Short-term Outcomes Research Articles

Gender disparities in short-term outcomes of STEMI patients: the influence of universal health coverage

Abstract Background Even after the event, individuals recovering from ST-elevation myocardial infarction (STEMI) face lingering risks, including potential subsequent events and mortality. The introduction of Universal Health Coverage (UHC) seeks to enhance healthcare outcomes for all segments of the population. Purpose This study evaluates the effect of UHC on 30-day mortality in post-STEMI patients, focusing on medication access and treatment disparities. Using a gender-stratified approach, we analyze changes before and after UHC implementation to provide insights into the difference in therapy between genders and how gender influences healthcare outcomes for post-STEMI patients. Methods Analyzing two cohorts, Cohort 1 (211 STEMI patients, 2013-2014 pre-UHC) and Cohort 2 (365 STEMI patients, 2018-2020 post-UHC), this study employed the chi-square test to determine differences between genders and the Kaplan–Meier log-rank test to compare survival rates. Results Comparing pre- and post-UHC, we observed a significant increase in both medication and reperfusion therapy (p<0.001). However, even in both periods, women continued to have lower rates of medication and reperfusion compared to men (Men vs Women: Before UHC 14.3% vs 0%; After UHC 58.5% vs 47.9%). Within 30 days after the STEMI event, we noted a reduction in mortality rates across genders before and after UHC implementation, yet the decrease was less pronounced in women compared to men (Before UHC: Men 13.0%, Women 22.0%; After UHC: Men 8.2%, Women 18.3%). Conclusion UHC led to improvements in medication and reperfusion therapy for STEMI patients. Despite this progress, persistent gender disparities were observed, with women consistently having lower treatment rates. While mortality rates reduced for both genders, the decrease was less pronounced in women, especially after the implementation of UHC. These findings emphasize the need for targeted interventions to address gender-specific healthcare discrepancies within the scope of comprehensive health coverage.Baseline characteristicsMortality outcomes within 30 Days

Epicardial adipose tissue volumes for long-term risk stratification in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Abstract Background Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR. Purpose We hypothesized that EAT impacts long-term outcome of patients with severe AS undergoing TAVR independently from subtype and other risk factors. Methods A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74cm3 of EAT into groups with low-EAT and high-EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses. Results A total number of 341 of 416 patients (median age 80.9years, 45% female) was included in the final analysis. Patients with high-EAT volumes had similar short-term outcome (p=0.794) but significantly worse long-term prognosis (p=0.023) compared to patients with low-EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59;p=0.031) independently from concomitant cardiovascular risk factors, general type of AS and functional echocardiography parameters of AS severity (HR1.69;p=0.013). Conclusion Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS.Graphical Abstract

A sex-specific comparison of valve-in-valve transcatheter aortic valve implantation

Abstract Introduction Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a viable and less-invasive alternative to open heart surgery in selected patients with bioprosthetic valve dysfunction. Since patients receiving initially a new bioprosthetic aortic valve are predominantly male, data on a sex-specific comparison of ViV-TAVI is scarce. Thus, we compared patient characteristics, procedural outcomes, and 1-year outcomes of female (F) versus male (M) patients with failing bioprosthetic aortic valves undergoing ViV-TAVI. Methods A total of 375 Patients at 3 German centres were included in this analysis. The 1-year mortality was the primary outcome measure, secondary outcomes included VARC-3 defined technical and device success and early safety. Results Overall, 160 (42.6 %) women and 215 (57.4 %) men were included. Women were older (F 81 (77; 84), p < 0.001), had a greater surgical risk (STS PROM F: 9.1 (6.1; 13,9) %, p < 0.001) and a higher rate of previous coronary bypass surgery (F: 25.6 % vs M: 40 %, p = 0.004), while presenting mostly failed valve sizes < 20 mm (F: 59.4 % vs M: 33.4 %, p < 0.001) and therefore higher gradients (F: 40 (31; 50) mmHg vs M: 32 (25; 42) mmHg, p < 0.001). Aortic regurgitation was the mode of failure in 7.5 % of F vs. 14.4 % of M. The number of stentless valves was higher in men (F: 8,1 % vs M: 14 %, p = 0.08). Patients received a self-expanding TAVI prostheses in 79.4 % and 75.8 % respectively in F and M patients. The rates of technical success (F: 75.6 % vs M: 83.3 %, p =0.06), device success (F: 52.5 % vs M: 58.2 %, p = 0.27) and early safety (F: 67.5 % vs M: 67 %, p = 0.91) were comparable between genders. Residual mean gradients were higher in F (F: 15 (11;22) mmHg vs M: 15 (10; 20) mmHg, p = 0.03), while the rates of residual regurgitations were greater in M patients (F: 1 (0.6 %) vs M: 11 (5.1 %), p = 0.04). The Kaplan-Meier estimated 30-day mortality rate (F: 2.5% vs M: 3.3%, p = 0.66) and 1-year mortality rates (F: 10 % vs M: 92.6 %, p = 0.37) were comparable between genders. Conclusion: F and M patients treated by ViV-TAVI have comparable short-term outcomes according to VARC-3-defined endpoints and similar mortality rates after 30 days and 1 year. The residual gradients in F and residual regurgitations in M could be explained by structural features of their failed valves. Further large scale studies are needed to determine, if such procedural outcomes are truly sex-specific.

Is conversion to duodenal switch after Roux-en-Y gastric bypass safe? Short-term outcomes review.

Weight regain after Roux-en-Y gastric bypass (RYGB) can be seen in approximately 20% of patients. Surgical management options include revision of RYGB and conversion to duodenal switch (DS). Using recently included revisional surgery variables in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared the safety and efficacy of RYGB revision versus conversion to DS. An analysis of the 2020 MBSAQIP Participant Use Data File (PUF) revealed 1421 patients who underwent revision of RYGB (n = 1255) or conversion from RYGB to DS (n = 166) for inadequate weight loss or weight regain. Patient characteristics, preoperative body mass index (BMI), operating room (OR) time, and 30-day complications were compared between groups. When compared with the revision RYGB group, the DS group had higher mean BMI (47.5 vs 42.7, p < 0.001) and longer operative time (209.1 vs 133.4min, p < 0.001). DS had higher rates of any complication compared to revision RYGB (22.3 vs 5.58%, p < 0.001). DS had higher 30-day readmission rates (16.3 vs 5.50%, p < 0.001), reoperation within 30days (9.04 vs 2.87%, p < 0.001), venous thromboembolism (VTE) (3.01 vs 0.08%, p < 0.001), intensive care unit (ICU) admission (8.43 vs 0.72%, p < 0.001), anastomotic leak (7.83 vs 0.40%, p < 0.001), surgical site occurrence (SSO) (11.5 vs 2.71%, p < 0.001), and death (0.60 vs 0%, p < 0.001). This short-term data suggests that conversion of RYGB to DS is associated with higher rates of postoperative complications when compared with revision of RYGB. Given the complexity of the procedure, it is best performed by experienced surgeons with careful consideration given to appropriate patient selection and only after extensive patient counseling on associated risks and complications.

Long-term efficacy of cardiac resynchronization therapy with triple-site ventricular stimulation in heart failure patients

Abstract Background Cardiac resynchronization therapy (CRT) reduces cardiac electrical dyssyncrhony and improves clinical outcomes in selected symptomatic patients with left ventricular (LV) systolic dysfunction. However, patients after conventional CRT (Bi-V) have residual cardiac electrical dyssynchrony. CRT with multi-site pacing has gained attention to improve short-term outcome refractory to BiV. However, long-term follow up outcome is still uncertain. We evaluated the efficacy of CRT with triple-site ventricular stimulation (Tri-V), involving 2 LV lead in 2 anatomically separated veins and a single RV lead in RV apex for long-term follow up period. Methods Ninety-two consecutive patients with New York Heart Association class II-IV heart failure, LV ejection fraction &amp;lt;0.35, and QRS interval &amp;gt;120ms, who underwent CRT implantation between 2010 and 2016, were enrolled. Acute hemodynamic responses to temporary dual-site and triple-site ventricular pacing were evaluated, and patients were assigned to either the Bi-V or Tri-V group based on the results. The primary endpoint was the HF clinical composite score, which scores patients as improved, unchanged, or worsened. The secondary endpoint included cumulative survival from any cause of death and HF hospitalization. Results Tri-V was successfully implanted in 32 patients. Five patients were excluded during follow-up because of uncaptured pacing in one of the LV leads. One year post-implantation, the clinical composite score significantly improved in 84% of Tri-V patients compared to 57% in the Bi-V group (p=0.026). After a median follow-up of 12.0 years, there was no significant difference about all-cause mortality between Tri-V and Bi-V (p=0.147). However, Tri-V group showed significant lower HF hospitalization (p=0.005) than Bi-V group. The number of battery exchange was not significantly different between Tri-V than Bi-V group (1.4±0.7 vs. 1.2±0.8, p=0.361). Conclusion CRT with Tri-V, characterized by stable lead parameters, appears to offer greater long-term benefits than Bi-V in terms of clinical status without excessive battery exchanges.figure

Transcatheter versus surgical aortic valve replacement in aortic stenosis patients requiring mechanical circulation support: a nationwide Japanese study

Abstract Introduction Transcatheter aortic valve replacement (TAVR) has demonstrated comparable clinical outcomes to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS). However, previous trials excluded patients who had required mechanical circulatory support (MCS) for cardiogenic shock. Thus, the clinical feature of aortic valve replacement requiring MCS and the efficacy of TAVR compared to SAVR has not been fully exhibited in AS patients. Purpose This study investigated the demography and clinical outcomes comparing TAVR and SAVR for AS demanding MCS. Methods The current study was an observational retrospective study using Japanese nationwide data from the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). Between April 1, 2012, and March 31, 2022, AS patients undergoing TAVR or SAVR who required MCS were evaluated. The primary outcome was 30-day mortality. In addition, we assessed ischemic stroke, hemorrhagic stroke during hospitalization. Result During the period, 80,752 patients (TAVR=36,546 and SAVR=44,206) were identified. The frequency of MCS (intra-aortic balloon pumping and/or extracorporeal membrane oxygenation) was 3.0% (1,097 patients) of the TAVR group and 4.8% (2,133 patients) of the SAVR group. In the TAVR group, 78% of patients were implanted balloon-expandable valve and 7.1% of patients were transapical apical approach. TAVR was performed in older (median age: 85 years vs. 76 years, p&amp;lt;0.001), lower body mass index (BMI) (median BMI: 21.5 kg/m2 vs. 22.7 kg/m2, p&amp;lt;0.001), and more female patients (42% vs. 27%, p&amp;lt;0.001) than SAVR. The 30-day mortality was lower in TAVR than SAVR (12% in TAVR and 19% in SAVR, p&amp;lt;0.001) (Figure). After adjusting age, gender, TAVR was significantly associated with decreased 30-day mortality compared to SAVR (adjusted HR 0.52 (0.41–0.67), p&amp;lt;0.001). In contrast, the incidence of ischemic stroke and hemorrhagic stroke were comparable in 2 groups (ischemic stroke; 4.2% in TAVR vs. 4.1% in SAVR, p=0.93 and hemorrhagic stroke; 0.3% vs. 0.3%, respectively). Conclusion According to nationwide real-world clinical data on aortic valve replacement for AS, the frequency of patients requiring MCS due to cardiogenic shock was 3.0% in the TAVR group and 4.8% in the SAVR group. Our findings demonstrated short-term outcomes following TAVR for patients requiring MCS for cardiogenic shock was better than those following SAVR.

Prognostic value of MELD-XI score and hemodynamic parameters in patients undergoing transcatheter tricuspid valve intervention

Abstract Background Hepatorenal dysfunction is a strong prognostic predictor in patients with tricuspid regurgitation. Patients are often hospitalized with acute heart failure due to volume overload and peripheral hypoperfusion. End-organ dysfunction is associated with the development of right ventricular failure related to hemodynamic changes such as low cardiac output and passive congestion from increased right ventricular filling pressures. Purpose This study aimed to investigate the prognostic value of hepatorenal dysfunction using the Model for End-stage Liver Disease (MELD) Score, the modified version of the score, MELD-XI, and of parameters determined during right-heart catheterization in patients undergoing transcatheter tricuspid valve intervention. Methods In this single-center prospective cohort study, data from patients undergoing edge-to-edge repair or heterotopic minimal invasive tricuspid valve repair were analyzed. Serum creatinine, INR and bilirubin were measured and the MELD score as well as the MELD XI score was calculated. All patients underwent right heart catheterization before the intervention. Receiver operator characteristics with calculation of the area under the curve (AUC) were performed to determine the predictive value of MELD (XI) score and hemodynamic parameters for the combined endpoint of rehospitalization due to decompensated heart failure and mortality within 3 months. Results Data from 36 consecutive patients were analyzed. 28 patients underwent edge-to-edge repair and 8 patients heterotopic minimal invasive tricuspid valve repair. Mean age of patients was 80.2 ± 5.9 years; 33.3% (12/36) were male. Baseline characteristics are shown in table 1. Rehospitalization due to decompensated heart failure occurred in 9/36 patients (25%). Mortality within the first 3 months was 11% (4/36). The predictive value for the composite endpoint of the modified MELD IX score was AUC 0.82 (95 % CI 0.63-0.99; p=0.009), while the conventional MELD score had an AUC of 0.77 (95 % CI 0.55-0.99; p = 0.059) (figure 1). RV pressure (AUC 0.84, 95% CI 0.66-1.00, p= 0.012) and RA pressure (AUC 0.83, 95% CI 0.67-0.98, p=0.016) showed a good predictive value for the composite endpoint (figure 2). The combination of MELD XI (at admission) and RV or PA pressure improved the AUC (MELD XI + RV: AUC 0.85; MELD XI + PA: AUC 0.84). Conclusion In this pilot-study, the modified MELD XI score, as indicator of hepatorenal dysfunction, was identified as a potential marker for short-term outcome after interventional tricuspid valve treatment.

Trans catheter edge to edge repair for mitral regurgitation and left ventricular outflow obstruction in hypertrophic cardiomyopathy

Abstract Background Based on previous reports, mitral valve transcatheter edge to edge repair (TEER) may be considered in patients with severe mitral regurgitation (MR) and left ventricular obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) that are high risk for surgery. Objective We aimed to evaluate the feasibility, and immediate and short-term outcomes of mitral TEER in symptomatic patients with severe MR and HOCM. Methods Five patients (age 75±6, 3 men) with severe MR and HOCM with high surgical risk, and anatomy not suitable for septal ethanol ablation, who remained symptomatic despite maximally tolerated drug therapy were selected for TEER using the MitrClip system. Result The procedure was performed successfully on all 5 patients. Devices were deployed at the A2-P2 scallops of the mitral valve. MR severity declined from severe to mild in all patients, left ventricular outflow (LVOT) maximal gradient decreased from 140±46 to 8±5 mmHg after TEER, and was 41±32 mmHg at 4±2 month follow- up, Clinically, all patients reported improvement of their symptoms to Class I-II NYHA functional Class. Conclusion TEER may be a beneficial procedure for severely symptomatic patients with severe MR and obstructive HOCM on maximal tolerated medical therapy, who are not amenable to surgery because of excessive risk, old age, and frailty.Pre and Post procedure EchoPre and Post Cath

Short-term outcomes of da Vinci SP versus Xi for rectal cancer surgery: a propensity score matching analysis of two tertiary center cohorts.

This study compares the perioperative outcomes of robotic rectal cancer surgery between da Vinci single-port (SP) system, the most recent system allowing minimally invasive surgery with reduced ports, and the da Vinci Xi system. Patients who underwent robotic surgery for rectal adenocarcinoma from January 2016 to September 2023 at two tertiary referral centers were included. A retrospective analysis was conducted to compare key parameters between patient cohorts before and after propensity score matching. A total of 378 patients (SP, 65 vs. Xi, 313) were analyzed. The SP group comprised a higher proportion of females (44.6% vs. 28.4%; p = 0.016) and a higher tumor location (8.25cm vs. 6.71cm from the anal verge; p < 0.001) than did the Xi group. SP surgery promoted a shorter total incision length (4.9 cm vs. 9.2 cm; p < 0.001), lower maximum pain scores (5 vs. 7; p < 0.001), and shorter hospital stay (6 vs. 7days; p < 0.001) than did Xi surgery. Operation time (175 vs. 182min; p = 0.829) and postoperative complications (9.2% vs. 12.1%; p = 0.650) did not significantly differ between the groups. Lower lying rectal tumors were more frequently treated using the Xi system than the SP system, promoting a higher diverting stoma rate (13.8% vs. 45.4%; p < 0.001) and a lower anastomosis level (4.6cm vs. 3.3cm; p < 0.001). After 1:1 matching, SP maintained its advantages over Xi in terms of incision length (p < 0.001), maximum pain scores (p = 0.001), and hospital stay (p < 0.001). Overall postoperative complication rates were similar between both groups (10.8% vs. 12.3%; p = 0.777). The da Vinci SP system continues to offer minimal invasive benefits in rectal cancer surgery. However, the Xi system's instrument diversity provides a certain advantage, particularly in cases involving low-lying rectal tumors. Tailoring robotic approaches based on individual patient characteristics remains pivotal for optimizing outcomes of rectal cancer surgery.

Comparison of Short-Term Outcomes of DSA and ALMIS Approach for Bipolar Cemented Hemiarthroplasty in Patients with Neck of Femur Fracture.

Background/Objectives: A neck of femur (NOF) fracture is one of the most common fractures, and its treatment in the geriatric population using cemented bipolar hemiarthroplasty (HA) is a standard procedure worldwide. Various surgical approaches have been described for this operation, aiming to reduce complications and improve early mobilization. The present study compares two minimally invasive approaches, the anterolateral minimally invasive approach (ALMIS) and the direct superior approach (DSA), with respect to their intraoperative and early postoperative complications in cemented bipolar HA. Methods: The medical records of all patients undergoing cemented bipolar HA for a NOF fracture between January 2017 and December 2023 were analyzed. The aim of the study was to compare the two surgical approaches. The evaluation focused on intraoperative parameters and early complications. Results: A total of 226 patients were included in the analysis, with 62 undergoing DSA and 164 ALMIS, with an average age of 83.5 years. The two approaches did not differ significantly in terms of stem implantation quality, length of hospital or intensive care unit stay, postoperative mobilization, or the need for transfusions. However, the ALMIS was associated with a significantly shorter operative time (DSA: 89.7 min vs. ALMIS: 77.2 min; p < 0.01). On the other hand, the DSA had a significantly lower complication rate (DSA: 0/61 vs. ALMIS: 11/163; p = 0.04). Conclusions: In a comparison of the two minimally invasive approaches, DSA and ALMIS, for treating a NOF fracture with cemented bipolar HA, the DSA demonstrated a lower complication rate, though it had a slightly longer operating time.

HEPATECTOMIA CONVENCIONAL EM DOIS ESTÁGIOS VERSUS ALPPS: UMA REVISÃO DE LITERATURA SOBRE O TRATAMENTO DE METÁSTASE HEPÁTICA COLORRETAL

This study compared the outcomes of two modalities of hepatectomies for the treatment of colorectal liver metastasis. The research is justified by the high morbidity and mortality associated with hepatic surgical interventions, as these require a delicate approach and intricate techniques, posing a challenge in the surgical field. The aim was to highlight the operative technique with greater efficacy, outlining its associated benefits and risks, in order to identify the definitively superior aspects within the literature among the analyzed modalities. The methodology involved a literature review of 46 articles, written in Portuguese and English, available in various databases from 2019 to 2024. The results indicated that ALPPS had limited advantages compared to HDE, demonstrating greater surgical efficacy, while the rates of perioperative complications and short-term outcomes were comparable between the two techniques, with no evidence of differences in reducing morbidity and mortality. Conversely, there were discrepancies in determining the overall survival rates between the two techniques, underscoring the need for further studies on the topic and the exploration of less invasive methods with lower rates of surgical morbidity and mortality.

Acellular Particulated Costal Allocartilage Improves Cartilage Regeneration in High Tibial Osteotomy: Data From a Randomized Controlled Trial.

This study aimed to compare short-term arthroscopic and clinical outcomes between microfractures with (treatment group) and without (control group) acellular particulated costal allocartilage in patients undergoing concurrent high tibial osteotomy (HTO). This retrospective cohort study enrolled 19 and 21 patients in the treatment and control groups, respectively, and reviewed them at a minimum 2-year follow-up after HTO. Cartilage regeneration status was evaluated according to the International Cartilage Repair Society-Cartilage Repair Assessment (ICRS-CRA) grading and Koshino's macroscopic staging systems during medial locked plate removal. Patient-reported measures, including the visual analog scale pain score, Knee Injury and Osteoarthritis Outcome Score, and International Knee Documentation Committee score, assessed clinical outcomes. The total points of the ICRS-CRA grading system were significantly higher in the treatment group than in the control group (7.7 ± 3.8 vs 4.2 ± 3.0, respectively; P = 0.007). Likewise, the cartilage status according to Koshino's macroscopic staging system was better in the treatment group (P = 0.022). Patient-reported functional outcomes significantly improved postoperatively but were equivalent between the study groups at the final follow-up. Microfractures augmented with acellular particulated costal allocartilage resulted in better repair quality than microfractures alone at a minimum 2-year follow-up after HTO, but functional outcomes improved similarly for both treatment approaches.

Foreign Workers and Remittance Outflow in Malaysia

This conceptual paper reviews foreign workers and remittance outflows in Malaysia. Foreign workers in Malaysia, who remit a portion of their earnings back home, play a crucial role in the country's economic development. With approximately 1.5 million foreign workers engaged in various sectors such as manufacturing, plantation, construction, and agriculture, Malaysia relies heavily on foreign labor. Predominantly, these workers come from Indonesia, Nepal, and Bangladesh. Factors such as Malaysia's economic performance, government recruitment policies addressing labor shortages, and cultural and geographical proximity influence why these workers choose Malaysia. Despite concerns that foreign workers might negatively impact short-term labor market outcomes by taking jobs from locals and suppressing wages, the evidence suggests their presence does not significantly harm these outcomes. However, the growing number of foreign workers has led to a notable increase in remittance outflows. Remittance outflows represent a transfer of capital from host countries to the workers' countries of origin. Among the ASEAN-5 countries, Malaysia has recorded the highest remittance outflows, surpassing inflows. While research on remittance flows has expanded, the focus has traditionally been on inflows, with outflows receiving less attention due to their relatively small impact on the macroeconomic indicators of sending countries. Existing literature indicates that remittance outflows can influence the economic growth and inflation of sending countries, including Malaysia, despite varied findings.

Short Term Outcome of Percutaneous Fixation of Transverse Acetabular Fractures

Short Term Outcome of Percutaneous Fixation of Transverse Acetabular Fractures

The Impact of Blood Pressure Rhythm and Perioperative Blood Pressure Variability on Short-Term Prognosis in Patients with Type A Aortic Dissection.

Aims/Background Previous studies have indicated a strong correlation between disturbances in blood pressure (BP) circadian rhythm and major cardiovascular adverse events. Similarly, blood pressure variability (BPV) has been closely linked to cerebral small vessel disease and leukoaraiosis. This study aims to investigate the relationship between BP rhythm and BPV with the short-term prognosis of patients with Type A aortic dissection, offering insights for targeted perioperative nursing interventions and improving patient outcomes. Methods This retrospective study included patients undergoing surgical treatment for Type A aortic dissection at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) from June 2022 to March 2024. The study followed patients from the completion of surgery to 30 days postoperatively, with all-cause mortality within 30 days as the endpoint representing poor short-term prognosis. Clinical data were compared along with: types of BP rhythm; BPV parameters including the mean 24-hour systolic BP (24hSBP), 24-hour diastolic BP (24hDBP), and pulse pressure; and the coefficient of variability (CV) for 24hSBP, 24hDBP, and pulse pressure. Multivariate logistic regression analysis was utilized to identify risk factors for poor short-term outcomes in these patients, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of BP rhythm types and BPV indicators. Results The study ultimately included 115 participants, with 31 deaths occurring within 30 days post-surgery, resulting in a postoperative mortality rate of 26.96%. The multivariate logistic regression analysis revealed that white blood cell count, neutrophil count, non-dipping BP rhythm, pulse pressure, and the CV for 24hSBP, 24hDBP, and pulse pressure, were significant risk factors for poor short-term prognosis (p < 0.05). The ROC curve analysis demonstrated that non-dipping BP rhythm, pulse pressure, 24hSBP-CV, 24hDBP-CV, and pulse pressure-CV had areas under the curve (AUC) of 0.685, 0.749, 0.751, 0.773, and 0.763, respectively. The combination of these indicators yielded the highest AUC at 0.918. Conclusion A combination of BP rhythm and BPV indicators provides significant predictive value for poor short-term outcomes in patients with Type A aortic dissection. Clinicians and nursing staff can use these features to formulate targeted preventive measures.

Association of High-Risk Obstructive Sleep Apnea with Artificial Intelligence-Guided, CT-Based Severity Scores in Patients with COVID-19 Pneumonia.

Background: We have previously demonstrated that high-risk obstructive sleep apnea (HR-OSA), based on a modified Berlin Questionnaire (mBQ), is linked to worse clinical outcomes. Chest computed tomography (CT) imaging with the implementation of an artificial intelligence (AI) analysis program has been a valuable tool for the speedy assessment of huge numbers of patients during the COVID-19 epidemic. In the current study, we addressed how the severity of AI-guided, CT-based total opacity ratio (TOR) scores are associated with high-risk OSA and short-term outcomes in the same cohort. Methods: The ratio of the volume of high opacity areas to that of the total lung volume constituted the TOR. We arbitrarily applied thresholds of <5 (no or mild TOR), ≥5 and <15 (moderate TOR), and ≥15 (severe TOR). Results: In total, 221 patients were included. HR-OSA was observed among 11.0% of the no or mild TOR group, 22.2% of the moderate TOR group, and 38.7% of the severe TOR group (p < 0.001). In a logistic regression analysis, HR-OSA was associated with a severe TOR with an adjusted odds ratio of 3.06 (95% confidence interval [CI] 1.27-7.44; p = 0.01). A moderate TOR predicted clinical worsening with an adjusted hazard ratio (HR) of 1.93 (95% CI 1.00-3.72; p = 0.05) and a severe TOR predicted worsening with an HR of 3.06 (95% CI 1.56-5.99; p = 0.001). Conclusions: Our results offer additional radiological proof of the relationship between HR-OSA and worse outcomes in patients with COVID-19 pneumonia. A TOR may also potentially indicate the individuals that are at higher risk of HR-OSA, enabling early intervention and management strategies. The clinical significance of TOR thresholds needs further evaluation in larger samples.

Maximizing Knee OA Treatment: A Comparative Look at Physiotherapy and Injections

Background: Knee osteoarthritis (OA) is a prevalent and disabling condition often managed with physiotherapy or intra-articular injections. However, the comparative effectiveness of these treatments remains unclear. This systematic review aimed to evaluate and compare the efficacy of physiotherapy and intra-articular injections in managing knee OA. Methods: A systematic search of PubMed, Scopus, Web of Science, PEDro, and Cochrane Library was conducted. Randomized controlled trials (RCTs) comparing physiotherapy and intra-articular injections in knee OA patients were included. Key outcomes included pain (VAS), function (WOMAC, KOOS), range of motion (ROM), and quality of life. Data from five studies with a total of 552 participants were analyzed. Results: Intra-articular injections, particularly botulinum toxin and hyaluronic acid, were found to provide rapid pain relief, outperforming physiotherapy in short-term pain management. However, physiotherapy contributed significantly to long-term functional improvements, particularly in early-stage OA. Combination therapy of injections and physiotherapy yielded the best short-term pain relief and functional outcomes. Heterogeneity in study designs and follow-up periods limited the generalizability of findings. Conclusions: Intra-articular injections are effective for immediate pain control, while physiotherapy plays a crucial role in maintaining joint function, especially for long-term management. Combining both interventions may offer the most comprehensive benefits. Further research is needed to determine the long-term efficacy of these treatments.

Management of Rotator Cuff Injuries: Surgical Repair vs. Conservative Treatment

Rotator cuff injuries are a common cause of shoulder pain and dysfunction, resulting from acute trauma or degenerative changes. These injuries, including partial and full-thickness tears, can significantly impair daily activities and reduce quality of life. Treatment options range from conservative measures, such as physical therapy and NSAIDs, to surgical interventions like arthroscopic repair. The choice of treatment depends on factors such as tear size, patient age, and activity level. This review compares the effectiveness of conservative treatment and surgical repair for rotator cuff injuries, focusing on pain relief, functional recovery, and complication rates. Conservative treatment is typically the first-line approach for partial-thickness tears or patients with lower physical demands. Physical therapy and nonsteroidal anti-inflammatory drugs are common modalities that can improve symptoms, particularly for smaller tears. Corticosteroid injections are also used to provide short-term relief, although their long-term benefits are less clear. For larger or full-thickness tears, surgery is often necessary due to the risk of progressive degeneration and persistent symptoms. Arthroscopic repair is particularly beneficial for younger or more active patients, offering superior long-term outcomes in terms of strength and function. Studies indicate that while conservative treatment and surgery may offer similar short-term outcomes for smaller tears, surgery provides better long-term recovery for more extensive injuries. Ultimately, the decision between conservative and surgical treatment should be individualized, considering tear size, patient age, activity level, and overall health. Surgery is recommended for full-thickness tears or when conservative treatment fails to yield sufficient improvement, while conservative management remains effective for many smaller tears.

Short-term outcomes of 47 selective laparoscopic lymph node dissection for rectal cancer: A retrospective study.

This study aims to analyze the safety, feasibility, and short-term oncology outcomes of selective laparoscope lateral lymph node dissection (LLND) with total mesorectal excision surgery. Between December 2019 and May 2023, LLND with total mesorectal excision surgery was performed in 47 selected patients with advanced rectal cancer. Surgical complications and 2-year oncology survival outcomes were analyzed in the study. All 47 procedures were technically successful without converting conversion to open surgery. The mean operation time was 200.6 minutes (135-321 minutes), and the mean estimated blood loss was 92.9 mL (range 10-2000 mL). The most common postoperative complications were anastomotic (8.5%, n = 4), ileus (6.4%, n = 3), and chyle leakage (4.3%, n = 2). Lateral pelvic lymph node metastases were found in 19 (40.4%) patients. When divided into lateral pelvic lymph node positive and negative groups, there was no significant impact on overall survival (94.4% vs 100%, Log-rank P = .596) and local recurrence-free survival (LFRS) (76.7% vs 89.6%, Log-rank P = .210), except disease-free survival (DFS) (58.3% vs 90.2%, Log-rank P = .005). Subgroup analysis showed similar short-term survival outcomes between the pN+ group and the internal iliac metastasis group (Log-rank P of overall survival, LFRS, and DFS were all ˃.05). LRFS and DFS in the obturator or external iliac metastasis group were worse than those in the internal iliac metastasis group when the follow-up time was extended (Log-rank P of LFRS and DFS were .05 and .063). Selective laparoscopy LLND for rectal cancer is safety and feasibility, and its complications are manageable. Oncology survival outcomes for lateral pelvic lymph node metastases limited to the internal iliac are similar to the pN+ stage; therefore, it should be treated positively.

Efficacy of hypertonic dextrose (prolotherapy) in early knee osteoarthritis: a short term outcome

Background: Knee osteoarthritis (OA) is a prevalent, painful, and progressive condition significantly affecting patients' quality of life and imposing a social and economic burden. Traditionally managed through symptom relief and joint function improvement, research is increasingly focusing on disease-modifying treatments. Dextrose prolotherapy, a low-cost alternative involving the injection of a hypertonic solution, has shown promise despite limited acceptance in current guidelines. Methods: This prospective cohort study, approved by the Institutional Ethical Board of Jamia Hamdard University, assessed the effects of 12.5% hypertonic dextrose prolotherapy in 92 patients with knee OA. Patients received injections at multiple sites over a 6-week period. Outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores at baseline, 4, 8, 16, and 24 weeks. Results: Significant improvements were observed in both WOMAC and VAS scores. WOMAC scores decreased from 53.83 to 26.70 (p&lt;0.0001), and VAS scores dropped from 7.12 to 3.06 (p&lt;0.0001) at the 24-week follow-up. No major complications were noted, with minimal adverse effects reported. Improvement was consistent across all OA grades. Conclusions: Dextrose prolotherapy demonstrated substantial, sustained improvements in pain and function in knee OA patients. Given its safety, low cost, and efficacy, it represents a viable therapeutic option, especially in resource-constrained settings. Further high-quality randomized controlled trials are needed to confirm these findings and optimize treatment protocols.