Broeatkinson4543
0001). MVG remained unchanged (3.29mm Hg). For severe MR, MRF, MVG, and EOA were 59.79%, 4.98mm Hg, and 2.73cm
, respectively. Compared with the no-MitraClip case, 1 MitraClip decreased MRF to 30.72% (P<.0001) and EOA to 1.82cm
(P<.0001); MVGremained unchanged (4.03mm Hg). MVG remained statistically unchanged. Two MitraClips decreased MRF to 23.10% (P<.0001) and EOA to 1.58cm
(P<.0001); MVG remained statistically unchanged (3.82mm Hg). Both MR models yielded no statistical difference between 1 and 2 MitraClips.
There is limited concern regarding elevation of MVG when reducing MR using 1 or 2 MitraClips, although 2 MitraClips did not significantly continue to reduce MRF.
There is limited concern regarding elevation of MVG when reducing MR using 1 or 2 MitraClips, although 2 MitraClips did not significantly continue to reduce MRF.
To establish a machine learning (ML)-based prediction model for readmission within 30days (early readmission or early readmission) of patients based on their profile at index hospitalization for esophagectomy.
Using the National Readmission Database, 383 patients requiring early readmission out of a total of 2037 esophagectomy patients alive at discharge in 2016 were identified. Early readmission risk factors were identified using standard statistics and after the application of ML methodology, the models were interpreted.
Early readmission after esophagectomy connoted an increased severity score and risk of mortality. Chronic obstructive pulmonary disease and malnutrition as well as postoperative prolonged intubation, pneumonia, acute kidney failure, and length of stay were identified as factors most contributing to increased odds of early readmission. The reasons for early readmission were more likely to be cardiopulmonary complications, anastomotic leak, and sepsis/infection. Patients with upper esophageal neoplasms had significantly higher early readmission and patients who received pyloroplasty/pyloromyotomy had significantly lower early readmission. Two ML models to predict early readmission were generated 1 with 71.7% sensitivity for clinical decision making and the other with 84.8% accuracy and 98.7% specificity for quality review.
We identified risk factors for early readmission after esophagectomy and introduced ML-based techniques to predict early readmission in 2 different settings clinical decision making and quality review. ML techniques can be utilized to provide targeted support and standardize quality measures.
We identified risk factors for early readmission after esophagectomy and introduced ML-based techniques to predict early readmission in 2 different settings clinical decision making and quality review. ML techniques can be utilized to provide targeted support and standardize quality measures.
Pure ground-glass nodules are considered to be radiologically noninvasive in lung adenocarcinoma. However, some pure ground-glass nodules are found to be invasive adenocarcinoma pathologically. This study aims to identify the computed tomography parameters distinguishing invasive adenocarcinoma from adenocarcinoma in situ and minimally invasive adenocarcinoma.
From May 2011 to December 2015, patients with completely resected adenocarcinoma appearing as pure ground-glass nodules were reviewed. To evaluate the association between computed tomography features and the invasiveness of pure ground-glass nodules, logistic regression analyses were conducted.
Among 432 enrolled patients, 118 (27.3%) were classified as adenocarcinoma in situ, 213 (49.3%) were classified as minimally invasive adenocarcinoma, 101 (23.4%) were classified as invasive adenocarcinoma. There was no postoperative recurrence for patients with pure ground-glass nodules. Logistic regression analyses demonstrated that computed tomography siznts with pure ground-glass nodules, computed tomography size was the only radiographic parameter associated with tumor invasion. Measuring computed tomography density provided no advantage in differentiating invasive adenocarcinoma from adenocarcinoma in situ and minimally invasive adenocarcinoma.
Cell salvage (CS) reduces intraoperative blood transfusion. However, it may cause deformity of the red blood cells and loss of coagulation factors, which may lead to unwanted sequelae. Thus, we hypothesized that extensive CS would lead to adverse outcomes after descending/thoracoabdominal aortic aneurysm (D/TAAA) repair.
Between 1991 and 2017, 2012 patients undergoing D/TAAA repair were retrospectively reviewed. After we excluded patients without reported intraoperative CS amount, patients were enrolled in the study (N=1474) and divided into 2 groups low CS (salvaged units <40, N=983) and high CS (salvaged units ≥40, N=491). Analyses were performed to verify the extensive CS as the risk factor for adverse outcomes.
Preoperative demographics showed that the high-CS group had a significantly greater incidence of male patients (72% vs 58%), heritable aortic disease (24% vs 17%), redo (27% vs 20%), greater glomerular filtration rate (mL/min/1.73m
, 75 vs 66) and more extensive aneurysms (TAAA extent II-IV). The high-CS group had significantly more postoperative complications compared with the low-CS group, including respiratory failure, renal failure, cardiac complications, neurologic deficits, bleeding, and 30-day mortality. Multivariable analysis confirmed high CS was an independent risk factor for renal failure along with long bypass time, older age, and extent of repairs. There was an incremental risk of renal failure and 30-day mortality proportional to salvaged cell unit (P<.001 in both).
Increased salvaged cell units were associated with adverse postoperative outcomes after D/TAAA repairs. Risk of renal failure and mortality increased proportionally to the salvaged cell units.
Increased salvaged cell units were associated with adverse postoperative outcomes after D/TAAA repairs. Risk of renal failure and mortality increased proportionally to the salvaged cell units.
Early-stage lung adenocarcinomas that are suitable for limited resection to preserve lung function are difficult to identify. Using a radiomics approach, we investigated the efficiency of voxel-based histogram analysis of 3-dimensional computed tomography images for detecting less-invasive lesions suitable for sublobar resection.
We retrospectively reviewed the medical records of 197 patients with pathological stage 0 or IA adenocarcinomas who underwent lung resection for primary lung cancer at our institution between January 2014 and June 2018. The lesions were categorized as either less invasive or invasive. We evaluated tumor volumes, solid volume percentages, mean computed tomography values, and variance, kurtosis, skewness, and entropy levels. We analyzed the relationships between these variables and pathologically less-invasive lesions and designed an optimal model for detecting less-invasive adenocarcinomas.
Univariate analysis revealed seven variables that differed significantly between less invasive (n=71) and invasive (n=141) lesions. TL13-112 in vitro A multivariate analysis revealed odds ratios for tumor volumes (0.64; 95% confidence interval (CI), 0.46-0.89; P=.008), solid volume percentages (0.96; 95% CI, 0.93-0.99; P=.024), skewness (3.45; 95% CI, 1.38-8.65; P=.008), and entropy levels (0.21; 95% CI, 0.07-0.58; P=.003). The area under the receiver operating characteristic curve was 0.90 (95% CI, 0.85-0.94) for the optimal model containing these 4 variables, with 85% sensitivity and 79% specificity.
Voxel-based histogram analysis of 3-dimensional computed tomography images accurately detected early-stage lung adenocarcinomas suitable for sublobar resection.
Voxel-based histogram analysis of 3-dimensional computed tomography images accurately detected early-stage lung adenocarcinomas suitable for sublobar resection.
The last decade has witnessed an increased number of stand-alone interventional cardiology units due to the consolidation of cardiac surgery services. We aimed to explore the impact of a heart team on the midterm outcomes of patients with multivessel coronary artery disease.
This prospective registry included 1063 consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and percutaneous coronary intervention, with or without on-site cardiac surgery services.
Of the 1063 patients, 576 (54%) and 487 (46%) were admitted to centers with or without on-site cardiac surgery services, respectively. Centers with cardiac surgery services compared with those without had more male patients (82% vs 77%, P=.026) and more patients who were taking aspirin (75% vs 67%, P=.008) before admission. Other characteristics were similar between the groups, including mean SYNTAX score (22.5±9.6 vs 22.2±10, P=.680). Late outcomes revealbased intervention with coronary artery bypass grafting, which is associated with less favorable outcomes. These findings suggest that a heart-team approach should be mandatory even in centers with stand-alone interventional cardiology units.
We aimed to investigate tricuspid valve function and adverse events after conventional repair and valve replacement for Ebstein's anomaly and compare them with cone repair.
The medical records of 151 patients (mean age, 25years; 62% were female) who underwent operation in a single center from 1985 to 2018 were retrospectively analyzed. To determine tricuspid valve regurgitation during follow-up, serial echocardiographic examination was used (n=2397, tricuspid regurgitation grades were graphed for every patient).
Thirty-nine patients underwent cone repair, 107 patients underwent other repair techniques, and 5 patients underwent valve replacement. The operative mortality was 1.3% (n=2). Failed valve repair (defined as in-hospital death, conversion to replacement, or in-hospital reoperation) was less frequent after cone repair than after other repair techniques (5%, n=2 vs 20%, n=21, P=.039). Mean follow-up was 12.3years (cone repair 3.7years). The 5-year cumulative incidence of moderate or greater recurrelower incidence of moderate or greater recurrent tricuspid regurgitation at the midterm follow-up.
Primary pulmonary sarcomas (PPS) and pulmonary carcinosarcomas (PCS) are rare aggressive lung malignancies. We reviewed our 21-year experience with the surgical and nonsurgical treatment of both tumors, comparing their clinical, histopathologic, and treatment results.
All patients with PPS or PCS who underwent surgical and nonsurgical treatment between 1998 and 2019 at our cancer center were retrospectively reviewed. Multivariable Cox proportional hazards model was constructed.
In total, 100 patients were analyzed 45 with PPS and 55 with PCS. Among patients with PPS, 31 of 45 (69%) underwent surgery with 1 (3%) operative mortality. For patients with PCS, 29 of 55 (53%) underwent surgery with no operative mortality. Patients with PPS were younger than PCS (P<.01). Fewer patients were smokers among PPS (58%) versus PCS (93%) (P<.01). For resected PPS, mean tumor size was 8.2±4.1cm (range 2.2-18.0) compared with 10.1±5.0cm (range 3.9-17.0) for unresected PPS. Tumor size for resected PCS was 6.2±2.6cm (range 2.
