190 results match your criteria: "Hirakata kohsai Hospital[Affiliation]"

Article Synopsis
  • * Recent studies have raised concerns about this 12-month regimen, suggesting adjustments based on patients' bleeding or ischemic risks, arguing some may benefit from shorter or longer durations.
  • * Several strategies to modify DAPT practices, such as de-escalating to less potent medications or shortening therapy, have shown to reduce bleeding risks without significantly increasing cardiovascular issues, yet the 12-month recommendation remains unchanged in guidelines.
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Background: Initial hemodynamic status in patients with acute pulmonary embolism (PE) concerns their acute clinical outcomes. Nevertheless, the characteristics of initial hemodynamic dysfunction and acute mortality in PE patients with active cancer is still controversial.

Methods: We analyzed the data of 1715 PE patients in the COMMAND VTE Registry to compare initial hemodynamic dysfunction, management strategies, and mortality outcomes at 30 days after PE diagnosis between patients with and without active cancer (N = 393 and N = 1322).

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  • A study investigated the prevalence and effects of cerebrovascular disease found on pre-procedure CT scans in patients undergoing aortic valve replacement (AVR) due to severe aortic stenosis.
  • Out of 567 patients, 35.3% had cerebrovascular disease, but only 28.5% of these patients reported prior strokes.
  • The findings revealed that those with cerebrovascular disease had a significantly higher 3-year incidence of death or stroke (40.7%) compared to those without (24.1%), indicating they faced worse clinical outcomes regardless of their history of symptomatic stroke.
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  • Current guidelines suggest avoiding anticoagulation after PCI for acute coronary syndrome (ACS), but this recommendation lacks strong evidence.
  • In a study analyzing outcomes of patients with ACS who did or did not receive post-PCI heparin, those receiving heparin had a significantly higher risk of bleeding and a slightly increased risk of cardiovascular events.
  • The use of post-PCI heparin in ACS patients was common, but it was linked to increased bleeding without demonstrating any clear benefit in reducing serious cardiovascular outcomes.
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  • The PE-SARD bleeding score was developed to predict early major bleeding in patients with pulmonary embolism (PE) but has not been fully validated externally.
  • A study using data from the COMMAND VTE Registry involving 2,781 acute PE patients categorized them into high, intermediate, and low-risk groups based on this score, revealing a clear increase in bleeding rates with higher risk scores.
  • The results indicated the score has modest effectiveness in predicting bleeding risk overall, with better performance in patients without active cancer.
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Laparoscopic redo surgery for sigmoid volvulus following laparoscopic sigmoidectomy.

Surg Case Rep

June 2024

Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.

Background: Sigmoid volvulus (SV) is an acute abdominal condition characterized by torsion of the sigmoid colon around the mesentery, and often results in intestinal obstruction that may progress to bowel ischemia, necrosis, or perforation. Although SV commonly occurs due to predisposing factors like anatomic variations, age-related motility disorders, chronic constipation, and neurologic diseases, its incidence following sigmoid colon cancer surgery has rarely been reported. Herein, we report a rare case of recurrent SV following laparoscopic sigmoidectomy, which was successfully treated by laparoscopic redo surgery.

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Article Synopsis
  • The study examined the impact of very low levels of low-density lipoprotein cholesterol (LDL-C) on patients with coronary artery disease, using data from over 39,000 patients who underwent coronary revascularization.
  • It was found that patients with very low LDL-C levels (<85 mg/dL) had more health issues and a higher risk of all-cause mortality compared to those with higher levels, revealing significant risks for various types of death and heart failure.
  • Overall, the research suggests that lower LDL-C levels correlate with more serious health problems and increased mortality risk, highlighting the need for careful management of cholesterol levels in at-risk patients.
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  • Statins are suggested to help prevent recurrent venous thromboembolism (VTE), based on findings from a large study of over 5,000 VTE patients in Japan.
  • The study divided patients into two groups based on statin use at discharge, revealing that the group using statins had a significantly lower incidence of recurrent VTE compared to the non-statin group (6.8% vs. 10.1%) over five years.
  • Although statins also showed a trend towards reducing major bleeding risk, this was not statistically significant after adjusting for confounding factors.
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Background: There is a scarcity of data on the prevalence of abnormal findings on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with aortic stenosis (AS).

Methods: Among consecutive 593 patients with severe AS who were planned to undergo AVR, we evaluated the prevalence of clinically significant incidental noncardiac findings on preprocedural CT. Clinically significant incidental noncardiac findings were defined as newly detected abnormalities that required therapy, consultation for expert, further investigation, or clinical follow-up.

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Aims: In recent years, there has been remarkable development in machine learning (ML) models, showing a trend towards high prediction performance. ML models with high prediction performance often become structurally complex and are frequently perceived as black boxes, hindering intuitive interpretation of the prediction results. We aimed to develop ML models with high prediction performance, interpretability, and superior risk stratification to predict in-hospital mortality and worsening heart failure (WHF) in patients with acute heart failure (AHF).

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Background: There was no study evaluating the effects of an aspirin-free strategy in patients undergoing complex percutaneous coronary intervention (PCI).

Objectives: The authors aimed to evaluate the efficacy and safety of an aspirin-free strategy in patients undergoing complex PCI.

Methods: We conducted the prespecified subgroup analysis based on complex PCI in the STOPDAPT-3 (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3), which randomly compared low-dose prasugrel (3.

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Article Synopsis
  • There is limited data on the outcomes of patients with diabetes who undergo IVUS-guided PCI, particularly in cases of multivessel disease.
  • The study enrolled 1,021 patients, comparing those with diabetes (560 patients) to those without (461 patients), focusing on the incidence of serious health events after the procedure.
  • Results showed similar one-year clinical outcomes for both groups, indicating that diabetes did not significantly increase risks after the procedure when managed with modern practices.
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  • The study analyzed the presence of mitral regurgitation (MR) in patients with severe aortic stenosis (AS) and how it relates to different treatment methods: TAVI, SAVR, and conservative management.
  • Among the 3,365 patients examined, 384 (11.4%) had moderate/severe MR, and this group showed a significantly higher 3-year incidence of death or heart failure (HF) hospitalization compared to those with no/mild MR.
  • The risk of death or HF hospitalization was notably higher in patients treated with SAVR and conservative strategies, while this risk was less clear in those who underwent TAVI.
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Background:  Real-world data on clinical characteristics and outcomes related to the use of different direct oral anticoagulants (DOACs) for cancer-associated venous thromboembolism (VTE) is lacking.

Methods:  The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive patients with acute symptomatic VTE from 31 centers in Japan from January 2015 to August 2020. Our study population comprised 1,197 patients with active cancer who were divided into the edoxaban ( = 643, 54%), rivaroxaban ( = 297, 25%), and apixaban ( = 257, 22%) groups.

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Article Synopsis
  • Direct oral anticoagulants (DOACs) are commonly used for treating venous thromboembolism in cancer patients, yet they can lead to bleeding complications, particularly in those with gastrointestinal (GI) cancers.
  • A study analyzed data from 1,149 cancer patients on DOACs to assess bleeding outcomes, showing that those with upper GI cancer had a higher incidence of major bleeding (22.4%) compared to those with lower GI (15.4%) and non-GI cancers (11.6%).
  • The research concluded that upper GI cancer significantly increases the risk of major bleeding during anticoagulation therapy, unlike lower GI cancer, which had no significant difference in bleeding risk compared to non-GI cancers.
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Article Synopsis
  • Researchers studied unprovoked venous thromboembolisms (VTEs) in a large registry to identify distinct patient phenotypes using latent class analysis (LCA).
  • The study classified patients into three subgroups based on age and health conditions: younger patients, older patients with few comorbidities, and older patients with many comorbidities.
  • Findings revealed differences in treatment outcomes, with higher anticoagulation discontinuation and bleeding risks in older patients with more comorbidities, suggesting tailored management strategies could improve patient care.
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Article Synopsis
  • The ONCO DVT study showed that a 12-month treatment with edoxaban is more effective than a 3-month treatment for preventing blood clots in patients with cancer-associated isolated distal deep vein thrombosis (DVT).
  • In a subgroup analysis, both standard (60 mg/day) and reduced (30 mg/day) dosages of edoxaban had lower rates of recurrent blood clots in those treated for 12 months compared to 3 months, but the risk of major bleeding was higher for the standard dose over 12 months.
  • Overall, while a longer duration of edoxaban treatment is beneficial for reducing thrombotic risk, there is a cautionary note about increased bleeding risks with the higher dosage over extended periods
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Patient-physician sex concordance and outcomes in cardiovascular disease: a systematic review.

Eur Heart J

May 2024

Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA.

The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient-physician sex concordance and its association with outcomes. The authors review the existing literature on the relationship between patient-physician sex concordance and clinical outcomes in patients with cardiovascular disease, the evidence of a benefit in clinical outcomes with female patient-physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.

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Background: Data on the incidence, timing, and severity of myocardial damage after anthracycline-based chemotherapy (AC) in Japanese patients with breast cancer are limited.

Method: We evaluated cancer therapy-related cardiac dysfunction (CTRCD) in Japanese women with breast cancer (n = 51) after the first AC according to the definitions of the 2022 European Society of Cardiology onco-cardiology guideline, including assessment of high-sensitivity troponin I (TnI) and B-type natriuretic peptide (BNP) levels.

Results: CTRCD was detected in 67 % of the patients (3.

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Article Synopsis
  • * Out of 178 patients, 37% received home treatment, with low rates of serious complications: 4.6% had major bleeding, but there were no deaths or recurrent PE in this group.
  • * The findings suggest that certain cancer patients with low-risk PE could safely manage their treatment at home instead of in a hospital setting.
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Introduction: There is limited data on the safety of direct oral anticoagulants (DOACs) in fragile patients with venous thromboembolism (VTE).

Materials And Methods: We used the COMMAND VTE Registry-2 enrolling patients with acute symptomatic VTE. The study population consisted of 3928 patients receiving DOACs, who were divided into fragile (2136 patients) and non-fragile groups (1792 patients).

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Systemic thromboembolism associated with atrial fibrillation (AF) is usually caused by thrombi in the left atrial appendage and acute onset. We experienced an unusual case of a woman in her 60s who presented to the outpatient district having bilateral intermittent claudication for more than 1 month, which turned out to be multiple thromboembolism from asymptomatic AF with tachycardia. She was also complicated with non-ischaemic dilated cardiomyopathy with reduced ejection fraction, consistent with arrhythmia-induced cardiomyopathy (AiCM), along with left atrial and left ventricular thrombi and thromboembolism in multiple organs.

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  • The REDISCOVER consensus conference focused on creating guidelines for the perioperative care of patients with borderline-resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC).
  • Using a structured methodology and expert consensus, the conference developed 34 recommendations on various aspects of surgical care, patient selection, and management of pancreatic cancer.
  • Despite the low evidence quality for most recommendations, participants highlighted the importance of establishing an international registry to enhance understanding and care for this patient group.
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Background: The multicenter, open-label, randomized clinical trial ONCO DVT compared 3-month and 12-month edoxaban treatment regimens for isolated distal deep vein thrombosis (DVT) and suggested potential benefits of prolonged edoxaban treatment in terms of thrombotic risk. However, the risk-benefit balance of prolonged edoxaban treatment in patients with renal function remains unclear.

Objectives: To compare the safety and efficacy of 3-month and 12-month edoxaban treatment regimens in patients with cancer-associated isolated distal DVT and different renal functions.

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