Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: Insights from the national inpatient sample

BACKGROUND Previous studies have established a role of gout in predicting risk and prognosis of cardiovascular diseases. However, large-scale data on the impact of gout on inpatient outcomes of acute coronary syndrome (ACS)-related hospitalizations and post-revascularization is inadequate. AIM To evaluate the impact of gout on in-hospital outcomes of ACS hospitalizations, subsequent healthcare burden and predictors of post-revascularization inpatient mortality. METHODS We used the national inpatient sample (2010-2014) to identify the ACS and goutrelated hospitalizations, relevant comorbidities, revascularization and postrevascularization outcomes using the ICD-9 CM codes. A multivariable analysis was performed to evaluate the predictors of post-revascularization in-hospital mortality. RESULTS We identified 3144744 ACS-related hospitalizations, of which 105198 (3.35%) also had gout. The ACS-gout cohort were more often older white males with a higher prevalence of comorbidities. Coronary artery bypass grafting was required more often in the ACS-gout cohort. Post-revascularization complications including cardiac (3.2% vs 2.9%), respiratory (3.5% vs 2.9%), and hemorrhage (3.1% vs 2.7%) were higher whereas all-cause mortality was lower (2.2% vs 3.0%) in the ACSgout cohort (P < 0.001). An older age (OR 15.63, CI: 5.51-44.39), non-elective admissions (OR 2.00, CI: 1.44-2.79), lower household income (OR 1.44, CI: 1.17- 1.78), and comorbid conditions predicted higher mortality in ACS-gout cohort undergoing revascularization (P < 0.001). Odds of post-revascularization inhospital mortality were lower in Hispanics (OR 0.45, CI: 0.31-0.67) and Asians (OR 0.65, CI: 0.45-0.94) as compared to white (P < 0.001). However, postoperative complications significantly raised mortality odds. Mean length of stay, transfer to other facilities, and hospital charges were higher in the ACS-gout cohort. CONCLUSION Although gout was not independently associated with an increased risk of postrevascularization in-hospital mortality in ACS, it did increase postrevascularization complications.

Is medical management useful in Moyamoya disease?

Moyamoya disease(MMD),characterized by progressive internal carotid artery stenosis and collateral vessel formation,prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes.A multifa-ceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy,while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arte-rial stenosis and fragile collateral vessels.Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants,despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemo-rrhagic complications.Transcranial doppler has proven useful in thromboembolic detection,despite persisting challenges concerning the efficacy and safety of an-tithrombotic treatments.Furthermore,antihypertensive interventions aim to ma-nage blood pressure meticulously,especially during intracerebral hemorrhage,with recommendations and protocols varying based on the patient’s hypertension status.Additionally,lipid-lowering therapeutic strategies,particularly employing statins,are appraised for their possible beneficial role in MMD management,even as comprehensive data from disease-specific clinical trials remains elusive.Com-prehensive guidelines and protocols to navigate the multifaceted therapeutic ave-nues for MMD,while maintaining a delicate balance between efficacy and safety,warrant further meticulous research and development.This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.

Superficial femoral artery pseudoaneurysm at implantation site of drug eluting stent discovered due to bacteremia:A case report

BACKGROUND Drug-eluting stents(DES)are used to treat lower extremity arterial disease.During DES treatment,aneurysmal degeneration occasionally occurs,especially with fluoropolymer-based DES.However,the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region,although there have been several reports on pseudoaneurysm formation after DES placement in the coronary artery region.CASE SUMMARY We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis.Bacteremia was diagnosed by blood culture,and after admission,he developed pain on the medial side of the right thigh.A pseudoaneurysm was observed in the right superficial femoral artery(SFA)at the proximal end of a previously placed DES.The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery,and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment.The pseudoaneurysm of the right SFA rapidly expanded after admission,but the expansion rate was reduced after infection control.Seven months after the first admission,the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft.CONCLUSION Although pseudoaneurysm after DES placement in the lower extremity region is rare,it must be considered in patients with bacteremia.

Analysis of the Effect of the Comprehensive Nursing Model on Patients with Moyamoya Disease Undergoing Intracranial and Extracranial Revascularization Surgery

Objective:To explore the effect of a comprehensive nursing model on patients with Moyamoya disease who underwent intracranial and extracranial revascularization surgery.Methods:110 cases were divided into control and observation groups with 55 cases each.The control group received routine perioperative care,and the observation group received perioperative care along with comprehensive nursing care.The two groups’disease cognition levels,anxiety,symptoms,daily living ability scores,and postoperative complication rates were compared.Results:The anxiety score and total postoperative complications of the observation group upon discharge were lower than that of the control group,and the disease cognition level and daily living ability upon discharge were higher than that of the control group(P<0.05).Conclusion:Applying the comprehensive nursing model in conjunction with perioperative care for patients undergoing surgery can effectively improve their anxiety,strengthen activities of daily living,and reduce the risk of postoperative complications.

Association between serum paraoxonase-1 activity level and repeat coronary revascularizations

Repeat coronary revascularizations (RCR) are common in patients underwent percutaneous coronary intervention.There is no available prediction model for RCR at present.The association between paraoxonas-1 (PON1) and the development,progression,and prognosis of coronary artery disease is under hot research.The rela-tionship of serum PON1 activity level and RCR has not been reported.This research aimed to detect the difference of serum PON1 activity levels between RCR and single coronary revascularization(SCR) ,hence to illuminate the value of PON1 in predicting RCR.Methods Serum PON1 activity levels of 200 patients who had achieved complete revascu-larizations in first percutaneous coronary intervention (PCI) were determined by colorimetric method.All patients re-ceived one-year follow-up.Coronary angiographies were performed at 6th month.Patients who need more revasculariza-tion procedure during follow-up were enrolled in RCR group; those who did not need more revascularization procedure were enrolled in SCR group.One hundred patients with normal coronary angiography during the same period were setup as non-coronary heart disease control group (NCC) .Results Sixty two patients were enrolled in RCR group (28 with in-stent restenosis,34 with lesion progression in other coronary segments) .Serum PON1 activity levels in RCR group, SCR group and NCC group were 109.2 ± 98.6 μkat/L,132.8 ± 79.4 μkat/L and 156.4 ± 82.8 μkat/L,respective-ly.Statistic differences were found among three groups (P < 0.05) .Conclusions Serum PON1 activity levels are lower in patients who need repeat coronary revascularizations than in patients need single percutaneous coronary inter-vention or without coronary heart disease.A lower serum PON1 activity level is closely associated to repeat coronary re-vascularization.

Diabetic foot ulcer:A comprehensive review of pathophysiology and management modalities

Diabetic foot ulcer (DFU) is a debilitating and severe manifestation ofuncontrolled and prolonged diabetes that presents as ulceration, usually locatedon the plantar aspect of the foot. Approximately 15% of individuals with diabeteswill eventually develop DFU, and 14%-24% of them will require amputation ofthe ulcerated foot due to bone infection or other ulcer-related complications. Thepathologic mechanisms underlying DFU are comprise a triad: Neuropathy,vascular insufficiency, and secondary infection due to trauma of the foot.Standard local and invasive care along with novel approaches like stem celltherapy pave the way to reduce morbidity, decrease amputations, and preventmortality from DFU. In this manuscript, we review the current literature withfocus on the pathophysiology, preventive options, and definitive management ofDFU.

Effect of complete revascularization in acute coronary syndrome after 75 years old:insights from the BleeMACS registry

BACKGROUND The prognostic benefit of complete revascularization in elderly patients(aged over 75 years)with multi-vessel disease and acute coronary syndrome(ACS)is currently unclear.This study aimed to determine the long-term prognostic impact of complete revascularization in this population.METHODS We conducted this study using data obtained from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry,which was carried out from 2003 to 2014.The objective was to categorize older patients diagnosed with ACS into two groups:those who underwent complete revascularization and those who did not.Propensity score matching and the Kaplan-Meier analysis were employed to examine differences in one-year clinical outcomes.The primary endpoint was major adverse cardiovascular event(MACE),which encompassed a combination of all-cause mortality and myocardial infarction.RESULTS Out of 1263 patients evaluated,445 patients(35.2%)received complete revascularization.Patients who underwent complete revascularization had a higher prevalence of hypertension and prior percutaneous coronary intervention compared to those who did not.During the one-year follow-up period,complete revascularization was associated with a significantly decreased risk of MACE[13.7%vs.20.5%,hazard ratio(HR)=0.63,95%CI:0.45–0.88,P=0.007]and a lower risk of myocardial infarction(5.9%vs.9.9%,HR=0.55,95%CI:0.33–0.92,P=0.02).However,it was not linked to a lower risk of all-cause death(9.5%vs.13.5%,HR=0.68,95%CI:0.45–1.02,P=0.06).Similar results were observed in the subgroup analysis.CONCLUSIONS Long-term clinical improvements were observed in ACS patients aged over 75 years with multi-vessel disease who achieved complete revascularization.Therefore,adhering to guidelines for complete revascularization should be recommended for elderly patients.

Different endodontic treatments induced root development of two nonvital immature teeth in the same patient:A case report

BACKGROUND Pulp revascularization is a novel way to treat immature teeth with periapical disease,and the technique has become increasingly well established in recent years.By puncturing the periapical tissue,bleeding is induced,and a blood clot is formed in the root canal.The blood clot acts as a natural bioscaffold onto which mesenchymal stem cells from periapical tissue can be seeded and restore pulp vascularity,thus promoting root development as well as apical closure.Although the effect of pulp revascularization is ideal,there are certain requirements for the apical condition of the teeth.The apical barrier technique and apexification are still indispensable for teeth that cannot achieve ideal blood clot formation.In addition,a meta-analysis of several clinical studies concluded that pulp revascu-larization has no significant advantages over other treatments.CASE SUMMARY A 10-year-old girl complained of pain in the right upper and lower posterior teeth for 2 d.Clinical and radiological examinations revealed that both the right maxillary and mandibular second premolars were immature with periapical radiolucency.The right maxillary second premolar was treated by pulp revascu-larization,while the right mandibular second premolar was treated by conven-tional apical barrier surgery after revascularization failed.The purpose of this report is to compare the different root maturation processes induced by the pulp revascularization and apical barrier techniques in the same patient in homonymous teeth from different jaws.Twelve months of follow-up showed that the apical foramen of both teeth presented a clear tendency to close;however,the tooth treated with pulp revascularization showed a significant increase in root length as well as root canal wall thickness.CONCLUSION For the treatment of nonvital immature teeth,pulp revascularization showed a superior therapeutic effect in comparison with the apical barrier technique.

Salvage anastomosis in free PAP-flap breast reconstruction:What about free flap neovascularization?

Since the emergence of microsurgery in reconstructive surgery, free flaps have become a key tool in the management of patients with breast cancer. One such flap is the profunda artery perforator(PAP) flap. To date,there is no scientific consensus on whether voluminous free flaps remain dependent on their vascular pedicle throughout their lifespan. Therefore, the pedicle should always be carefully protected during revision surgery.In this article, we review the case of a middle-aged woman who suffered a pedicle transection needing reanastomosis during revision surgery six months after free-flap breast reconstruction. A 52-year-old woman who noticed a firm nodule in her right breast and armpit was referred to our department for surgical management. The Caucasian woman presented with no significant medical history or symptoms at the first consultation. Ultrasound-guided biopsy confirmed an invasive grade Ⅲ lobular carcinoma. Following staging,the patient underwent neoadjuvant chemotherapy before a right mastectomy with a complete homolateral axillary lymph node dissection and postoperative radiotherapy. One year after completing radiotherapy, free flap reconstruction with a PAP flap was performed, and six months later, revision surgery was required to enhance the volume of the reconstructed breast with a tissue expander and later an implant. Unfortunately,pedicle transection occurred during revision surgery, causing complete devascularization of the flap, which was confirmed by intraoperative Indocyanine Green imaging. The authors elected to perform salvage reanastomosis during the surgery. In keeping with the author’s 23-year experience with free flaps, the vascular pedicle should always be preserved in voluminous free flaps, as neovascularization alone may not ensure whole flap survival. The authors suggest always attempting re-anastomosis if vessels are compromised during revision surgery.

Complex inferior vena cava reconstruction during ex vivo liver resection and autotransplantation:A case report

BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.

Coronary Physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India

Fractional flow reserve (FFR), a physiology-based diagnostic method, has emerged as an important decision-making tool in determining the borderline or intermediate coronary lesions requiring revascularization. As per the guidelines recommended by European and American cardiology associations, functional assessment of indeterminate lesions is to be considered strongly prior to PCI. However, in India, FFR continues to be a much-underutilized tool due to limited facilities, and many times, physicians are reluctant to advise FFR because of its time-consuming nature with additional cost implications of simple diagnostic tests. Notably, for stenoses ranging between 50% - 70% where the choice between revascularization and medication becomes ambiguous, FFR provides invaluable insight. Without such guidance, there is a risk of improper decisions and strategies while planning revascularization procedures, which might adversely influence clinical outcomes, escalation of the cost due to unnecessary procedures, and prolonged hospitalization as a result of simple vs complex procedures. Landmark studies have validated the efficacy of FFR in enhancing outcomes in coronary artery disease (CAD) patients, especially when paired with a coronary angiogram. This combination provides robust evidence of the functional significance of stenosis in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well with conventional FFR. Hence, adopting FFR-guided management can have transformative effects on the clinical and economic facets of treating severe CAD with intermediary lesions in Indian settings.

Long-term follow-ups of revascularized immature necrotic teeth:three case reports

Revascularization of immature necrotic teeth is a reliable treatment alternative to conventional apexogenesis or apexification. In case 1, a 12-year-old boy had his necrotic, immature mandibular left second premolar treated with a revascularization technique. At a 24-month follow-up, periapical radiolucency had disappeared and thickening of the root wall was observed. In cases 2 and 3, a lO-year-old boy had his necrotic, immature, bilateral mandibular second premolars treated with the same modality. At 48-month （in case 2） and 42-month （in case 3） follow-ups, loss of periapical radiolucencies and increases in the root wall thickness were also observed.

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Previous studies demonstrated that coronary revascularization,especially percutaneous coronary intervention(PCI),does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease.Many studies using myocardial perfusion imaging(MPI) showed that,for patients with moderate to severe ischemia,revascularization is the preferred therapy for survival benefit,whereas for patients with no to mild ischemia,medical therapy is the main choice,and revascularization is associated with increased mortality.There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia,which is associated with increased mortality.Studies using fractional flow reserve(FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI,and the presence of ischemia is the key to decisionmaking for PCI.Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method's limitations.Recent studies of appropriateness criteria showed that,although PCI in the acute setting and coronary bypass surgery are properly performed in most patients,PCI in the non-acute set-ting is often inappropriate,and stress testing to identify myocardial ischemia is performed in less than half of patients.Also,some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis.Taken together,the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease,and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.

Comparative study of on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease

Objective To compare the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease. Methods A total of 300 consecutive isolated multiple CABG patients entered into off-pump coronary artery bypass (OPCAB group, n=150) or CABG with cardiopulmonary bypass (CPB) (CCABG group, n=150). There were no significant difference regarding the degree of angina, history of myocardial infarction, diabetes and left main disease between two groups. The ejection fraction in OPCAB before surgery was lower than CCABG (P<0.01). More patients had a history of stroke, and abnormal renal function in OPCAB pre-operatively( P< 0.01 ). Single deep pericardial stay suture with a sling snared down was used to expose the target vessels in OPCAB, along with a stabilizer and a coronary shunt. Medi-Stim Butterfly Flowmeter was used to measure the flow of grafts in both groups. Results No one in OPCAB needed to convert to CCABG. The number of the distal anastomosis and the index of completeness of revisualization (ICR) were similar in both groups. The respiratory support time, the volume of chest tube drainage and blood transfusion were less in OPCAB than in CCABG post-operatively (both P<0.01). The incidence of pulmonary dysfunction and renal insufficiency were less in OPCAB than in CCABG post-operatively ( both P<0.05 ) . There was no significant difference in the mortality and other morbidities (peri-opetative MI, stroke, atrial fibrillation). Conclusion OPCAB can be applied to patients with triple vessels disease and achieved similar completeness of revascularization, similar early surgical results with shorter respiratory support, reduced transfusion requirement, less pulmonary dysfunction and abnormal renal function.

The interaction of stem cells and vascularity in peripheral nerve regeneration

The degree of nerve regeneration after peripheral nerve injury can be altered by the microenvironment at the site of injury. Stem cells and vascularity are postulated to be a part of a complex pathway that enhances peripheral nerve regeneration;however, their interaction remains unexplored. This review aims to summarize current knowledge on this interaction, including various mechanisms through which trophic factors are promoted by stem cells and angiogenesis. Angiogenesis after nerve injury is stimulated by hypoxia, mediated by vascular endothelial growth factor, resulting in the growth of preexisting vessels into new areas. Modulation of distinct signaling pathways in stem cells can promote angiogenesis by the secretion of various angiogenic factors. Simultaneously, the importance of stem cells in peripheral nerve regeneration relies on their ability to promote myelin formation and their capacity to be influenced by the microenvironment to differentiate into Schwann-like cells. Stem cells can be acquired through various sources that correlate to their differentiation potential, including embryonic stem cells, neural stem cells, and mesenchymal stem cells. Each source of stem cells serves its particular differentiation potential and properties associated with the promotion of revascularization and nerve regeneration. Exosomes are a subtype of extracellular vesicles released from cell types and play an important role in cell-to-cell communication. Exosomes hold promise for future transplantation applications, as these vesicles contain fewer membrane-bound proteins, resulting in lower immunogenicity. This review presents pre-clinical and clinical studies that focus on selecting the ideal type of stem cell and optimizing stem cell delivery methods for potential translation to clinical practice. Future studies integrating stem cell-based therapies with the promotion of angiogenesis may elucidate the synergistic pathways and ultimately enhance nerve regeneration.

Acute recurrent cerebral infarction caused by moyamoya disease complicated with adenomyosis:A case report

BACKGROUND Moyamoya disease is essentially an ischemic cerebrovascular disease.Here,we describe a case of acute recurrent cerebral infarction caused by moyamoya disease with concurrent adenomyosis which,to our knowledge,is the first in the literature.A literature review is also presented.CASE SUMMARY A 38-year-old female presented to the Research and Treatment Center of Moyamoya Disease in our hospital with"left limb weakness"as the main symptom.She was diagnosed with acute cerebral infarction and moyamoya disease through magnetic resonance imaging and digital subtraction angiography.Prior to this,she had experienced a prolonged menstrual period of one-month duration.This was investigated and adenomyosis was diagnosed.After passing the acute cerebral infarction phase,the patient underwent surgery for adenomyosis followed by combined cerebral revascularization.During the postoperative follow-up,improvements of the perfusion imaging stage and modified Rankin Scale were observed.A review of the literature showed only 16 reported cases of gynecological diseases complicated with stroke.The clinical characteristics,pathogenesis,therapeutic effects,and long-term prognosis of these cases have been studied and discussed.CONCLUSION In patients with moyamoya disease,early management of gynecological-related bleeding disorders is essential to prevent the complications of cerebral events.

Penile revascularization--contemporary update

Contemporary therapies for erectile dysfunction are generally targeted towards older men and universally engage pharmacological and/ or device related treatment options. Penile revascularization, using microvascular arterial bypass surgical techniques, is a non-pharmacological, non-device-related, and reconstructive surgical strategy for men with erectile dysfunction that was first described by Dr Vaclav Michal in 1973.

Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock

Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related cardiogenic shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardiac care unit(ICCU)and revascularization on outcomes of elderly patients with MI-CS.We aimed to assess the prognostic impact of DM according to age in patients with MI-CS,and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System’s Basic Data Set.Centers were classified according to their availability of ICCU.Main outcome measured was in-hospital mortality.Results A total of 23,590 episodes of MI-CS were identified,of whom 12,447(52.8%)were in patients aged≥75 years.The impact of DM on in-hospital mortality was different among age subgroups.While in younger patients,DM was associated to a higher mortality risk(0.52 vs.0.47,OR=1.12,95%CI:1.06–1.18,χ^2<0.001),this association became non-significant in older patients(0.76 vs.0.81,χ^2=0.09).Adjusted mortality rate of MI-CS aged≥75 years was lower in patients admitted to hospitals with ICCU(adjusted mortality rate:74.2%vs.77.7%,P<0.001)and in patients undergoing revascularization(74.9%vs.77.3%,P<0.001).Conclusions Prognostic impact of DM in patients with MI-CS was different according to age,with a significantly lower impact at older ages.The availability of ICCU and revascularization were associated with better outcomes in these complex patients.

Sequential vs simultaneous revascularization in patients undergoing liver transplantation:A meta-analysis

AIM: We undertook this meta-analysis to investigate the relationship between revascularization and outcomes after liver transplantation.METHODS: A literature search was performed using MeSH and key words. The quality of the included studies was assessed using the Jadad Score and the NewcastleOttawa Scale. Heterogeneity was evaluated by the χ 2and I 2 tests. The risk of publication bias was assessed using a funnel plot and Egger's test, and the risk of bias was assessed using a domain-based assessment tool.A sensitivity analysis was conducted by reanalyzing the data using different statistical approaches.RESULTS: Six studies with a total of 467 patients were included. Ischemic-type biliary lesions were significantly reduced in the simultaneous revascularization group compared with the sequential revascularization group(OR = 4.97, 95%CI: 2.45-10.07; P < 0.00001),and intensive care unit(ICU) days were decreased(MD = 2.00, 95%CI: 0.55-3.45; P = 0.007) in the simultaneous revascularization group. Although warm ischemia time was prolonged in simultaneous revascularization group(MD =-25.84, 95%CI:-29.28-22.40; P < 0.00001), there were no significant differences in other outcomes between sequential and simultaneous revascularization groups. Assessment of the risk of bias showed that the methods of random sequence generation and blinding might have been a source of bias. The sensitivity analysis strengthened the reliability of the results of this meta-analysis.CONCLUSION: The results of this study indicate that simultaneous revascularization in liver transplantation may reduce the incidence of ischemic-type biliary lesions and length of stay of patients in the ICU.

Staged versus ＂one-time＂ multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome

评估一次性对上演的 multivessel stenting 的临床的结果在老( 60 年)有 non-ST-elevation 的病人急性冠的症候群(NSTE交流)和 multivessel 疾病( MVD ) .MethodsWe 与 multivessel 分析了连续NSTE交流病人的数据经皮的冠的干预(一种总线标准)在沈阳军人的医院将军被注册在 2008 和 2012 之间的区域。60 的 1090 个合格病人的一个总数进一步被分成一次性的组(n = 623 ) 并且上演一种总线标准组(n = 467 ) 根据干预策略。主要端点是心肌的梗塞(MI ) 的合成结果或心脏的死亡在 3 年的 follow-up.ResultsThe 期间估计了心脏的死亡的 3 年的合成的率或 MI 在上演一种总线标准组是 7.0% 并且 9.5% 在一次性的组(P = 0.110 ) 。Multivariate 分析在主要事件上证实了上演一种总线标准的利益在老(HR：0.638， 95% CI：0.408-0.998， P = 0.049 ) 。在倾向， 20 匹配队，上演一种总线标准与主要事件的更低的率被联系(6.1% 对 10.4% ， P = 0.046 ) 并且 MI (3.4% 对 7.4% ， P = 0.037 ) 在三年。另外，在在 30 天的 stent 血栓有减少的趋势(0.3% 对 1.4% ， P = 0.177 ) 并且在三年(1.1% 对 2.4% ， P = 0.199 ) 在上演一种总线标准组。在 3 年的目标容器 revascularization 没有重要差别(15.5% 对 14.4% ， P = 0.746 ).ConclusionsIn 有 MVD 的老 NSTE 交流病人，上演一种总线标准可能是与一次性的一种总线标准策略相比与减少的长期的心脏的死亡或 MI 联系的最佳的策略，它需要进一步的证实。