scholarly journals ANALYSIS OF INTERMEDIATE RESULTS OF A COMPARATIVE MULTICENTER RANDOMIZED TENDERA STUDY INVESTIGATING THE DISTAL RADIATION ACCESS

2021 ◽  
Vol 29 (3) ◽  
pp. 285-295
Author(s):  
A.V. Korotkikh ◽  
◽  
A.M. Babunashvili ◽  
A.L. Kaledin ◽  
R.V. Akhramovich ◽  
...  
Keyword(s):  
Radial Artery ◽  
Primary Endpoint ◽  
Comparison Group ◽  
Entry Point ◽  
Long Term Results ◽  
Observation Group ◽  
Endovascular Interventions ◽  
Intermediate Results ◽  
Distal Radial Artery

Objective. To prove the safety and efficacy of distal radial artery (DRA) puncture for endovascular interventions versus the traditional forearm radial artery (RA) puncture site by comparing immediate and long-term results. Methods. In 2017, a multicenter, open, randomized (1:1) study TENDERA (Comparison between Traditional Entry Point and Distal Puncture of Radial Artery) was started. During 2 years, 520 patients were included, mean age 63.4±10.0 years. The observation group (DRA puncture) included 271 patients, the comparison group (RA puncture) - 249 patients. The study included both stable patients and those with NSTEMI: the observation group - 39 (14.4%), the comparison group - 34 (13.7%), p=0.809. The primary endpoint is immediate (hospital) or late radial thrombosis. Secondary endpoints are: 1 - composite point, complications from the access artery; 2 - puncture parameters. Results. The average difference in the diameters of the RA and DRA was 0.3 mm and 0.4 mm, in some patients the DRA diameter corresponded to the RA or even exceeded it. The diameter of RA and DRA in men and women significantly differs, 2.65±0.44 mm and 2.36±0.36 mm (p=0.001), 2.31±0.39 mm and 2.13±0.38 mm (p=0.001). Technical success of DRA access requre the number of attempts. 94.1% - the percentage of successful cardiac catheterization performed through the distal radial artery approach, which is significantly less than via RA - 100% (p<0.001). In the observation group, significantly fewer rebleedings and rehemostasis were occured. In the long-term period, there were registered outstandingly more hematomas in the observation group at the time of discharge and after 1 week. Conclusion. Intermediate analysis of the results of the TENDERA study shows that there is no significant difference in the primary endpoint, but the number of complications in the observation group associated with the puncture markedly - hematoma more than 5 cm to the day of discharge and after 7 days. What this paper adds Intermediate results of the first multicenter open randomized (1:1) study devoted to the comparison of distal puncture of the radial artery versus the traditional entry point of puncture of the radial artery on the forearm during the endovascular interventions have been presented. A significant reduction of the number of local complications has been revealed in the group of distal puncture of the radial artery and the absence of differences according to the primary endpoint: early and late radial artery thrombosis.

scholarly journals Long-Term Results of Endovascular Femoropopliteal Interventions

2018 ◽  
Vol 27 (03) ◽  
pp. 151-157 ◽  
Author(s):  
Luke Marone ◽  
Robert Hacker
Keyword(s):  
Limb Salvage ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Long Term Results ◽  
Secondary Patency ◽  
Endovascular Interventions ◽  
Significant Difference ◽  
Societal Consensus

Background and Objective Short-term results of endovascular intervention for femoropopliteal lesions have been extensively reported; however, there exists a paucity of long-term objective data related to outcomes of these interventions. We sought to characterize these long-term results including patency, limb salvage, and mortality. Methods From May 2003 to July 2009, all patients who underwent technically successful endovascular balloon angioplasty and/or stenting for Trans-Atlantic Inter-Societal Consensus (TASC) II B, C, and D lesions were identified in a retrospective fashion. Patient demographics, clinical characteristics, arterial noninvasive data, and angiographic anatomic data were evaluated. Results A total of 236 limbs in 186 patients (mean age 74, range 37–94) were treated. Lesion distributions by TASC II classification B, C, and D were 121 (51.3%), 37 (15.7%), and 78 (33%), respectively. Critical limb ischemia (CLI) was the indication for intervention in 42.4% of patients. Five-year primary and primary-assisted patency rates stratified by TASC II classification were B: 55.1%, 91.9%; C: 37.4%, 74.6%; D: 35.5%, 67%, respectively (p = 0.23). Secondary patency based on TASC II classification was B: 92.9%, C: 83%, and D: 75.9%, respectively. Univariate analysis identified age > 75, CLI, and cerebrovascular disease as predictors for loss of patency. Reinterventions to maintain patency were required in 26.5% of TASC II B, 43.2% of TASC II C, and 25.6% of TASCII D lesions (p = NS) and mean time to reintervention ranged from 22 to 29 months with no significant difference related to TASC II classification. A total of eight limbs (3.38%) were converted to open revascularization with two (0.85%) having a change in their initial preoperatively identified bypass target site. Three limbs (1.27%) required a major amputation during follow-up. Survival at 5 years was 44.3%; CLI and smoking were identified as risk factors for death (hazard ratio [HR] 2.6, 1.75–3.84, p < 0.001, HR 3.33, 1.70–6.52, p < 0.001), respectively. Conclusion Long-term patency of endovascular interventions for complicated femoropopliteal lesions is acceptable across TASC II classification and is associated with excellent limb salvage. Mortality in this patient cohort is significant with CLI and smoking being identified as predictors of death.

scholarly journals Long-Term Results of the RAPCO Trials

Circulation ◽  
2020 ◽  
Vol 142 (14) ◽  
pp. 1330-1338 ◽  
Author(s):  
Brian F. Buxton ◽  
Philip A. Hayward ◽  
Jai Raman ◽  
Simon C. Moten ◽  
Alexander Rosalion ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Radial Artery ◽  
Graft Failure ◽  
Internal Thoracic Artery ◽  
Patient Survival ◽  
Hazard Ratio ◽  
Long Term Results ◽  
Survival Estimate ◽  
To Receive

Background: An internal thoracic artery graft to the left anterior descending artery is standard in coronary bypass surgery, but controversy exists on the best second conduit. The RAPCO trials (Radial Artery Patency and Clinical Outcomes) were designed to compare the long-term patency of the radial artery (RA) with that of the right internal thoracic artery (RITA) and the saphenous vein (SV). Methods: In RAPCO-RITA (the RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or <60 years of age if they had diabetes mellitus) were randomized to receive RA or free RITA graft on the second most important coronary target. In RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients ≥70 years of age (or ≥60 years of age if they had diabetes mellitus) were randomized to receive RA or SV graft. The primary outcome was 10-year graft failure. Long-term mortality was a nonpowered coprimary end point. The main analysis was by intention to treat. Results: In the RA versus RITA comparison, the estimated 10-year patency was 89% for RA versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI, 0.23–0.88]). Ten-year patient survival estimate was 90.9% in the RA arm versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI, 0.30–0.95]). In the RA versus SV comparison, the estimated 10-year patency was 85% for the RA versus 71% for the SV (hazard ratio for graft failure, 0.40 [95% CI, 0.15–1.00]), and 10-year patient survival estimate was 72.6% for the RA group versus 65.2% for the SV group (hazard ratio for mortality, 0.76 [95% CI, 0.47–1.22]). Conclusions: The 10-year patency rate of the RA is significantly higher than that of the free RITA and better than that of the SV. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00475488.

scholarly journals Long-Term Outcomes of Additional Surgery After Noncurative Endoscopic Resection in Patients with Early Gastric Cancer: A Meta-Analysis

2021 ◽  
Author(s):  
Jian Jiao ◽  
Han Li ◽  
Liang Shang ◽  
Hao Wu ◽  
Ronghua Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Resection ◽  
Meta Analysis ◽  
Long Term Results ◽  
Good Survival ◽  
Observation Group ◽  
Surgery Group ◽  
Additional Surgery

Abstract BackgroundThe influence of additional surgery on the prognosis of early gastric cancer who underwent noncurative endoscopic resection was controversial. Different results were observed in different studies. Therefore, this meta-analysis was conducted to evaluate whether additional surgery could produce survival benefits for these patients.MethodsA systematic search was conducted in the PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure and Wanfang databases for relevant articles published until 31 March 2021 to investigate the differences in long-term results between the additional surgery group and the observation group. ResultsSixteen studies including 3877 patients were included in this meta-analysis. The results had shown that the surgery group were younger and more male, higher undifferentiated type, higher rate of SM2, lymphatic and vascular invasion, lower recurrence and metastasis than the observation group. Good survival benefits were observed in additional surgery group with obvious significant differences in the 5-year OS, 5-year DSS and 5-year DFS. Similar results were obtained in the subgroup analysis, such as elderly patients (aged ≥70 years) in 5-year OS. ConclusionThis meta-analysis illustrated that significant survival benefits, including 5-year OS, 5-year DSS and 5-year DFS, could be obtained with additional gastrectomy in patients with EGC after noncurative ER, and patients ≥70 years could also benefit from surgery.

Changes in biochemical parameters in workers exposed to chemical production factors (heptane and hexane)

2021 ◽  
Vol 61 (6) ◽  
pp. 379-384
Author(s):  
Marina A. Zemlyanova ◽  
Juliya V. Koldibekova ◽  
Ekaterina V. Peskova ◽  
Victor M. Ukhabov
Keyword(s):  
Blood Serum ◽  
Blood Plasma ◽  
Biochemical Parameters ◽  
Comparison Group ◽  
Processing Plant ◽  
Observation Group ◽  
Chemical Production ◽  
Production Factors ◽  
Nasal Secretions

Introduction. Long-term constant exposure to certain representatives of aliphatic hydrocarbons during the extraction and processing of potash ore can lead to pathological changes on critical organs and systems in production workers. The study aims to evaluate the change in biochemical parameters in workers exposed to chemical production factors (heptane and hexane). Materials and methods. The study of the content of hexane, heptane in the air of the working area and the urine of workers, the establishment of changes in several biochemical (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, glutamyltransferase, epinephrine, and norepinephrine) and general clinical (eosinophils, neutrophils and the eosinophilia index) indicators, modeling of cause-and-effect relationships. Results. Specialists found in the observation group relative to the comparison group: increased levels of heptane and hexane in the urine up to 1.7 times; increased levels of adrenaline and norepinephrine in the blood plasma up to 1.8 times, up to 1.4 times ALAT and γ-GT in the blood serum, up to 1.9 times neutrophils in the nasal secretions associated with increased concentrations of heptane and hexane in the urine; an increase of up to 4.4 times in the frequency of diseases of the nervous system, respiratory organs, and digestion. Conclusions. In the air of the working area of the workers of the flotation shop of the sylvinite processing plant, the concentrations of the studied limit hydrocarbons were below the detection limit; there is an increased concentration of heptane and hexane in the urine. In the workers of the studied production, an increase of 1.4-1.8 times in the level of adrenaline and norepinephrine in blood plasma, 1.2-1.4 times in ALAT and γ-GT in blood serum, 1.9 times in the content of neutrophils in nasal secretions, which characterizes adverse effects from the respiratory, digestive and nervous systems. We proved the dependence of the increased frequency of diseases of the listed organs and systems on the increased concentration of heptane in the urine (R2=0.26-0.43; p=0.0001-0.028).

Short- and long-term results of radial artery and saphenous vein grafts in the right coronary system: a propensity-matched study

Surgery Today ◽  
2016 ◽  
Vol 47 (3) ◽  
pp. 335-343 ◽  
Author(s):  
Shohei Yoshida ◽  
Satoshi Numata ◽  
Yasushi Tsutsumi ◽  
Osamu Monta ◽  
Sachiko Yamazaki ◽  
...  
Keyword(s):  
Radial Artery ◽  
Saphenous Vein ◽  
Long Term Results ◽  
Vein Grafts ◽  
Saphenous Vein Grafts ◽  
System A ◽  
Short And Long Term ◽  
The Right ◽  
Matched Study

scholarly journals ALGORITHM OF COMPLEX TREATMENT OF DESTRUCTIVE FORMS OF PULMONARY TUBERCULOSIS AND ITS RATIONALE

2021 ◽  
Vol 19 (1) ◽  
pp. 36-39
Author(s):  
Yu. A. Sheifer ◽  
◽  
I. S. Gelberg ◽  
Keyword(s):  
Drug Resistance ◽  
Pulmonary Tuberculosis ◽  
Comparison Group ◽  
Main Group ◽  
Long Term Results ◽  
Complex Treatment ◽  
Results Of Treatment ◽  
Artificial Pneumothorax ◽  
Cavity Closure

Background. In destructive forms of pulmonary tuberculosis, especially in the presence of drug resistance of mycobacteria, one of the ways to increase the effectiveness of therapy is the use of collapse therapeutic techniques in various modifications. Purpose of the study: to develop and substantiate an algorithm for complex treatment of destructive forms of pulmonary tuberculosis, using artificial pneumothorax (AP). Material and methods: A cohort of 84 people with destructive pulmonary tuberculosis was formed. It was divided into two groups: 42 patients in the main group (chemotherapy (ChT) + AP) and 42 in the comparison group (ChT). Results: an algorithm for the treatment of patients with destructive forms of pulmonary tuberculosis was formulated. Within a period of up to 6 months, abacillation was achieved in 61.9% of cases in the main group (MG), and in 18.9% (p <0.05) in the comparison group (CG). By the 10th month of treatment, the closure of decay cavities was achieved in 78.7% of cases in the MG and in 42.8% (p <0.05) in the CG. By 12 months the closure of decay cavities was observed in 92.1 and 52.4% of cases respectively (p <0.05). Conclusions: The use of the algorithm for the complex treatment of destructive forms of pulmonary tuberculosis makes it possible to achieve abacillation at an earlier time (up to 6 months - in 61.9%). It also allows to increase the frequency of cavity closure by 39.6% as well as achieve an increase in clinical cure (according to long-term results of treatment) by 23.8% and a decrease in the amplification of drug resistance and mortality by 14.3% and 11.9% correspondingly.

scholarly journals Immediate and Long-Term Results of Original Methods of Longitudinal Pancreatojejunostomy With The Expansion of the Area of Pancreatojejunal Anastomosis

2020 ◽  
Vol 9 (1) ◽  
pp. 35-45
Author(s):  
A. R. Propp ◽  
E. N. Degovtsov ◽  
S. A. Nikulina
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Comparison Group ◽  
Pancreatic Head ◽  
Main Group ◽  
Long Term Results ◽  
Hospital Treatment ◽  
Enzyme Preparations

RELEVANCE. The dependency results of draining operations on the efficcacy of drainig of ductal system of the pancreas and adequate outflow of the pancreatic juce through anastomosis are undoubtful, therefore the development of new techniques of longitudinal pancreatojejunostomy (LPJ) extending area of anastomosis is an actual challenge.AIM OF STUDY. To compare the immediate and long-term results of longitudinal pancreatojejunostomy with the expansion of the area of anastomosis in patients with chronic pancreatitis.MATERIAL AND METHODS. We analysed immediate and long-term results of LPJ in 58 patients with chronic pancreatitis with impaired patency of the major pancreatic duct (MPD) without the head enlargement.RESULTS. All patients were divided into two groups: comparison group ( n=26, operated up to 2008 ) and main group (n=32, operated stumps during the MPD diastasis and posterior pancreatic surface (n=3) into anastomosis, with resection of the anterior pancreatic surface in the form of triangular fragments (n=11), with circulation of the small intestine loop during the recovery phase (n=19). The original LPJ in the study group of patients did not lengthened the surgery (160 [135, 185]) and intraoperative blood loss (265 [175, 340]). In the main group of patients there was no postoperative complications and fatal outcomes, but the average duration postoperative hospital treatment (18 [16; 20.5]) exceeded some data of foreign and domestic authors. Pain within 5 years after surgery in patients of the main group exceeded 26.6% and the appearance of diarrheal syndrome with dependance from reception of enzyme preparations was twice lower than in patients og the comparison group. According to questionnaire EORTC QLQ-C30, 5 years after surgery statistically significant differences between groups in terms of scales CF, NV, DY (p=0.03, 0.02, 0.006 respectively), indicating the advantage of intervention performed in the mail group.CONCLUSIONS. 1. An indication for longitudinal pancreatojejunostomy in chronic pancreatitis is impaired patency of the main pancreatic duct in the absence of an increase and inflammatory mass in the pancreatic head.2. The width of the main pancreatic duct is less than 5 mm and the presence of diastasis between its proximal and distal stumps with the posterior surface of the pancreas preserved, is not a reason for refusing longitudinal pancreatic jujunostomy in favor of the resection method.3. The expansion of pancreatojejunal anastomosis when performing longitudinal pancreatojejunostomy can improve the immediate and longterm results of surgical treatment for chronic pancreatitis.

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