Postgraduate medical journal
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The prevalence of spontaneous coronary artery dissection (SCAD) has increased over the last decades in young adults presenting with acute coronary syndrome. Although the diagnostic tools, including intracoronary imaging, have permitted a more accurate diagnosis of SCAD, the prognosis and overall outcomes remain dismal. Furthermore, the disproportionate sex distribution affecting more women and the underdiagnosis in many parts of the world render this pathology a persistent clinical challenge, particularly since the management remains largely supportive with a limited and controversial role for percutaneous or surgical interventions. The purpose of this review is to summarize the available literature on SCAD and to provide insights into the gaps in knowledge and areas requiring further investigation.
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Controlled low central venous pressure (CLCVP) technique has been extensively validated in clinical practices to decrease intraoperative bleeding during liver resection process; however, no studies to date have attempted to propose a scoring method to better understand what risk factors might still be responsible for bleeding when CLCVP technique was implemented. ⋯ Anesthesiologists should be aware of the potential impact of increased Pringle maneuver duration and lactate levels on intraoperative major bleeding in patients undergoing liver resection with CLCVP technique. What is already known on this topic-Low central venous pressure technique has already been extensively validated in clinical practices, with no prediction model for major bleeding. What this study adds-The XGBoost classifier outperformed logistic regression model for the prediction of major bleeding during liver resection with low central venous pressure technique. How this study might affect research, practice, or policy-anesthesiologists should be aware of the potential impact of increased PM duration and lactate levels on intraoperative major bleeding in patients undergoing liver resection with CLCVP technique.
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Sepsis is a reaction to infection with high morbidity and mortality. It has been noted that patients with obesity were more likely to suffer from sepsis. However, the causality remains elucidating, as reverse causality and residual confounding could not be largely mitigated in conventional observational studies. ⋯ This MR study showed that obesity contributed to an increased risk of sepsis, indicating that obesity management might be beneficial for reducing sepsis risk. Key messages What is already known on this topic-Observational studies have reported the association between obesity and sepsis, but the causality has not been determined. What this study adds-This Mendelian randomization study demonstrated that obesity-related phenotypes, including body mass index and Waist circumstance, causally increased the risk of sepsis. How this study might affect research, practice, or policy-The findings of our study might have an implication for clinicians that obesity management might be a promised strategy for reducing the risk of sepsis.