Worsening Of Clinical Outcomes Research Articles

Targeting neutrophil serine proteases in bronchiectasis.

Persistent neutrophilic inflammation is a central feature in both the pathogenesis and progression of bronchiectasis (BE). Neutrophils release neutrophil serine proteases (NSPs), such as neutrophil elastase, cathepsin G and proteinase 3. When chronically high levels of free NSP activity exceed those of protective antiproteases, structural lung destruction, mucosal-related defects, further susceptibility to infection and worsening of clinical outcomes can occur. Despite the defined role of prolonged, high levels of NSPs in BE, no drug that controls neutrophilic inflammation is licensed for the treatment of BE. Previous methods of suppressing neutrophilic inflammation (such as direct inhibition of neutrophil elastase) have not been successful; however, an emerging therapy designed to address neutrophil-mediated pathology, inhibition of the cysteine protease cathepsin C (CatC, also known as dipeptidyl peptidase 1), is a promising approach to ameliorate neutrophilic inflammation, since this may reduce the activity of all NSPs implicated in BE pathogenesis, and not just neutrophil elastase. Current data suggest that CatC inhibition may effectively restore the protease-antiprotease balance in BE and improve disease outcomes as a result. Clinical trials for CatC inhibitors in BE have reported positive Phase III results. In this narrative review, we discuss the role of high NSP activity in BE, and how this feature drives the associated morbidity and mortality seen in BE. This review discusses therapeutic approaches aimed at treating neutrophilic inflammation in the BE lung, summarising clinical trial outcomes, and highlighting the need for more treatment strategies that effectively address chronic neutrophilic inflammation in BE.

The Effects of Convalescent Plasma Transfusion on Serum Levels of Macrophage-Associated Inflammatory Biomarkers in Patients with Severe COVID-19.

As an antibody-based therapy, plasma therapy has been used as an emergency therapeutic strategy against severe acute respiratory syndrome coronavirus type 2 infection. Due to the critical role of macrophages in coronavirus disease-19 (COVID-19)-associated hyperinflammation, the main objective of this study was to assess the effect of plasma transfusion on the expression levels of the inflammatory biomarkers involved in activation and pulmonary infiltration of macrophages. The target population included 50 severe hospitalized COVID-19 patients who were randomly assigned into 2 groups, including intervention and control. Serum levels of chemokine (C-C motif) ligand (CCL)-2, CCL-3, tumor necrosis factor (TNF)-α, and interleukin (IL)-6 were measured by enzyme-linked immunosorbent assay. Moreover, quantitative real-time polymerase chain reaction (PCR) was carried out to assess the relative expression of nuclear factor (NF)-κB1, NF-κB2, nuclear factor erythroid 2 p45-related factor 2 (NRF-2), and thioredoxin-interacting protein genes. Sampling was done at baseline and 72 h after receiving plasma. The intervention group demonstrated significantly lower serum levels of IL-6, TNF-α, and CCL-3. In addition, real-time PCR data analyses showed that the relative expression of NF-κB2 was significantly declined in the patients who received plasma. The use of convalescent plasma probably has a significant inhibitory effect on the cytokines, chemokines, and inflammatory genes related to macrophage activation, which are closely associated with the worsening of clinical outcomes in severe COVID-19.

COVID-19 monitoring in workers at a Brazilian public university: a retrospective cohort study

Introduction: primary care action strategies are relevant for disease prevention and health promotion, as well as for the initial management of suspected cases and the individual monitoring of patients with confirmed diagnoses of COVID-19. This study aimed to evaluate the outcome of clinical worsening and demographic, occupational, andclinical variables of workers with COVID-19 in a community health center at a public university in southeastern Brazil. Methods: a retrospective cohort study was conducted with 1,459 symptomatic workers with COVID-19. Data were extracted from the database of the unit’s epidemiological surveillance center between March 2020 and March 2021. Results: The average age of participants was 41.1 (SD 10.8) years, most women (71.1%), who hadobesity (19.9%) and hypertension (17.0%). Among the symptoms, headache (75.3%) and cough (74.9%) stood out. The worsening of clinical outcome during follow-up occurred in 3.4% of cases. The demographic, occupational and clinical factors associated with clinical worsening were gender, professional category, hypertension, diabetesmellitus, obesity, dyslipidemia, olfactory disorders, cough, fever, and dyspnea. The Poisson regression showed that the prevalence of clinical worsening was greater with age, obesity, fever, and dyspnea. Conclusion: Clinical worsening occurred in 3.4% of the cases and was more prevalent according to age, obesity, fever, and dyspnea. The follow-up has shown promise in the early detection and treatment of COVID-19.

QLTI-02. ADVERSE EVENTS IN GLIOMA SURGERY: RESULTS OF A PROSPECTIVELY COMPILED DATABASE OF A SINGLE-CENTER TERTIARY CARE HOSPITAL

Abstract BACKGROUND Adverse events in glioma surgery can cause severe problems for patients and can be a significant burden to healthcare systems. Therefore, understanding and avoiding adverse events should be essential in centers performing glioma surgery. Nevertheless, it is still uncommon to assess adverse events in a prospective, standardized manner. In this study we want to share the findings of our prospectively compiled database for adverse events in glioma surgery. METHODS Every patient treated at our institution received a peer-reviewed, standardized discharge form focused on adverse events. Any event, that led to readmission, worsening of clinical outcome, new neurological deficits, revision surgery, contributed to death or prolonged hospital stay within 30 days of discharge was recorded and classified according to the treatment-related classification system of Clavien-Dindo (Grade 1 requiring to treatment to Grade 5 resulting in death). RESULTS In 2022 a total of n = 194 patients received glioma surgery at our institution. Surgery was performed using a common craniotomy in 145 cases (74.7%), an awake craniotomy in 16 cases (8.2%) and in 33 cases (17.0 %) a stereotactic approach for biopsy was chosen. A total of n = 44 (22.7%) adverse events were recorded among these cases. The most common adverse event was a new neurological deficit after surgery in 20 cases (10.3%) followed by non-surgery related adverse events in 10 cases (5.2%). Wound healing disorders and CSF-leaks were recorded in 8 cases (4.1%) and in 6 cases (3.1%), respectively. Clavien Dindo classification showed low-grade complications (grade 1,2) in 15.9% and high-grade complications (grade 3,4,5) in 6.6%. Revision surgery was necessary in 9 cases (4.6%). CONCLUSION Adverse events in glioma surgery are not uncommon. Understanding and classifying these events in a prospective, standardized manner may help to reduce the risk of adverse events in glioma surgery in the future.

Inhibiting IL-6 in medicine: a new twist to sustain inhibition of his cytokine tin the therapy of Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a chronic, progressive disease characterized by an increase in blood pressure in the lungs' arteries. It can occur in a variety of species, including humans, dogs, cats, and horses. To date, PAH has a high mortality rate in both veterinary and human medicine, often due to complications such as heart failure. The complex pathological mechanisms of PAH involve multiple cellular signalling pathways at various levels. IL-6 is a powerful pleiotropic cytokine that regulates several phases of immune response, inflammation, and tissue remodelling. The hypothesis of this study was that the use of an IL-6 antagonist in PAH could interrupt or mitigate the cascade of events that leads to the progression of the disease and the worsening of clinical outcome, as well as tissue remodelling. In this study, we used two pharmacological protocols with an IL-6 receptor antagonist in a monocrotaline-induced PAH model in rats. Our results showed that the use of an IL-6 receptor antagonist had a significant protective effect, ameliorating both haemodynamic parameters, lung and cardiac function, tissue remodelling, and the inflammation associated with PAH. The results of this study suggest that the inhibition IL-6 could be a useful pharmacological strategy in PAH, in both human and veterinary medicine.

Factors Affecting Outcome in Diabetic Patients with COVID-19: A Cross-sectional Study

BACKGROUND: Type-2 diabetes mellitus (T2DM) is a chronic disease and often found as a comorbid in COVID-19. Poor glycemic control might play a role in worsening of clinical outcome in COVID-19 patients who lead to increase morbidity and mortality. AIM: We conducted a study to evaluate relationship between T2DM with or without macrovascular and microvascular complications and cigarette smoking habit with COVID-19 outcomes. METHODS: A cross-sectional study of hospitalized COVID-19 patients was conducted in Dr. Wahidin Sudirohusodo Hospital, Makassar from May 2020 to August 2020. COVID-19 status was obtained using real-time polymerase chain reaction for SARS-CoV-2, T2DM status was obtained using blood glucose or HbA1c, and other characteristic data were obtained. Mortality was the clinical outcome in our study. RESULTS: One hundred and six subjects data were enrolled. Most subjects were male (n = 55; 51.9%), and 55–65 year-old (n = 40; 37.7%). Eighty subjects were survived (75.5%) and 26 subjects did not survive (24.5%). Onset of T2DM ≥ 5 years had a higher mortality rate compared to onset < 5 years (34.9% vs. 17.5%; p = 0.041). Other factors such as gender, age, nutritional status, hypertension, heart disease, smoking habit, and HbA1c did not show significant difference in terms of mortality. CONCLUSION: COVID-19 patients with onset of T2DM for more than 5 years had a worse outcome compared to the onset of T2DM <5 years.

Results of Using Various Conduction System Pacing Options in Patients with Bradyarrhythmia

Chronic right ventricular myocardial pacing causes an asynchronous pattern of left ventricular activation, reduces left ventricular ejection fraction (LVEF), and may be associated with worsening of clinical outcomes in the long term. Although with the emergence of algorithms that minimize ventricular pacing it became possible to reduce the percentage of paced complexes in patients with sinus node dysfunction, permanent ventricular pacing is still inevitable in patients with high-degree atrioventricular (AV) block. The use of permanent conduction system pacing is a promising method for preserving the physiological activation of the ventricular myocardium and preventing the development of heart failure due to ventricular dyssynchrony.
 The aim. To analyze the immediate and long-term results of the use of conduction system pacing in patients with indications for permanent ventricular pacing.
 Materials and methods. This study included 18 patients with indications for permanentventricular pacing who were operated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 01/01/2013 to 12/31/2022, in whom permanent conduction system pacing was used. There were 17 patients with bradyarrhythmias, of these 16 (88%) suffered from high-degree AV block (including 1 patient with Frederick’s syndrome and 1 (5%) patient with atrial ϐibrillation with slow ventricular response) and 1 (5%) patient with ischemic cardiomyopathy with left bundle branch block and ϐirstdegree AV block with indications for cardiac resynchronization therapy. The mean age of the patients was 55 ± 16 years (8 men, 10 women), LVEF at the time of the intervention was 56.42 ± 9.13 %, end diastolic volume 130.2 ± 23.8 ml, end systolic volume 55.1 ± 17.7 ml, diameter of the left atrium 4.01 ± 0.6 cm. The average QRS width before implantation was 116.5 ± 27.7 ms. In 6 (33%) patients, a special delivery system (С304-L69, Medtronic in 1 patient [5%], C315HIS in 5 [27%] patients) and 4.1F active ϐixation lead Medtronic 3830 Select Secure (69 or 74 cm) were used; in other cases (66%) standard 6F leads with active ϐixation and a lumen for a stylet without a delivery system were used.
 Results. The average follow-up period after implantation of pacemaker was 36.35 ± 29.65 months. During the observation period, LVEF was 57.07 ± 5.38 %, end diastolic volume111.5 ± 18.09 ml, end systolic volume 49.5 ± 13.4 ml, diameter of the left ventricle 3.9 ± 0.5 cm. The mean duration of paced QRS was 119.1 ± 10.09 ms. In 6 patients (33%), it was possible to demonstrate a change in the QRS width when the amplitude of ventricular stimulation was reduced, with 2 variants of transitions: 1) 4 (22%) patients with a transition from non-selective His bundle pacing (NSHBP) to selective His bundle pacing (SHBP), in 2 (11%) of these patients with a transition from SHBP with correction of right bundle branch block (RBBB) to SHBP without correction of RBBB, and then loss of capture of the myocardium of the ventricles; 2) 2 patients (11%) with a transition from NSHBP to myocardial septal ventricular pacing and further with a decrease in amplitude to the loss of capture of the myocardium of the ventricles. One (5%) patient with complete heart block had permanent non-selective left bundle branch area pacing. The other 11 (61%) patients met the criteria for parahisian pacing without visible transitions with a change in the amplitude of ventricular pacing. The average global longitudinal strain was -17.6 ± 2.7 %. The average interval from the stimulus to the peak of the R-wave in lead V6, which indicated the time of left ventricular activation, was 73.2 ± 8.7 ms. Pacing parameters were standardly set according to the primary indications, but with correction of the amplitude of ventricular stimulation relative to the thresholds of pacing of the conduction system. AV delay was corrected for the latency from the stimulus to the onset of the QRS in SHBP or for the duration of the “pseudodelta” wave in NSHBP which in both cases was the duration of the H-V interval. There were no complications in the acute or long-term postoperative period.
 Conclusions. Conduction system pacing is a challenge in the practice of cardiologist for treating life-threatening bradyarrhythmias and heart failure, but at the same time it is a safe method that provides physiological electrical and mechanical activation of the myocardium of the ventricles, that allows to effectively avoid the consequences of dyssynchrony due to permanent myocardial ventricular pacing.

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

The GooD Pregnancy Network: An Alternative Approach for Gestational Diabetes

Basildon and Thurrock University Hospital in the East of England region of the United Kingdom (UK) witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team’s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to the conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights the contemporary necessity to equip and empower all maternity stakeholders to deliver the basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic “hub” to Educating Gestational Diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS “faculty” includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families, aiming to foster long term healthy lifestyle changes. The final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened the “diagnosis to first consultation” intervals and eliminated overbooked specialist clinics (none since January 2016), without further worsening of clinical outcomes. It also boosted research recruitment and avoided additional running costs to the tune of GBP 66,384 a year.

Mandatory preoperative COVID-19 testing for cancer patients-Is it justified?

BackgroundSevere acute respiratory syndrome coronavirus 2 has caused substantial disruptions in routine clinical care. Emerging data show that surgery in coronavirus disease (COVID)‐positive cases can be associated with worsening of clinical outcomes and increased postoperative mortality. Hence, preoperative COVID‐19 testing for all patients before elective surgery was implemented in our institution.Materials and MethodsTwo hundred and sixty‐two asymptomatic cancer patients were preoperatively tested for COVID‐19 using reverse‐transcription polymerase chain reaction technique with nasopharyngeal and oropharyngeal swabbing. All negative patients were operated within 72 hours, and positive patients were quarantined for a minimum 14 days before re‐swabbing.ResultsIn our cohort, 21 of 262 (8.0%) asymptomatic preoperative patients, who were otherwise fit for surgery, tested positive. After adequate quarantine and a negative follow‐up test report, 12 of 21 (57%) had an operation. No major postoperative morbidity due to COVID‐19 was noted during the immediate postoperative period before discharge from the hospital.ConclusionRoutine preoperative COVID‐19 testing was successful in identifying asymptomatic viral carriers. There was no incidence of symptomatic COVID‐19 disease in the postoperative period, and there was no incidence of morbidity attributable to COVID‐19. These data suggested a beneficial role for mandatory preoperative COVID‐19 testing.

Abstract WP377: Heart Rate Variability Biofeedback Improves Cardiac Autonomic Function in Patients With Acute Ischaemic Stroke: A Randomized Controlled Study

Introduction: In patients with acute ischaemic stroke (AIS) dysregulation of cardiac function with decreased heart rate variability (HRV) due to impaired integrity of the autonomic nervous system is a frequent complication which is associated with increased mortality and worsening of clinical outcome. HRV biofeedback has previously been suggested to improve cardiac autonomic function by increasing parasympathetic tone. Hypothesis: We hypothesized that HRV biofeedback can be used to complement stroke unit care and alleviate autonomic cardiac dysfunction following AIS. Methods: We randomly allocated patients with AIS to either receive 9 sessions of HRV (n=24) or sham (n=24) biofeedback in addition to standard stroke unit care. These patients underwent detailed assessment of autonomic cardiac function including analysis of HRV via standard deviation of NN intervals (SDNN) and spectral analysis. Furthermore, we assessed vasomotor and sudomotor autonomic function, severity of autonomic symptoms and neurological and functional outcomes. Results: We included 48 patients (19 females, ages 65±14 years, baseline NIHSS 2.2 ± 2.2, mean ± standard deviation). Patients who had undergone HRV biofeedback displayed improved cardiac function compared to baseline (SDNN 72.6 ± 52.4 ms vs. 45.5 ± 34.7 ms, p<0.01) which was not seen in those who received sham biofeedback (p=ns). Similar changes were seen on spectral analysis measures of parasympathetic function (p<0.01). Improvement of autonomic cardiac function following HRV biofeedback was paralleled by decreased severity of autonomic symptoms (p<0.05). Contrasting our observation of an increase in predominantly parasympathetic parameters such as CVNN, sympathetic measures of sudomotor and vasomotor function remained unchanged in both groups (p=ns). Neurological and functional outcomes were unchanged immediately post intervention, however 3-month follow up is yet to be completed. Discussion: HRV biofeedback can modulate autonomic cardiac function post AIS to increase HRV and alleviate autonomic symptoms which might be beneficial in facilitating recovery from functional impairment. This seems to be mediated by a predominantly parasympathetic mechanism of action.

Reappraising the role of inflammation in heart failure.

The observation that heart failure with reduced ejection fraction is associated with elevated circulating levels of pro-inflammatory cytokines opened a new area of research that has revealed a potentially important role for the immune system in the pathogenesis of heart failure. However, until the publication in 2019 of the CANTOS trial findings on heart failure outcomes, all attempts to target inflammation in the heart failure setting in phase III clinical trials resulted inneutral effects or worsening of clinical outcomes. This lack of positive results in turn prompted questions on whether inflammation is a cause or consequence of heart failure. This Review summarizes the latest developments in our understanding of the role of the innate and adaptive immune systems in the pathogenesis of heart failure, and highlights the results of phase III clinical trials of therapies targeting inflammatory processes in the heart failure setting, such as anti-inflammatory and immunomodulatory strategies. The most recent of these studies, the CANTOS trial, raises the exciting possibility that, in the foreseeable future, we might be able to identify those patients with heart failure who have a cardio-inflammatory phenotype and will thus benefit from therapies targeting inflammation.

Health status, diseases and vaccinations of the homeless in the city of Palermo, Italy.

In Italy, as in the rest of the world, the number of homeless people is increasing considerably. Many of them suffer from chronic conditions, mental health problems and addiction to alcohol, drugs or smoking, and need complex medical care. Their health status is often exacerbated by greater difficulty in accessing primary care. The aim of the present study was to assess health conditions of homeless people living in Palermo, Southern Italy, and to find ways to limit the spread of common infectious diseases that can be prevented by vaccination. A self-administered questionnaire was distributed. The questionnaire was structured into two parts including an introduction with socio-demographic information, and a second part investigating health status, chronic diseases and vaccinations. A multivariable logistic regression model was used and adjusted Odds Ratios (aOR) are presented. The sample consisted of 52 homeless, 35 (67.3%) of whom were male and the most represented age class (55.8%) was < 50 years of age. The average age of the sample was 49.6 years (SD ± 15.2) and 88.5% were born in Italy. A multivariable logistic regression model based on 52 observations was used. The analysis showed that the female gender was significantly associated with: not performing regular physical activity (aOR 4.14, 95% C.I. 1.20 - 14.32, p = 0.025), suffering from chronic diseases (aOR 3.52, 95% C.I. 1.02 - 12.11, p = 0.046) and taking medicines (aOR 3.95, 95% C.I. 1.14 - 13.64, p = 0.030). This particularly fragile population is exposed to diseases that are largely preventable or curable through a wider and more early access to care by local health facilities with a subsequent reduction in the worsening of clinical outcomes and related social costs.

Tricuspid regurgitation after implantable cardioverter-defibrillator implantation in patients with arrhythmogenic right ventricular cardiomyopathy

Introduction. The problem of lead-induced tricuspid regurgitation (LITR) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is poorly investigated. Patients with high risk of adverse outcome usually receive implantable cardioverter-defibrillator (ICD) as a prevention of sudden cardiac death (SCD). nfortunately, the insertion of ICD into the right ventricle is supposed to exacerbate tricuspid regurgitation. As ICD (or cardiac resynchronization therapy defibrillator) seems to be necessity in prevention of SCD in quite large group of patients, we aimed to evaluate frequency of LITR and further outcome in these persons. Material and methods. In a database of 55 patients with ARVC and ICD implanted in prevention of SCD, we selected 35 patients (mean age 48.78 ± 13.56 years) with data suitable for analysis. Based on the results of echocardiography, study population was divided into 2 groups: TR+ group with worsening of tricuspid regurgitation (TR) defined as its deterioration to higher grade and TR– group (without worsening of TR). Results. In 65.71% of patients TR worsened after ICD implantation. Mean time of observation was 91.06 ± 55.32 months. In TR+ group, 2 patients (8.7%) died because of heart failure and 1 patient died in a traffic accident. In TR– group 1 patient (8.33%) died because of heart failure and 1 patient had heart transplantation (results were statistically insignificant). Conclusions. We couldn’t prove that the worsening of TR was associated with worsening of clinical outcome. Further studies are needed to assess an influence of LITR on prognosis in patients with ARVC and ICD implanted.

Assessment of depression and anxiety in patients with chronic liver disease.

In recent years mental health of patients including those with chronic liver disease (CLD), has become interesting because its disturbance leads to reduced quality of life, that is associated with worsening of clinical outcome, reduced compliance and increased mortality. The aim of the study was to determinate the frequency and severity of depression and frequency of anxiety in patients with CLD and to assess the contribution of selected socio-demographic, clinical and laboratory risk factors for depression and anxiety. In this cross-sectional study, we used the Hamilton depression rating scale (HDRS) and Hamilton anxiety rating scale (HARS) in patients with CLD. The study included 54 male and 43 female patients. Depression was present in 62.9%, and anxiety in 13.4% of the patients. A higher HDRS was noted in the patients older than 50 years (p = 0.022) and unemployed patients (p = 0.043). The patients with at least one episode of gastrointestinal bleeding had a significantly higher frequency of anxiety than those without bleeding (p = 0.018). A higher HARS score was present in the women (p = 0.011), unemployed patients (p = 0.008) and those with non-alcoholic liver disease (p = 0.007). There was a significant correlation between the mean corpuscular volume (MCV) and the value of the HDRS score, and between serum potassium and sodium levels and HDRS score. Age and the mean corpuscular volume have significant influence on the HDRS score while unemployment, gastrointestinal bleeding, serum potassium and serum sodium have predictive value for HARS score.

Long-term clinical outcomes and radiological findings and their correlation with each other after standard open discectomy for lumbar disc herniation.

This retrospective study was designed to evaluate the clinical outcomes and radiological findings after open lumbar discectomy (OLD) in patients who were followed up for 10 years or longer. The authors classified 79 patients who had a mean age (±SD) of 53.6±13.6 years (range 30-78 years) into 4 groups according to the length of their follow-up. Patients in Group 1 were followed up for 10-14 years, in Group 2 for 15-19 years, in Group 3 for 20-24 years, and in Group 4 for more than 25 years. In all of these patients, the clinical outcomes were assessed by using patients' self-reported scores on visual analog scales (VASs) measuring back and leg pain and by using scores from the Oswestry Disability Index (ODI). In addition, 10 radiological parameters suggesting degenerative changes or instability at the operated segment were recorded at various time points and used to calculate a numeric radiological finding (NRF) score by rating a presence for each finding of spinal degeneration or instability as 1. The authors observed that OLD decreased pain and disability scores in all groups. Numeric radiological findings were highest in Group 4, and a significant correlation was detected between NRFs and VAS scores of back pain (p=0.039). In this cohort, the reoperation rate was 13.9% during a mean follow-up period of 15.3 years. Clinical outcomes tended to be most favorable in Group 1, representing patients who had OLD most recently, and they tended to deteriorate in the other 3 groups, indicating some worsening of outcomes over time. Degeneration of the spine at the operated level measured with radiographic methods tended to increase over time, but some stabilization was observed. Although spinal degeneration was stable, clinical outcomes deteriorated over time. This cross-sectional assessment of a retrospective cohort indicates that outcomes after OLD deteriorate over time. Increased back pain indicated a worsening of clinical outcomes, and this worsening was correlated with radiological findings of degeneration at the operated segment.

Hyperoxia: A Review of the Risks and Benefits in Adult Cardiac Surgery

Perioperative hyperoxia has been claimed to have a number of therapeutic advantages. However, in the setting of cardiac surgery and cardiopulmonary bypass (CPB), enthusiasm for its use has been tempered by concerns regarding the effect of high partial pressures of oxygen on cardiac, vascular, and respiratory function and the potential for exacerbation of ischemia–reperfusion injury. There is encouraging evidence from animal studies that hyperoxia is effective in myocardial preconditioning, at least in nondiseased hearts. There is also evidence that hyperoxia reduces gas microemboli production and longevity during CPB, although it is unclear whether this translates into a clinical benefit in terms of a reduction in postoperative neurological morbidity. Hyperoxia leads to changes in cardiovascular function. However, the effects of these changes remain unclear. At a tissue level, there is evidence that hyperoxia does not lead to improvement in partial pressure of oxygen. Indeed, the opposite may be the case with reductions in capillary density leading to areas of reduced tissue oxygenation. The risks of hyperoxia in association with CPB include lung injury, increased systemic reactive oxygen species generation, and exacerbation of reactive oxygen species-mediated myocardial injury at the time of reperfusion. Again, it is difficult to know whether the changes demonstrated are temporary or if they translate into a worsening of clinical outcomes. In conclusion, perhaps the key to the use of hyperoxia is in the timing. In the period pre-CPB, hyperoxia may precondition the myocardium and, paradoxically, confer a degree of protection against reactive oxygen species-induced injury at the time of reperfusion. Hyperoxia during CPB is probably harmful and should be avoided unless the risk from gas microemboli is thought to be significant, in which case the risks and benefits to the individual patient must be weighed.

Abstract 4455: The Impact of Platelet Count Decline on Clinical Outcome of Patients Undergoing Percutaneous Coronary Intervention

BACKGROUND: Severe decline in platelet count (DPC) ≥ 50% has been shown to be predictor of outcome after PCI. The prognosis of mild or moderate DPC is unknown. This study aimed to examine the impact of various degrees of DPC on clinical outcome. METHODS: The study included 10,146 consecutive patients who were subjected to PCI. The population was divided in four groups according to the magnitude of the decline in platelet post PCI: no DPC (DPC ≤ 10 %), minor DPC (10 –25 %), mild DPC (26 –50 %) and severe DPC (≥50%). The primary endpoint for this analysis was the composite criteria of death-MI at 30 days. RESULTS: Among the 10,146 patients, 36 % had a DPC ≤10 %, 47.7% had a DPC 10 –25%, 14% had a DPC 26 –50% and 2.3% had a DPC ≥50%. At 30 days, there was a worsening of clinical outcome with the severity of DPC (table 1 ). In univariate analysis, numerous variables were detected associated with the risk of death-MI at 30 days including both mild and severe DPC. After adjustment in multivariate analysis, DPC (25–50 %) and DPC (≥50%) were independently associated with the composite criteria death-MI at 30 days. All independent predictors in multivariate analysis are listed in table 2 . CONCLUSIONS: DPC after PCI is an independent predictor of death-MI at 30 days. The clinical significance of DPC is not limited to major DPC (≥50%) but also seen with moderate DPC (26 –50 %). Careful attention to platelet count is required in patients subjected to PCI who experienced more than 25% decline in their platelet count following the intervention. Relation between Decline in platelet count and Death - MI Independent predictors of death-MI at 30 days