Long-term outcomes of left atrial appendage closure with or without concomitant pulmonary vein isolation:a propensity score matching analysis based on CLACBAC study.

BACKGROUND: The combined procedure of left atrial appendage closure (LAAC) with concomitant pulmonary vein isolation (PVI) has demonstrated its efficacy and safety. However, there is still a lack of comparative investigations regarding the long-term benefits of the combined procedure when compared to LAAC alone. Our study aims to assess the long-term outcomes of combined procedure of LAAC with concomitant PVI in comparison with a propensity matched LAAC alone group. METHODS: Propensity score matching (PSM) was employed to rectify covariate imbalances, resulting in the inclusion of 153 comparable patients from the initial cohort of 333 non-valvular atrial fibrillation (AF) patients. Clinical outcomes, encompassing thrombotic events, major cardiocerebrovascular adverse events (MACCE), re-hospitalization due to cardiovascular disease (CVD), and atrial tachycardia (AT), were juxtaposed between the two groups. Bleeding events and peri-device complications, such as residual flow, device-related thrombus, and device replacement, were also compared. Additionally, a patients group underwent PVI alone was included for comparing AF recurrence rates between the PVI alone group and the combined group. RESULTS: Following PSM, 153 patients (mean age 70.3 ± 8.9, 62.7% men) were included, with 102 undergoing the combined procedure and 51 undergoing LAAC alone. No significant differences were found in baseline characteristics between the two groups. The mean follow-up time was 37.6 ± 7.9 months, and two patients were lost to follow-up in the combined procedure group. Thrombotic events were observed in 4 (7.8%) patients in the LAAC alone group and 4 (4.0%) in the combined group (Log-rank p = 0.301). The proportion of patients experiencing MACCE, re-hospitalization due to CVD, and AT between the two groups was comparable, as were bleeding events and peri-device complications. Among patients from the combined procedure group without AF recurrence, a significant difference was noted in prior-procedure left ventricular ejection fraction (LVEF) and LVEF at the 12th month after the procedure (57.2% ± 7.1% vs. 60.5% ± 6.5%, p = 0.002). CONCLUSION: The concomitant PVI and LAAC procedure did not increase procedure-related complications, nor did it confer significant benefits in preventing thrombotic events or reducing other cardiovascular events. However, the combined procedure improved heart function, suggesting potential long-term benefits.

Effects of Nurse-Led Support Via WeChat, a Smartphone Application, for Breast Cancer Patients After Surgery: A Quasi-Experimental Study.

Background: Women with breast cancer (BC) commonly experience physical and psychosocial symptoms after surgery. Web- and smartphone-based support can significantly improve women's symptoms and quality of life. Social care applications (apps) are widely used in China, but there are few studies on their effectiveness BC support. This study aimed to examine the effects of nurse-led support on the social care app WeChat® (Tencent Holdings Limited, Shenzhen, China) in BC patients after surgery. Methods: A quasi-experimental study was conducted between June 2015 and August 2015. Sixty patients with BC (30 in the intervention group, 30 in the control group) were enrolled. Subjects in the intervention group participated in a WeChat-based support program (WSP) led by nurses, while subjects in the control group received a follow-up by telephone. Subjects in both groups were evaluated at the time of discharge and at 1, 3, and 6 months of follow-up. Physical well-being status, psychology status, and social support were evaluated. Results: There were no differences between intervention and control patients at baseline. Physical well-being (p < 0.001), anxiety (p < 0.001), depression (p < 0.001), and support from outside of family (p = 0.037) were significantly better in the intervention group than in the control group after 6 months. The intervention group showed that physical well-being (p = 0.036), anxiety (p < 0.001), and depression (p < 0.001) were significantly different from baseline to 6 months of follow-up. Conclusion: WSP assisted with nurse-led support and had physical, psychological, and social benefits for patients after surgery for BC.

Comparison of fast track protocol and standard care in patients undergoing elective open colorectal resection: a meta-analysis update.

OBJECTIVE: We conducted a systematic review of randomized controlled trials assessing the clinical results of fast track protocol (FTP) and standard care (SC) in patients undergoing elective open colorectal resection using meta-analysis. METHOD: A literature search for electronic databases and references for eligible studies was conducted through Medline, Embase and Cochrane library between 1966 and 2013. RESULT: A total of 9 randomized controlled trials (n=947 patients) were included. From the pooled results, we obtained: FTP showed significantly better results compared to SC in terms of postoperative complications, total hospital stay as well as time for flatus, defecation, and soft diet. However, no difference in the incidence of readmission was observed. Postoperative rate of death within 4 weeks did not differ significantly between two groups. CONCLUSION: The current evidence of this meta-analysis suggested that fast track protocol after colorectal surgery pathways might be able to reduce postoperative complication rates, length of hospital stay as well as time for gut function recovery without affecting readmission rate or mortality compared to standard care.

Global Trends in Orthopedic Biofilm Research: A Bibliometric Analysis of 1994-2022.

Objective: Bibliometric analysis is commonly used to visualize the knowledge foundation, trends, and patterns in a specific scientific field by performing a quantitative evaluation of the relevant literature. The purpose of this study was to perform a bibliometric analysis of recent studies in the field of orthopedic biofilm research and identify its current trends and hotspots. Methods: Research studies were retrieved from the Web of Science Core Collection and Scopus databases and analyzed in bibliometrix with R package (4.2.2). Results: A total of 2426 literature were included in the study. Journal of orthopaedic research and Clinical orthopaedics and related research ranked first in terms of productivity and impact, with 57 published articles and 32 h-index, respectively. Trampuz A, Ohio State Univ and the United States ranked as the most productive authors, institutions, and countries. Biofilm formation, role of sonication, biomaterial mechanism and antibiotic loading have been investigated as the trend and hotspots in the field of orthopedic biofilm research. Conclusion: This study provides a thorough overview of the state of the art of current orthopedic biofilm research and offers valuable insights into recent trends and hotspots in this field.

Barriers and facilitators to bridging the healthcare digital divide for the older adults: A qualitative research from patients in China.

AIM: The aim of this study was to explore the barriers and facilitators underlying the healthcare digital divide by using qualitative methodologies, integrated with the Capabilities, Opportunities, Motivations, and Behaviors (COM-B) as well as the Behavior Change Wheel (BCW) theoretical frameworks. METHODS: To conduct a thorough analysis, semi-structured，in-depth interviews were orchestrated among a cohort of older patients who had experiences with digital healthcare systems. Data were meticulously analyzed via Colaizzi's seven-step methodological procedure. RESULTS: Nine barriers were elucidated, including physical limitation, inadequate training and support, self-imposed denial, failure to rebuild the digital healthcare environment, equipment constraints, deficits in communication and feedback, skepticism regarding data accuracy and validity, sense of social deprivation, and network information boycott. Conversely, eleven facilitators were identified, encompassing peer modeling, availability of training and support, reconstructive efforts toward the digital healthcare environment, mandatory usage, familial influence, media impact, scientific publicity and education, enhancement of self-efficacy, sense of social participation, perceived convenience, and access to healthful information. CONCLUSION: Based on the COM-B and BCW models, healthcare organizations may be able to improve their digital healthcare support systems (capabilities), technical design, network speed, and equipment configuration (opportunities), as well as focus on "human-computer integration," the parallel existence of digital technology and humanistic care, and taking into account the issues of information security, accuracy, and human rights equality (motivation) while benefiting the patients, in order to bridge the healthcare digital divide for the older adults.

Artificial intelligence applications in bone fractures: A bibliometric and science mapping analysis.

Background: Bone fractures are a common medical issue worldwide, causing a serious economic burden on society. In recent years, the application of artificial intelligence (AI) in the field of fracture has developed rapidly, especially in fracture diagnosis, where AI has shown significant capabilities comparable to those of professional orthopedic surgeons. This study aimed to review the development process and applications of AI in the field of fracture using bibliometric analysis, while analyzing the research hotspots and future trends in the field. Materials and methods: Studies on AI and fracture were retrieved from the Web of Science Core Collections since 1990, a retrospective bibliometric and visualized study of the filtered data was conducted through CiteSpace and Bibliometrix R package. Results: A total of 1063 publications were included in the analysis, with the annual publication rapidly growing since 2017. China had the most publications, and the United States had the most citations. Technical University of Munich, Germany, had the most publications. Doornberg JN was the most productive author. Most research in this field was published in Scientific Reports. Doi K's 2007 review in Computerized Medical Imaging and Graphics was the most influential paper. Conclusion: AI application in fracture has achieved outstanding results and will continue to progress. In this study, we used a bibliometric analysis to assist researchers in understanding the basic knowledge structure, research hotspots, and future trends in this field, to further promote the development of AI applications in fracture.

Stratification of venous thromboembolism risk in stroke patients by Caprini score.

BACKGROUND: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolus (PE) is a serious complication in hospitalized stroke patients. This study is designed to examine the incidence of VTE and the effectiveness of chemo thromboprophylaxis in this population. METHODS: From January 2015 to April 2018, we calculate the Caprini score for every admitted patient to evaluate VTE risk. For analysis Demographic information, Caprini score, national institutes of health stroke scale (NIHSS) score, prothrombin time (PT), thrombin time (TT), D-Dimer and medical co-morbidity are noted. RESULTS: Of 3,824 inpatients during the study period, 21 patients (0.55%) have VTE complications. Among patients (n=148) with a Caprini score between 0 and 2, 1 patient (0.68%) have VTE. VTE (52.38%) most commonly occurred in patients of Caprini score 7-8 group. In patients with VTE (n=21) age, Caprini score, NIHSS score, National Early Warning Score (NEWS) score, PT, TT, D-Dimer are significantly higher than those (n=3,803) without VTE (P<0.05). CONCLUSIONS: The Caprini score is highly recommended to assess the risk of venous thrombosis in stroke patients. Early mechanical and chemical prophylaxis are recommended for patients to reduce the incidence of venous thrombosis.

Outcome of hemiarthroplasty and total hip replacement for active elderly patients with displaced femoral neck fractures: a meta-analysis of 8 randomized clinical trials.

BACKGROUND: Displaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis. METHODS: A literature search for randomized clinical trials was conducted through Medline, Embase and Cochrane library between 1969 and 2013 with no restrictions. Additional relevant articles were referred as source of information by way of manual searches on major orthopedic journals. Upon the search, two authors independently evaluated study quality and relevant data was extracted. RESULTS: A total of 8 studies with 983 patients were included in this meta-analysis. After pooling the available data, a significant dominance of Harris hip score was found for total hip replacement compared with hemiarthroplasty (SMD: -7.11, 95%:-10.70,-3.53) one year postoperatively and the advantage kept over (SMD: -6.91, 95%:-12.98, -0.85) two years after surgery. A trend toward a higher dislocation rate was found in total hip replacement group (RR: 0.46, 95%: 0.21, 1.02), of which the difference was considered insignificant. The risk of revision in group hemiarthroplasty appeared to be more than two folds higher than that after total hip replacement (RR: 4.14, 95%CI: 2.09, 8.19). CONCLUSION: Even though there is a higher rate of dislocation after total hip replacement, this disadvantage could be accounted for, on the basis of a better functional score and the lower revision rate. However, from the results, it stands to reason that total hip replacement should be strongly suggested in elderly active patients with femoral neck fracture.

Effectiveness of silver-impregnated central venous catheters for preventing catheter-related blood stream infections: a meta-analysis.

OBJECTIVES: The purpose of this meta-analysis was to examine the effectiveness of silver-impregnated central venous catheters (CVCs) in preventing catheter bacterial colonization and catheter-related blood stream infections (CRBSIs). METHODS: PubMed, Cochrane, and Embase databases were searched up to April 30, 2014. Studies in which other antiseptic reagents were used (e.g., chlorhexidine, octenidine dihydrochloride, urokinase rinses, benzalkonium chloride, rifampin-minocycline) were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Tests of heterogeneity and publication bias were performed. RESULTS: Twelve studies were included in the meta-analysis. The studies enrolled a total of 2854 patients; 1440 received a standard CVC and 1414 received a silver-impregnated CVC. No significant difference in catheter bacterial colonization rates was found between silver-impregnated and standard CVCs (OR 0.907, 95% CI 0.758-1.087, p=0.290). No significant difference in CRBSI rates was found between silver-impregnated and standard CVCs (pooled OR 0.721, 95% CI 0.476-1.094, p=0.124). No significant heterogeneity or publication bias was noted. CONCLUSIONS: Silver-impregnated CVCs are not associated with reduced rates of bacterial colonization or CRBSI.