Postoperative anemia increases the rate of early postoperative mortality and major ischemic events, particularly in patients at higher baseline cardiac risk. It also adversely affects respiratory complications and ICU LOS. Until a randomized trial definitively settles the issue, restrictive transfusion strategies should be practiced with caution in patients undergoing major vascular interventions.
Background: Percutaneous transhepatic gallbladder drainage (PT-GBD) has been the treatment of choice for acute cholecystitis patients who are not suitable for surgery. The effectiveness of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as an alternative to PT-GBD is not clear. In this meta-analysis, we have compared their efficacy and adverse events. Methods: We adhered to the PRISMA statement to conduct this meta-analysis. Online databases were searched for studies that compared EUS-GBD and PT-GBD for acute cholecystitis. The primary outcomes of interest were technical success, clinical success, and adverse events. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using the random-effects model. Results: A total of 396 articles were screened, and 11 eligible studies were identified. There were 1136 patients, of which 57.5% were male, 477 (mean age 73.33 ± 11.28 years) underwent EUS-GBD, and 698 (mean age 73.77 ± 8.7 years) underwent PT-GBD. EUS-GBD had significantly better technical success (OR 0.40; 95% CI 0.17–0.94; p = 0.04), fewer adverse events (OR 0.35; 95% CI 0.21–0.61; p = 0.00), and lower reintervention rates (OR 0.18; 95% CI 0.05–0.57; p = 0.00) than PT-GBD. No difference in clinical success (OR 1.34; 95% CI 0.65–2.79; p = 0.42), readmission rate (OR 0.34; 95% CI 0.08–1.54; p = 0.16), or mortality rate (OR 0.73; 95% CI 0.30–1.80; p = 0.50) was noted. There was low heterogeneity (I2 = 0) among the studies. Egger’s test showed no significant publication bias (p = 0.595). Conclusion: EUS-GBD can be a safe and effective alternative to PT-GBD for treating acute cholecystitis in non-surgical patients and has fewer adverse events and a lower reintervention rate than PT-GBD.
Compared to the HM scheduling approach, the proposed data-driven RM scheduling methodology improves multiple measures of OS efficiency and OS personnel satisfaction without adversely affecting clinical outcomes.
Objectives: Peripheral arterial disease (PAD) has a significant population prevalence range between 3% and 10%, with intermittent claudication (IC) presenting as one of the earliest and most common symptoms. IC has detrimental effects on patients' walking ability in terms of maximum walking distance (MWD) and pain-free walking distance (PFWD). Research has suggested that extracorporeal shockwave therapy (ESWT) may induce angiogenesis in treated tissue, and therefore, our objective was to assess the safety, tolerability, and efficacy of ESWT as a novel treatment of intermittent claudication.Methods: Thirty patients with unilateral claudication were randomized to receive either ESWT or sham treatment to the calf muscle bulk three times per week for 3 weeks. Baseline assessments of MWD, CD, and anklebrachial index (ABI) were formally assessed before treatment. The Piezowave 2 Shockwave system was used to treat all active treatment group subjects with 6000 impulses applied at each treatment session. Patients were followed up at 4 and 8 weeks to assess subject tolerability, safety, MWD, CD and ABI. All walking assessments were performed using standardized treadmill testing at a speed of 2.5 km/h and 10% incline.Results: ESWT was well tolerated by all patients within the active treatment group, with no safety issues or complications reported. At both 4 and 8 weeks there was a statistically significant improvement (P > .05) in both PFWD and MWD in those assigned to active ESWT when compared to the sham treatment group. In the active treatment group, the mean PFWD improved by 56.4 m (97%) at 4 weeks and 102.7 m (176%) at 8 weeks. The mean MWD increased by 76.3 m (75%) at 4 weeks and 121.5 m (128%) at 8 weeks. No changes in ABI were observed.Conclusions: ESWT is safe and well tolerated when applied to the calf muscle bulk and demonstrated a dramatic improvement in walking distances, comparable to more established treatment options. While these results are encouraging, further research is required to help substantiate these findings with medium-and long-term results assessed and a larger study size.
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