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1.
Ghada S. Youssef Marwa S. Mashaal Dalia R. El Remisy Khalid A. Sorour Hussein H. Rizk 《Indian heart journal》2019,71(1)
Background
Pericardial effusion (PE) is widely believed to signify more advanced infective endocarditis (IE) and a generally worse outcome.Purpose
To determine the prevalence and clinical significance of PE in a series of patients with confirmed native and prosthetic valve infections.Methods
Data were collected from 338 consecutive patients with definite or possible IE who visited a single referral center; these patients were examined for the presence of PE as detected by transthoracic echocardiography. Clinical characteristics, the incidence of complications, and outcomes were compared between patients with IE with and without PE. IE patients with PE were then divided into two subgroups: those with and those without cardiac prostheses.Results
Eighty-eight patients out of the total 338 (26%) were found to have PE. Compared with patients who did not have PE, patients who did were significantly younger (32.9 ± 13.4 vs 29.0 ± 9.2, p = 0.003), had more left-sided vegetation (55.6% vs 77.3%, p < 0.001), more root abscesses (9.2% vs 25.0%, p < 0.001), needed surgery more frequently (68.0% vs 84.1%, p = 0.001), and had a higher mortality rate (22.0% vs 32.9%, p = 0.03). PE was not found to be a predictor of mortality. No significant difference was found between IE patients with PE with (n = 13) and without (n = 75) prostheses with regard to causative organisms, clinical characteristics, or clinical outcomes.Conclusion
Regardless of whether the IE was in native or prosthetic valves, compared with patients without PE, patients with PE had more severe infections and a worse prognosis, but PE was not an independent predictor of mortality. 相似文献2.
Chathura Bathiya Bandara Ratnayake Benjamin PT. Loveday John Albert Windsor Benjamin Lawrence Sanjay Pandanaboyana 《Pancreatology》2019,19(3):462-471
Background
This systematic review aimed to define the outcomes of different pancreatic resection procedures for multiple endocrine neoplasia type 1 (MEN1) associated pancreatic neuroendocrine neoplasms (pNENs).Methods
A search of PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines.Results
Twenty-seven studies including 533 patients undergoing initial pancreatic resection for MEN1 associated pNENs were included in this systematic review. Three hundred and sixty-six (68.7%) distal pancreatectomies (DP), 120 (22.5%) sole enucleations (SE) and 47 (8.8%) pancreaticoduodenectomies (PD) were identified. SE was associated with a higher rate of recurrence than DP (25/67, 37% vs 40/190, 21% respectively, P?=?0.008) but a lower rate of endocrine insufficiency than PD (1/20, 5% vs 8/21, 38% respectively, P?=?0.010). A meta-analysis of major pancreatic resections (PD or DP) vs SE in 15 studies showed that SE is associated with an increased rate of recurrence (Major resection 42/184, 23% vs SE 20/53, 38% RR 0.65 CI 0.43–0.96?P?=?0.032) but reduced rate of postoperative endocrine insufficiency (Resection 37/93, 40% vs SE 0/24, 0% RR 7.37 CI 1.57–34.64?P?=?0.008). Similarly, insulinomas and functional pNENs overall had lower rates of recurrence and reoperation with major resection. There was no difference in the reoperation rates or survival outcomes after SE compared with major pancreatic resections at follow-up (pooled overall mean duration: 85 months).Conclusion
Major pancreatic resections for MEN1 associated pNENs have a lower risk of recurrence and a higher risk of postoperative endocrine insufficiency when compared to sole enucleation, but a similar rate of reoperation and survival. 相似文献3.
James R. Butler Joshua K. Kays Michael G. House Eugene P. Ceppa Attila Nakeeb Christian M. Schmidt Nicholas J. Zyromski 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):301-309
Background
Cirrhosis increases the risk of perioperative mortality in gastrointestinal surgery. Though cirrhosis is sometimes considered a contraindication to pancreatoduodenectomy (PD), few data are available in this patient population. The aim of the present study is to identify predictors of outcome in cirrhotic patients undergoing PD.Methods
Patients undergoing PD with biopsy-proved cirrhosis were evaluated. Primary endpoints were morbidity and mortality. Child score, MELD score, and radiographic evidence of portal hypertension (pHTN) were assessed for accuracy in preoperative risk stratification. A systematic review of the literature with meta-analysis was also performed to query morbidity and mortality of patients with cirrhosis reported to undergo PD.Results
Between 2005 and 2015, 36 cirrhotic patients underwent PD; three year follow-up was complete. Median Child score was 6 (range 5–10); median MELD score was 9 (range 7–18). Perioperative (90-day) mortality was 6/36. Median survival was 37 months (range 0.2–116). MELD ≥ 10 was associated with increased mortality (4/13 vs. 2/13, p = 0.004). Irrespective of Child or MELD score, those with pHTN had poor outcomes including significantly greater intraoperative blood loss, increased incidence of major complication, and length of stay. Postoperative mortality was significantly higher with pHTN (3/16 vs. 1/13, p = 0.012).Conclusion
Pancreatoduodenectomy may be considered in carefully selected cirrhotic patients. MELD ≥ 10 predicts increased risk of postoperative mortality. Specific attention should be afforded to patients with preoperative radiographic evidence of portal hypertension as this group experiences poor outcomes irrespective of MELD or Child score. 相似文献4.
Marco Del Chiaro Elena Rangelova Asif Halimi Zeeshan Ateeb Chiara Scandavini Roberto Valente Ralf Segersvärd Urban Arnelo Caroline S. Verbeke 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):219-225
Background
Few studies have investigated the outcome of pancreatectomy associated with artery resection (PAR).Methods
Retrospective analysis of a cohort of operated borderline or locally advanced pancreatic cancer patients with surgically confirmed arterial involvement. Short and long-term outcome were analyzed and compared in patients who underwent PAR (Group 1) and palliative surgery (Group 2).Results
Of 73 patients who underwent surgical exploration with intent of resection, 34 underwent PAR (±venous resection) (Group 1) and 39 underwent palliation (Group 2). 23 patients (67.7%) in Group 1 underwent combined artery-vein resection (AVR). Operation time was longer and blood loss higher in group 1 compared to group 2. There were no differences in post-operative mortality (2.9% vs 2.6%, p = 0.9) and post-operative surgical complications (38.2% vs 25.6%, p = 0.2). The 1, 3 and 5 years survival in Group 1 was superior to Group 2 (63.7%, 23.4% and Q3 23.4% vs 41.7%, 3.2% and 0, p = 0.003).Conclusion
PAR seems to be safe and feasible in well selected patients and associated with an advantage of survival compared to palliation, in patients affected by locally advanced pancreatic cancer. 相似文献5.
Xiu-Ping Zhang Yu-Zhen Gao Ya-Bo Jiang Kang Wang Zhen-Hua Chen Wei-Xing Guo Jie Shi Yao-Jun Zhang Min-Shan Chen Wan Y. Lau Shu-Qun Cheng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):335-344
Background
Lymph node metastasis (LNM)has widely been recognized as a poor prognostic indicator for hepatocellular carcinoma (HCC) patients. Preoperative prediction of LNM is important for clinicians to decide on treatment. This study was designed to develop a simple and convenient system to predict LNM.Methods
Consecutive HCC patients who were suspected to have LNM were divided into a training, an internal validation and an external validation cohort. The receiver operating characteristic (ROC) analysis was used to determine the threshold value of the preoperative serological variables. A nomogram visualization system model was then established.Result
Of the 287 patients, there were 31 patients who had LNM (10.8%), and 21 of 203 patients (10.3%) were in the training cohort and 10 of 84 patients (11.9%) in the internal validation cohort. Sixteen of 176 patients (9.1%) in the external validation cohort had LNM. The serological indices including neutrophil/lymphocyte rate, age, platelet, prothrombin time, and total protein, were included in the nomogram. The areas of the ROC curve were 0.846, 0.679 and 0.738 in predicting LNM in the training cohort, the internal validation cohort and the external validation cohort, respectively.Conclusion
The scoring system constructed using the preoperative serological variables predicted LNM in HCC patients. 相似文献6.
Isamu Hosokawa Hiroaki Shimizu Hideyuki Yoshitomi Katsunori Furukawa Tsukasa Takayashiki Satoshi Kuboki Keiji Koda Masaru Miyazaki Masayuki Ohtsuka 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):489-498
Background
Right hepatectomy (RH) is the standard surgical procedure for perihilar cholangiocarcinoma (PHC) with right-sided predominance in many centers. Although left trisectionectomy (LT) is aggressively performed for PHC with left-sided predominance in high-volume centers, the surgical and survival outcomes of LT are unclear. Therefore, this study aimed to compare the outcomes of LT and RH for PHC.Methods
Consecutive patients who underwent surgical resection for PHC at Chiba University Hospital from 2008 to 2016 were retrospectively reviewed. The outcomes of patients with PHC who underwent LT were compared with those who underwent RH following one-to-one propensity score matching.Results
Of 171 consecutive PHC resection patients, 111 were eligible for the study; 41 (37%) underwent LT, and 70 (63%) underwent RH. In a matched cohort (LT: n = 27, RH: n = 27), major complication rates (67% vs. 52%; p = 0.42), 90-day mortality rates (15% vs. 0%; p = 0.11) and R0 resection rates (56% vs. 44%; p = 0.58) were similar in both groups. The 3-year recurrence-free survival rates (27% vs. 47%; p = 0.27) and overall survival rates (45% vs. 60%; p = 0.17) were also similar in both groups.Conclusions
In patients with PHC, LT could achieve similar surgical and survival outcomes as RH. 相似文献7.
Anuhya Kommalapati Sri Harsha Tella Gaurav Goyal Mitesh Borad Steven R. Alberts Lewis Roberts Joleen M. Hubbard Lori Durgin Sean Cleary Amit Mahipal 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):379-386
Background
To determine the association between the number of patients with intra-hepatic cholangiocarcinoma (IHCC) treated annually at a treatment facility (volume) and overall survival (outcome).Methods
Patients with IHCC reported to the National Cancer Database (years 2004–2015) were included. We classified facilities by tertiles (T; mean IHCC patients treated/year): T1: <2.56; T2: 2.57–5.39 and T3: ≥5.40. Volume–outcome relationship was determined by using Cox regression adjusting for patient demographics, comorbidities, tumor characteristics, insurance type and therapy received.Results
There were 11,344 IHCC patients treated at 1106 facilities. On multivariable analysis, facility volume was independently associated with all-cause mortality (p < 0.001). The unadjusted median OS by facility volume was: T1: 5 months (m), T2: 8.1 m, and T3: 13.1 m (p < 0.001). Compared with patients treated at T3 facilities, patients treated at lower-tertile facilities had significantly higher risk of death [T2 hazard ratio (HR), 1.12 [95% CI, 1.05–1.23]; T1 HR, 1.21 [95% CI, 1.11–1.33]. Patients treated at high-volume centers were more likely to get surgery (34.6 vs 13.1%) and adjuvant therapy.Conclusion
IHCC patients treated at high-volume facilities had a significant improvement in OS and were more likely to receive surgery and adjuvant therapy as compared to that of patients at low-volume facilities. 相似文献8.
Jia Hao Law Jarrod Kah Hwee Tan Kien Yee Michael Wong Wan Qi Ng Poh Seng Tan Glenn Kunnath Bonney Shridhar Ganpathi Iyer Madhavan Krishnakumar Wei Chieh Alfred Kow 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):242-248
Background
To compare the presentations and outcomes of anti-HBc seropositive Hepatocellular Carcinoma (HBc-HCC) with anti-HBc seronegative (NHBc-HCC) patients in HBsAg negative Non-HBV Non-HCV (NBNC-HCC) HCC population.Methods
515 newly diagnosed HCC patients from January 2011 to September 2016 were retrospectively reviewed. 145 (66.5%) NHBc-HCC and 73 (33.5%) HBc-HCC patients were identified. Patient demographics, disease characteristics, details of treatments, recurrence and survival outcomes were analysed.Results
A significantly lower proportion of HBc-HCC patients were diagnosed through surveillence (6.8% vs 26.2%, p = 0.001). HBc-HCC patients were less likely cirrhotic (p < 0.001), portal hypertensive (p < 0.001), ascitic (p = 0.008) and thrombocytopenic (p = 0.003). A higher proportion of HBc-HCC patients had treatment with curative intent (46.6% vs 30.3%, p = 0.018) and surgery (39.7% vs 16.6%, p < 0.001). Although HBc-HCC patients had larger median tumor size (74.0 mm vs 55.0 mm, p = 0.016) with a greater proportion of patients having tumors ≥5 cm, there was no difference in the overall median survival (19.0 months vs 22.0 months, p = 0.919) and recurrence rates (38.2% vs 40.9%).Conclusion
Isolated anti-HBc seropositivity in HbsAg negative patients tend to present incidentally with delayed diagnoses resulting in larger tumors, but their long-term survival remain comparable. 相似文献9.
Matteo Pagnesi Won-Keun Kim Lenard Conradi Marco Barbanti Giulio G. Stefanini Tobias Zeus Thomas Pilgrim Joachim Schofer David Zweiker Luca Testa Maurizio Taramasso David Hildick-Smith Alexandre Abizaid Alexander Wolf Nicolas M. Van Mieghem Alexander Sedaghat Jochen Wöhrle Saib Khogali Azeem Latib 《JACC: Cardiovascular Interventions》2019,12(5):433-443
Objectives
The aim of this study was to compare transcatheter aortic valve replacement (TAVR) with the Acurate neo (NEO) and Evolut PRO (PRO) devices.Background
The NEO and PRO bioprostheses are 2 next-generation self-expanding devices developed for TAVR.Methods
The NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) registry retrospectively included patients who underwent transfemoral TAVR with either NEO or PRO valves at 24 centers between January 2012 and March 2018. One-to-one propensity score matching resulted in 251 pairs. Pre-discharge and 30-day Valve Academic Research Consortium (VARC)–2 defined outcomes were evaluated. Binary logistic regression was performed to adjust the treatment effect for propensity score quintiles.Results
A total of 1,551 patients (n = 1,263 NEO; n = 288 PRO) were included. The mean age was 82 years, and the mean Society of Thoracic Surgeons score was 5.1%. After propensity score matching (n = 502), VARC-2 device success (90.6% vs. 91.6%; p = 0.751) and pre-discharge moderate to severe (II+) paravalvular aortic regurgitation (7.3% vs. 5.7%; p = 0.584) were comparable between the NEO and PRO groups. Furthermore, there were no significant differences in any 30-day clinical outcome between matched NEO and PRO pairs, including all-cause mortality (3.2% vs. 1.2%; p = 0.221), stroke (2.4% vs. 2.8%; p = 1.000), new permanent pacemaker implantation (11.0% vs. 12.8%; p = 0.565), and VARC-2 early safety endpoint (10.6% vs. 10.4%; p = 1.000). Logistic regression on the unmatched cohort confirmed a similar risk of VARC-2 device success, paravalvular aortic regurgitation II+, and 30-day clinical outcomes after NEO and PRO implantation.Conclusions
In this multicenter registry, transfemoral TAVR with the NEO and PRO bioprostheses was associated with high device success, acceptable rates of paravalvular aortic regurgitation II+, and good 30-day clinical outcomes. After adjusting for potential confounders, short-term outcomes were similar between the devices. 相似文献10.
Yuki Hashimoto Mitsuaki Ishida Hironori Ryota Tomohisa Yamamoto Hisashi Kosaka Satoshi Hirooka So Yamaki Masaya Kotsuka Yoichi Matsui Hiroaki Yanagimoto Koji Tsuta Sohei Satoi 《Pancreatology》2019,19(3):443-448
Objective
Adipophilin is a lipid droplet-associated protein, and its expression has been correlated with aggressive clinical behavior in some types of carcinomas, though its role in pancreatic ductal adenocarcinoma (PDAC) has not been clarified. This study aimed to evaluate the role of adipophilin in PDAC.Methods
By immunohistochemical staining using tissue microarrays, we analyzed the expression profiles of adipophilin in 181 consecutive PDAC patients who underwent macroscopic margin-negative resection from January 2008 to December 2015. Overall survival (OS) and recurrence-free survival (RFS) were compared based on adipophilin expression, and the risk factors for OS, RFS, and early recurrence (within 6 months) were analyzed.Results
Of the 181 evaluated patients, 51 (28.2%) were positive for adipophilin expression. A histopathological grade of 3 (p?=?0.0012), higher CA19-9 level (p?=?0.0016), and R1 status (p?=?0.028) were significantly associated with adipophilin-positive patients who had significantly poor OS and RFS compared to those associated with adipophilin-negative patients (p?=?0.0007 and p?=?0.0022, respectively). They also showed a significantly higher incidence of early recurrence (p?=?0.030), based on multivariate analyses.Conclusions
Adipophilin is a potential independent prognostic marker for PDAC. 相似文献11.
Robert J. Lederman Vasilis C. Babaliaros Toby Rogers Annette M. Stine Marcus Y. Chen Kamran I. Muhammad Robert A. Leonardi Gaetano Paone Jaffar M. Khan Bradley G. Leshnower Vinod H. Thourani Xin Tian Adam B. Greenbaum 《JACC: Cardiovascular Interventions》2019,12(5):448-456
Objectives
The authors investigated 1-year outcomes after transcaval access and closure for transcatheter aortic valve replacement (TAVR), using commercially available nitinol cardiac occluders off-label.Background
Transcaval access is a fully percutaneous nonfemoral artery route for TAVR. The intermediate-term fate of transcaval access tracts is not known.Methods
The authors performed a prospective, multicenter, independently adjudicated trial of transcaval access, using Amplatzer nitinol cardiac occluders (Abbott Vascular, Minneapolis, Minnesota), among subjects without traditional transthoracic (transapical or transaortic) access options. One-year clinical follow-up included core laboratory analysis of serial abdominal computed tomography (CT).Results
100 subjects were enrolled. Twelve-month mortality was 29%. After discharge, there were no vascular complications of transcaval access. Among 83 evaluable CT scans after 12 months, 77 of fistulas (93%) were proven occluded, and only 1 was proven patent. Fistula patency was not associated with overall survival (p = 0.37), nor with heart failure admissions (15% if patent vs. 23% if occluded; p = 0.30). There were no cases of occluder fracture or migration or visceral injury.Conclusions
Results are reassuring 1 year after transcaval TAVR and closure using permeable nitinol occluders off-label. There were no late major vascular complications. CT demonstrated spontaneous closure of almost all fistulas. Results may be different in a lower-risk cohort, with increased operator experience, and using a dedicated transcaval closure device. (Transcaval Access for Transcatheter Aortic Valve Replacement in People With No Good Options for Aortic Access; NCT02280824) 相似文献12.
Gunnar Tepe Antonio Micari Koen Keirse Thomas Zeller Dierk Scheinert Pei Li Randy Schmahl Michael R. Jaff 《JACC: Cardiovascular Interventions》2019,12(5):484-493
Objectives
This study evaluated the 12-month safety and effectiveness of a paclitaxel drug-coated balloon for treatment of intermittent claudication or rest pain in subjects with femoropopliteal chronic total occlusions (CTO).Background
CTOs are difficult to treat, and the optimal intervention remains to be determined.Methods
The IN.PACT Global Study is an international single-arm study that enrolled 1,535 patients with symptomatic femoropopliteal artery disease. The study contains prospectively defined cohorts with prospectively planned imaging analyses, including a CTO (≥5 cm) cohort in which subjects underwent duplex ultrasonography analyzed by an independent core laboratory. The primary safety endpoint was a composite of freedom from device- and procedure-related mortality through 30 days, and freedom from major target limb amputation and target vessel revascularization through 12 months. An independent Clinical Events Committee adjudicated all adverse events. The primary effectiveness endpoint was primary patency at 12 months, defined as freedom from clinically driven target lesion revascularization and freedom from restenosis.Results
The CTO imaging cohort had 126 subjects with 127 lesions (mean lesion length 22.83 ± 9.76 cm). Primary patency by Kaplan-Meier estimate was 85.3% through 12 months. Provisional stenting was performed in 46.8% of lesions. The primary safety composite endpoint was achieved by 88.7% of subjects. There were no device- or procedure-related deaths through 30 days or major target limb amputations through 12 months.Conclusions
The paclitaxel drug-coated balloon was safe and highly effective at 12 months after treatment of subjects with CTO ≥5 cm in the femoropopliteal arteries. (IN.PACT Global Clinical Study; NCT01609296) 相似文献13.
Soedarsono Soedarsono Mochamad Cahyo Subiantoro 《The Indian journal of tuberculosis》2019,66(1):134-138
Background
Pulmonary tuberculosis (TB) produces an inflammatory process of the lung parenchyma. While effective treatment of pulmonary TB and disease resolution processes have an impact on decreasing inflammatory conditions of the pulmonary parenchyma. This stimulates researchers to investigate changes in lung parenchymal inflammatory conditions detected from changes of C-reactive protein (CRP) serum levels pre and post two months of anti-tuberculosis drug treatment.Objectives
To know the changes of CRP serum levels in pulmonary TB patients with Acid Fast Bacillus (AFB) smear-positive sputum before and 2 months after receiving anti-tuberculosis drug treatment.Method
This study used prospective cohort study design, conducted in pulmonary outpatient unit at Dr. Soetomo General Hospital Surabaya from March to June 2013. Sample size was 30 pulmonary TB patients with AFB smear-positive sputum. AFB sputum grading and CRP serum level was measured before and 2 months after receiving anti-tuberculosis drug treatment. International Union Against Tuberculosis and Lung Disease (IUATLD) scale was used for AFB sputum grading. CRP serum was measured using immunoturbidimetric method.Result
The average CRP serum levels of pre anti-tuberculosis drug treatment were 6.48 ± 4.27 mg/dL in males and 6.28 ± 5.26 mg/dL in females. After two months of anti-tuberculosis drug treatment, the average CRP serum levels were 1.21 ± 1.94 mg/dL in males and 1.21 ± 1.22 mg/dL in females. Sputum conversion occurred in 27 out of 30 samples after two months of anti-tuberculosis drug treatment.Conclusion
The CRP serum levels was not significantly different in patients with pulmonary TB who experienced sputum conversion compared to patients without sputum conversion after two months of anti-tuberculosis drug treatment. 相似文献14.
Tomoko Tomioka Kento Fukui Shuhei Tanaka Yoshitaka Ito Hiroki Shioiri Jiro Koyama Kanichi Inoue 《Indian heart journal》2019,71(1)
Background
Chronic obstructive pulmonary disease (COPD), a known risk factor for the development of congestive heart failure (CHF), was recently shown to predict the prevalence of atrial fibrillation (AF). Here, we explore the influence of AF on cardiac prognosis in COPD patients.Methods
A total of 339 consecutive patients who underwent spirometry from 2010 to 2013 for various reasons were retrospectively examined. Based on the diagnostic criteria, patients were stratified into COPD and non-COPD groups, which were both further divided into those with AF (chronic AF or paroxysmal AF) or sinus rhythm (SR) based on previous electrocardiography results. Significances of differences in cardiac events were assessed by the chi-square test. Multivariate logistic regression analyses and Cox proportional hazard models were applied to evaluate the influence of AF on cardiac events.Results
Of the 339 patients, 190 were diagnosed with COPD, with 42 of these were having AF. During the mean follow-up period of 7.4 ± 0.8 years, CHF developed more frequently in COPD patients with AF than in COPD patients without AF [50% vs 7%; odds ratio (OR) 12.4, 95% confidence interval (CI): 5.25–29.49, p < 0.05]. AF was an independent predictor of CHF development (OR 20.4, 95% CI: 6.55–79.80, p < 0.05) and cardiac mortality (OR 2.8, 95% CI: 1.79–4.72, p < 0.05). Moreover, positive correlations were found between the severity of pulmonary obstruction with AF and CHF development (R = 0.69, p < 0.05), as well as cardiac mortality (R = 0.78.p < 0.05).Conclusions
These results suggest that AF may be strongly associated with cardiac mortality and CHF in COPD patients. 相似文献15.
Ngai-Yin Chan Chi-Chung Choy Ho-Chuen Yuen Hoi-Fan Chow Ho-Fai Fong 《The Canadian journal of cardiology》2019,35(4):396-404
Background
Persistent iatrogenic atrial septal defect (iASD) is a common but poorly characterized complication after cryoballoon (CB) pulmonary vein isolation (PVI) procedures. We therefore investigate its prevalence, evolution, risk factors, and clinical outcomes in a prospective longitudinal study.Methods
A total of 108 patients (41 women, mean age 57 ± 11.3) underwent CB PVI for AF. Serial transesophageal echocardiography (TEE) was performed 9 months and then annually until 6 years after the procedure to study the characteristics of persistent iASD.Results
Persistent iASD occurred in 33 (30.6%) patients 9 months after CB PVI. Spontaneous closure of iASD was found in 6 (22.2%) and 3 (15.8%) patients 2 and 3 years after the procedures, respectively. No spontaneous closure was observed on 4, 5, and 6-year TEE follow-up. The projected long-term persistence rate of iASD after CB PVI was therefore 20% (30.6% × 0.778 × 0.842). Using multivariate logistic regression, a higher number of cryoapplications (≥ 2 minutes) was the only independent predictor of persistent iASD 9 months after CB PVI (odds ratio [OR] 1.207; 95% confidence interval [CI], 1.033-1.411, P = 0.018). Two (1.9%) patients with significantly larger iASD size than the others (long diameter 12.6 ± 0.8 vs 3.7 ± 1.5 mm, P < 0.001; short diameter 10.9 ± 0.2 vs 3 ± 1.1 mm, P < 0.001) required percutaneous closure because of exertional dyspnea and right ventricular enlargement. Over 129.7 patient-years follow-up, during which iASD persisted, there was no occurrence of neurologic events.Conclusions
Approximately one fifth of patients undergoing CB PVI will have permanently persistent iASD. Patients with defect sizes of greater than 10 mm may need percutaneous closure due to significant left-to-right shunting. 相似文献16.
Yoav Michowitz Anat Milman Antoine Andorin Georgia Sarquella-Brugada M. Cecilia Gonzalez Corcia Jean-Baptiste Gourraud Giulio Conte Frederic Sacher Jimmy J.M. Juang Sung-Hwan Kim Eran Leshem Philippe Mabo Pieter G. Postema Aviram Hochstadt Yanushi D. Wijeyeratne Isabelle Denjoy Carla Giustetto Yuka Mizusawa Bernard Belhassen 《Journal of the American College of Cardiology》2019,73(14):1756-1765
Background
Information on young patients with Brugada syndrome (BrS) and arrhythmic events (AEs) is limited.Objectives
The purpose of this study was to describe their characteristics and management as well as risk factors for AE recurrence.Methods
A total of 57 patients (age ≤20 years), all with BrS and AEs, were divided into pediatric (age ≤12 years; n = 26) and adolescents (age 13 to 20 years; n = 31).Results
Patients’ median age at time of first AE was 14 years, with a majority of males (74%), Caucasians (70%), and probands (79%) who presented as aborted cardiac arrest (84%). A significant proportion of patients (28%) exhibited fever-related AE. Family history of sudden cardiac death (SCD), prior syncope, spontaneous type 1 Brugada electrocardiogram (ECG), inducible ventricular fibrillation at electrophysiological study, and SCN5A mutations were present in 26%, 49%, 65%, 28%, and 58% of patients, respectively. The pediatric group differed from the adolescents, with a greater proportion of females, Caucasians, fever-related AEs, and spontaneous type-1 ECG. During follow-up, 68% of pediatric and 64% of adolescents had recurrent AE, with median time of 9.9 and 27.0 months, respectively. Approximately one-third of recurrent AEs occurred on quinidine therapy, and among the pediatric group, 60% of recurrent AEs were fever-related. Risk factors for recurrent AE included sinus node dysfunction, atrial arrhythmias, intraventricular conduction delay, or large S-wave on ECG lead I in the pediatric group and the presence of SCN5A mutation among adolescents.Conclusions
Young BrS patients with AE represent a very arrhythmogenic group. Current management after first arrhythmia episode is associated with high recurrence rate. Alternative therapies, besides defibrillator implantation, should be considered. 相似文献17.
Javeed Ahmad Tantray K. Pratap Reddy Kaiser Jamil Shiva Kumar Yerra 《Indian heart journal》2019,71(1)
Background
The cytochrome P-450 2J2 (CYP2J2) is known to be one of the major enzymes of epoxygenase pathway of arachidonic acid in extrahepatic tissues, which produces series of regioisomeric cis-epoxyeicosatrienoic acids (EETs) such as 5,6-, 8,9-, 11,12-, and 14,15-EETs. In the present study, we analyzed the impact of a genetic variant in CYP2J2 on coronary artery disease (CAD) in the Telangana region of Indian population.Material and methods
The case–control study consisted of 100 CAD cases and 110 healthy controls. The deoxyribonucleic acid was extracted using the salting out method. Genotyping and gene expression was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism and real-time-PCR methods.Results
In the present study, the percentage of smokers, alcoholics, hypertensive patients, and diabetics was high. Increase in fasting glucose, urea, creatinine, fasting triglycerides, total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), total cholesterol/high-density lipoprotein (TC/HDL), LDL/HDL, homocysteine, and C-reactive protein levels were significantly higher in patients with CAD than in controls (p < 0.001). CYP2J2 G-50T was associated with CAD (p = 0.04). The mRNA expression of CYP2J2 showed altered gene expression in this study among CAD patients in comparison with control (p = 0.01).Conclusions
A functionally relevant polymorphism of the CYP2J2 gene was independently associated with an increased risk of CAD. 相似文献18.
Atsushi Kohga Kenji Suzuki Takuya Okumura Kimihiro Yamashita Jun Isogaki Akihiro Kawabe Taizo Kimura 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):508-514
Background
There have been only a few reports that describe the long-term outcomes of Subtotal cholecystectomy (SC).Methods
A total of 59 patients underwent “reconstituting” SC at our hospital between January 2005 and July 2017. In the 59 patients, risk factors for long-term complications were analyzed. In addition, in the patients with acute cholecystitis (AC), perioperative and long-term clinical factors were compared for patients who underwent SC (n = 48) and those who underwent total cholecystectomy (n = 378).Results
In the 59 patients who underwent SC, long-term complication developed in 14 (23.7%), including residual calculus in the common bile duct (n = 12), remnant cholecystitis (n = 1), and persistent severe inflammatory response (n = 1). Postoperative magnetic resonance image was performed in 35/59 patients (59.3%) who underwent SC. In these 35 patients, the size of the remnant gallbladder calculated by magnetic resonance cholangiopancreatography was significantly associated with the occurrence of long-term complications (p = 0.009). In the patients with AC, regarding long-term complications, the incidence of residual calculus in the common bile duct (16.6 versus 0.7%) was significantly higher in the SC group.Conclusions
SC was associated with a relatively high incidence of long-term complications associated with remnant calculus. 相似文献19.
Rodrigo Figueroa Nicolas Golse Fernando A. Alvarez Oriana Ciacio Gabriella Pittau Antonio Sa Cunha Daniel Cherqui René Adam Eric Vibert 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):387-392
Background
Primary graft dysfunction (PGD) is a leading cause of graft loss after liver transplantation. There is no reliable method to anticipate this complication intraoperatively. Indocyanine green (ICG) fluorescence imaging is a technique used in hepatobiliary surgery for detection of liver malignancies, but has never been reported in the setting of liver transplantation (LT) for function assessment. We hypothesized that there could be an association between the type of fluorescence and the occurrence of PGD.Methods
We retrospectively analyzed 72 patients who underwent LT at our center. An assessment of the liver graft with the ICG fluorescence technique was carried out. A classification comprising 3 types of fluorescence was created after evaluation of the recorded images. We assessed the relationship between the type of fluorescence and the occurrence of PGD.Results
Crosstabulation analysis of the fluorescent types and occurrence of PGD yielded a statistically significant association (p = 0.002). Univariate analysis showed that an abnormal ICG fluorescence pattern was a risk factor for the occurrence of PGD after LT.Conclusions
Our findings suggest that there could be an association between ICG fluorescence imaging and graft function. This intraoperative tool could be useful to detect patients at risk of developing PGD after LT. 相似文献20.
Masayuki Akita Keitaro Sofue Kohei Fujikura Kyoko Otani Tomoo Itoh Tetsuo Ajiki Takumi Fukumoto Yoh Zen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):226-234