20966 research outputs found
Sort by
Outcomes of carotid artery stenting for nonatherosclerotic disease
No full textOBJECTIVE: This study aims to evaluate and compare the outcomes of transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (tfCAS) in patients with nonatherosclerotic carotid diseases, including dissection, trauma, and fibromuscular dysplasia.
METHODS: Patients who underwent TCAR and tfCAS for nonatherosclerotic carotid diseases between 2016 and 2024 were identified in the Vascular Quality Initiative (VQI) database. Patients were classified into TCAR or tfCAS based on the procedure performed. Baseline characteristics, demographics, and operative details were collected. Primary outcomes included stroke, death, and major adverse cardiovascular events (MACE), which was defined as the composite of stroke, myocardial infarction, and death. Secondary outcomes included perioperative complications. Descriptive statistics, univariable comparisons, and multivariable logistic regression analyses were performed to evaluate the association between procedure type and outcomes. A two-tailed P value of \u3c .05 was considered statistically significant.
RESULTS: Six hundred seventy six patients were identified (tfCAS, n = 503; TCAR, n = 173). TCAR patients were older (64 ± 14 years vs 56 ± 16 years; P \u3c .001), and had higher rates of hypertension (74% vs 60.4%; P = .001) and coronary artery disease (34.1% vs 22.2%; P = .002). Dissection was the most common etiology (TCAR, 77.5%; tfCAS, 77.9%), followed by fibromuscular dysplasia (TCAR, 14.5%; tfCAS, 10.5%) then trauma (TCAR, 8.1%; tfCAS, 11.5%). Intraoperatively, TCAR patients had shorter fluoroscopy times (5 minutes vs 18.25 minutes; P \u3c .001) and required less radiocontrast (30 mL vs 95 mL; P \u3c .001), but had slightly longer procedure times (75.5 minutes vs 69 minutes; P = .055). When analyzed by procedure type, TCAR was associated with significantly lower rates of MACE (1.2% vs 7%; P = .004) and stroke/death (1.2% vs 6.4%; P = .007) compared with tfCAS. Furthermore, when stratified by symptomatic status, TCAR consistently had lower rates of MACE and stroke/death. On multivariate analysis, TCAR was independently associated with a significantly lower risk of MACE (odds ratio, 0.09; 95% confidence interval, 0.01-0.74; P = .025) and stroke/death (odds ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .045).
CONCLUSIONS: TCAR was associated with superior perioperative outcomes compared with tfCAS in the treatment of nonatherosclerotic carotid diseases. These findings highlight TCAR\u27s potential to be a safer and more effective treatment option for this challenging patient population
Socioeconomic Disparities Explain Increased Exacerbations Among Black Patients With Severe Asthma
No full textBACKGROUND: In the United States (US), Black patients with asthma experience higher exacerbation rates compared with non-Black patients.
OBJECTIVE: To identify factors that might explain the exacerbation rate association with race in a cohort of patients with severe asthma (SA).
METHODS: CHRONICLE was an observational study of US adults with SA treated by allergists-immunologists or pulmonologists. The analysis population was patients not receiving biologic treatment. We used propensity score (PS) methods to identify factors associated with Black race. Non-Black-non-Hispanic or Latino patients (non-Black) were the control group. A generalized linear model (GLM) assessed the association between Black race and exacerbation rate, adjusted for the PS.
RESULTS: Between February 2018 and July 2022, 180 Black and 574 non-Black patients were eligible for PS analysis. Socioeconomic status was the strongest discriminator of race (C statistic of 0.75), followed by environment (0.65), demographics (0.64), smoking status (0.55), and comorbidities (0.55). Before adjusting for PS, the GLM showed a 1.28-fold higher exacerbation rate among Black patients compared with non-Black patients (rate ratio = 1.28; 95% CI, 1.01-1.62; P = .039). In the PS-adjusted GLM, Black race was no longer associated with the exacerbation rate (rate ratio = 0.87; 95% CI, 0.56-1.35; P = .522). Results were similar for asthma-related emergency department visit and hospitalization rates.
CONCLUSIONS: Higher exacerbation rates in Black patients with SA may be explained by factors associated with Black race, such as socioeconomic status. Addressing socioeconomic disparities and social determinants of health may help reduce the exacerbation risk difference observed between Black and non-Black patients with SA
The Year in Aortic Surgery: Selected Highlights from 2024
No full textThis is the second special article in a series that discusses important highlights in the field of aortic surgery. Specifically, this article reviews (1) outcomes in type A dissection, (2) recommendations related to ascending aortic disease from the 2024 European Society of Cardiology guideline, (3) Kommerell diverticulum, and (4) differences in outcomes in aortic surgery based on sex. The aim of this review is to aid cardiac anesthesiologists in keeping up to date on the latest literature in a field that is constantly evolving
Deucravacitinib, an Oral, Selective, Allosteric Tyrosine Kinase 2 Inhibitor, in Asian Patients With Moderate to Severe Psoriasis: Improvements in Patient-Reported Outcomes in a Randomized Trial
No full textPOETYK PSO-3, a 52-week, double-blind, phase 3 study, evaluated the efficacy and safety of deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, in adult patients with moderate to severe plaque psoriasis in mainland China, Taiwan, and South Korea. Secondary and additional endpoints included improvement on two patient-reported outcome measures: the Psoriasis Symptoms and Signs Diary (PSSD) total score and the Dermatology Life Quality Index (DLQI). Patients were randomized 1:2 to placebo or deucravacitinib 6 mg once daily; at week 16, patients receiving placebo crossed over to receive deucravacitinib. PSSD and DLQI score changes from baseline and response rates for achieving meaningful within-patient change from baseline in PSSD total score (≥ 15 points) and DLQI of 0 or 1 (DLQI 0/1) were assessed over 52 weeks. In POETYK PSO-3, 74 patients were randomized to placebo and 146 patients to deucravacitinib. At week 16, mean (95% confidence interval [CI]) PSSD total score changes from baseline were -1.9 (-6.9, 3.1) and -28.8 (-32.6, -25.0) in patients receiving placebo and deucravacitinib, respectively. At both weeks 16 and 52, the response rate for ≥ 15-point meaningful change in PSSD total score (95% CI) was 73.3% (65.3, 80.3) in the group randomized to deucravacitinib. At week 16, mean (95% CI) DLQI changes from baseline were -1.7 (-3.1, -0.4) and -7.4 (-8.4, -6.4) in patients receiving placebo and deucravacitinib, respectively. In patients randomized to deucravacitinib, DLQI 0/1 response rates (95% CI) at weeks 16 and 52 were 36.4% (28.5, 44.4) and 44.7% (36.5, 52.9), respectively. Deucravacitinib was associated with meaningful and sustained improvements in psoriasis symptoms and signs and in quality of life in Asian patients with moderate to severe plaque psoriasis. Trial Registration: ClinicalTrials.gov identifier: NCT04167462
Squamous Cell Carcinoma Arising in Extragenital Lichen Sclerosus et Atrophicus in a Fitzpatrick Type VI Patient
No full text
Photographic Assessment of the Anatomic Localization and Extent of Hidradenitis Suppurativa: A Delphi Study
No full textBACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease with fluctuating activity that requires long-term visual documentation to evaluate disease severity and treatment response. A standardized protocol for photographing HS is critically needed.
OBJECTIVES: To establish a standardized protocol for using photography to clinically document HS.
METHODS: We brought together a panel of international experts and used a modified Delphi process to reach consensus on statements about standardized practices for using photography to document HS in clinical practice and research settings. A 75% agreement level was prespecified as the cutoff for consensus.
RESULTS: Consensus for photographically documenting HS was developed within 6 key areas: patient preparation, background, lighting, size and reference scale, camera considerations, and patient positioning. The revised and optimized protocol includes 34 standardized reference illustrations. However, the proposed recommendations are for ideal scenarios, and their implementation may not always be practical in a clinical setting. Variations in resources may not have been captured.
CONCLUSIONS: The proposed consensus-based protocol provides a standard for consistent photographic documentation of HS. This protocol may help clinicians provide better disease surveillance and patient care, and it may aid in more precise and reliable research and clinical trials for HS
NASCI case of the month: the role of FDG PET-CT in detecting active Takayasu arteritis
No full textTakayasu arteritis (TA) is a chronic, granulomatous vasculitis which primarily affects large elastic arteries including the aorta and its major branches, leading to stenosis, occlusion, and aneurysm formation [de Souza et al. in Journal of Autoimmunity 48:79-83, 2014; Pelletier-Galarneau and Ruddy in Current Cardiology Reports 21(5), 2019, https://doi.org/10.1007/s11886-019-1122-z ]. Additional sequelae include heart failure secondary to hypertension, aortic regurgitation, and coronary artery involvement [Comarmond et al. in Circulation 136(12):1114-1122, 2017]. We describe the case of a young woman with progressive TA highlighting the role of fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET CT) in evaluating active inflammation. While FDG-PET CT can also be used to monitor response to treatment, this case demonstrates the utility of FDG-PET CT in evaluating active arteritis, allowing radiologists to help the clinician in guiding appropriate management
Reduction in D-dimer levels after treatment with Auxora in patients with severe COVID-19 pneumonia
No full textIntroduction: A phase 2 double-blinded trial (CARDEA) (NCT04345614) in patients diagnosed with COVID-19 revealed that intravenous zegocractin treatment (Auxora™) was associated with improved clinical outcomes compared to standard of care (SOC). D-dimer serum level is a biomarker of thrombosis in COVID-19, and elevated levels are directly correlated with a high risk of poor outcomes. Here, we report biomarker analyses from blood samples collected from patients in that study.
Methods: Quantification of D-dimer levels was the primary endpoint of the study. Secondary endpoints measured levels of angiopoietin 1 (Ang1), angiopoietin 2 (Ang2), soluble CD25 (sCD25), and renin. CARDEA was conducted in 17 U S. clinical centers. Patients were randomly assigned to receive Auxora plus SOC (n = 143) or placebo plus SOC (n = 141). The medications were administered by a 4-h intravenous infusion at 2.0 mg/kg (1.25 mL/kg) at 0-h and 1.6 mg/kg (1 mL/kg) at 24 h and 48 h.
Findings: Patients in the Auxora group had a baseline mean D-dimer value of 2.61 mg/L and those in the placebo group had a value of 2.05 mg/L. Treatment with Auxora resulted in a statistically significant decrease in D-dimer levels within the first 72 h compared to placebo (delta = −0.92; [95 % CI: −1.82, −0.02]; p \u3c 0.046). The decrease in D-dimer levels correlated with an increase in imputed PaO2/FiO2 at 72 h (r: −0.193; p \u3c 0.05) and improved clinical status at 168 h (r: 0.218, p \u3c 0.01). Auxora treatment reduced levels of Ang2 and sCD25, and increased Ang1 levels compared to placebo.
Conclusion: Auxora treatment significantly reduced D-dimer levels in patients diagnosed with COVID-19, and the decrease was associated with an improved clinical status