Tag: pubmed

Indian Heart J. 2023 Jul 2:S0019-4832(23)00111-6. doi: 10.1016/j.ihj.2023.06.010. Online ahead of print.

ABSTRACT

OBJECTIVE: The present study compares the treatment outcomes of only culprit vessel PCI and complete revascularization in patients with STEMI and multivessel disease (MVD) following thrombolysis.

METHODS: This was a single-center, prospective randomized study including total 108 patients at a tertiary care center within 3-24 h post-thrombolysis and undergoing pharmacoinvasive PCI, were enrolled and randomized into two groups: complete revascularization PCI group and culprit only PCI group. The primary outcomes were evaluated by cardiac mortality, repeat myocardial infarction (MI)/acute coronary syndrome (ACS) and refractory angina. The secondary outcomes include repeat revascularization and safety outcomes namely contrast induced nephropathy (CIN), cerebrovascular accident (CVA) and major bleeding were compared among both the groups at one year follow-up.

RESULTS: Complete revascularization PCI group and culprit only PCI group had 54 patients in each group. Left ventricular ejection fraction did not show significant difference at discharge (p = 1) but was significantly improved in complete revascularization PCI group (p = 0.001) at one year follow-up. Reduced number of outcomes with a significant difference in both the groups were seen in the primary outcomes such as cardiac mortality (p = 0.01), repeat MI/ACS (p = 0.01) and refractory angina (p = 0.038) along with repeat revascularization (p = 0.001) at one year follow-up. Complete revascularization did not show any statistically significant difference in CIN (p = 0.567), CVA (p = 0.153) and major bleeding (p = 0.322) then culprit only revascularization group.

CONCLUSION: In patients with STEMI and MVD, complete revascularization was found more favourable in terms of primary and secondary outcomes compared to culprit only revascularization.

PMID:37402433 | DOI:10.1016/j.ihj.2023.06.010

Epidemiol Health. 2023 Jun 19:e2023059. doi: 10.4178/epih.e2023059. Online ahead of print.

ABSTRACT

OBJECTIVES: Sarcopenic obesity is closely related to aging and the prevalence of various chronic diseases and frailty. The purpose of this study was to analyze whether diet quality is related to obesity, sarcopenia, and sarcopenic obesity, and if so, to explore the difference in that relationship between urban and rural settings.

METHODS: Using data from the Korea National Health and Nutrition Examination Survey of 2016-2018, a total of 7,151 participants aged 40 years or older were analyzed. Sarcopenia was diagnosed using handgrip strength. Diet quality was assessed using Korea Healthy Eating Index (KHEI) scores, and obesity was determined based on participants’ abdominal circumference. Multinomial logistic analysis was used for testing statistical significance.

RESULTS: Rural participants had significantly lower KHEI scores and a higher prevalence of sarcopenic obesity than urban participants. The study findings demonstrate that participants without obesity, sarcopenia, or sarcopenic obesity had significantly higher KHEI scores in both rural and urban settings. Multinomial regression analysis further revealed that a higher KHEI score was associated with a lower risk of sarcopenia and sarcopenic obesity among urban residents, while only the risk of obesity was lower with higher diet quality scores among rural residents.

CONCLUSION: Since diet quality and health status were lower in rural areas, it is important to address this regional disparity with appropriate policy measures. To mitigate urban health disparities, urban residents in poor health with few resources should also be supported.

PMID:37402414 | DOI:10.4178/epih.e2023059

J Neurol Surg A Cent Eur Neurosurg. 2023 Jul 4. doi: 10.1055/a-2122-7391. Online ahead of print.

ABSTRACT

Background Neurocysticercosis is significant due to its high prevalence and considerable morbidity and mortality. The intraventricular form of NCC is less common than parenchymal, may have a rapidly progressive course and it requires a corresponding therapeutic response. Despite the extensive literature dealing with NCC and intraventricular cystic lesions, no systematic reviews have addressed similar work related to the clinical course and treatment of the infestation. Our main objective was to analyze the clinical type of the disease and the management for each ventricle separately on the basis of case reports or series of patients with individual data on the course of the disease and its treatment. As a control group, we used data on signs&symptoms and treatment of patients from published series on intraventricular neurocysticercosis. Method We performed a search in the Medline database. Google Scholar was also randomly searched. We extracted the following data from the eligible case/series: age and gender, symptoms, clinical signs, diagnostic examinations and findings, localization, treatment, follow-up period, outcome, and publication year. All data are presented in the form of absolute and relative numbers. The frequency of signs and symptoms, treatment and outcomes of the observed groups were checked by the Chi-square test and Fisher’s test. The hypothesis was tested with p <0.05 as statistical significance. Results We selected 160 cases of intraventricular neurocysticercosis (IVNCC) and divided them according to their localization into five categories. Hydrocephalus was recognized in 134 cases (83.4%). Patients with isolated IVNCCare are younger (P=.0264) and have a higher percentage of vesicular cysts (p <.00001). In mixed IVNCC, degenerative and multiple confluent cysts predominate (p = 0.00068). Individuals carrying fourth + third ventricular cysts (potentially obstructive form) are younger than individuals with lateral ventricles (potentially less obstructive forme) (p = .0083). The majority of patients had individual symptoms for a longer period before the acute onset of the disease (p <.00001). The predominant clinical manifestation is headache (88.7%); the proportion within the groups ranged from 100% to 75% without statistical significance (p.074214). The same was true for patients with symptoms of vomiting or nausea, who had a lower and roughly balanced percentage of 67.7% to 44.4% (p.34702). Altered level of consciousness (ranging from 21% to 60%) and focal neurological deficit (from 51.2% to 15%) are the only clinical category with statistical significance (p <0.001 and p.023948 ). Other signs and symptoms were less frequent and statistically irrelevant. Surgical resection of the parasite was the predominant type of treatment, varying from 55.5% to 87.5% (p- .02395); endoscopy (48.2%) and craniotomy (24.4%), each individually, showed statistical significance (.00001 and .000073, respectively). The difference was also relevant among patients who had CSF diversion performance with/without medical treatment (p-.002312. Postoperatively, 31.8% of patients received anthelmintics with/without anti-inflammatory or other drugs. Endoscopy, open surgery, and postoperative antiparasitic therapy showed statistical differences (p < 0.001). Favorable outcomes or regression of symptoms were recorded in 83.7%, mortality 7.5%. In the case series, the clinical signs&symptoms were as follows: headache-64%, nausea and vomiting 48.4%, focal neurological deficit 33.6% and altered level of consciousness 25%. Open surgery was the predominant form of intervention (craniotomy (57.6% or endoscopy 31.8%); with statistical significance between them (p< .00001). Conclusion. Ventricular neurocysticercosis is an alarming clinical condition. Hydrocephalus is the dominant diagnostic sign. Isolated IVNCC patients were recognized at a younger age than Mix.IVNCC individuals; poeple with cysts in the fourth and third ventricles (as a potentially more occlusive type of disease), presented their symptoms at a younger age than individuals with LVNCC. The majority of patients had long-term signs and symptoms before the acute onset of the disease. Headache, nausea& vomiting are the most common symptoms of infestation accompanied by altered sensorium and focal neurological deficits. Surgery is the best treatment option. A sudden increase in ICP due to cerebrospinal fluid obstruction with a successive cerebral hernia is the leading cause of fatal outcomes.

PMID:37402404 | DOI:10.1055/a-2122-7391

Thorac Cardiovasc Surg. 2023 Jul 4. doi: 10.1055/a-2122-7149. Online ahead of print.

ABSTRACT

BACKGROUND: Thoracogastric airway fistula (TGAF) is a fatal complication after esophagectomy. Without active treatment, patients may die of intractable pneumonia, sepsis, massive hemoptysis, or respiratory failure. We determined the clinical value of the two-tube method that involves the precise interventional placement of the nasojejunal tube (NJT) and nasogastric tube (NGT) for TGAF.

METHODS: Clinical data of patients with TGAF who had undergone fluoroscopic interventional placement of NJT and NGT were analyzed retrospectively. The paired t-test was used to compare the index values before and after treatment. Statistical significance was set at p < 0.05.

RESULTS: In total, 212 patients (177 male and 35 female; mean age, 61.3 ± 7.9 years [47-73 years]) with TGAF who had undergone the two-tube method were included. Posttreatment chest spiral computed tomography and inflammatory indicators showed significantly improved pulmonary inflammation compared with that before treatment. The patients’ general condition remained stable. Of 212 patients, 12 (5.7%) underwent surgical repair, 108 (50.9%) received placement of airway stents, and 92 (43.4%) cases only continued treatment with the two-tube method owing to patients’ conditions. In total, 47.8% (44/92) patients died of secondary pulmonary infection, bleeding, and primary tumor progression, while 52.2% (48/92) patients survived with both tubes.

CONCLUSION: The two-tube method, which involves the precise interventional placement of the NJT and NGT, is simple, safe, and effective for treating TGAF. This method is a bridge for successive treatments or a treatment itself for patients who are unsuitable for surgical repair or stent placement.

PMID:37402403 | DOI:10.1055/a-2122-7149

J Neurol Surg A Cent Eur Neurosurg. 2023 Jul 4. doi: 10.1055/s-0042-1759827. Online ahead of print.

ABSTRACT

BACKGROUND: Ventriculostomy (VST) is a frequent neurosurgical procedure. Freehand catheter placement represents the standard current practice. However, multiple attempts are often required. We present augmented reality (AR) headset guided VST with in-house developed head models. We conducted a proof of concept study in which we tested AR-guided as well as freehand VST. Repeated AR punctures were conducted to investigate if a learning curve can be derived.

METHODS: Five custom-made 3D-printed head models, each holding an anatomically different ventricular system, were filled with agarose gel. Eleven surgeons placed two AR-guided as well as two freehand ventricular drains per head. A subgroup of four surgeons did a total of three series of AR-guided punctures each to test for a learning curve. A Microsoft HoloLens served as the hardware platform. The marker-based tracking did not require rigid head fixation. Catheter tip position was evaluated in computed tomography scans.

RESULTS: Marker-tracking, image segmentation, and holographic display worked satisfactorily. In freehand VST, a success rate of 72.7% was achieved, which was higher than under AR guidance (68.2%, difference not statistically significant). Repeated AR-guided punctures increased the success rate from 65 to 95%. We assume a steep learning curve as repeated AR-guided punctures led to an increase in successful attempts. Overall user experience showed positive feedback.

CONCLUSIONS: We achieved promising results that encourage the continued development and technical improvement. However, several more developmental steps have to be taken before an application in humans can be considered. In the future, AR headset-based holograms have the potential to serve as a compact navigational help inside and outside the operating room.

PMID:37402395 | DOI:10.1055/s-0042-1759827

Facial Plast Surg. 2023 Jul 4. doi: 10.1055/s-0043-1770764. Online ahead of print.

ABSTRACT

BACKGROUNDS: Over the years, different techniques have been developed to reduce the number of incisions and scars in subnasal lip lifting and to increase the amount of lifting. The aim of this study was to present a new technique to hide the scars at the nasal base in subnasal lip lifting procedures and to review the literature.

METHODS: The file of patients who underwent subnasal lip lifting between January 2019 and January 2021 were examined. In all patients, the nasal sill flap that was designed was elevated, and the nasal sill flap that was prepared was adapted to its new location when the excision had been completed. Two different plastic surgeons evaluated the patients in the postoperative 12-month follow-ups. The scars were evaluated for vascularity, pigmentation, elasticity, thickness, and height.

RESULTS: The study included 26 patients. While 21 patients had no histories of lip lifting, five patients had had previous lip lifting history. The mean operation time was 37.11 minutes. Patients’ skin types were determined as Type 3 in 18 patients and Type 4 in eight patients according to the Fitzpatrick classification. The mean follow-up period of the patients was 13.11 months. At the end of the 12-month period, the mean scar score of the patients was calculated as 11.15. The mean scar score of primary cases was 11.14, and the mean scar score of secondary cases was 11.20 (p = 0.983). There was no statistically significant difference in terms of complications among smokers (p = 0.356). The mean scar score was calculated as 12.17 in patients who had Type 3 skin and 8.88 in patients with Type 4 skin (p = 0.075).

CONCLUSIONS: This technique is beneficial for patients because the scars are discrete and easier for patients to accept.

PMID:37402393 | DOI:10.1055/s-0043-1770764

Thromb Haemost. 2023 Jul 4. doi: 10.1055/a-2122-7780. Online ahead of print.

ABSTRACT

BACKGROUND: The Caprini risk assessment model (RAM) is the most commonly used tool for evaluating venous thromboembolism (VTE) risk, the high scoring for arthroplasty can result in patients being classified as high risk for VTE. Therefore, its value in post arthroplasty has been subject to debate.

METHODS: Retrospective data was collected from patients who underwent arthroplasty between August 2015 and December 2021. The study cohort included 3807 patients, all of whom underwent a thorough evaluation using Caprini RAM and vascular Doppler ultrasonography preoperatively.

RESULTS: 432 individuals (11.35%) developed VTE, while 3375 did not. 32 (0.84%) presented with symptomatic VTE, while 400 (10.51%) were detected as asymptomatic. Additionally, 368 (9.67%) VTE events occurred during the hospitalization period, and 64 (1.68%) cases were detected during post-discharge follow-up. Statistical analysis revealed significant differences between the VTE and non-VTE groups in terms of ages, blood loss, d-dimer, BMI>25, visible varicose veins, swollen legs, smoking, history of blood clots, broken hip, percent of female, hypertension and knee joint arthroplasty(P<0.05). The Caprini score was found to be significantly higher in the VTE group (10.10±2.23) compared to the non-VTE group (9.35±2.14) (P<0.001). Furthermore, there was a significant correlation between the incidence of VTE and the Caprini score (r=0.775, p=0.003). Patients with a score ≥9 are at a high-risk threshold for postoperative VTE.

CONCLUSION: The Caprini RAM shows a significant correlation with the occurrence of VTE. A higher score indicates a greater likelihood of developing VTE. The score ≥9 is a particularly high risk of developing VTE.

PMID:37402391 | DOI:10.1055/a-2122-7780

Physiol Meas. 2023 Jul 4. doi: 10.1088/1361-6579/ace414. Online ahead of print.

ABSTRACT

Cardiovascular disease (CVD) is one of the world’s most serious diseases threatening human health. Among them, arterial blood pressure (ABP) waveform has a great relationship with cardiovascular diseases. It contains a lot of cardiovascular information, which plays an important role in diagnosing and preventing cardiovascular diseases. This paper proposes a deep learning model of ABP-MultiNet3+, which can convert photoplethysmogram (PPG) signals into ABP waveforms containing cardiovascular physiological information. The PPG signal is obtained by monitoring the human body with sensors, and its working principle ensures non-invasiveness and universality. To ensure the quality of the predicted ABP waveform, this paper carefully designs the network structure, input signal, loss function, and structural parameters. A fully convolutional neural network (CNN) MultiResUNet3+ is used as the core architecture of ABP-MultiNet3+. In addition to performing Kalman filtering on the original PPG signal, its first-order derivative and second-order derivative signals are used as ABP-MultiNet3+ enter. The model’s loss function uses a combination of mean absolute error (MAE) and means square error (MSE) loss to ensure that the predicted ABP waveform matches the reference waveform. The proposed ABP-MultiNet3+ model was tested in a subject-dependent manner on the public MIMIC II database, and the MAE of the predicted waveform from the reference waveform was 1.88 mmHg in the subject experiment, indicating a small error in the performance of the model better. In the method of this paper, the MAP and DBP reached the A level in the AAMI and BHS standards, and the Bland-Altman analysis and regression analysis confirmed the statistical significance of the experimental results.

PMID:37402386 | DOI:10.1088/1361-6579/ace414

Melanoma Res. 2023 Jul 3. doi: 10.1097/CMR.0000000000000907. Online ahead of print.

ABSTRACT

Patients with melanoma brain metastases (MBM) have poor prognosis, albeit advances in locoregional and systemic treatments. The melanoma-specific Graded Prognostic Assessment (GPA) effectively stratifies survival for patients with MBM. Nevertheless, lactate dehydrogenase (LDH), a well known prognostic factor for patients with melanoma, is not represented in the GPA scores and might add prognostic information for patients with MBM. In this study, 150 consecutive patients with MBM were retrospectively analyzed with the aim of evaluating independent prognostic factors for MBM patients, including LDH. Furthermore, we implemented a disease-specific prognostic score and estimated survival according to treatment modalities. On the basis of multivariable Cox regression analyses, six prognostic factors (age, BRAF status, number of MBM, number of extracranial metastatic sites, performance status, and LDH level) resulted statistically significant in terms of survival and were combined in a prognostic score to stratify patients in distinct prognostic groups (P < 0.0001). Among treatment modalities, a multimodal approach with stereotactic radiosurgery or neurosurgery associated with systemic therapy showed the best outcome (median overall survival: 12.32 months, 95% confidence interval, 7.92-25.30). This is the first study to demonstrate that LDH has independent prognostic value for patients with MBM and might be used to improve prognostic stratification, albeit external validation is mandatory. Survival of patients with MBM is affected by both disease-specific risk factors and treatment modalities, with locoregional treatments associated with better outcomes.

PMID:37402350 | DOI:10.1097/CMR.0000000000000907

Porcine Health Manag. 2023 Jul 5;9(1):16. doi: 10.1186/s40813-023-00311-3.

ABSTRACT

BACKGROUND: Statistical Process Control (SPC) is a powerful statistical tool that can be used in animal production to evaluate the evolution of production parameters overtime in response to the implementation of a specific strategy. The aim of this study was to evaluate the effect of supplementing growing-finishing pigs with isoquinoline alkaloids (IQ) on growth performance parameters by using the SPC method. IQ are natural secondary plant metabolites which have been extensively investigated in food animals due to their efficacy in supporting growth performance and the overall health status. Performance parameters and medication usage were collected from 1,283,880 growing-finishing pigs fed the same basal diet, 147,727 of which were supplemented with IQ from day 70 of life until slaughter.

RESULTS: Supplementation with IQ improved feed conversion ratio, while feed intake and daily gain were maintained.

CONCLUSION: SPC methods are useful statistical tools to evaluate the effect of using a new feed additive in the feed of pigs on growth performance at a commercial level. Additionally, IQ supplementation improved growth performance and it can be considered as a good strategy to reduce feed conversion in growing-finishing pigs.

PMID:37403176 | DOI:10.1186/s40813-023-00311-3