Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis.

This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.

Comprehensive frailty assessment with multidimensional frailty domains as a predictor of mortality among vascular and cardiac surgical patients.

Purpose: The frailty concept has become a fundamental part of daily clinical practice. In this study our purpose was to create a risk estimation method with a comprehensive aspect of patients' preoperative frailty. Patients and methods: In our prospective, observational study, patients were enrolled between September 2014 and August 2017 in the Department of Cardiac Surgery and Department of Vascular Surgery at Semmelweis University, Budapest, Hungary. A comprehensive frailty score was built from four main domains: biological, functional-nutritional, cognitive-psychological and sociological. Each domain contained numerous indicators. In addition, the EUROSCORE for cardiac patients and the Vascular POSSUM for vascular patients were calculated and adjusted for mortality. Results: Data from 228 participants were included for statistical analysis. A total of 161 patients underwent vascular surgery, and 67 underwent cardiac surgery. The preoperatively estimated mortality was not significantly different (median: 2.700, IQR (interquartile range): 2.000-4.900 vs. 3.000, IQR: 1.140-6.000, P = 0.266). The comprehensive frailty index was significantly different (0.400 (0.358-0.467) vs. 0.348 (0.303-0.460), P = 0.001). In deceased patients had elevated comprehensive frailty index (0.371 (0.316-0.445) vs. 0.423 (0.365-0.500), P < 0.001). In the multivariate Cox model an increased risk for mortality in quartiles 2, 3 and 4 compared with quartile 1 as a reference was found (AHR (95% CI): 1.974 (0.982-3.969), 2.306 (1.155-4.603), and 3.058 (1.556-6.010), respectively). Conclusion: The comprehensive frailty index developed in this study could be an important predictor of long-term mortality after vascular or cardiac surgery. Accurate frailty estimation could make the traditional risk scoring systems more accurate and reliable.

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery.

BACKGROUND: The frailty score has been developed to determine physiological functioning capacity. The aim of our research was to explore the relationship between frailty factors and mortality in cardiac surgery patients. METHODS: Our research is an observational, single-center, prospective cohort study (registered on ClinicalTrials.gov: NCT02224222), and we studied 69 patients who underwent elective cardiac surgery between 2014 and 2017. Thirty days before the surgery, they completed a questionnaire that contained questions related to social support, self-reported life quality-happiness, cognitive functions, anxiety and depression. Demographic, anthropometric and medical data were widely collected. The Geriatric Nutritional Risk Index (GNRI) and the Comprehensive Geriatric Assessment (CGA)-based frailty index were calculated as a sum and the domains, respectively. Cox regression and the Kaplan-Meier tests were applied to analyze survival and relative risk. The primary outcome was mid-term mortality. RESULTS: The patients' mean age was 65.43 years [standard deviation (SD): 9.81 years]. The median follow-up was 1,656 days of survival [interquartile range (IQR), 1,336-2,081 years], during this period 14 patients died. The median of EuroSCORE II was 1.56 (1.00-2.58) points. The median preoperative albumin level was 32.80 g/L (IQR, 29.9-35.8 g/L). Major adverse cardiovascular and cerebral events (MACCEs) occurred 7 times during follow-up. The nutrition score of the CGA was significantly associated with worse long-term survival [score; hazard ratio (HR): 5.35; 95% CI: 1.10-25.91, P=0.037]. After adjustment for EuroSCORE II and postoperative complications the noncardiovascular CGA score was associated with overall mortality [adjusted hazard ratio (AHR): 1.44, 95% CI: 1.02-2.04, P=0.036]. In the multivariable Cox regression, GNRI <91 showed an increased risk for mortality (AHR: 4.76, 95% CI: 1.52-14.92, P=0.007). CONCLUSIONS: The CGA-based noncardiovascular score and nutritional status should be assessed before cardiac surgery prehabilitation and may help decrease long-term mortality.

The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery.

BACKGROUND: In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery. METHODS: In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses. RESULTS: The patients' mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004). CONCLUSION: Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.

Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients.

Introduction Opioid derivates are an essential part of everyday clinical pain management practice. They have excellent analgesic, sedative, and sympatholytic effects and are widely used in various conditions. Beyond advantageous aspects, there are numerous problems with the chronic use of these agents. Dependency and life-threatening complications are the biggest problems with both illegal and prescribed opioid derivates. In our current study, effects of chronic opioid use were observed on mortality and life quality in the case of vascular surgery. Methods This prospective, observational study was conducted between 2014 and 2017. After obtaining informed consent, all participants were asked to fill a questionnaire containing different psychological tests. Perioperative data, chronic medical therapy, and anthropometric data were also collected. Opioid user and non-user patients' psychological results were compared with non-parametrical tests. The effect of chronic opioid administration was investigated with logistic regression method with bootstrapping. Results Finally, the data of 164 patients were analyzed. 64.0% of participants were male, the mean age was 67.05 years, and the standard deviation was 9.48 years. The median follow-up time was 1312 days [interquartile range (IQR): 930-1582 days]. During the follow-up time, 42 patients died (25.6%). In the examined patient cohort, the frequency of opioid derivate use was 3.7% (only six patients). In the non-survived group, opioid use was significantly higher (1.6% vs. 9.5%, p=0.019). Significant differences were found in the aspect of cognitive performance measured by Mini-Mental State Examination (MMSE), opioid users have had lower points [25.5 (IQR: 24.5-26.0) vs. 28.0 (IQR: 27.0-29.0) p=0.008]. Opioid users have showed higher score on Beck Depression Inventory (BDI) [15.5 (IQR: 10.0-18.0) vs. 6.0 (IQR: 3.0-11.0), p=0.030). In a multivariate Cox regression model built up from registered preoperative medical treatment, opioids were found as a risk factor for all-cause mortality [adjusted hazard ratio (AHR): 4.31, 95% CI: 1.77-10.55, p=0.001]. Conclusion Our current findings suggest that chronic, preoperative use of opioids could associate with increased mortality. Furthermore, both decrease in cognitive performance and increased depression symptoms were found in the opioid user cohorts which emphasize the importance of further risk stratification of these patients.

Differences in guidelines for patients with carotid artery stenosis in some European countries / A nyaki veroér-szukületes betegek ellátási irányelveinek különbségei Európa különbözo országaiban.

Összefoglaló. A tudomány jelenlegi állása szerint - csoportok összehasonlítására épülo matematikai-statisztikai eszközökkel - a leginkább hatékonynak és hatásosnak vélt kezelési módszerek szisztematikus elemzése mentén, a bizonyítékokon alapuló irányelveken nyugvó gyógyító munkát tekintjük követendonek. A nyaki veroérszukület ellátása esetén az utóbbi években elkészült mind a hazai, mind az európai irányelv, mindemellett a társszakmák irányelveiben is megjelentek kezelési javaslatok. Közleményünkben összehasonlítottuk a témában publikált magyar, angol, német és olasz nyelvu, valamint az európai társaságok által kiadott irányelveket. Az irányelvek alapelveikben hasonlóak, formailag és tartalmilag azonban jelentos (idonként egymásnak ellentmondani látszó) különbségeket találhatunk. Az ellentmondások három leggyakoribb oka: 1) az egyes irányelvek által kituzött célok különbözosége, 2) az aszimptomatikus és szimptomatikus betegcsoport definíciói, valamint 3) az eltéro evidenciaszintek. Az irányelvek összevetése alapján a tünetes, szignifikáns nyaki veroérszukületek sebészi ellátása evidenciának tekintheto. A szimptomatikus nyaki veroérszukület a definíció szerint ellenoldali cerebralis ischaemia okozta, tranziens vagy definitív plegia, paresis, aphasia és az azonos oldali arteria centralis retinae embolisatiója miatti amaurosis fugax. A tünetmentes nyaki veroérszukületek ellátása tekintetében az európai és a nemzeti irányelvek nem azonosak, ezen esetek terápiás döntése egyéni mérlegelést igényel. Tünetmentes, 70%-os stenosis esetén vascularteam-konzílium javasolt. Orv Hetil. 2020; 161(51): 2139-2145. Summary. The correct practice is the one that is proven to be the most effective based on systematic statistical analyses of different treatment methods, and is applied according to evidence-based principles. In recent years, not only has the European Society of Vascular Surgery created a guideline about the management of supra-aortic steno-occlusive disease, but some nations' vascular surgical societies and related disciplines have also developed their own guidance. In this paper, the guidelines by the European societies on the clinical care of patients with carotid artery luminal narrowing is compared to national guidelines published in Hungarian, English, German, and Italian. Although the fundamental points of the guidelines are similar, there are some important differences among them both in presentation and in content; as a result, they sometimes appear to be contradictory. The three main sources of inconsistency are the various goals, the discrepancy in the definition of symptomatic and asymptomatic carotid artery stenosis, and the bias arising from the use of distinct evidence levels. A comparison of guidelines suggests that the treatment of symptomatic significant carotid artery stenosis with surgery can be considered evidence. Symptomatic carotid artery stenosis is defined as transient or definite plegia, paresis, aphasia due to cerebral ischemia, and monocular blindness caused by embolism in the central retinal artery. However, in the case of asymptomatic 70% or greater carotid artery stenosis, the guidelines are quite heterogeneous, and these patients require individual consideration and a vascular team decision is recommended. Orv Hetil. 2020; 161(51): 2139-2145.

La detección de mensajes salientes de papers sobre investigación en ciencias sociales y su aplicación en búsqueda de documentos / The detection of salient mesages from social science research papers and its aplicati on in document search

El procesamiento del lenguaje natural proporciona instrumentos eficaces para ayudar a investigadores a enfrentarse con el cuerpo creciente de literatura científica. Uno de los usos más acertados y bien establecidos es la extracción de la información, por ejemplo, la extracción de entidades y hechos. Esta aplicación, sin embargo, no es del todo aplicable a las ciencias sociales, ya que los mensajes principales de las publicaciones no son hechos sino argumentos. En este artículo proponemos una metodología de procesamiento del lenguaje natural destinado a detectar oraciones que comunican mensajes salientes en trabajos de investigación pertenecientes a las ciencias sociales. Consideramos dos tipos de oraciones que contienen mensajes salientes: oraciones que resumen el artículo en su totalidad o partes del artículo y las oraciones que comunican cuestiones de investigación. Tales oraciones son detectadas usando un analizador gramatical de dependencia y reglas especiales de “unión de conceptos”. En un experimento de prueba-de-concepto hemos mostrado la eficacia de nuestra proposición: buscando artículos en la base de documentos de ciencia educativa construida por el proyecto EERQI hemos descubierto que la presencia de la(s) palabra(s) de pregunta en las oraciones salientes detectadas por nuestro instrumento es un indicador importante de la importancia del artículo. Hemos comparado la importancia de los artículos recuperados con nuestro método con aquellos recuperados por el motor de búsqueda Lucene como configurado para la base de contenido de EERQI, con el ranking de importancia de omisión, que está basado en medidas de frecuencia de palabras. Los resultados son complementarios, lo cual señala la utilidad de la integración de nuestro instrumento en el Lucene.

Natural language processing provides effective tools to help researchers cope with the growing body of scientific literature. One of the most successful and well-established applications is information extraction, i.e. the extraction of named entities andfacts. This application, however, is not well suited to social sciences, since the main messages of the publications are not facts, but rather arguments. In this article we propose a natural language processing methodology in order to detect sentences that convey salient messages in social science research papers. We consider two sentencetypes that bear salient messages: sentences that sum up the entire article or parts of the article and sentences that convey research issues. Such sentences are detected using a dependency parser and special “concept-matching” rules. In a proof-of-concept experiment we have shown the effectiveness of our proposition: searching for articles in the educational science document base built by the EERQI project we have found that the presence of the query word(s) in the salient sentences detected by our tool isan important indicator of the relevance of the article. We have compared the relevance of the articles retrieved with our method with those retrieved by the Lucene search engine as configured for the EERQI content base with the default relevance ranking which is based on word frequency measures. The results are complementary, which points to the utility of the integration of our tool into Lucene.

La detección de mensajes salientes de papers sobre investigación en ciencias sociales y su aplicación en búsqueda de documentos / The detection of salient mesages from social science research papers and its aplicati on in document search

El procesamiento del lenguaje natural proporciona instrumentos eficaces para ayudar a investigadores a enfrentarse con el cuerpo creciente de literatura científica. Uno de los usos más acertados y bien establecidos es la extracción de la información, por ejemplo, la extracción de entidades y hechos. Esta aplicación, sin embargo, no es del todo aplicable a las ciencias sociales, ya que los mensajes principales de las publicaciones no son hechos sino argumentos. En este artículo proponemos una metodología de procesamiento del lenguaje natural destinado a detectar oraciones que comunican mensajes salientes en trabajos de investigación pertenecientes a las ciencias sociales. Consideramos dos tipos de oraciones que contienen mensajes salientes: oraciones que resumen el artículo en su totalidad o partes del artículo y las oraciones que comunican cuestiones de investigación. Tales oraciones son detectadas usando un analizador gramatical de dependencia y reglas especiales de ¶unión de conceptos÷. En un experimento de prueba-de-concepto hemos mostrado la eficacia de nuestra proposición: buscando artículos en la base de documentos de ciencia educativa construida por el proyecto EERQI hemos descubierto que la presencia de la(s) palabra(s) de pregunta en las oraciones salientes detectadas por nuestro instrumento es un indicador importante de la importancia del artículo. Hemos comparado la importancia de los artículos recuperados con nuestro método con aquellos recuperados por el motor de búsqueda Lucene como configurado para la base de contenido de EERQI, con el ranking de importancia de omisión, que está basado en medidas de frecuencia de palabras. Los resultados son complementarios, lo cual señala la utilidad de la integración de nuestro instrumento en el Lucene.(AU)

Natural language processing provides effective tools to help researchers cope with the growing body of scientific literature. One of the most successful and well-established applications is information extraction, i.e. the extraction of named entities andfacts. This application, however, is not well suited to social sciences, since the main messages of the publications are not facts, but rather arguments. In this article we propose a natural language processing methodology in order to detect sentences that convey salient messages in social science research papers. We consider two sentencetypes that bear salient messages: sentences that sum up the entire article or parts of the article and sentences that convey research issues. Such sentences are detected using a dependency parser and special ¶concept-matching÷ rules. In a proof-of-concept experiment we have shown the effectiveness of our proposition: searching for articles in the educational science document base built by the EERQI project we have found that the presence of the query word(s) in the salient sentences detected by our tool isan important indicator of the relevance of the article. We have compared the relevance of the articles retrieved with our method with those retrieved by the Lucene search engine as configured for the EERQI content base with the default relevance ranking which is based on word frequency measures. The results are complementary, which points to the utility of the integration of our tool into Lucene.(AU)