共查询到20条相似文献，搜索用时 31 毫秒
1.
Sean P. Martin Samantha Ruff Laurence P. Diggs Justin Drake Reed I. Ayabe Zachary J. Brown Michael M. Wach Seth M. Steinberg Jeremy L. Davis Jonathan M. Hernandez 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):419-424
Background
Portal lymphadenectomy for intrahepatic cholangiocarcinoma (ICC) is encouraged for staging purposes, though it is under-utilized for clinically early-stage tumors. We sought to determine if any factor knowable prior to resection influences rates of portal lymph node metastases.Methods
The Surveillance, Epidemiology, and End Results (SEER) Program (1973–2014) database was queried to identify patients with T1/T2 ICC undergoing resection. Patients were stratified by lymph node (LN) status. Patients deemed LN negative required examination of six or more LNs (AJCC guidelines).Results
One-hundred and fifty-two patients were included in the analysis (LN negative: 38, LN positive: 114). Patients with LN negative cancers experienced prolonged overall survival as compared to patients with positive LNs (median 77 months vs 19 months, respectively p < 0.001). Twelve patients had well-differentiated tumors (G1), 92 patients had moderately-differentiated tumors (G2) and 58 patients had poorly-differentiated tumors (G3). Tumor grade (OR 3.9, CI 1.1–13.7, p = 0.031) and male sex (OR 2.6, CI 1.1–6.1, p = 0.022) were associated with positive LNs on multivariable logistic regression analysis.Conclusion
Intermediate/High grade and male sex are associated with high rates of lymph node metastasis for patients with early-stage ICC, which portends abbreviated overall survival. 相似文献2.
Eric Siskind Leo Amodu Chang Liu Meredith Akerman Joshua Stodghill Ravinder Wali James Piper Johann Jonsson Ernesto Molmenti Jorge Ortiz 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):195-203
Background
The decision to utilize portal or systemic venous drainage in pancreas transplantation is surgeon- and center-dependent. Information regarding the superior method is based on single-center reports and animal models.Methods
UNOS data on adults receiving pancreas and kidney-pancreas transplants from 1987 to 2016 were analyzed (n = 29 078). The groups analyzed were: systemic venous pancreas graft drainage (SVD, n = 24 512) or portal venous pancreas graft drainage (PVD, n = 4566). A Cox proportional hazard model compared patient and allograft survival between groups.Results
No statistically significant differences were observed for patient and allograft survival at 1, 3, 5, 10, or 15 years post-transplant at each time interval and cumulatively (patient – HR:1.041; 95% CI:0.989–1.095; allograft – HR:0.951; 95% CI:0.881–1.027). PVD reduced the risk of death by 22.0% (P = 0.017) compared to SVD for patients undergoing pancreas after kidney transplant (PAK); no statistically significant difference was found for patients undergoing other types of transplants.Conclusion
There is no significant clinical difference in patient or allograft survival between PVD and SVD in pancreas transplantation for the majority of patients. For the subgroup of PAK, PVD was associated with decreased mortality. For individual surgeons, center and patient scenarios should dictate which technique is performed. 相似文献3.
Andrew R. Kolarich Roniel Cabrera Steven J. Hughes Thomas J. George Brian S. Geller Joseph R. Grajo 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):249-257
Background
The aim of this retrospective review was to evaluate the long-term survival benefits of thermal ablation versus wedge or segmental resection in solitary HCC lesions using tumor size and clinical factors.Methods
Survival analysis was performed on 43,601 patients from 2004 to 2015 in the National Cancer Database with solitary HCC lesions ≤5 cm with further stratification by tumor size, fibrosis score, and type of resection.Results
In patients with moderate fibrosis or less, survival benefit was seen with one-segment resection over ablation in tumors 1.1–3 cm (HR 0.54, p = 0.03) while tumors of 3.1–5 cm received survival benefit from wedge (HR 0.44, p = 0.04), one (HR 0.28, p = 0.001) and two-segment (HR 0.20, p = 0.001) resections over ablation. In patients with severe fibrosis to cirrhosis, wedge resection demonstrated survival benefit over ablation in patients with tumors 1.1–3 cm (HR 0.48, p = 0.01) with no survival benefit of any resection type in patients with tumors of 3.1–5 cm.Conclusion
These findings suggest that the decision to utilize thermal ablation versus resection to extend survival in solitary HCC lesions should include tumor size, fibrosis score, and type of resection. 相似文献4.
Kasper Kyhl Kiril Aleksov Ahtarovski Lars Nepper-Christensen Kathrine Ekström Adam Ali Ghotbi Mikkel Schoos Christoffer Göransson Litten Bertelsen Steffen Helqvist Lene Holmvang Erik Jørgensen Frants Pedersen Kari Saunamäki Peter Clemmensen Ole De Backer Dan Eik Høfsten Lars Køber Henning Kelbæk Thomas Engstrøm 《JACC: Cardiovascular Interventions》2019,12(8):721-730
Objectives
The aim of this study was to evaluate the effect of fractional flow reserve (FFR)–guided revascularization compared with culprit-only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) on infarct size, left ventricular (LV), function, LV remodeling, and the presence of nonculprit infarctions.Background
Patients with STEMI with multivessel disease might have improved clinical outcomes after complete revascularization compared with PCI of the infarct-related artery only, but the impact on infarct size, LV function, and remodeling as well as the risk for periprocedural infarction are unknown.Methods
In this substudy of the DANAMI-3 (Third Danish Trial in Acute Myocardial Infarction)–PRIMULTI (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization) randomized trial, patients with STEMI with multivessel disease were randomized to receive either complete FFR-guided revascularization or PCI of the culprit vessel only. The patients underwent cardiac magnetic resonance imaging during index admission and at 3-month follow-up.Results
A total of 280 patients (136 patients with infarct-related and 144 with complete FFR-guided revascularization) were included. There were no differences in final infarct size (median 12% [interquartile range: 5% to 19%] vs. 11% [interquartile range: 4% to 18%]; p = 0.62), myocardial salvage index (median 0.71 [interquartile range: 0.54 to 0.89] vs. 0.66 [interquartile range: 0.55 to 0.87]; p = 0.49), LV ejection fraction (mean 58 ± 9% vs. 59 ± 9%; p = 0.39), and LV end-systolic volume remodeling (mean 7 ± 22 ml vs. 7 ± 19 ml; p = 0.63). New nonculprit infarction occurring after the nonculprit intervention was numerically more frequent among patients treated with complete revascularization (6 [4.5%] vs. 1 [0.8%]; p = 0.12).Conclusions
Complete FFR-guided revascularization in patients with STEMI and multivessel disease did not affect final infarct size, LV function, or remodeling compared with culprit-only PCI. 相似文献5.
Robert W. Yeh Hector Tamez Eric A. Secemsky J. Aaron Grantham James Sapontis John A. Spertus David J. Cohen William J. Nicholson Kensey Gosch Philip G. Jones Linda R. Valsdottir Jeffrey Bruckel William L. Lombardi Farouc A. Jaffer 《JACC: Cardiovascular Interventions》2019,12(7):651-658
Objectives
This study sought to examine depression prevalence among chronic total occlusion (CTO) patients and compared symptom improvement among depressed and nondepressed patients after percutaneous coronary intervention (PCI).Background
Depression in cardiovascular patients is common, but its prevalence among CTO patients and its association with PCI response is understudied.Methods
Among 811 patients from the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry, we evaluated change in health status between baseline and 1-year post-PCI, as measured by the Seattle Angina Questionnaire (SAQ) and the Rose Dyspnea Score. Depression was defined using the Personal Health Questionnaire-8. The independent association between health status and depression following PCI was assessed using multivariable regression.Results
Among the 811 patients, 190 (23%) screened positive for major depression, of whom 6.3% were on antidepressant therapy at intervention. Depressed patients experienced more baseline angina, but by 1-year post-PCI they experienced greater improvements than nondepressed patients (change in SAQ Summary: 31.4 ± 22.4 vs. 24.2 ± 20.0; p < 0.001). After adjustment, baseline depressed patients had more improvement in health status (adjusted difference in SAQ Summary improvement, depressed vs. nondepressed: 5.48 ± 1.81; p = 0.003).Conclusions
Depression is common among CTO PCI patients, but few were treated with antidepressants at baseline. Depressed patients had more severe baseline angina and significant improvement in health status after PCI. (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion [OPEN-CTO]; NCT02026466) 相似文献6.
Dmitri Bezinover Molly F. Deacutis Priti G. Dalal Robert P. Moore Jonathan G. Stine Ming Wang Ethan Reeder Christopher S. Hollenbeak Fuat H. Saner Thomas R. Riley Piotr K. Janicki 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):370-378
Background
This retrospective UNOS database evaluation analyzes the prevalence of preoperative portal vein thromboses (PVT), and postoperative thromboses leading to graft failure in pediatric patients undergoing liver transplantation (LT).Methods
The evaluation was performed in three age groups: I (0–5), II (6–11), III (12–18) years old. Factors predictive of pre- and postoperative thromboses were analyzed.Results
Between 2000 and 2015, 8982 pediatric LT were performed in the US. Of those, 390 patients had preoperative PVT (4.3%), and 396 (4.4%) had postoperative thromboses. The prevalence of both types of thromboses was less in Group III than in the other two groups (3.20% vs 4.65%, p = 0.007 and 1.73% vs. 5.13%, p < 0.001, respectively). The prevalence of postoperative thromboses was significantly higher in Group I than in the other two groups (5.49% vs. 2.51%, p < 0.001). Preoperative PVT was independently associated with postoperative thromboses (OR = 1.7, p = 0.02). Children less than 5 years of age were more likely to develop postoperative thromboses leading to graft failure (OR = 2.9, p < 0.001).Conclusion
Younger children undergoing LT are prone to pre-and postoperative thrombotic complications. Preoperative PVT at the time of transplantation was independently associated with postoperative thromboses. Perioperative antithrombotic therapy should be considered in pediatric patients undergoing LT. 相似文献7.
Domingo A. Pascual-Figal Antoni Bayes-Genis Maria C. Asensio-Lopez Alvaro Hernández-Vicente Iris Garrido-Bravo Francisco Pastor-Perez Javier Díez Borja Ibáñez Antonio Lax 《Journal of the American College of Cardiology》2019,73(9):1016-1025
Background
Soluble ST2 (sST2), which is the soluble form of interleukin (IL)-1 receptor-like 1, identifies risk in acutely decompensated heart failure (ADHF). IL-1β is an inflammatory cytokine that has deleterious effects in myocardial remodeling and function. IL-1β inhibition has beneficial effects after acute myocardial infarction. However, the role of IL-1β in ADHF and its relationship to ST2 remain unclear.Objectives
This study sought to investigate the relationship between IL-1β and sST2, and the prognostic impact of such a relationship in patients with ADHF.Methods
This study examined 316 consecutive patients who were hospitalized with ADHF (72 ± 12 years of age, 57% male, and left ventricular ejection fraction 45 ± 17%). Blood samples were collected at presentation, and IL-1β and sST2 levels were measured. All-cause mortality was obtained for all patients at 1 year.Results
The IL-1β concentration at presentation was associated with prior HF hospitalizations, functional impairment, and higher N-terminal pro–B-type natriuretic peptide and high-sensitivity troponin T concentrations. IL-1β was higher in patients who died during the year after hospitalization (n = 52, 16.5%) (p = 0.005), and the optimal threshold was identified with levels over 49.1 pg/ml (hazard ratio: 2.5; 95% confidence interval: 1.43 to 4.49; p = 0.0014). Circulating IL-1β positively correlated with sST2 (ρ = 0.65; p < 0.001). Considering the prognostic thresholds of IL-1β (≥49.1 pg/ml) and sST2 (≥35.0 ng/ml) concentrations: all patients with low sST2 also presented with low IL-1β; among patients with high sST2, only those with also high IL-1β had a significantly higher risk of death (30% vs. 14%; hazard ratio: 2.52; 95% confidence interval: 1.40 to 4.56; p = 0.002).Conclusions
Circulating IL-1β concentrations are clinically meaningful in ADHF patients and interplay with the predictive ability of sST2. IL-1 axis-related inflammation signaling may represent a therapeutic target in ADHF. 相似文献8.
Jay J. Idrees Fabio Bagante Faiz Gani Brad F. Rosinski Qinyu Chen Katiuscha Merath Mary Dillhoff Jordan Cloyd Timothy M. Pawlik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):456-464
Background
The objective of the current study was to compare outcomes among patients combined colon (CR) and liver resection (LR) for the treatment of simultaneous colorectal liver metastasis (CRLM) versus patients undergoing two-stage CR and LR.Methods
Patients undergoing surgery for CRLM between 2004 and 2014 were identified using the Nationwide Inpatient Sample (NIS). Propensity-score matching was used to compare patients undergoing CR + LR with patients undergoing two-stage CR and LR.Results
Among 83,410 patients, CR + LR was performed in 5659 (6.7%), stage C + LR was performed in 5659 (6.7%), while isolated CR and LR was performed in 70,177 (84.0%) and 7574 (9.3%) patients, respectively. The number of patients undergoing CR + LR increased from 423 in 2004 to 580 in 2014 (Δ = +37%). Patients undergoing CR + LR had lower postoperative morbidity (CR + LR vs. two-staged CR and LR: 38.5% vs. 61.2%), shorter LOS (median LOS: 8 days [IQR: 7–12] vs. 14 days [IQR: 10–21]), and lower postoperative mortality (3.1% vs. 5.9%) versus patients undergoing two-stage CR and LR. Compared with patients undergoing two-staged CR and LR, median hospital costs were $13,093 lower for patients undergoing CR + LR (median costs: $36,775 [IQR: 26,416–54,245] vs. $23,682 [IQR: 16,299–32,996]).Conclusion
CR + LR was increasingly performed for treatment of CRLM. Compared with two-staged CR and LR, CR + LR was associated with improved outcomes and lower costs. 相似文献9.
Rody El Nawar Bertrand Lapergue Michel Piotin Benjamin Gory Raphael Blanc Arturo Consoli Georges Rodesch Mikael Mazighi Frederic Bourdain Maéva Kyheng Julien Labreuche Fernando Pico 《JACC: Cardiovascular Interventions》2019,12(4):385-391
Objectives
The aim of this study was to determine whether individual operator characteristics have an impact on reperfusion and procedural complication rates.Background
Mechanical thrombectomy (MT) is a Level IA treatment in acute ischemic stroke (AIS) patients. The operator’s effect has been found to be an independent predictor for clinical outcome and technical performance in interventional cardiology.Methods
From the ETIS (Endovascular Treatment in Ischemic Stroke) study, a prospective, multicenter, observational real-world MT registry, the authors included all AIS patients consecutively treated by MT between January 2012 and March 2017 in 3 high-volume comprehensive stroke centers by 19 operators. We assessed the effect of individual operator characteristics on successful reperfusion, defined as modified Thrombolysis In Cerebral Infarction 2b/3 at the end of MT, and procedural complications using multivariable hierarchical logistic regression models.Results
A total of 1,541 patients with anterior and posterior AIS were enrolled (mean age 67 years; median NIHSS 16). There was a significant operator effect on successful reperfusion, with an intraclass correlation coefficient of 0.036 (p = 0.046), but not on complications (intraclass correlation coefficient = 0). There was a dose–response relationship between annual operator volume and successful reperfusion rate (p = 0.003) with an adjusted odds ratio for successful reperfusion equal to 2.52 (95% confidence interval: 1.37 to 4.64) for patients treated by an operator with an annual volume ≥40 MT/year compared with those treated by an operator with <14 MT/year (first tertile). Nevertheless, this result did not translate to better clinical outcomes.Conclusions
Our data suggest that operator volume of MT/year has a positive impact on successful reperfusion in AIS patients, but not on clinical outcomes nor on complication rates. Further studies are warranted to investigate threshold procedure numbers associated with better outcomes. 相似文献10.
Scott Kizy Ariella M. Altman Schelomo Marmor Keith Wirth Jane Y. Ching Hui Todd M. Tuttle Jason W. Denbo Eric H. Jensen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):235-241
Background
Nodal positivity is a predictor of poor survival following resection for intrahepatic cholangiocarcinoma (ICC). The aim of this study was to evaluate the impact of surgical resection on survival in patients with lymph node (LN) positive ICC.Methods
An augmented version of the Surveillance, Epidemiology, and End Results program database was utilized to identify patients with LN-positive ICC without distant metastases from 2000 to 2014. Patients were stratified by treatment: chemotherapy alone or surgical resection with/without chemotherapy. Survival was evaluated using Kaplan–Meier and Cox proportional hazard models.Results
169 patients who underwent treatment for LN-positive ICC were identified. 88% underwent surgical resection and 12% underwent chemotherapy alone. The median survival for patients who underwent surgical resection was not different from patients treated with chemotherapy alone (19 months 95% Confidence Interval (CI) 17–33 versus 20 months CI 10–27, p = 0.323). A cox-proportional hazard ratio model demonstrated that black race was associated with worse survival (p < 0.05), while surgical resection was not independently associated with survival.Conclusion
Surgical resection for patients with LN-positive ICC may not improve survival compared to chemotherapy alone. Pathologic LN evaluation should be performed prior to surgical resection, to improve patient selection and ensure receipt of optimal therapy. 相似文献11.
Ju-Dong Li Xin-Fei Xu Jun Han Han Wu Hao Xing Chao Li Jiong-Jie Yu Ya-Hao Zhou Wei-Min Gu Hong Wang Ting-Hao Chen Yong-Yi Zeng Wan Y. Lau Meng-Chao Wu Feng Shen Tian Yang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):157-166
Background
Serum prealbumin is a sensitive and stable marker for nutritional status and liver function. Whether preoperative prealbumin level is associated with long-term prognosis in patients undergoing liver resection for hepatocellular carcinoma (HCC) is unclear.Methods
Patients who underwent liver resection for HCC between 2001 and 2014 at six institutions were enrolled. These patients were divided into the low and normal prealbumin groups using a cut-off value of 170 mg/L for preoperative prealbumin level. The overall survival (OS) and recurrence-free survival (RFS) were compared between them.Results
In 1483 patients, 437 (29%) had a low prealbumin level. The 3- and 5-year OS and RFS rates of patients in the low-prealbumin group were 57 and 31%, and 40 and 20%, respectively, which were significantly poorer than those in the normal-prealbumin group (76 and 43%, and 56 and 28%, respectively, both p < 0.001). Multivariable Cox-regression analyses revealed that preoperative prealbumin level was an independent predictor of OS (HR, 1.45, 95% CI: 1.24–1.70, p <0.001) and RFS (HR, 1.28, 95% CI: 1.10–1.48, p <0.001).Conclusions
Preoperative prealbumin level could be used in predicting long-term prognosis for patients undergoing liver resection for HCC. 相似文献12.
Quinn S. Wells Deepak K. Gupta J. Gustav Smith Sean P. Collins Alan B. Storrow Jane Ferguson Maya Landenhed Smith Jill M. Pulley Sarah Collier Xiaoming Wang Dan M. Roden Robert E. Gerszten Thomas J. Wang 《Journal of the American College of Cardiology》2019,73(17):2195-2205
Background
Circulating biomarkers can facilitate diagnosis and risk stratification for complex conditions such as heart failure (HF). Newer molecular platforms can accelerate biomarker discovery, but they require significant resources for data and sample acquisition.Objectives
The purpose of this study was to test a pragmatic biomarker discovery strategy integrating automated clinical biobanking with proteomics.Methods
Using the electronic health record, the authors identified patients with and without HF, retrieved their discarded plasma samples, and screened these specimens using a DNA aptamer-based proteomic platform (1,129 proteins). Candidate biomarkers were validated in 3 different prospective cohorts.Results
In an automated manner, plasma samples from 1,315 patients (31% with HF) were collected. Proteomic analysis of a 96-patient subset identified 9 candidate biomarkers (p < 4.42 × 10?5). Two proteins, angiopoietin-2 and thrombospondin-2, were associated with HF in 3 separate validation cohorts. In an emergency department–based registry of 852 dyspneic patients, the 2 biomarkers improved discrimination of acute HF compared with a clinical score (p < 0.0001) or clinical score plus B-type natriuretic peptide (p = 0.02). In a community-based cohort (n = 768), both biomarkers predicted incident HF independent of traditional risk factors and N-terminal pro–B-type natriuretic peptide (hazard ratio per SD increment: 1.35 [95% confidence interval: 1.14 to 1.61; p = 0.0007] for angiopoietin-2, and 1.37 [95% confidence interval: 1.06 to 1.79; p = 0.02] for thrombospondin-2). Among 30 advanced HF patients, concentrations of both biomarkers declined (80% to 84%) following cardiac transplant (p < 0.001 for both).Conclusions
A novel strategy integrating electronic health records, discarded clinical specimens, and proteomics identified 2 biomarkers that robustly predict HF across diverse clinical settings. This approach could accelerate biomarker discovery for many diseases. 相似文献13.
Paul Sorajja Neil Moat Vinay Badhwar Darren Walters Gaetano Paone Brian Bethea Richard Bae Gry Dahle Mubashir Mumtaz Paul Grayburn Samir Kapadia Vasilis Babaliaros Mayra Guerrero Lowell Satler Vinod Thourani Francesco Bedogni David Rizik Paolo Denti David Muller 《Journal of the American College of Cardiology》2019,73(11):1250-1260
Background
Transcatheter mitral valve replacement (TMVR) is a rapidly evolving therapy. Follow-up of TMVR patients remains limited in duration and number treated.Objectives
The purpose of this study was to examine outcomes with expanded follow-up for the first 100 patients who underwent TMVR with the prosthesis.Methods
The Global Feasibility Study enrolled symptomatic patients with either primary or secondary mitral regurgitation (MR) who were at high or prohibitive surgical risk. The present investigation examines the first 100 patients treated in this study. Clinical outcomes through last clinical follow-up were adjudicated independently.Results
In the cohort (mean age 75.4 ± 8.1 years; 69% men), there was a high prevalence of severe heart failure symptoms (66%), left ventricular dysfunction (mean ejection fraction 46.4 ± 9.6%), and morbidities (Society of Thoracic Surgeons Predicted Risk of Mortality, 7.8 ± 5.7%). There were no intraprocedural deaths, 1 instance of major apical bleeding, and no acute conversion to surgery or need for cardiopulmonary bypass. Technical success was 96%. The 30-day rates of mortality and stroke were 6% and 2%, respectively. The 1-year survival free of all-cause mortality was 72.4% (95% confidence interval: 62.1% to 80.4%), with 84.6% of deaths due to cardiac causes. Among survivors at 1 year, 88.5% were New York Heart Association function class I/II, and improvements in 6-min walk distance (p < 0.0001) and quality-of-life measurements occurred (p = 0.011). In 73.4% of survivors, the Kansas City Cardiomyopathy Questionnaire score improved by ≥10 points.Conclusions
In this study of TMVR, which is the largest experience to date, the prosthesis was highly effective in relieving MR and improving symptoms, with an acceptable safety profile. Further study to optimize the impact on long-term survival is needed. 相似文献14.
Katharina Joechle Claire Goumard Eduardo A. Vega Masayuki Okuno Yun-Shin Chun Ching-Wei D. Tzeng Jean-Nicolas Vauthey Claudius Conrad 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):361-369
Background
While post-hepatectomy liver failure (PHLF) accurately predicts short-term mortality, its role in prognosticating long-term overall survival (OS) remains unclear.Methods
Patients who underwent hepatectomy for colorectal liver metastases (CRLM) after portal vein embolization during 1999–2015 were evaluated retrospectively. PHLF was defined per International Study Group of Liver Surgery (ISGLS) criteria and as PeakBil >7 mg/dl. Survival was analyzed using log-rank statistic and Cox regression; patient mortality within 90 days was excluded.Results
Of 175 patients, 68 (39%) had PHLF according to ISGLS criteria, including 40 (23%) with ISGLS grade B/C, and 14 (8%) had PeakBil >7 mg/dl. Patients with PeakBil >7 mg/dl had significantly worse OS than patients without PHLF (median OS, 16 vs 58 months, p = 0.001). Patients with ISGLS defined PHLF (p = 0.251) and patients with ISGLS grade B/C PHLF (p = 0.220) did not have worse OS than patients without PHLF.Conclusion
Peak bilirubin >7 mg/dl impacts on long-term survival after hepatectomy for CRLM and is a better predictor of long-term survival than ISGLS-defined PHLF. 相似文献15.
Jay S. Shavadia Anita Y. Chen Alexander C. Fanaroff James A. de Lemos Michael C. Kontos Tracy Y. Wang 《JACC: Cardiovascular Interventions》2019,12(8):709-717
Objectives
The aims of this study were to describe variability in intensive care unit (ICU) utilization for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI), evaluate the proportion of these patients who developed in-hospital complications requiring ICU care, and assess whether ICU use patterns and complication rates vary across categories of first medical contact to device times.Background
In the era of rapid primary percutaneous coronary intervention, ICUs may be overutilized as patients presenting with STEMI are less likely to develop complications requiring ICU care.Methods
Using data from the Chest Pain-MI Registry linked to Medicare claims, the authors examined patterns of ICU utilization among hemodynamically stable patients with STEMI ≥65 years of age treated with uncomplicated primary percutaneous coronary intervention, stratified by timing of reperfusion: early (first medical contact–to–device time ≤60 min), intermediate (61 to 90 min), or late (>90 min).Results
Of 19,507 patients with STEMI treated at 707 hospitals, 82.3% were treated in ICUs, with a median ICU stay of 1 day (interquartile range [IQR]: 1 to 2 days). The median FMC-to-device time was 79 min (IQR: 63 to 99 min); 22.0% of patients had early, 44.8% intermediate, and 33.2% late reperfusion. ICU utilization rates did not differ between patients with early, intermediate, and late reperfusion times (82%, 83%, and 82%; p for trend = 0.44). Overall, 3,159 patients (16.2%) developed complications requiring ICU care while hospitalized: 3.7% died, 3.7% had cardiac arrest, 8.7% shock, 0.9% stroke, 4.1% high-grade atrioventricular block requiring treatment, and 5.7% respiratory failure. Patients with longer FMC-to-device times were more likely to develop at least 1 of these complications (early 13.4%, intermediate 15.7%, and late 18.7%; p for trend <0.001; adjusted odds ratio [early as reference] for intermediate: 1.13 [95% confidence interval: 1.01 to 1.25]; adjusted odds ratio for late: 1.22 [95% confidence interval: 1.08 to 1.37]).Conclusions
Although >80% of stable patients with STEMI are treated in the ICU after primary percutaneous coronary intervention, the risk for developing a complication requiring ICU care is 16%. Implementing a risk-based triage strategy, inclusive of factors such as degree of reperfusion delay, could optimize ICU utilization for patients with STEMI. 相似文献16.
So-Ryoung Lee Eue-Keun Choi Chan Soon Park Kyung-Do Han Jin-Hyung Jung Seil Oh Gregory Y.H. Lip 《Journal of the American College of Cardiology》2019,73(8):919-931
Background
It is unclear whether the overall effectiveness and safety of direct oral anticoagulants (DOACs) are consistent in patients with nonvalvular atrial fibrillation (AF) and extremely low body weight (<50 kg).Objectives
This study compared DOACs with warfarin in AF patients with low body weight.Methods
Using data from the Korean National Health Insurance Service database from January 2014 to December 2016, AF patients with body weight ≤60 kg and who were treated with oral anticoagulants (n = 14,013 taking DOACs and n = 7,576 taking warfarin) were included and examined for ischemic stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding, major bleeding, all-cause death, and composite outcome. The propensity score weighting was used to balance the 2 groups.Results
Baseline characteristics were well balanced between the 2 groups (mean age 73 years, mean CHA2DS2-VASc score 4, and 28% of patients weighed <50 kg). DOACs were associated with lower risks of ischemic stroke (hazard ratio [HR]: 0.591; 95% confidence interval [CI]: 0.510 to 0.686) and major bleeding (HR: 0.705; 95%: CI 0.601 to 0.825), which were caused by a reduction in ICH (HR: 0.554; 95% CI: 0.429 to 0.713) compared with warfarin. DOAC improved the net clinical benefit compared with warfarin (HR for composite outcome: 0.660; 95% CI: 0.606 to 0.717), and this was consistent in patients who weighed <50 kg (HR for composite outcome: 0.665; 95% CI: 0.581 to 0.762).Conclusions
In this real-world Asian AF population with low body weight, DOACs showed better effectiveness and safety than warfarin. These results were consistent in patients with extremely low body weight. Regular dosages of DOACs showed comparable results as reduced dosages of DOACs in both effectiveness and safety. 相似文献17.
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18.
John G. Webb Dale J. Murdoch Robert H. Boone Robert Moss Adrian Attinger-Toller Philipp Blanke Anson Cheung Mark Hensey Jonathon Leipsic Kevin Ong Janarthanan Sathananthan David A. Wood Jian Ye Paolo Tartara 《Journal of the American College of Cardiology》2019,73(11):1239-1246
Background
Severe mitral regurgitation (MR) conveys significant morbidity and mortality, and surgical repair or replacement may not be a desirable option.Objectives
The purpose of this study was to evaluate the feasibility of a percutaneous transseptal transcatheter mitral valve replacement (TMVR) system.Methods
This first-in-human study was conducted between August 2017 and August 2018. The system comprises a nitinol dock, which encircles the chordae tendineae, and a balloon-expandable transcatheter heart valve. The dock and transcatheter heart valve form an ensemble, with the native mitral valve leaflets secured in between, thereby abolishing MR. Key inclusion criteria were severe symptomatic MR and high surgical risk; exclusion criteria included left ventricular ejection fraction <30% or screening suggesting unfavorable anatomy. The primary endpoint was technical success as defined by Mitral Valve Academic Research Consortium (MVARC) criteria at completion of the index procedure. The secondary endpoint was freedom from mortality, stroke, and device dysfunction (MR grade >1, mitral gradient >6 mm Hg, left ventricular outflow tract gradient >20 mm Hg) at 30 days.Results
Ten patients with severe MR of various etiologies (4 degenerative, 4 functional, and 2 mixed) were treated. The device was successfully implanted and the primary endpoint was achieved in 9 of 10 patients (90%). By transesophageal echocardiography, total MR was reduced to ≤ trivial in all implanted patients, and mean transmitral gradient was 2.3 ± 1.4 mm Hg. A pericardial effusion occurred in 1 patient: pericardiocentesis was performed, and the device was not implanted. Median length of hospital stay was 1.5 days. At 30 days, there was no stroke, myocardial infarction, rehospitalization, left ventricular outflow tract obstruction, device migration, embolization, or conversion to mitral surgery. One patient had recurrent regurgitation due to a paravalvular leak, treated with a closure device. All other treated patients had ≤1+ MR. No patients died.Conclusions
Percutaneous transvenous transseptal TMVR is feasible and safe in patients with severe MR who are at high risk for mitral valve surgery. Further evaluation is warranted. 相似文献19.
Michael Frank Salma Adham Stéphanie Seigle Anne Legrand Tristan Mirault Pierrick Henneton Juliette Albuisson Nicolas Denarié Jean-Michaël Mazzella Elie Mousseaux Emmanuel Messas Pierre Boutouyrie Xavier Jeunemaitre 《Journal of the American College of Cardiology》2019,73(15):1948-1957
Background
Vascular Ehlers-Danlos syndrome (vEDS) is a rare genetic connective tissue disorder secondary to pathogenic variants within the COL3A1 gene, resulting in exceptional arterial and organ fragility and premature death. The only published clinical trial to date demonstrated the benefit of celiprolol on arterial morbimortality.Objectives
The authors herein describe the outcomes of a large cohort of vEDS patients followed ≤17 years in a single national referral center.Methods
All patients with molecularly confirmed vEDS were included in a retrospective cohort study. After an initial work-up, patients were treated or recommended for treatment with celiprolol (≤400 mg/day) in addition to usual care and scheduled for yearly follow-up. vEDS-related events and deaths were collected and recorded for each patient.Results
Between 2000 and 2017, 144 patients (median age at diagnosis 34.5 years, 91 probands) were included in this study. After a median follow-up of 5.3 years, overall patient survival was high (71.6%; 95% confidence interval: 50% to 90%) and dependent on the type of COL3A1 variant, age at diagnosis, and medical treatment. At the end of the study period, almost all patients (90.3%) were treated with celiprolol alone or in combination. More than two-thirds of patients remained clinically silent, despite a large number (51%) with previous arterial events or arterial lesions at molecular diagnosis. Patients treated with celiprolol had a better survival than others (p = 0.0004). The observed reduction in mortality was dose-dependent: the best protection was observed at the dose of 400 mg/day versus <400 mg/day (p = 0.003). During the period surveyed, the authors observed a statistically significant difference in the ratio of hospitalizations for acute arterial events/hospitalizations for regular follow-up before and after 2011.Conclusions
In this long-term survey, vEDS patients exhibited a low annual occurrence of arterial complications and a high survival rate, on which the overall medical care seems to have a positive influence. 相似文献20.
Partha Sardar Deepak L. Bhatt Ajay J. Kirtane Kevin F. Kennedy Saurav Chatterjee Jay Giri Peter A. Soukas William B. White Sahil A. Parikh Herbert D. Aronow 《Journal of the American College of Cardiology》2019,73(13):1633-1642