Rejoining Veins for Forced Maturation of Small-Caliber Arteriovenous Fistula.

BACKGROUND: To evaluate the efficacy of rejoining mainstream and accessory veins for forced maturation of autogenous arteriovenous fistula (AVF). METHODS: Twenty-three patients who underwent forced maturation through vein rejoining between January 2018 and September 2022 were included. In cases where AVF maturation failure due to the presence of accessory veins, rejoining was primarily considered when distinguishing the main branch becomes challenging. This difficulty typically occurs when the sizes of the 2 vessels are nearly equal and the combined diameters of these veins exceed 6 mm. RESULTS: The mean age and follow-up duration were 57.39 ± 16.22 years and 965.65 ± 573.42 days, respectively. Rejoining of both arterial and venous cannulation sites was performed in 11 patients (47.8%), and rejoining of only the venous cannulation site or only the arterial cannulation site was performed in 11 patients (47.8%) and 1 patient (4.3%), respectively. The mean vein size was 0.35 ± 0.06 cm before rejoining and 0.69 ± 0.07 cm after surgery, indicating a significant increase in size (P < 0.01), whereas the flow did not change significantly following rejoining surgery. Maturation and cannulation success was 100%. The 1-year primary patency rate after surgery was 82.0%. During the follow-up period, 34.8% of the patients required additional percutaneous transluminal angioplasty to maintain patency, and 2 patients (11.8%) had stenosis in the rejoined section. CONCLUSIONS: Rejoining surgery is an effective method for achieving AVF maturation in patients with accessory veins when identification of the mainstream vein is difficult, and this method may be considered when achieving maturation by sacrificing 1 vein is expected to be challenging.

Changes in the Remaining Iliac Artery According to Retrograde Flow after Aorto-Femoral Bypass in Abdominal Aortic Aneurysms.

BACKGROUND: Considering a patient's anatomy and vascular conditions, aorto-femoral bypass is a treatment approach for the open repair of abdominal aortic aneurysms. This study aimed at evaluating changes in the remnant iliac artery and their correlation with the preservation state of retrograde flow from femoral anastomosis. METHODS: Of 221 patients who underwent abdominal aortic aneurysm surgery between 2007 and 2022 in Pusan National University Hospital, 29 patients who underwent aorto-femoral bypass were included in this retrospective cohort study. Of these patients, 21 underwent aortobifemoral bypass and 8 underwent aortoiliac-and-femoral bypass. The change in size of the iliac artery from preoperative to postoperative and whether this difference in size depended on the status of postoperative retrograde flow were investigated. Additionally, factors affecting overall mortality and ischemic complications were identified. RESULTS: The median duration from operation to the last follow-up was 2069.5 days (about 5.7 years). The average age of the patients was 78.1 years, and the proportion of males was 75.9%. In cases of disappearance of postoperative retrograde flow from the femoral anastomosis, the postoperative iliac artery size was significantly reduced compared to its preoperative size (18.4 ± 18.9 mm vs. 13.2 ± 7.9 mm, respectively; P = 0.04). The group with maintained retrograde flow had significantly larger residual common iliac artery size than the group with disappearance of flow. (20.0 ± 28.0 mm vs. 14.6 ± 8.5 mm, respectively; P = 0.02). Disappearance of retrograde flow was a significant factor in the iliac artery size reduction after surgery (odds ratio, 2.5; 95% confidence interval, 1.9-5.3; P = 0.02). Three patients with maintained retrograde flow (18.8%) required intervention owing to an increase in the size of the iliac artery. The factors that significantly influenced overall death as analyzed by Cox proportional hazard regression were chronic obstructive pulmonary disease (hazard ratio, 36.8; 95% confidence interval, 1.6-870.0; P = 0.03), peripheral arterial occlusive disease (hazard ratio, 12.7; 95% confidence interval, 1.4-115.8; P = 0.02), and disappearance of retrograde flow (hazard ratio, 8.7; 95% confidence interval, 1.2-63.9; P = 0.03). CONCLUSIONS: Among the open repair methods for abdominal aortic aneurysms, if retrograde flow was not maintained through femoral anastomosis when aorto-femoral bypass was performed, the size of the remaining iliac artery decreased. However, loss of retrograde flow increased long-term mortality. When aorto-femoral bypass is performed, regular imaging follow-up is necessary at appropriate intervals to check the remnant iliac artery and retrograde flow.

Review of scoring systems for predicting 30-day mortality in ruptured abdominal aortic aneurysm.

BACKGROUND: Ruptured abdominal aortic aneurysms (rAAAs) are a serious disease that can lead to high mortality; thus, their early prediction can save patients' lives. The aim of this study was to compare the accuracies of various models for predicting rAAA mortality-including the Glasgow Aneurysm Score (GAS), Vancouver Scoring System (VSS), Dutch Aneurysm Score (DAS), Edinburgh Ruptured Aneurysm Score (ERAS), and Hardman index-based on rAAA treatment outcomes at our institution. METHODS: Between 2016 and 2022, we retrospectively analyzed the early outcome data-including 30-day mortality-of patients who underwent emergency surgery for rAAA at our institution. Receiver operating characteristic (ROC) curve analysis was performed to compare the aneurysm scoring systems for mortality using the area under the ROC curve (AUC). RESULTS: The AUC was better for the ERAS (0.718; 95% confidence interval [CI], 0.601-0.817) than for the other scoring systems. Significant differences were observed between ERASs and Hardman indices (difference: 0.179; p=0.016). No significant differences were found among the GAS, VSS, and DAS predictive risk models. CONCLUSIONS: Among the models for predicting mortality in patients with rAAA, the ERAS model demonstrated the highest AUC value; however, significant differences were only observed between ERASs and Hardman indices. This study may help develop strategies for improving rAAA prediction.

Outcomes in trauma patients undergoing veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome.

BACKGROUND: The use of veno-venous extracorporeal membrane oxygenation (VV ECMO) remains controversial in trauma patients with acute respiratory distress syndrome (ARDS). Here, we aimed to investigate the therapeutic benefits of VV ECMO and the factors affecting patient outcomes. METHODS: From 2017 to 2019, 21/1938 trauma patients (median age: 47 years; 18 men) at a level I trauma center received VV ECMO for post-traumatic ARDS. Demographic, injury-specific, ECMO, and outcome data were prospectively collected and retrospectively reviewed to analyze the factors affecting hospital mortality and ECMO results. RESULTS: 19 patients (90.5%) were successfully weaned off ECMO; 16 patients (76.2%) survived to discharge. In univariate analysis, there was a significant difference in survival between the groups with a Trauma and Injury Severity Score (TRISS) ⩾0.5 and TRISS <0.5 (p = 0.05). The area under the receiver operating characteristic curve (AUC) for both TRISS and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores for death was 0.78. In those who failed ECMO weaning, the AUCs of the TRISS and RESP scores were 0.90 and 0.80, respectively. CONCLUSIONS: In patients with ARDS caused by severe trauma and supported by VV ECMO, survival is associated with TRISS; TRISS and RESP scores may be predictive of mortality and failure in ECMO weaning.

Failure to preserve the internal iliac artery during abdominal aortic aneurysm repair is associated with mortality and ischemic complications.

OBJECTIVE: Open or endovascular repair of abdominal aortic aneurysms (AAAs) can involve sacrifice of the internal iliac artery (IIA). In the present study, we investigated the effect of IIA exclusion on ischemic complications and overall mortality. METHODS: The data from 326 patients who had undergone elective open surgical or endovascular treatment of a nonruptured AAA from January 2010 to December 2019 in a tertiary hospital were retrospectively reviewed. Ischemic complications included buttock claudication, spinal ischemia (including paraparesis), ischemic colitis, lower limb paresthesia, and skin necrosis. Their duration and mortality during the study period were investigated. RESULTS: Nearly 50% of patients (148; 45.4%) had undergone endovascular aortic aneurysm repair and 178 (54.6%) had undergone open surgery. The median patient age was 78 years (range, 31-94 years). The median follow-up period was 1140 days (range, 0-4757 days). Of the 326 patients, 50 (15.3%) had died during follow-up. The bilateral IIAs were preserved in 187 patients (57.4%), a single IIA in 86 patients (26.4%), and no IIA in 53 patients (16.3%). Ischemic complications occurred in 57 patients (17.5%). Multivariable analysis revealed failure to preserve the bilateral IIAs (hazard ratio [HR], 8.65; 95% confidence interval [CI], 4.31-17.36; P < .01), management of the IIA (HR, 3.05, 95% CI, 2.17-4.28; P < .01), and hyperlipidemia (HR, 2.09; 95% CI, 1.04-4.17; P = .04) affected the occurrence of ischemic complications. Furthermore, univariable analysis revealed that patients had experienced more ischemic complications when a single IIA (HR, 6.97; 95% CI, 3.74-13.02; P < .01) or none of the IIAs had been preserved (HR, 8.88; 95% CI, 4.12-19.16; P < .01) than when both IIAs were preserved. Moreover, multivariable analysis revealed that stage 5 chronic kidney disease (HR, 2.7; 95% CI, 1.09-6.14; P = .03), age >75 years (HR, 2.48; 95% CI, 1.12-5.49; P = .03), cerebrovascular accident (HR, 1.95; 95% CI, 1.00-3.78; P = .05), and failure to preserve the bilateral IIAs (HR, 1.91; 95% CI, 1.02-3.46; P = .04) were associated with higher mortality after AAA repair. CONCLUSIONS: IIA exclusion is a risk factor for ischemic complications and overall mortality. Thus, preservation of the IIA as much as possible during AAA repair is recommended.

Reverse shock index multiplied by Glasgow coma scale as a predictor of massive transfusion in trauma.

BACKGROUND AND PURPOSE: Previous studies have identified that the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) is a good predictor of mortality in trauma patients. However, it is unknown if rSIG has utility as a predictor for massive transfusion (MT) in trauma patients. The present study evaluated the ability of rSIG to predict MT in trauma patients. METHODS: This was a retrospective, observational study performed at a level 1 trauma center. Consecutive patients who presented to the trauma center emergency department between January 2016 and December 2018 were included. The predictive ability of rSIG for MT was assessed as our primary outcome measure. Our secondary outcome measures were the predictive ability of rSIG for coagulopathy, in-hospital mortality, and 24-h mortality. We compared the prognostic performance of rSIG with the shock index, age shock index, and quick Sequential Organ Failure Assessment. RESULTS: In total, 1627 patients were included and 117 (7.2%) patients received MT. rSIG showed the highest area under the receiver operating characteristic (AUROC) curve (0.842; 95% confidence interval [CI], 0.806--0.878) for predicting MT. rSIG also showed the highest AUROC for predicting coagulopathy (0.769; 95% CI, 0.728-0.809), in-hospital mortality (AUROC 0.812; 95% CI, 0.772-0.852), and 24-h mortality (AUROC 0.826; 95% CI, 0.789-0.864). The sensitivity of rSIG for MT was 0.79, and the specificity of rSIG for MT was 0.77. All tools had a high negative predictive value and low positive predictive value. CONCLUSION: rSIG is a useful, rapid, and accurate predictor for MT, coagulopathy, in-hospital mortality, and 24- h mortality in trauma patients.

Surgical Experience of Behcet's Disease Involving the Peripheral Artery.

BACKGROUND: Behcet's disease with arterial involvement shows rapid poor progression compared with Behcet's disease without arterial involvement, such that it may be thought of as a different disease. With arterial involvement, high rates of postoperative recurrence and anastomotic complications are observed. METHODS: The medical records of 1,361 patients diagnosed with Behcet's disease who visited our hospital from January 2007 to December 2019 were reviewed. Overall, 118 patients with blood vessel involvement were considered. Those with only vein involvement, intracerebral arterial involvement, and coronary arterial involvement were excluded. The 8 patients who underwent surgical treatments and the 9 patients who underwent conservative treatments were included and reported in this study. RESULTS: The mean age and mean follow-up duration of the 17 patients with peripheral arterial involvement were 49.82 ± 13.24 years and 89.85 ± 52.70 months, respectively. In all cases where the operations were performed, the first operation was an emergency operation for rupture of the aneurysm, impending sign of rupturing, or acute ischemia. Eight patients received a total of 18 operations. The average number of operations per patient and the reoperation rate were 2.25 ± 0.89 times and 75%, respectively. The 5-year and 10-year survival rates of the patients who underwent surgery were 75.0% and 30.0%, respectively. When arterial involvement occurs in the form of an aneurysm, the hazard ratio for death is 9.644 (P = 0.040, confidence interval 1.11-83.74). CONCLUSIONS: When the artery invades in the form of an aneurysm, the mortality rate is higher regardless of surgery. The main cause of mortality is complications that occur in the anastomosis sites after the operation. Postoperative short-term and regular imaging of the anastomosis area can be beneficial to detect such complications early to decrease the frequency of emergency surgeries, which will help reduce mortality.

Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture.

BACKGROUND: We retrospectively compared chest trauma scoring systems in patients with rib fractures without major extrathoracic injury for predicting respiratory complications. We also evaluated the predictive power according to the presence or absence of pulmonary contusion. MATERIALS AND METHODS: Data from 177 patients with isolated rib fractures were included (December 2013 to April 2018). The primary outcome was respiratory complications (pneumonia, respiratory failure, or empyema). The Abbreviated Injury Scale (AIS), Thoracic Trauma Severity Score (TTSS), Chest Trauma Score (CTS), Rib Fracture Score (RFS), and RibScore were evaluated using univariate and receiver operating characteristic (ROC) analyses to determine their predictive value for pulmonary complications. We divided patients into two groups according to the presence or absence of pulmonary contusion, and constructed ROC curves for both groups. RESULTS: Twenty-eight patients (15.8%) had ≥1 respiratory complication, with significantly higher numbers of standard, segmental, and displaced rib fractures as well as significantly higher TTSS, CTS, RFS, and AIS scores. In all patients, the TTSS (0.723, 95% confidence interval [CI] 0.651-0.788) showed the highest area under the ROC curve (AUROC), followed by the CTS, RFS, AIS, and RibScore. In patients with pulmonary contusion, TTSS also showed the highest AUROC (0.704, 95% CI 0.613-0.784). In patients without pulmonary contusion, RFS showed the highest AUROC (0.759, 95% CI 0.630-0.861). CONCLUSIONS: TTSS was the most useful system for predicting respiratory complications in isolated rib fracture patients with pulmonary contusion. By contrast, RFS was the most useful in patients without pulmonary contusion.

Life-threatening massive empyema: A novel complication of intrathoracic omental herniation.

Intrathoracic omental herniation (ITOH) is the herniation of the omentum through the esophageal hiatus without herniation of the stomach. It is a rare disease and serious complications due to ITOH have not been reported in the literature. Here, we reported the case of 47-year old man who presented to the emergency department with dyspnea and chest pain. Enhanced computed tomography (CT) demonstrated a large retrocardiac mass and ITOH was suspected. During the observation period in the emergency department, the patient's condition rapidly deteriorated. Follow-up CT showed large parapneumonic effusion and empyema. Emergency surgery was performed and the omental sac was removed. The patient's vital signs were restored and his symptoms were relieved. He was discharged on hospital day 15 without complications. Emergency physicians should be aware that severe complications of ITOH could develop and that if the patient's symptoms and vital signs worsen, emergency surgery should be considered.

Staged angioplasty using a full-length balloon catheter to achieve maturation of arteriovenous fistulas.

PURPOSE: To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure. METHODS: This study included patients who underwent AVF surgery using an autogenous vein between February 2020 and June 2021 and received staged angioplasty with a full-length balloon catheter. To minimize balloon overlap and the risk of barotrauma to the immature vein, serial-staged upsizing balloon angioplasty with a long balloon catheter covering the entire vein segment was employed approximately 2 weeks apart. RESULTS: Twenty-three patients (mean age, 69.50 years; mean follow-up, 620.62 days) with average diameters of the radial artery and cephalic vein at 2.14 ± 0.5 mm and 2.43 ± 0.5 mm, respectively, were enrolled. In the first procedure, the average AVF diameter and flow were 4.03 ± 0.57 mm and 438.08 ± 220.95 mL/min, respectively, with juxta-anastomotic stenosis (JAS) present in 61.5% of cases. After staged full-length BAM, the average fistula diameter and flow improved to 5.95 ± 0.86 mm and 717.52 ± 305.95 mL/min, respectively. Maturation was achieved in 87% of the cases. No hematomas or ruptures occurred around the arterialized veins. Despite successful maturation and cannulation, 65.2% of the patients required additional percutaneous transluminal angioplasty (PTA) during the follow-up period. The necessity for PTA was determined by the presence of JAS prior to the first staged full-length BAM, with an odds ratio of 11.74 (95% confidence interval: 1.31-104.96, P = 0.03). CONCLUSION: Staged full-length BAM can be safely used in patients with small veins requiring further maturation. Most patients achieved successful cannulation following maturation without post-procedural complications. CLINICAL SIGNIFICANCE: Staged full-length BAM is a safe and effective method for enhancing maturation in patients with underdeveloped small veins.

Impact of insertion into the left internal jugular vein in chemoport-associated infections: a retrospective single-center study of 1690 cases.

We analyzed chemoport insertion procedures to evaluate infectious morbidity and factors causing infection. This single-center retrospective study included 1690 cases of chemoport implantation between January 2017 and December 2020. Overall, chemoports were inserted in 1582 patients. The average duration of chemoport use was 481 days (range 1-1794, median 309). Infections occurred in 80 cases (4.7%), with 0.098 per 1000 catheter-days. Among the 80 cases in which chemoports were removed because of suspected infection, bacteria were identified in 48 (60%). Significantly more cases of left internal jugular vein punctures were noted in the infected group (15 [18.8%] vs. 147 [9.1%]; p = 0.004). Pulmonary embolism was significantly different between the infection groups (3 [3.8%] vs. 19 (1.2%), p = 0.048). The hazard ratio was 2.259 (95% confidence interval [CI] 1.288-3.962) for the left internal jugular vein, 3.393 (95% CI 1.069-10.765) for pulmonary embolism, and 0.488 (95% CI 0.244-0.977) for chronic obstructive pulmonary disease. Using the right internal jugular vein rather than the left internal jugular vein when performing chemoport insertion might reduce subsequent infections.

Benefit in physical function and quality of life to nonsurgical treatment of varicose veins: Pilot study.

BACKGROUND: Studies on varicose veins have focused its effects on physical function; however, whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear. Moreover, the differences in such functions between individuals with varicose veins and healthy individuals remain unclear. AIM: To investigate changes in physical function and the quality of life (QOL) following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity. METHODS: We enrolled 37 participants (those with varicose veins, n = 17; healthy individuals, n = 20). We performed the following measurements pre- and post-nonsurgical treatment in the varicose vein patients and healthy individuals: Calf muscle oxygenation during the two-minute step test, open eyes one-leg stance, 30 s sit-to-stand test, visual analog scale (VAS) for pain, Pittsburgh sleep quality index, physical activity assessment, and QOL assessment. RESULTS: Varicose veins patients and healthy individuals differ in most variables (physical function, sleep quality, and QOL). Varicose veins patients showed significant differences between pre- and post-nonsurgical treatment- results in the 30 sit-to-stand test [14.41 (2.45) to 16.35 (4.11), P = 0.018), two-minute step test [162.29 (25.98) to 170.65 (23.80), P = 0.037], VAS for pain [5.35 (1.90) to 3.88 (1.73), P = 0.004], and QOL [39.34 (19.98) to 26.69 (17.02), P = 0.005]; however, no significant difference was observed for muscle oxygenation. CONCLUSION: Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients, bringing their condition close to that of healthy individuals. Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.

Correction: Effect of acute alcohol intoxication on mortality, coagulation, and fibrinolysis in trauma patients.

[This corrects the article DOI: 10.1371/journal.pone.0248810.].

Venous adventitial cystic disease is a very rare disease that can cause deep vein thrombosis: A case report.

BACKGROUND: Venous adventitial cystic disease (VACD) is a rare disease characterized by cysts, filled with a gelatinous mucous substance similar to joint fluid, in the adventitia of blood vessels adjacent to the joints. It is often misdiagnosed as deep vein thrombosis (DVT), femoral varices, venous tumors, or lymphadenopathy. CASE SUMMARY: A 69-year-old woman visited our hospital with a complaint of swelling in the right lower extremity. The patient was diagnosed with DVT and prescribed apixaban at an outpatient clinic. After 3 wk, the patient was hospitalized again because of sudden swelling in the right lower extremity. We diagnosed VACD and performed surgery for cyst removal as well as patch angioplasty and thrombectomy of the right common femoral vein. The patient received anticoagulants for 6 mo and has been doing well without recurrence for 1 year postoperatively. CONCLUSION: Recurrent VACD requires complete removal of the connections to the joint cavity to prevent recurrence.

Overlapping stent insertion for a treatment-resistant seroma after arteriovenous fistulation using prosthetic grafts.

An arteriovenous fistula was required for permanent vascular access in a patient undergoing hemodialysis due to progressive chronic kidney disease associated with short bowel syndrome. In the present report, we discuss the case of a patient who underwent arteriovenous grafting because there was no proper native vein as a route, following which a seroma developed near the arterial anastomosis. Despite several surgical treatments, seroma not only recurred but also affected dialysis by compressing the graft. A stent was inserted into the graft to withstand the pressure from the seroma, and because one stent could not withstand the pressure, the stent overlapped where it received the most compression. Since then, the patency of graft has been well maintained for more than 2 years. Increasing the radial force of overlapping stents would be an alternative plan to help solve the problematic repeated compressible seroma despite multiple surgical treatments.

Comparison between Kissing Stents and Direct Surgical Bypass for Aortoiliac Occlusive Disease.

Background: The optimal management strategy for aortoiliac occlusive disease (AIOD) remains debatable. This study compared early and late outcomes between direct surgical bypass and kissing stents for AIOD treatment. Methods: We retrospectively reviewed data, including age, sex, risk factors, comorbidities, symptoms, TransAtlantic Inter-Society Consensus (TASC) II classification, operation time, perioperative complications, in-hospital mortality, and length of hospital stay, from a cohort of 46 patients treated for AIOD (24 with kissing stents and 22 with direct surgical bypass) at Pusan National University Hostpital from January 2007 to December 2016. The primary, assisted primary, and secondary patency rates in both groups were compared. Results: The hospital stay (direct surgical bypass vs. kissing stents: 16.36±5.19 days vs. 9.08±10.88 days, p=0.007) and operation time (direct surgical bypass vs. kissing stents: 316.09±141.78 minutes vs. 99.54±37.95 minutes, p<0.001) were significantly shorter for kissing stents. Kaplan-Meier analysis revealed that the primary, assisted primary, and secondary patency rates in the direct surgical bypass group were 95.5%, 95.5%, and 95.5%, respectively, at 1 year; 86.4%, 86.4%, and 95.5% at 3 years; and 77.3%, 77.3%, and 95.5% at 5 years. The primary, assisted primary, and secondary patency rates in the kissing stent group were 100.0%, 100.0%, and 100.0%, respectively, at 1 year; 95.8%, 95.8%, and 100.0% at 3 years; and 95.8%, 95.8%, and 100.0% at 5 years. Conclusion: Except for special cases wherein endovascular revascularization is difficult, kissing stents are more advantageous for TASC II C and D lesions.

Health Provider's Feedback on Physical Activity Surveillance Using Wearable Device-Smartphone Application for Adults with Metabolic Syndrome; a 12-Week Randomized Control Study.

Purpose: Research on whether wearable device interventions can effectively prevent metabolic syndrome remains insufficient. This study aimed to evaluate the effect of feedback on clinical indicators in patients with metabolic syndrome on activities measured using wearable devices, such as smartphone apps. Methods: Patients with metabolic syndrome were recruited and prescribed to live for 12 weeks using a wrist-wearable device (B.BAND, B Life Inc., Korea). A block randomization method was used to distribute participants between the intervention (n=35) and control groups (n=32). In the intervention group, an experienced study coordinator provided feedback on physical activity to individuals through telephonic counseling every other week. Results: The mean number of steps in the control group was 8892.86 (4473.53), and those in the intervention group was 10,129.31 (4224.11). After 12 weeks, metabolic syndrome was resolved. Notably, there were statistically significant differences in the metabolic composition among the participants who completed the intervention. The mean number of metabolic disorder components per person remained at 3 in the control group, and decreased from 4 to 3 in the intervention group. Additionally, waist circumference, systolic and diastolic blood pressure, and triglyceride levels were significantly reduced, while HDL-cholesterol levels were significantly increased in the intervention group. Conclusion: Overall, 12 weeks of telephonic counseling intervention using wearable device-based physical activity confirmation improved the damaged metabolic components of patients with metabolic syndrome. Telephonic intervention can help increase physical activity and reduce waist circumference, which is a typical clinical indicator of metabolic syndrome.

Usefulness of the BIG Score in Predicting Massive Transfusion and In-Hospital Death in Adult Trauma Patients.

The base deficit (B), international normalized ratio (I), and Glasgow coma scale (GCS) (BIG) score is useful in predicting mortality in pediatric trauma patients; however, studies on the use of BIG score in adult patients with trauma are sparse. In addition, studies on the correlation between the BIG score and massive transfusion (MT) have not yet been conducted. This study aimed to evaluate the predictive value of BIG score for mortality and the need for MT in adult trauma patients. This retrospective study used data collected between 2016 and 2020 at our hospital's trauma center and registry. The predictive value of BIG score was compared with that of the Injury Severity Score (ISS) and Revised Trauma Score (RTS). Logistic regression analysis was carried out to assess whether BIG score was an independent risk factor. Receiver operating characteristic (ROC) curve analysis was performed, and predictive values were evaluated by measuring the area under the ROC curve (AUROC). In total, 5,605 patients were included in this study. In logistic regression analysis, BIG score was independently associated with in-hospital mortality (odds ratio (OR): 1.1859; 95% confidence interval (CI): 1.1636-1.2086) and MT (OR: 1.0802; 95% CI: 1.0609-1.0999). The AUROCs of BIG score for in-hospital mortality and MT were 0.852 (0.842-0.861) and 0.848 (0.838-0.857), respectively. Contrastingly, the AUROCs of ISS and RTS for in-hospital mortality were 0.795 (0.784-0.805) and 0.859 (0.850-0.868), respectively. Moreover, AUROCs of ISS and RTS for MT were 0.812 (0.802-0.822) and 0.838 (0.828-0.848), respectively. The predictive value of BIG score for mortality and MT was significantly higher than that of the ISS. The BIG score also showed a better AUROC for predicting in-hospital mortality compared with RTS. In conclusion, the BIG score is a useful indicator for predicting mortality and the need for MT in adult trauma patients.

Acute limb ischemia after minimally invasive cardiac surgery using the ProGlide: A case series.

BACKGROUND: We report two cases of acute femoral artery occlusion following the use of ProGlide in minimally invasive cardiac surgery and insertion of large-bore catheters through the common femoral artery. This will add to the existing body of literature by highlighting the possible complications associated with the use of ProGlide and reiterate that the use of the sono-guided ProGlide skill will reduce the incidence of these complications. CASE SUMMARY: A 78-year-old man underwent minimally invasive cardiac surgery for severe aortic valve stenosis. After the operation, the puncture site of the common femoral artery was closed using ProGlide. The next morning, after regaining consciousness, he complained of pain, motor weakness (grade 2), and coldness in the right lower extremity. A 65-year-old man underwent minimally invasive cardiac surgery for a large secundum atrial septal defect (5 cm × 5 cm). After the operation, the puncture site of the common femoral artery was closed using ProGlide. After extubation, the patient complained of paresthesia of the right thigh. Both the patients underwent emergency surgery for acute occlusion of the common femoral artery. CONCLUSION: If the sono-guided ProGlide skill is used, complications can be prevented, and ProGlide can be safely used.