Education of Hospitalized Diabetic Patients: Analysis of Training Needs among Nurses in a Lebanese Hospital - A Secondary Publication

The design of diabetes inpatient educational preparation should be based on the needs of the nurses involved in terms of skills in this area. The objective of this qualitative study is to identify the preparatory needs of nurses working in the medical and surgical units of a Lebanese hospital in terms of Survival Skills Education for Hospitalized Diabetic Patients (SSEHDP). Method: The focus group method is used for data collection using a semi-structured interview guide. The needs expressed by the thirty-two participating nurses were classified into categories of the competency framework for providing self-management education to diabetic patients proposed by the American Diabetes Association. Results: By focusing on the themes of an SSEHDP, a list of preparatory needs was drawn up. The needs identified and analyzed are then translated into general and specific learning objectives for educational preparation. Conclusion: The needs analysis is only the first step in a work that will ideally continue into the implementation and eventual evaluation of an educational program developed to help nurses acquire skills in the education of diabetic patients.

Phase II Clinical Study of Three-Dimensional Printed Coplanar Template Combined with CT-Guided Percutaneous Core Needle Biopsy of Pulmonary Nodules in Elderly Patients

Background: As the population age structure gradually ages, more and more elderly people were found to have pulmonary nodules during physical examinations. Most elderly people had underlying diseases such as heart, lung, brain and blood vessels and cannot tolerate surgery. Computed tomography (CT)-guided percutaneous core needle biopsy (CNB) was the first choice for pathological diagnosis and subsequent targeted drugs, immune drugs or ablation treatment. CT-guided percutaneous CNB requires clinicians with rich CNB experience to ensure high CNB accuracy, but it was easy to cause complications such as pneumothorax and hemorrhage. Three-dimensional (3D) printing coplanar template (PCT) combined with CT-guided percutaneous pulmonary CNB biopsy has been used in clinical practice, but there was no prospective, randomized controlled study. Methods: Elderly patients with lung nodules admitted to the Department of Oncology of our hospital from January 2019 to January 2023 were selected. A total of 225 elderly patients were screened, and 30 patients were included after screening. They were randomly divided into experimental group (Group A: 30 cases) and control group (Group B: 30 cases). Group A was given 3D-PCT combined with CT-guided percutaneous pulmonary CNB biopsy, Group B underwent CT-guided percutaneous pulmonary CNB. The primary outcome measure of this study was the accuracy of diagnostic CNB, and the secondary outcome measures were CNB time, number of CNB needles, number of pathological tissues and complications. Results: The diagnostic accuracy of group A and group B was 96.67% and 76.67%, respectively (P = 0.026). There were statistical differences between group A and group B in average CNB time (P = 0.001), number of CNB (1 vs more than 1, P = 0.029), and pathological tissue obtained by CNB (3 vs 1, P = 0.040). There was no statistical difference in the incidence of pneumothorax and hemorrhage between the two groups (P > 0.05). Conclusions: 3D-PCT combined with CT-guided percutaneous CNB can improve the puncture accuracy of elderly patients, shorten the puncture time, reduce the number of punctures, and increase the amount of puncture pathological tissue, without increasing pneumothorax and hemorrhage complications. We look forward to verifying this in a phase III randomized controlled clinical study. .

Information Needs and Self-Care Practices of Diabetic Patients in Mbala, Northern Province, Zambia

Introduction: Diabetes mellitus (DM) is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. It is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both” manifested by carbohydrates, fat and protein metabolism abnormality. If untreated high blood sugar can damage the nerves, eyes, kidneys, and other organs. The purpose of this study was to assess the information needs and self-care practice of Diabetic Patients in Mbala, Northern Province Zambia. Methods: This was an analytical cross-sectional study where 105 respondents aged 18 years and above participated in the study. Participants were randomly selected. A structured interview schedule and a check list were used to collect data. Statistics Package for Social Sciences computer software package version 23.0 was used to analyze data. Chi square and fisher’s exact tests were used to test the significance of the association between Knowledge of Diabetes Mellitus, attitude towards self-care practices, self-care practices among Diabetic patients and the need for information among Diabetic patients. A 95% confidence interval and P value of 0.05 were used to ascertain the degree of significance. Multi-variate binary logistic regression model to determine predictors of self-care practices and need for information was also used. Result: On analyzing the dependent variables, more than half (61.9%), had high need for information and three quarters (85.7%) of respondents had poor self-care practices. Slightly more than half (58.1%) had high knowledge levels majority (78.1%), had a negative attitude. Significant associations were found P Conclusion: Negative attitudes and lack of information among Diabetic patients were the main reasons associated with poor self-care practices. Particular attention should therefore be given to ensuring that Diabetic patients are given adequate information on Diabetes self-care in order to improve the quality of life.

Managements of Special Health Care Needs Patients from Dental Assistant Point

The main role of this article is to describe dental assistants and the dental department’s role in the dental delivery system for Special health care needs (SCHN) by creating a structure to educate the dental assisting profession and project factors that have a significant impact on the dental assistant. The dental assisting management of SCHN patient’s profession including dental Assistance general responsibilities, regulation credentialing, and education. The SCHN patient’s management creates a challenge in all area of the dental department. Handling patient with a SCHN is underexplored throughout the dental staff especially when there is not enough theoretical foundation, education and training to deal with this category of patients. SCHN patients are defined as individuals who have abnormal behavioral impairments, mental conditions or/and chronic disease or abnormal laboratory results. Thus, the aim of this article is to guide all dental assistance staff in the best dental management choice for SCHN patients. All health care teams are part of patient care in most medical settings. A work environment supportive ensures positive outcomes for patient care. This article was considered as those categories of patients required more care and special way to deal with, moreover language, age, gender and education level of the patient are also considered significant parries. Not Many studies were found to support the care of SCHN patients in dentistry department. Taking experience from other area help to design a system to handle the SCHN even if it requires hiring a Dentist who is specialized in that filed.

Needs and Opportunities for Information in Patients with Metastatic Breast Cancer Attending a Tertiary Hospital in Tanzania—A Qualitative Study

Background: The majority of breast cancer patients in Tanzania present with advanced disease, and a significant proportion has metastatic breast cancer (MBC) on presentation or develops it during the course of their follow-up. With few treatment options to choose from, such patients often benefit from empathic support and access to information to help them make treatment decisions based on their individual circumstances and needs. Patients with MBC have been shown to present with unique physical, social and psychological needs that require additional time, counselling and availability of health care providers in addition to the routine options available to other patients. In resource-limited settings, the needs of such patients are often unknown and unaddressed, which adds to the anxiety associated with the diagnosis and its treatment. Materials and methods: This descriptive qualitative study was conducted using 3 focus group discussions with a total of 17 participants with metastatic breast cancer (MBC) attending Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Participants were purposively selected for the study from outpatient clinics and inpatient wards. A semi-structured FGD guide was used to moderate discussions and analysis was done using a thematic approach. Results: The median age of participants was 51 (range 33 - 81 years) with an average of 4 months (range 1 - 12 months) from diagnosis of BC to the interview. 4 (24%) were diagnosed with MBC on first presentation (denovo). Participants spoke about the importance of accurate BC-related information in allowing timely referral and treatment both in the community and within the health system. They recognized the role of mass and social media in increasing awareness about BC and identified myths surrounding cancer treatment especially mastectomy. Correct and timely information at points of care, through media platforms and via ambassadors/patient support groups was perceived as a means to avoiding delays and securing early and effective treatment. Conclusion: Patients with MBC in Tanzania have many unmet informational needs in relation to their disease. Accurate BC-related information is important in allowing early detection and diagnosis. At the community level, provision of information through established media platforms and the use of patient advocates may help to enable early referral and treatment of patients.

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

Hemoperfusion and continuous veno-venous hemodiafiltration for eliminating chlorfenapyr in poisoning patients

Chlorfenapyr is a liposoluble insecticide belonging to the pyrrole family.Chlorfenapyr is activated when the N-ethoxymethyl side chain breaks,forming a toxic metabolite,which uncouples oxidative phosphorylation in the mitochondria,inhibits the production of adenosine triphosphate (ATP),and leads to the death of cells and targe organisms.[1] Symptoms of chlorfenapyr poisoning in patients are mild and atypical in the early stage,especially in patients receiving low dose exposure;however,such cases are rare and may be ignored by physicians,often leading to delayed treatment.[2,3].

Aggressive fluid management may be associated with disease progression in suspected sepsis patients admitted to the intensive care unit: a retrospective cohort study

Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.

Molecular Characterization of Coxsackievirus B1 Strains Isolated from Patients with Hand Foot and Mouth Disease in Yunnan,Southwest China

Coxsackievirus(CV)B belongs to the species Enterovirus B,genus Enterovirus of the family Picornaviridae.Enterovirus B(EV-B)includes 63 serotypes:CVB1-6;CVA9;echoviruses E1-7,9,11-21,24-27,and 29-33;EV-B69,EV-B 73-75,EV-B77-88,EV-B 93,EV-B 97-101,EV-B 106-107.

Timing of hepatectomy following the Omicron variant infection for vaccinated-patients:A retrospective cohort study

Many previous studies suggested that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection elevated the risk of morbidity and 90-day mortality after operation, especially pulmonary complications [1–7]. Uncertainty about perioperative safety puts off the progress of elective surgery [8]. The Omicron variant has recently become the dominant variant causing prevalence in several countries [9]. Although a high rate of patients with Omicron presented asymptomatic status [10], it is still unclear whether Omicron infection would raise the risk of postoperative complications.

The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest

The global incidence rates of in-hospital cardiac arrest(IHCA)range from1.2 to 9.0 per1,000 hospitalized patients,as per the National Cardiac Arrest Database.[1] While IHCAs tend to exhibit superior 30-day survival rates relative to out-of-hospital cardiac arrests (OHCA) due to situational advantages,such as immediate access to medical personnel and treatments.

Association of cardiometabolic multimorbidity with all-cause and cardiovascular disease mortality among Chinese hypertensive patients

BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.

Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction

BACKGROUND Prealbumin is considered to be a useful indicator of nutritional status. Furthermore, it has been found to be associated with severities and prognosis of a range of diseases. However, limited data on the association of baseline prealbumin level with outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI) are available.METHODS We analyzed 2313 patients admitted for acute STEMI between October 2013 and December 2020. In-hospital outcomes and mortality during the 49 months(interquartile range: 26–73 months) follow-up period were compared between patients with the low prealbumin level(< 170 mg/L) and those with the high prealbumin level(≥ 170 mg/L).RESULTS A total of 114 patients(4.9%) died during hospitalization. After propensity score matching, patients with the low prealbumin level than those with the high prealbumin level experienced higher incidences of heart failure with Killip class Ⅲ(9.9%vs. 4.4%, P = 0.034), cardiovascular death(8.4% vs. 3.4%, P = 0.035) and the composite of major adverse cardiovascular events(19.2%vs. 10.3%, P = 0.012). Multivariate logistic regression analysis identified that the low prealbumin level(< 170 mg/L) was an independent predictor of in-hospital major adverse cardiovascular events(odds ratio = 1.918, 95% CI: 1.250–2.942, P = 0.003). The cutoff value of prealbumin level for predicting in-hospital death was 170 mg/L(area under the curve = 0.703, 95% CI: 0.651–0.754, P< 0.001;sensitivity = 0.544, specificity = 0.794). However, after multivariate adjustment of possible confounders, baseline prealbumin level(170 mg/L) was no longer independently associated with 49-month cardiovascular death. After propensity score matching, Kaplan-Meier survival curves revealed consistent results.CONCLUSIONS Decreased prealbumin level closely related to unfavorable short-term outcomes. However, after multivariate adjustment and controlling for baseline differences, baseline prealbumin level was not independently associated with an increased risk of long-term cardiovascular mortality in STEMI patients.

Predictive value of neutrophil-to-lymphocyte ratio in coronary chronic total occlusion patients

BACKGROUND The neutrophil to lymphocyte ratio(NLR)has been reported as a novel predictor for atherosclerosis and car-diovascular outcomes.This study aimed to determine the effects of NLR on long-term clinical outcomes of chronic total occlusion(CTO)patients.METHODS A total of 670 patients with CTO who met the inclusion criteria were included at the end of the follow-up period.Patients were divided into tertiles according to their baseline NLR levels at admission:low(n=223),intermediate(n=223),and high(n=224).The incidence of major adverse cardiac events(MACEs)during the follow-up period,including all-cause death,nonfatal myocardial infarction(MI),or ischemia-driven revascularization,were compared among the three groups.RESULTS Major adverse cardiac events were observed in 27 patients(12.1%)in the low tertile,40(17.9%)in the intermediate tertile,and 61(27.2%)in the high NLR tertile(P<0.001).Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE,ischemia-driven coronary revascularization,non-fatal MI,and mortality in patients within the high tertile than those in the low and intermediate groups(all P<0.001).Multivariable COX regression analysis showed that the high tertile of baseline NLR level showed a strong association with the risk of MACE(hazard ratio[HR]=2.21;95%confidence interval[CI]:1.21-4.03;P=0.009),ischemia-driven coronary revascularization(HR=3.19;95%CI:1.56-6.52;P=0.001),MI(HR=2.61;95%CI:1.35-5.03;P=0.043)and mortality(HR=3.78;95%CI:1.65-8.77;P=0.001).CONCLUSION Our findings suggest that NLR is an inexpensive and readily available biomarker that can independently pre-dict cardiovascular risk in patients with CTO.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

The effect of fasting plasma glucose on in-hospital mortality after acute myocardial infarction in patients with and without diabetes:findings from a prospective,nationwide,and multicenter registry

OBJECTIVES To evaluate the predictive value of fasting plasma glucose(FPG)for in-hospital mortality in patients with acute myocardial infarction(AMI)with different glucose metabolism status.METHODS We selected 5,308 participants with AMI from the prospective,nationwide,multicenter CAMI registry,of which 2,081 were diabetic and 3,227 were nondiabetic.Patients were divided into high FPG and low FPG groups according to the optim-al cutoff values of FPG to predict in-hospital mortality for diabetic and nondiabetic cohorts,respectively.The primary endpoint was in-hospital mortality.RESULTS Overall,94 diabetic patients(4.5%)and 131 nondiabetic patients(4.1%)died during hospitalization,and the optimal FPG thresholds for predicting in-hospital death of the two cohorts were 13.2 mmol/L and 6.4 mmol/L,respectively.Compared with individuals who had low FPG,those with high FPG were significantly associated with higher in-hospital mortality in diabet-ic cohort(10.1%vs.2.8%;odds ratio[OR]=3.862,95%confidence interval[CI]:2.542-5.869)and nondiabetic cohort(7.4%vs.1.7%;HR=4.542,95%CI:3.041-6.782).After adjusting the potential confounders,this significant association was not changed.Further-more,FPG as a continuous variable was positively associated with in-hospital mortality in single-variable and multivariable models regardless of diabetic status.Adding FPG to the original model showed a significant improvement in C-statistic and net reclassification in diabetic and nondiabetic cohorts.CONCLUSIONS This large-scale registry indicated that there is a strong positive association between FPG and in-hospital mor-tality in AMI patients with and without diabetes.FPG might be useful to stratify patients with AMI.

Updates of developments in interventional therapy for elderly patients with cardiovascular diseases

Cardiovascular diseases(CVD)are the leading cause of death in the world and one of the most common diseases in the elderly,with high prevalence and poor prognosis,which seriously affect the health of the elder patients.One report showed that global deaths from CVD increased from 12.4 million in 1990 to 19.8 million in 2022,reflecting the global population growth and aging,as well as the impact of metabolic,environmental,and behavioral risks.[1]With the progress of aging population,the burden of CVD in the elderly in China has increased year by year,and factors including multiple complications,organ function decline,and high complication rate have made the interventional treatment of CVD in the elderly one of the difficulties and focuses in the field of cardiology in China.

Heterogeneous body compositions and all-cause mortality in acute coronary syndrome patients:a ten-year retrospective cohort study

BACKGROUND The association of different body components,including lean mass and body fat,with the risk of death in acute coronary syndrome(ACS)patients are unclear.METHODS We enrolled adults diagnosed with ACS at our center between January 2011 and December 2012 and obtained fol-low-up outcomes via telephone questionnaires.We used restricted cubic splines(RCS)with the Cox proportional hazards model to analyze the associations between body mass index(BMI),predicted lean mass index(LMI),predicted body fat percentage(BF),and the value of LMI/BF with 10-year mortality.We also examined the secondary outcome of death during hospitalization.RESULTS During the maximum 10-year follow-up of 1398 patients,331 deaths(23.6%)occurred,and a U-shaped relationship was found between BMI and death risk(P_(nonlinearity)=0.03).After adjusting for age and history of diabetes,the overweight group(24≤BMI<28 kg/m^(2))had the lowest mortality(HR=0.53,95%CI:0.29-0.99).Predicted LMI and LMI/BF had an inverse linear relationship with a 10-year death risk(P_(nonlinearity)=0.24 and P_(nonlinearity)=0.38,respectively),while an increase in BF was associ-ated with increased mortality(P_(nonlinearity)=0.64).During hospitalization,31 deaths(2.2%)were recorded,and the associations of the indicators with in-hospital mortality were consistent with the long-term outcome analyses.CONCLUSION Our study provides new insight into the“obesity paradox”in ACS patients,highlighting the importance of considering body composition heterogeneity.Predicted LMI and BF may serve as useful tools for assessing nutritional status and predicting the prognosis of ACS,based on their linear associations with all-cause mortality.

Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction

Background: Bithermal caloric irrigation, video head impulse test(vHIT), and rotational testing are commonly used to assess peripheral vestibular function, but the relative clinical utility of each test in differentiating patients with peripheral vestibulopathy is debated.Objectives: To determine whether(1) the combination of two or more vestibular tests enhances diagnostic utility over a single test;(2) abnormal test results on vestibular tests correlate with one another.Methods: Retrospective analysis of data collected from multidisciplinary vestibular clinics at two academic medical centers from 2016 to 2022.Results: 150 patients(54.10 ± 15.09 years, 88 females) were included. No individual test was significantly better at predicting the presence of peripheral vestibular damage(p > 0.05). vHIT test results improved significantly when combined with either the caloric test(p = 0.007) or rotary chair test(p = 0.039). Caloric and rotational testing had high sensitivity(74.65% and 76.06%, respectively) and specificity(83.54% and 78.48%, respectively). vHIT demonstrated excellent specificity(89.87%) but poor sensitivity(47.89%). Caloric, vHIT, and rotary chair tests results did not correlate with one another(p > 0.05).Conclusions: Vestibular function tests have comparable diagnostic utility, yet each offers unique advantages. Caloric and rotational testing may be best suited for screening peripheral damage and vHIT may function ideally as a confirmatory test.

Development and validation of a model integrating clinical and coronary lesion-based functional assessment for longterm risk prediction in PCI patients

OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort.RESULTS In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration(Hosmer–Lemeshow χ^(2)= 7.070;P = 0.529) for predicting 2-year patient-oriented composite endpoint(POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P < 0.01) after stratified the patients into high-risk group and low-risk group.CONCLUSIONS An improved scoring system combining clinical and coronary lesion-based functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological index and other commonly used risk scores.