bleeding. We performed a retrospective study of 2528 consecutive adult patients with LGIB at 143 hospitals in the United Kingdom, from September through December 2015; 917 were taking anticoagulant or antiplatelet drugs and 1218 were taking neither (unexposed). We collected data on demographic features of patients, interventions or medications, outcomes, laboratory test results, and patient readmission until patient death, discharge, or 28 days after admission (whichever came first). Rebleeding was defined as additional transfusion requirements and/or a decrease in hematocrit ≥20% after 24 hrs of clinical stability. Multivariate regression was used to examine the relationship between drug class on presentationwith LGIB and rebleeding, mortality, and cardiovascular events. Rates of rebleeding and cardiovascular complications in patients who had these drugs withheld were also analyzed. Patients receiving antiplatelets, but not those receiving warfarin (n= 232) or DOACs (n=102), had a higher risk of in-hospital rebleeding (monotherapy hazard ratio [HR], 3.57; 95% CI, 1.13-11.28; n= 504 and dual antiplatelet therapy hazard ratio, 5.3; 95% CI, 1.56-18.54; n= 79) compared with the unexposed group. This risk was not lower in patients who received antiplatelets and had the drug withheld for fewer than 5 days, compared to those who continued the drug throughout admission (HR, 0.98; 95% CI, 0.45-2.17) No differences were observed in risk-adjusted mortality or readmission with further bleeding for patients receiving antiplatelets, DOACs, or warfarin. Cardiovascular events were too few to allow meaningful comparison. In patients with LGIB, antiplatelet drugs, but not warfarin or DOACs, are associated with an increased risk of rebleeding. Withholding antiplatelets during admission does not lead to reduction in rebleeding.

Pregnancy outcomes in patients with a fontan circulation and proposal for a risk-scoring system: single centre experience

BackgroundPregnancy in women with Fontan physiology poses a significant management challenge and is deemed high risk. The aim of this study is to describe short and long-term pregnancy outcomes in women who have undergone Fontan palliation and propose a novel risk-stratification model specific to women with a Fontan heart.MethodsWe undertook a single-centre, retrospective cohort study of all female Fontan patients (n = 78) from 1991–2015. We recorded pregnancy outcome, maternal cardiovascular and obstetric complications and fetal outcome. We propose a risk stratification model to identify those women who might be at highest risk of adverse outcomes during pregnancy.ResultsTwenty-one women had 55 pregnancies, with 13 (24%) live births and 38 (69%) spontaneous miscarriages (p < 0.001). Eight (62%) out of 13 live birth pregnancies incurred maternal cardiovascular complications and six (46%) experienced maternal obstetric complications. Median gestational age at delivery was 32(27–39) weeks with 12 out of 13 (92%) pregnancies resulting in pre-term delivery. There were more pregnancies (OR 4.90, 95% CI 1.46–16.42, p ≤ 0.01) and a trend towards a higher proportion of live births (OR 7.60, 95% CI 1.81–31.97, p = 0.06), in the ‘lower risk’ compared to those women in the ‘very high risk’ group. There were no maternal deaths.ConclusionsWe observed a high first trimester miscarriage rate, significant maternal cardiovascular and obstetric complication rates and a high rate of pre-term births in pregnant Fontan women. Our risk stratification model requires further investigation but may identify those women at particularly high risk of a poor outcome, and inform realistic pre-pregnancy counselling.

Cardiovascular Risk Associated With White-Coat Hypertension: Con Side of the Argument.

Cardiovascular Risk Associated With White-Coat Hypertension: Con Side of the Argument.

Abstract P541: Ambulatory Blood Pressure and Endothelial Dysfunction an Hematopoietic Cell Transplant Patients

Hematopoietic cell transplantation (HCT) is a common treatment for malignancies, metabolic, and genetic disorders. Albuminuria post-HCT, which may represent systemic endothelial injury or inflammation from graft vs host disease, increases the risk of kidney disease and non-relapse mortality at 1 year post-HCT. HCT patients are also known to have abnormal blood pressure (BP) and increased rates of cardiovascular complications. We sought to determine the relationships between albuminuria, endothelial dysfunction and ambulatory BP in HCT patients. Patients ≥ 12 years of age who had their first allogeneic HCT between 2012-2015 and survived through day 80 were eligible. Peripheral endothelial function was assessed using the EndoPAT2000 device at day 80 post HCT along with a 24 hour ambulatory blood pressure monitor (ABPM) study. Clinical and lab data were collected and a urine sample for an albumin to creatinine ratio (ACR). Both logistic and linear regression analyses were used to identify associations between EndoPAT score and clinical variables including eGFR, 24 hour ABPM study, albuminuria, and serum lipids. Sixty patients completed the study. The median age was 48 years (range, 14-69). The median EndoPAT score (RHI normal ≥ 1.69) was 2.05 (range, 1.02- 4.45) and 28% (17/60) of the patients had abnormal endothelial function. Forty-two patients (72%) had hypertension based on the 24-hr ABPM results and 63% of the patients (38/60) had abnormal nocturnal dipping. Hypertension on ABPM (p = 0.04), abnormal nocturnal dipping (p=0.04), and elevated serum triglyceride levels (p=0.03) were associated with a lower EndoPAT score. Albuminuria was not associated with EndoPAT score or hypertension based on ABPM. Abnormal nocturnal dipping was associated with lower eGFR (p=0.03). There was a lack of agreement between office BP and use of medications and results on a 24 hour ABPM study (p &lt; 0.001). We did not find a correlation with lower EndoPAT scores and albuminuria; we did find associations between abnormal nocturnal dip, elevated triglyceride levels and hypertension diagnosed by 24 hour ABPM. Casual office BP readings do not accurately reflect the HCT patient’s true BP suggesting that 24 hour ABPM studies are needed to diagnose and treat hypertension appropriately.

Degree of pulmonary fissure completeness can predict postoperative cardiopulmonary complications and length of hospital stay in patients undergoing video-assisted thoracoscopic lobectomy for early-stage lung cancer

To estimate the effects of pulmonary fissure completeness on postoperative cardiopulmonary complications (PCCs) and hospital stay in patients undergoing video-assisted thoracoscopic surgery lobectomy for early-stage non-small-cell lung cancer. We performed a single-centre retrospective analysis based on the prospectively maintained data of our institution during the study period. Demographic differences between the PCC group and the non-PCC group were initially examined. Then, the patients were classified into 3 groups according to their fissure sum averages (FSAs: 0 ≤ FSA ≤ 1, 1 < FSA ≤ 2, 2 < FSA ≤ 3) calculated by fissure development scores. The differences in PCC incidences and hospital stay between these 3 groups were further evaluated. Finally, FSA > 1 was determined as the cut-off to indicate the degree of pulmonary fissure completeness and involved into a multivariate logistic regression model to identify the predictors for PCCs. In total, 528 patients with Stage I to Stage II non-small-cell lung cancer were enrolled. There were 343 patients with 0 ≤ FSA ≤ 1, 105 patients with 1 < FSA ≤ 2 and 80 patients with 2 < FSA ≤ 3. Pulmonary complication rate in patients with 1 < FSA ≤ 2 (25.7% vs 14.3%; P = 0.006) and with 2 < FSA ≤ 3 (33.8% vs 14.3%; P < 0.001) was significantly higher than that in patients with 0 ≤ FSA ≤ 1. No difference was found in cardiovascular complication rate between these groups (P = 0.22). The Kaplan-Meier analysis showed that the length of hospital stay and the length of chest tube drainage in patients with 1 < FSA ≤ 2 and with 2 < FSA ≤ 3 were significantly longer than those in patients with 0 ≤ FSA ≤ 1. Incomplete pulmonary fissure (FSA > 1) was a strong independent predictor for PCCs (odds ratio = 2.12; P = 0.002) in the multivariate analysis. The degree of pulmonary fissure completeness can predict the PCCs and the length of hospital stay following video-assisted thoracoscopic surgery lobectomy for early-stage non-small-cell lung cancer.

Clinical characteristics and the factors relevant to peritoneal transport function in patients with continuous ambulatory peritoneal dialysis

To observe the clinical characteristics with different peritoneal transport type in patients with continuous ambulatory peritoneal dialysis (CAPD), and to investigate the factors associated with peritoneal transport function. Methods: The clinical data of 158 CAPD patients were analyzed retrospectively. According to peritoneal equilibration test, a method for evaluation of the peritoneal transport function, the patients were divided into 2 groups: a high average and high peritoneal transport group (Group A, n=84) and a low average and low peritoneal transport group (Group B, n=74). The demographics, clinical biochemical indexes and the incidence of cardiovascular complications were compared between the 2 groups. Logistic regression analysis was used to find the factors relevant to peritoneal transport function. Results: The level of serum albumin (ALB) in the Group B was significantly higher than that in the Group A (P<0.05). The 4 h dialysate/plasma creatinine (D/Pcr), high-sensitivity C-reactive protein (hs-CRP), body mass index (BMI), and the rates of cardiovascular complications in the Group A were significantly higher than those in the Group B (P<0.05). Correlation analysis showed that the D/Pcr was positively correlated with the BMI, serum hs-CRP and cardiovascular complications (r=0.179, 0.373 and 0.426, respectively, P<0.05), while it was negatively correlated with ALB (r=-0.393, P<0.01). Logistic regression analysis showed that the high BMI (OR=1.178, P<0.05), cardiovascular complications (OR=5.035, P<0.01), and the low serum ALB (OR=0.852, P<0.01) were the risk factors for high peritoneal transport. Conclusion: The serum ALB level, BMI and the cardiovascular complications are associated with high peritoneal transport, which are useful markers for predicting the peritoneal transport function before peritoneal dialysis.

Gastrointestinal endoscopy in patients receiving novel direct oral anticoagulants: results from the prospective Dresden NOAC registry.

Patients receiving direct-acting, non-vitaminK oral anticoagulants (NOAC) frequently undergo gastrointestinal endoscopies (GIE) but little is known on the management and outcome of these interventions. With use of data from an ongoing, prospective, noninterventional registry of NOAC patients, the management and outcome of GIE were evaluated with use of standard event definitions. Patients undergoing GIE were categorized into two subgroups: (1) scheduled GIE (scheduled appointment, no acute bleeding) and (2) unscheduled GIE (unscheduled including management of acute gastrointestinal bleeding). The rates of major bleeding complications, cardiovascular complications, and all-cause death within 30days after the procedure were evaluated. Between October 1, 2011, and March 31, 2015, 492 patients underwent a total of 713 GIE (44.5% gastroscopies, 53.0% colonoscopies, 2.5% endoscopic retrograde cholangiopancreatography procedures), with 70.0% being scheduled procedures and 30.0% being unscheduled procedures. Endoscopies were performed within 24h after the last NOAC intake in 45 of 713 cases (6.3%), between 24 and 48h after the last intake in 336 cases (47.1%), and after NOAC therapy interruption for more than 48h in 213 cases (29.9%). Heparin bridging therapy was used in 180 of 713 procedures (25.3%) and predominantly (170/180; 94.4%) in cases of NOAC therapy interruption for longer than 72h. Until day 30 after the procedure, the event rates were 1.4% for cardiovascular events and 0.7% for major bleeding events. Continuation or short-term interruption of NOAC therapy seems to be a safe strategy for GIE. Heparin bridging therapy is predominantly used in cases of prolonged NOAC therapy interruption.

Vascular and Endothelial Function in Youth with Type 2 Diabetes Mellitus.

This review aims to discuss the burden of type 2 diabetes in youth and summarize the studies that have utilized noninvasive techniques to assess early vascular disease in youth with type 2 diabetes. Noninvasive imaging modalities provide researchers with tools to investigate the vasculature in adolescents with type 2 diabetes. The data published to date consistently show adolescents with type 2 diabetes have greater vascular thickness and stiffness and worse endothelial function compared to their obese and lean peers. As the prevalence of type 2 diabetes continues to increase adolescent youth, there is concern adolescents with type 2 diabetes are at risk to develop early onset cardiovascular disease and complications. Future studies need to address treatments that have the potential to improve or reverse vascular dysfunction and decrease the rate of cardiovascular disease and complications.

THE EFFICIENCY OF ANTI-COAGULANTS APPLIED DURING TRANSCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ELEVATION OF ST SEGMENT

The purpose of study. To evaluate efficiency of different coagulants used under transcutaneous coronary interventions in patients with acute coronary syndrome without elevation of ST segment.The methods. The sampling of 346 patients was randomized in two groups. In the group I (n=155) transcutaneous coronary intervention was implemented using bivalirudin and in group II (n = 191) - using unfractionated heparin. The additional randomization of patients of group I: in subgroup A (n = 77) infusion of bivalirudin continued during four hours after intervention and in subgroup B (n = 78) infusion was discontinued in X-ray operating room. The criteria of inclusion: patients with acute coronary syndrome without elevation of ST segment with multi-vascular affection of coronary channel (risk on SYNTAX score = 23-32); high and medium degree of risk according GRACE scale; absence of re-vascularization of myocardium in anamnesis. The criteria of exclusion: patients with very high risk according GRACE scale; affection of left coronary artery trunk. The results. During period of hospitalization, total rate of intra- and post-operative cardiovascular complications had no reliable differences in two groups and amounted to 7.1% and 8.4% correspondingly (p = 0.6423). The serious bleedings (BARC 3 and 5) occurred reliably more frequently in patients of group II. Also, the groups had no differences in rate of development of acute thrombosis of stents. In subgroup A reliably less frequently occurred serious cardiovascular complications as compared with patients of subgroup B (1,3% и 13% correspondingly; р = 0,001). At that, rate of bleeding reliably had no differences. At trans-radial access, in patients of group I rate of bleeding and cardiovascular complications amounted to 0% and 2.9% and at trans-femoral access these indices were reliably higher - 3,3% и 10% correspondingly (р &lt; 0,001). In group II a similar tendency is noted: at trans-radial access these indices amounted to 6% and 4.6% and at trans-femoral - 33.7% and 11.9% correspondingly (р

Burr-Hole Drainage for Chronic Subdural Hematoma Under Low-Dose Acetylsalicylic Acid: A Comparative Risk Analysis Study.

Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases typically affecting older people. Many of these patients have coronary artery disease and receive antiplatelet therapy, usually acetylsalicylic acid (ASA). Despite growing clinical relevance, there is still a lack of data focusing on the perioperative management of such patients. The aim of this study is to compare the perioperative and postoperative bleeding and cardiovascular complication rates of patients undergoing burr-hole drainage for cSDH with and without discontinuation of low-dose ASA. Of 963 consecutive patients undergoing burr-hole drainage for cSDH, 198 (20.5%) patients were receiving low-dose ASA treatment. In 26 patients (13.1%), ASA was not discontinued (ASA group; ASA discontinuation ≤7 days); in the remaining patients (n= 172; 86.9%), ASA was discontinued at least for 7 days (control group). The primary outcome measure was recurrent cSDH that required revision surgery owing to clinical symptoms, whereas secondary outcome measures were postoperative cardiovascular and thromboembolic events, other complications, operation and hospitalization time, morbidity, and mortality. No statistically significant difference was observed between the 2 groups regarding recurrence of cSDH (P= 1). Cardiovascular event rates, surgical morbidity, and mortality did not significantly differ between patients with and without discontinuation of low-dose ASA. Given the lack of guidelines regarding perioperative management with antiplatelet therapy, our findings elucidate one issue, showing comparable recurrence rates with and without discontinuation of low-dose ASA in patients undergoing burr-hole drainage for cSDH.