Hybrid revascularization of the heart and brain: which carotid endarterectomy is preferable?

The aim of this study was to analyse the inpatient and long-term results of hybrid surgery, incorporating percutaneous coronary intervention (PCI) and different types of carotid endarterectomy (CEA). Materials and methods. A prospective, open-label cohort comparison study was conducted in 20182020 and included 363 patients with atherosclerosis of both the internal carotid artery (ICA) and coronary artery, who underwent hybrid revascularization of the brain and myocardium. All patients were divided into four groups based on the revascularization strategy: group 1 (n = 107; 29.5%) PCI + eversion CEA; group 2 (n = 98; 27%) PCI + classic CEA with patch angioplasty; group 3 (n = 72; 19.8%) PCI + glomus-sparing CEA according to R.A. Vinogradov; and group 4 (n = 86; 23.7%) PCI + glomus-sparing CEA according to A.N. Kazantsev. The follow-up period was 20.8 8.0 months. The patient received a loading dose of clopidogrel (300 mg) before the PCI, and the procedure was then performed in an endovascular operating room. A radial artery catheter was inserted, and the patient received 10,000 IU of intravenous heparin before the procedure. After the PCI, the patient was taken to the vascular operating room, where they underwent the CEA. The patient received 5,000 IU of intravenous heparin before artery clamping. Glomus-sparing CEA according to A.N. Kazantsev was performed as follows: an arteriotomy was conducted along the internal edge of the external carotid artery (ECA), adjacent to the carotid sinus and 23 cm above the ostium, and extending to the common carotid artery (CCA) (also 23 cm below the ECA ostium), depending on the size of the atherosclerotic plaque. The ICA was transected in the area bound by the ECA and CCA walls. Eversion CEA of the ICA was performed, followed by open CEA of the ECA and CCA. The ICA was implanted in its previous position in the preserved area. Results. No mortality was recorded during the inpatient follow-up period. All cases of myocardial infarction occurred after eversion and classic CEA: 3 in group 1 (2.8%) and 1 in group 2 (1.02%); р = 0.2. No ischaemic stroke was recorded only in patients who underwent CAE according to A.N. Kazantsev (р = 0.66); however, ischaemic stroke occurred in two patients in group 1 (1.8%), in two patients in group 2 (2.04%) and in one patient in group 3 (1.38%). The highest number of cardiovascular events occurred in group 1, due to carotid glomus injury, which led to poorly controlled hypertension during the inpatient stay. This tendency influenced the composite endpoints (death + myocardial infarction + ischaemic stroke), which were highest in group 1 (5 or 4.6%) compared to 3 (3.06%), 1 (1.38%) and 0 in groups 24, respectively (р = 0.18). The groups were comparable in the frequency of long-term complications. However, the incidence of ICA restenosis was lowest and no ECA thrombosis/occlusion was observed after glomus-sparing CEA according to R.A. Vinogradov and A.N. Kazantsev. Conclusion. A hybrid PCI + CEA for brain revascularization should be glomus-sparing. CEA according to A.N. Kazantsev was characterized by lack of procedural arteriotomy complications. This procedure enables blood pressure monitoring in the postoperative period, thus minimizing the risk of cardiovascular complications.

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P6437Growth differentiation factor-15 and stromal cell-derived factor-1 as long-term prognosis biomarkers in acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz746.1031 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O M Peiro Ibanez ◽

N Farre ◽

J Ordonez-Llanos ◽

A Garcia ◽

G Bonet ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Combined Use ◽

Group 3 ◽

Stromal Cell Derived Factor ◽

Group 2 ◽

Long Term Prognosis ◽

Group 1

Abstract Introduction After an acute coronary syn bdrome (ACS) patients are at high risk of cardiovascular morbidity and mortality. In this scenario, Growth differentiation factor-15 (GDF-15) and Stromal cell derived factor-1 (SDF-1) has been reported as potential biomarkers in ACS. However, there is limited data about their combined use in long-term prognosis. Purpose To study the long-term prognostic value of GDF-15 and SDF-1 in ACS. Methods We included patients with ACS who underwent coronary angiography. During angiography an arterial blood sample was collected. Plasma SDF-1 and GDF-15 were measured and clinical data and long-term events were obtained. The cut-off point of SDF-1 and GDF-15 was identified individually by receiver operating characteristic curves. Patients were classified into 3 groups: 1) both biomarkers below cut-off points; 2) only one biomarker above cut-off points; 3) both biomarkers above cut-off points. Results A total of 238 patients were included. The median (IQR) age was 64 (55–74) year and 27.3% were female. Of all patients, 60.9% were admitted with non-ST-elevation myocardial infarction, 22.7% with ST-elevation myocardial infarction and 16.4% with unstable angina. The cut-off point of SDF-1 was 3283.5pg/mL and GDF-15 was 1849ng/L. A total of 127 patients were in group 1, 64 in group 2 and 47 in group 3. Group 3 patients were associated with older age, hypertension, dyslipidemia, diabetes mellitus and history of myocardial infarction (MI), stroke, chronic kidney disease and peripheral artery disease. Besides, they were more likely to have left ventricular dysfunction (ejection fraction <40%) and significant three vessels stenosis. During 6.5 years of follow-up 8 patients died (6.3%) in group 1, 7 patients died (10.9%) in group 2 and 25 patients died (53.2%) in group 3 (Figure 1). Multivariate Cox analysis showed that high levels of SDF-1 and GDF-15 (group 3) were an independent predictor of all-cause death (HR 5.8; 95% CI 2.4 - 14.1; p<0.001) and the composite of major adverse cardiovascular events (MACE) which were identified as all-cause death, nonfatal MI and heart failure (HR 3.9; 95% CI 2.1 - 7.3; p<0.001). During follow-up 1 patient had heart failure in group 1 (0.8%), 3 patients (4.7%) in group 2 and 9 patients (19.1%) in group 3. Despite the low number of events of heart failure, the multivariate competing risks regression showed association between group 3 and heart failure during follow-up (HR 28.0; 95% CI 3.5 - 225.2; p=0.002). Higher levels of SDF-1 and GDF-15 (group 3) were not associated with new MI in multivariate competing risks regression. Regarding group 2, all multivariate analyses were non-significant. Cumulative survival and incidence curves Conclusions Higher values of combined GDF-15 and SDF-1 are an excellent predictor of all-cause death, MACE and heart failure in long-term follow-up of patients with ACS. The combined use of SDF-1 and GDF-15 may be useful in long-term ACS prognosis.

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Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj2020283312-322 ◽

2020 ◽

Vol 28 (3) ◽

pp. 312-322

Author(s):

Anton N. Kazantsev ◽

Konstantin P. Chernykh ◽

Nona E. Zarkua ◽

Roman Yu. Lider ◽

Ekaterina A. Burkova ◽

...

Keyword(s):

Myocardial Infarction ◽

Long Term Results ◽

Lethal Outcome ◽

Group 4 ◽

Hospitalization Period ◽

Rehabilitation Period ◽

Group 3 ◽

Group 2 ◽

Group 1

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods. The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1st group in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2nd group in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3rd group in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4th group in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.812.5 months. Results. In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 0%; group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р=0.16)); myocardial infarction ((group 1 0%; group 2 0.4% (n=2); group 3 0%; group 4 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 4.2% (n=1); group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р1-2=0.01; р1-3=0.009; р1-4=0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 4.2% (n=1), in group 2 1.2% (n=6), in group 3 0.4% (n=2), in group 4 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 25% (n=6); group 2 5.5% (n=27); group 3 7.3% (n=35); group 4 14% (n=16); р1-2=0.002; р1-3=0.008; р2-4=0.012)); lethal outcome from cardiovascular causes ((group 1 4.2% (n=1); group 2 3.6% (n=18); group 3 4.8% (n=23); group 4 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 12.5% (n=3); group 2 3.6% (n=18); group 3 5.4% (n=26); group 4 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 16.6% (n=4); group 2 6.3% (n=31); group 3 6% (n=29); group 4 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 54.2% (n=13); group 2 15.4% (n=76); group 3 18.7% (n=90); group 4 31.3% (n=36); р1-2=0.0001; р1-3=0.0001; р1-4=0.005; р2-4=0.0006; р3-4=0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

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ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

Cardiology ◽

10.1159/000481814 ◽

2017 ◽

Vol 139 (1) ◽

pp. 53-61

Author(s):

Mert İlker Hayıroğlu ◽

Ahmet Okan Uzun ◽

Ceyhan Türkkan ◽

Muhammed Keskin ◽

Edibe Betül Börklü ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Death ◽

Anterior Myocardial Infarction ◽

St Depression ◽

St Segment ◽

St Elevation ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). Results: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). Conclusion: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

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Results of Coarctation Repair by Thoracotomy in Pediatric Patients: A Single Institution Experience

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211003505 ◽

2021 ◽

Vol 12 (4) ◽

pp. 492-499

Author(s):

Louis Heremans ◽

Arnaud Henkens ◽

Geoffroy de Beco ◽

Karlien Carbonez ◽

Stéphane Moniotte ◽

...

Keyword(s):

Aortic Coarctation ◽

Interrupted Aortic Arch ◽

Long Term Results ◽

Coarctation Repair ◽

Group 3 ◽

Group 2 ◽

Patient Prognosis ◽

Group 1

Background: Aortic coarctation is among the most common cardiovascular congenital abnormalities requiring repair after birth. Besides mortality, morbidity remains an important aspect. Accordingly, we reviewed our 20-year experience of aortic coarctation repair by thoracotomy, with emphasis on both short- and long-term outcomes. Methods: From 1995 through 2014, 214 patients underwent coarctation repair via left thoracotomy. Associated arch lesions were distal arch hypoplasia (n = 117) or type A interrupted aortic arch (n = 6). Eighty-four patients had isolated coarctation (group 1), 66 associated ventricular septal defect (group 2), and 64 associated complex cardiac lesions (group 3). Median follow-up was 8.4 years. Results: There was one (0.5%) procedure-related death. Nine (4.2%) patients died during index admission. In-hospital mortality was 0.7% in group 1 and 2 and 12.5% in group 3 ( P < .001). No patient had paraplegia. Actuarial five-year survival was 97.5% in group 1, 94% group 2 and 66% in group 3. Recurrent coarctation developed in 29 patients, all but four (1.8%) successfully treated by balloon dilatation. Freedom from reintervention (dilatation or surgery) at five years was 86%. At hospital discharge, 28 (13.5%) patients were hypertensive. At follow-up, hypertension was present in 11 (5.3%) patients. Conclusions: Long-term results of aortic coarctation repair by thoracotomy are excellent, with percutaneous angioplasty being the procedure of choice for recurrences. Patient prognosis is dependent on associated cardiac malformations. In this study, the prevalence of late arterial hypertension was lower than previously reported.

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Carotid endarterectomy with extended lesion: formation of a new bifurcation according to A.V.Pokrovsky or autoarterial reconstruction according to A.A.Karpenko?

Research n Practical Medicine Journal ◽

10.17709/2409-2231-2020-7-3-3 ◽

2020 ◽

Vol 7 (3) ◽

pp. 33-42

Author(s):

A. N. Kazantsev ◽

K. P. Chernykh ◽

N. E. Zarkua ◽

R. Yu. Leader ◽

K. G. Kubachev ◽

...

Keyword(s):

Carotid Artery ◽

Cardiovascular Events ◽

Atherosclerotic Lesion ◽

Long Term Results ◽

External Carotid ◽

Long Term Follow Up ◽

Group 2 ◽

Group 1

Purpose of the study. Comparison of hospital and long-term results of autoarterial reconstruction of carotid artery bifurcation and the formation of a new bifurcation with an extended atherosclerotic lesion of the internal carotid artery (ICA). Materials and methods. In the period from January 2018 to May 2020, this cohort, comparative, prospective, open-label study included 279 patients with an extended atherosclerotic lesion of the ICA operated on in the Alexandr Hospital. Depending on the implemented strategy of surgical correction, all patients were divided into two groups: group 1 (n=132) — autoarterial reconstruction of bifurcation of the carotid arteries; Group 2 (n=147) — the formation of a new bifurcation. Complications were recorded in the hospital and long-term postoperative periods. The total follow-up period was 16.4±9.3 months. The endpoints of the study were such adverse cardiovascular events as death, myocardial infarction (MI), stroke, thrombosis / restenosis of the anastomosis zone, combined endpoint (death from stroke / IM + IM + stroke). Results. The ICA clamping time in group 1 was 32.6±3.3 minutes, in group 2 – 31.7±3.5 minutes, which did not receive statistically significant differences (р=0.81). In the hospital postoperative period, adverse cardiovascular events were not recorded. In the long-term follow-up, the groups were comparable in the frequency of all complications. Identified lethal outcomes developed as a result of the formation of MI in patients with multiple lesions of the coronary arteries and a history of myocardial revascularization. The likely cause was shunt / stent thrombosis with subsequent coronary insufficiency and an increase in ischemic heart damage. The causes of stroke, recorded in each group in isolated cases, were the presence of atrial fibrillation. Patients did not comply with the recommended regimen of anticoagulant therapy, which provoked the development of cerebral catastrophe. In turn, the identified restenoses of the reconstruction zone were asymptomatic and were also observed in isolated cases in each group in the period 12 months after CEE. Conclusion. Autoarterial reconstruction of carotid bifurcation and the formation of a new bifurcation are comparable in safety and effectiveness methods of surgical treatment of an extended atherosclerotic lesion of the ICA. Operation techniques differ in the choice of an artery that is cut off from bifurcation — the external carotid artery or ICA. Further, the reconstruction progress is absolutely identical. Hospital and long-term follow-up results showed minimal indicators of the development of cardiovascular and hemodynamic changes due to the type of operation. Thus, both reconstruction techniques can be the operation of choice for an extended ICA lesion.

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Combined open and hybrid interventions in the coronary and internal carotid arteries - search for the perfect approach

Kardiologicheskii vestnik ◽

10.36396/ms.2020.16.3.006 ◽

2020 ◽

pp. 46-53

Author(s):

А.Н. Казанцев ◽

К.П. Черных ◽

Н.Э. Заркуа ◽

Р.Ю. Лидер ◽

К.Г. Кубачев ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Endarterectomy ◽

Carotid Arteries ◽

Internal Carotid ◽

Long Term Results ◽

Group 2 ◽

Internal Carotid Arteries ◽

Group 1

Цель: сравнительный анализ госпитальных и отдаленных результатов открытой симультанной стратегии коронарного шунтирования + каротидной эндартерэктомии (КШ+КЭЭ) и гибридной стратегии чрескожного коронарного вмешательства + каротидной эндартерэктомии (ЧКВ+КЭЭ). Материалы и методы: В данное когортное, сравнительное, ретроспективное, открытое исследование включено 180 пациентов с сочетанным поражением коронарных и внутренних сонных артерий, направлявшихся на симультанное вмешательство или гибридную операцию в период с января 2011г по декабрь 2015г. и имевших сопоставимое поражение коронарного русла. Все исследуемые пациенты были разделены на две группы: группа 1 – КШ+КЭЭ (n=116) и группа 2 − ЧКВ+КЭЭ (n=64). В группе 1 средний период наблюдения составил 50±17 мес, в группе 2 – 53±17 мес. Комбинированная конечная точка включала в себя совокупность таких кардиоваскулярных событий, как: смерть + ИМ + ОНМК/ТИА. При критическом уровне значимости p<0,05 различия считались статистически достоверными. Результаты: в госпитальном периоде значимых различий по частоте осложнений получено не было. В группе 1 выявлено 2 летальных исхода (1,7%), 1 инфаркт миокарда (0,9%), 5 ишемических инсультов (4,3%). В группе 2 среди осложнений получено 3 кровотечения, потребовавших ревизии раны (4,7%) относительно 9 кровотечений группы КШ+КЭЭ, закончившихся ремедиастинотомией (7,8%), р=0,63. В отдаленном периоде наблюдения значимых различий по частоте неблагоприятных исходов получено не было, однако отмечено возрастание частоты комбинированной конечной точки в группе ЧКВ+КЭЭ против КШ+КЭЭ (15/64 (23,4%) vs 17/116 (14,9%), р = 0,2) за счет рестеноза/тромбоза стента, спровоцировавшего инфаркт миокарда и повторную незапланированную реваскуляризацию миокарда. Заключение: исследование не показало значимых различий результатов открытой и гибридной реваскуляризации миокарда и головного мозга. Однако выявлена тенденция в нарастании числа неблагоприятных кардиоваскулярных событий после ЧКВ+КЭЭ в отдаленном периоде относительно КШ+КЭЭ в виду возрастания числа тромбозов/рестенозов стента. Данная особенность подчеркивает преимущества более агрессивных методов реваскуляризации над интервенционными. Objective: A comparative analysis of the hospital and long-term results of the open strategy - simultaneous coronary artery bypass grafting + carotid endarterectomy (CABG+CEE) and the hybrid strategy - percutaneous coronary intervention + carotid endarterectomy (PCI+CEE). Materials and methods: This cohort, comparative, retrospective, open-label study included 180 patients with a comparable lesion of the coronary channel and combined lesions of the coronary and internal carotid arteries going for simultaneous intervention or a hybrid operation from January 2011 to December 2015. All studied patients were divided into two groups: Group 1 - CABG+CEE (n=116); Group 2 - PCI+CEE (n=64). In group 1, the average follow-up period was 50±17 months; in group 2 - 53±17 months. Results: in the in-hospital period, no significant differences in the frequency of complications were obtained. 2 deaths (1.7%), 1 myocardial infarction (0.9%) and 5 ischemic strokes (4.3%) were detected in group 1. There were 3 bleedings cases requiring wound revision (4.7%) in the PCI + CEE group versus 9 in the CABG + CEE group requiring remediastinotomy (7.8%), p=0.63. In the long-term follow-up no significant differences in the frequency of adverse outcomes were obtained, however, an increase in the combined endpoint frequency in the PCI+CEE group as compared to CABG+CEE group was noted (15/64 (23,4%) vs 17/116 (14,9%), р=0,2, due to the stent restenosis/thrombosis which provoked myocardial infarction and repeated unplanned myocardial revascularization. Conclusion: the study showed no significant differences when performing open or hybrid myocardium and brain revascularization. However there is a tendency to increase the number of adverse cardiovascular events in the long-term period after PCI+CEE as compared to CABG+CEE mostly due to stent thromboses/restenoses. This feature emphasizes the advantages of more aggressive methods of revascularization over interventional.

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Clinical Outcome of Invasive Pituitary Prolactinomas Treated with Cabergoline

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v15i2.161 ◽

2020 ◽

Vol 15 (2) ◽

pp. 50-57

Author(s):

Bassam M Flamerz Arkawazi

Keyword(s):

Complete Response ◽

Neurological Dysfunction ◽

Serum Prolactin ◽

Group 4 ◽

Long Term Treatment ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: Treatment of invasive prolactinoma, which has several characteristics including invasive growth into cavernous sinuses and formation of giant adenomas compressing adjacent neural structures, resulting in neurological dysfunction, has been very challenging. There are relatively few reports available describing long-term treatment outcome. Aims of the study: In this study we evaluate the results of cabergoline administration as initial treatment during 4 years follow up period. Methods: We prospectively categorized 36 patients into four groups according to the results of 3 months of cabergoline treatment: group 1, tumor volume reduction (TVR) ˃25% with normalized serum prolactin (NP) (n = 24); group 2, TVR˃25% without NP (n = 4); group 3, TVR ˂25% with NP (n = 5); and group 4, TVR ˂25% without NP (n = 3). Results: During follow-up, 22 patients (91.7%) in group 1 achieved TVR˃50% with NP. Three patients (75%) in group 2 achieved TVR˃50% with NP after treatment for 8 months. In group 3, four patients (80.0%) continued medication because of improvement of symptoms and achieved additional TVR(18.8–46.4%). Surgery was performed on five patients (one in group 2, one in group 3, and three in group 4), and complete resection was achieved in four (80.0%). Overall, 25 (69.4%) of the 36 patients treated with cabergoline had complete response and 6 (16.7%) had partial response but did not require surgery. Thus, the overall response rate was 86%,with only five patients (14%) requiring surgical debulking. NP was not achieved by surgery alone in all cases, even after total resection of tumor. Conclusion: Patients who achieve TVR˃25%with NP with 3 months of cabergoline administration had a high possibility of showing good long term response (TVR˃50% with NP) to cabergoline. A higher dose of dopamine agonist (DA) should be considered for patients who achieve TVR˃25% without NP.

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Trajectory Analysis for Long-Term Mortality in Survivors of Childhood Cancer: A Korean Nationwide Observational Study

Blood ◽

10.1182/blood-2020-143461 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 5-6

Author(s):

Hyery Kim ◽

Hae Reong Kim ◽

Yu Rang Park

Keyword(s):

Childhood Cancer ◽

Trajectory Analysis ◽

Survival Rates ◽

Population Based ◽

Group 3 ◽

Group 2 ◽

Long Term Mortality ◽

Group 1

Background Survival rates of childhood cancers have improved substantially over the past four decades. However, these improvements have been accompanied by substantial long-term morbidity and premature mortality. In this study, we analyzed trajectory groups that correlate with long-term mortality in childhood cancer survivors. M ethods The National Health Insurance Service (NHIS) database is a population-based cohort covering over 95% of the population across all regions of South Korea. We used the patient-level longitudinal NHIS database which included patients who first received a cancer code ([ICD 10: C]) under the age of 20 years from 2002-2017. The onset of cancer diagnosis was defined as the time of the earliest diagnosis in patients who were prescribed any treatment excluding surgery within one month after the initial diagnosis. Claims codes for chemotherapeutic agents, radiotherapy, and transplantation were designated and analyzed in the database. For trajectory analysis, the total numbers of claimed diagnostic codes per year were used as the input variable of the group-based trajectory method. The separate trajectories were identified using the Proc Traj procedure in SAS 9.4. Results A total of 71,323 people were extracted from the NHIS database. After washing out previously diagnosed patients in 2002, 58,964 people remained from 2003-2017. We included 14,101 patients without records of any treatment for 3 years after the first diagnosis in the final analysis. Trajectory groups were generated in 14,101 and 8,119 patients who have survived more than 5 years and more than 10 years, respectively. Among the ≥ 5 years survivors, three groups were classified: Group 1 (N=5,654; 40.1%), Group 2 (N=7,027; 49.8%), and Group 3 (N=1,420, 10.1%) (Figure 1(A)). Likewise, three trajectory groups were identified in ≥ 10 years survivors: Group 1 (N=3,104; 38.2%), Group 2 (N=4,148; 51.1%), and Group 3 (N=867; 10.7%) (Figure 1(B)). Notably, the risk of death was significantly different between each trajectory group according to Cox regression analysis after being corrected for age and sex (Table 1). In patients with a follow-up of 5 years or more, mortality risk was 4.84 times higher in Group 3 compared to Group 1 (P<0.001). Also, in patients with follow-up of 10 years or more, mortality risk was 11.55 times higher in Group 3 compared with Group 1 (P<0.001). In the survival graph from the timepoints of 5 or 10 years after diagnosis, there were significant differences in overall survival between each trajectory group of the two patient cohorts (P<0.001, Figure 2). To identify characteristics associated with survival differences between trajectory groups, baseline characteristics at diagnosis and treatments were analyzed (Table 2, 3). There were significant differences in age at time of diagnosis in three trajectory groups: in both cohorts, age at diagnosis was significantly younger in Group 3 of the lowest survival rates than other groups. For initial diagnosis, there were increasing trends of Lymphoid leukemia and brain tumors in Group 3 of both cohorts. For types of treatment, the proportions of patients who received only chemotherapy or radiotherapy decreased from Group 1 to Group 3. However, the proportions of patients who received combined treatment with any stem cell transplantation increased from Group 1 to Group 3. The follow-up periods were significantly lower in Group 3, which corresponded to the survival probabilities. Whereas the numbers of prescribed codes for any treatment were significantly higher in Group 3, indicating that patients in Group 3 received more frequent and condensed treatments within shorter periods than those in Group 2, and this relationship was also seen between Group 2 and Group 1. Conclusions This study is the first trajectory analysis conducted in childhood cancer survivors using population-based longitudinal data. In this study, unlike previous trajectory analyses based on characteristics at the time of diagnosis, trajectories were classified based on the burden of diagnosis during periods, which resulted in differences in long-term mortality, and then the differences in characteristics between each group were analyzed. Our findings indicate that that long-term mortality is related to age at diagnosis and concentration of treatment relative to total follow-up duration rather than the absolute duration or intensity of treatment. Disclosures No relevant conflicts of interest to declare.

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Effects of posterior tibial slope on the mid-term results of medial unicompartmental knee arthroplasty

Arthroplasty ◽

10.1186/s42836-021-00070-y ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Zhijie Chen ◽

Kaizhe Chen ◽

Yufei Yan ◽

Jianmin Feng ◽

Yi Wang ◽

...

Keyword(s):

Knee Flexion ◽

Tibial Slope ◽

Posterior Tibial ◽

Significant Difference ◽

Medial Unicompartmental Knee Arthroplasty ◽

Group 3 ◽

Group 2 ◽

Postoperative Knee ◽

Group 1

Abstract Objective To evaluate the effect of medial posterior tibial slope (PTS) on mid-term postoperative range of motion (ROM) and functional improvement of the knee after medial unicompartmental knee arthroplasty (UKA). Methods Medical records of 113 patients who had undergone 124 medial UKAs between April 2009 through April 2014 were reviewed retrospectively. The mean follow-up lasted 7.6 years (range, 6.2–11.2 years). Collected were demographic data, including gender, age, height, weight of the patients. Anteroposterior (AP) and lateral knee radiographs of the operated knees were available in all patients. The knee function was evaluated during office follow-up or hospital stay. Meanwhile, postoperative PTS, ROM, maximal knee flexion and Hospital for Special Surgery (HSS) knee score (pre−/postoperative) of the operated side were measured and assessed. According to the size of the PTS, patients were divided into 3 groups: group 1 (<4°), group 2 (4° ~ 7°) and group 3 (>7°). The association between PTS and the knee function was investigated. Results In our cohort, the average PTS was 2.7° ± 0.6° in group 1, 5.6° ± 0.9° in group 2 and 8.7° ± 1.2° in group 3. Pairwise comparisons showed significant differences among them (p < 0.01). The average maximal flexion range of postoperative knees in each group was 112.4° ± 5.6°, 116.4° ± 7.2°, and 117.5° ± 6.1°, respectively, with significant difference found between group 1 and group 2 (p < 0.05), and between group 1 and group 3 (p < 0.05). However, the gender, age, and body mass index (BMI) did not differ between three groups and there was no significant difference between groups in terms of pre−/postoperative HSS scores or postoperative knee ROM. Conclusion A mid-term follow-up showed that an appropriate PTS (4° ~ 7°) can help improve the postoperative flexion of knee. On the other hand, too small a PTS could lead to limited postoperative knee flexion. Therefore, the PTS less than 4° should be avoided during medial UKA.

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The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

Blood Purification ◽

10.1159/000515639 ◽

2021 ◽

pp. 1-7

Author(s):

Emre Erdem ◽

Ahmet Karatas ◽

Tevfik Ecder

Keyword(s):

Serum Ferritin ◽

Hemodialysis Patients ◽

Rank Test ◽

Significant Difference ◽

All Cause Mortality ◽

Group 3 ◽

Group 2 ◽

The Relationship ◽

Group 1

Introduction: The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. Methods: A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin <800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin >1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. Results: Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, p = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; p = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; p = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; p = 0.063). Conclusion: Time-averaged serum ferritin levels >1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

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