Unravelling the "diabetes discrepancy": The presence of chronic complications is a hallmark of worse short-term outcomes in patients with diabetes mellitus after transcatheter aortic valve replacement.

Background: In transcatheter aortic valve replacement (TAVR), there is a notable "diabetes discrepancy", where worse/better/similar outcomes were all found for patients with diabetes mellitus (DM). Such divergent findings pose a challenge for clinicians to accurately assess the risks for DM patients undergoing TAVR. We hypothesized the presence of chronic complications could be linked to worse post-TAVR outcomes in DM patients.

Presence of chronic complications differentiates in-hospital outcomes of transjugular intrahepatic portosystemic shunt in patients with diabetes mellitus.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiological procedure to reduce portal hypertension. Hyperglycemic state in diabetes mellitus (DM) is associated with vascular injuries that can lead to chronic complications, which is implicative of the extent/control of DM. This study aimed to use chronic complications as a marker for uncontrolled DM and examine major in-hospital outcomes after TIPS among DM patients with (DM-WCC) and without chronic complications (DM-WOCC).

In-hospital outcomes of non-elective transapical transcatheter versus surgical aortic valve replacement.

When transfemoral (TF) access is not available during transcatheter aortic valve replacement (TAVR), transapical (TA)-TAVR can be performed. However, TA-TAVR is associated with significantly higher risk, and it is unclear whether it provides more benefit than surgical aortic valve replacement (SAVR) in non-elective cases. This study aimed to compare the in-hospital outcomes of non-elective TA-TAVR and SAVR by conducting a population-based analysis using a national registry.

Insulin Dependency Rather Than HbA1c May Be a Hallmark for Worse 30-Day Complications for Diabetes Mellitus Patients with Chronic Limb-Threatening Ischemia Undergoing Infrainguinal Bypass.

Background: The relationship between insulin use and clinical outcomes in patients with chronic-limb threatening ischemia remains unclear. This study evaluates differences between patients with diabetes mellitus (DM) stratified by insulin use, revealing potential outcome disparities following bypass procedures.

Methods: Thirty-day outcome data was collected retrospectively from a cohort of chronic-limb threatening ischemia patients with DM following bypass procedures between 2011 and 2022 using the American College of Surgeons National Surgical Quality Improvement Program.

Endovascular aneurysm repair for patients with disseminated cancer: A propensity-score matched study from ACS-NSQIP database from 2012-2022.

BackgroundDisseminated cancer may complicate decision-making processes for major surgical interventions, including endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). However, the postoperative outcomes of EVAR in patients with disseminated cancer have not been well-established. This study aimed to explore the impact of preoperative disseminated cancer on 30-day outcomes of non-ruptured EVAR.

Higher risks of thirty-day mortality and thromboembolism in disseminated cancer patients undergoing carotid endarterectomy: A perspective from the ACS-NSQIP database from 2011 to 2022.

BackgroundAtherosclerosis in carotid arteries can lead to carotid stenosis, where carotid endarterectomy (CEA) is the first-line intervention. Malignancy has a two-way relationship with atherosclerosis, where they share common molecular pathways in their pathophysiology. However, the postoperative outcomes of CEA in patients with disseminated cancer remain unclear.

In-Hospital Outcomes of Patients with Hepatorenal Syndrome Who Underwent Transjugular Intrahepatic Portosystemic Shunt Procedure.

Background: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis associated with poor survival. The use of transjugular intrahepatic portosystemic shunt (TIPS) as a therapeutic or bridging therapy for HRS patients remains debated due to its potential severe early complications. This study aimed to retrospectively compare the in-hospital outcomes of HRS patients who received TIPS with those who did not, using a large-scale, population-based national database.

Evidence for Stepwise Disruption of RNA Polymerase: λP Promoter Contacts and Duplex Formation in Transcription Initiation.

To initiate transcription, the σ subunit of RNA polymerase (RNAP) binds duplex promoter DNA regions upstream of the transcription start site (TSS). Then σ and core RNAP bind and separate the individual DNA strands to open 13 base pairs, including TSS, forming an open complex (OC) that initiates upon binding NTP. To escape the promoter, RNAP uses translocation stress to break RNAP-promoter and σ-core contacts, allowing duplex formation and releasing σ.

Short-Term Outcomes of Patients with Non-Metastatic Malignant Solid Tumor after Coronary Artery Bypass Grafting: A Population-Based Study of National/Nationwide Inpatient Sample From 2015 To 2020.

Introduction: Previous studies found that patients with a history of cancer either have similar outcomes or face an increased risk of early morbidity following cardiac surgery. However, the applicability of these findings to clinical practice may be constrained by the heterogeneity of cancer patients. To refine our understanding, this study focuses specifically on the in-hospital outcomes of patients with non-metastatic malignant solid tumors (NMST) undergoing coronary artery bypass grafting (CABG).

"Smoker's paradox" in in-hospital outcomes of left ventricular assist device implantation: a population-based analysis of National Inpatient Sample from 2015-2021.

Left ventricular assist device (LVAD) implantation is a treatment option for advanced heart failure. The relationship between smoking and perioperative outcomes in LVAD implantation remains inconclusive, as evidence has been limited to single-center studies. This study aimed to examine the association between smoking and in-hospital outcomes of LVAD implantation in a large-scale population-based analysis.

Anesthesia choice for endovascular repair of complex abdominal aortic aneurysm: A propensity-score-matched study from the ACS-NSQIP database from 2012 to 2022.

BackgroundWhile general anesthesia has been the dominant anesthesia used in endovascular aneurysm repair (EVAR), locoregional anesthesia is suggested as a viable alternative for eligible patients. However, the majority of previous findings came from infrarenal EVAR while the choice of anesthesia for complex EVAR remains less established. This study aimed to retrospectively compare the 30-day outcomes of patients who underwent non-emergency complex EVAR under locoregional or general anesthesia.

Open Repair for Nonruptured Abdominal Aortic Aneurysm in Octogenarians With Prior Abdominal Surgery.

Introduction: Previous abdominal surgery (PAS) has been shown to potentially affect outcomes of open surgical repair (OSR) for abdominal aortic aneurysm (AAA). Octogenarians have been observed to face significantly higher risks following OSR for AAA, which highlights the need for a more cautious selection of their surgical candidacy. This study aimed to assess the association between PAS and the 30-d outcomes of OSR for nonemergent intact AAA among octogenarians.

Thirty-Day Outcomes of Endovascular Repair of Non-Ruptured Thoracic Aneurysms in Patients with Chronic Obstructive Pulmonary Disease.

Background: Thoracic Endovascular Aortic Repair (TEVAR) is the preferred treatment for thoracic aneurysms for eligible patients. Chronic obstructive pulmonary disease (COPD) is a common comorbidity that shares common inflammatory pathways with atherosclerosis, the major cause of thoracic aneurysms. However, surgical outcomes of TEVAR among patients with COPD have not been thoroughly investigated.

Should we redefine the age of geriatric trauma? An insight from American College of Surgeons Trauma Quality Improvement Program database 30-day mortality risk.

Background: Older injured patients have higher mortality compared with their younger counterparts, and their outcomes worsen with each decade of life. However, the exact age to classify a patient as "geriatric" is not universally defined. Identifying an evidence-based age cutoff for "geriatric" trauma activations is important to preserve hospital and human resources by not superfluously including younger patients but also not depriving older high-risk patients of resources needed to achieve their best recovery.

National Trends in Central Retinal Artery Occlusion Presentations and Stroke Workup in United States Emergency Department.

Purpose: To investigate trends in acute central retinal artery occlusion (CRAO) diagnostic assessments and sociodemographic characteristics of patients in the United States (US) emergency department (ED).

Design: Retrospective trend study.

Subjects: Adult patients with CRAO presenting to ED from 2016 through 2021.

Comparison of Local and General Anesthesia on 30-Day Outcomes of Emergency Infrainguinal Endovascular Revascularization for Patients with Chronic Limb-Threatening Ischemia.

BackgroundInfrainguinal endovascular interventions can be the first-choice treatment for suitable patients with peripheral artery disease (PAD). However, the choice of anesthesia for infrainguinal endovascular procedures, particularly in emergency situations, remains underexplored. This study aimed to conduct a retrospective analysis based on a multi-institutional nationwide registry to compare the 30-day outcomes of patients with chronic limb-threatening ischemia (CLTI) who received either local anesthesia (LA) or general anesthesia (GA) during emergency infrainguinal endovascular interventions.

Predictors of 30-day Hospital Readmission after Autologous vs. Implant-based Breast Reconstruction: A 16-year Analysis of 175,474 Patients.

Objectives: Comorbidities that impair wound healing, increase infection risk, and compromise tissue viability influence rates of hospital readmission after autologous reconstruction and implant-based reconstruction. This study aimed to evaluate patient factors that increase risk for 30-day hospital readmission after autologous reconstruction and implant-based reconstruction and identify differences in the comorbidities that affect readmission risk after each method.

Methods: Patients from 2005 to 2021 were selected by autologous reconstruction and implant-based reconstruction current procedural terminology codes from the American College of Surgeons National Surgical Quality Improvement Program database.

Different mortality and transfer rates between teaching and nonteaching urban hospitals among patients presenting with Stevens-Johnson syndrome.

Stevens-Johnson Syndrome is a rare disorder of the skin and mucous membranes accompanied by systemic symptoms that are life threatening and require immediate intervention. We sought to determine if different hospital types, specifically urban nonteaching hospitals versus urban teaching hospitals, have different outcomes among patients presenting with Stevens-Johnson Syndrome during hospitalization. Patients presenting to urban teaching and urban nonteaching hospitals were compared.

Thirty-Day Endovascular Repair Outcomes of Stanford Type B Aortic Dissection in Patients With Diabetes Mellitus: A Propensity-Score-Matched Study From the ACS-NSQIP Database.

Background: The surgical intervention for Stanford type B aortic dissection (TBAD) has been revolutionized by thoracic endovascular aortic repair (TEVAR). While diabetes mellitus (DM) is associated with increased risks of short-term mortality and infectious complications after major surgeries, previous studies present conflicting findings regarding the outcomes of TEVAR in DM patients. This study aimed to assess the 30-day postoperative outcomes for DM patients who have undergone TEVAR for TBAD using a dataset from a multi-institutional national registry.

Should we adopt a "laparoscopy first" strategy? A comparison of 30-day outcomes between converted open from laparoscopic and planned open colectomy for volvulus.

While the majority of colectomy for volvulus is performed by an open approach, laparoscopy can be used as a potentially safer alternative. However, conversion to open is needed when the laparoscopic approach is unsuccessful. This study aimed to compare the 30-day outcomes of patients who had converted open from laparoscopy vs planned open colectomy for volvulus to assess a possible "laparoscopy first" strategy.

Insurance and In-hospital Outcomes of Type A Aortic Dissection Repair: A Population Study of National Inpatient Sample from 2015-2020.

Although insurance status has been linked to surgical outcomes in thoracic aortic operations, its specific association with the outcomes of Type A Aortic Dissection (TAAD) repair remains underexplored. This study aimed to conduct a comprehensive, population-based analysis to assess the association between insurance status and in-hospital outcomes after TAAD repair using a national registry.Patients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015 to 2020.

Preoperative Oral Antibiotics Preparation is Associated With Improved 30-day Outcomes in Elective Colectomy for Ulcerative Colitis.

BackgroundUlcerative colitis (UC) is characterized by colonic involvement, where the 10-year risk of colectomy remains high at about 20%. The use of preoperative oral antibiotic preparation (OAP) in colectomy remains a subject of debate and there was limited evidence for UC patients. This study aimed to retrospectively investigate the relationship between OAP and 30-day outcomes following elective colectomy in UC patients using a multi-institutional national dataset.

Local Versus General Anesthesia in Emergency Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm.

Background: While general anesthesia (GA) has been the common choice of anesthesia for patients undergoing endovascular aneurysm repair (EVAR), local anesthesia (LA) has been proposed as an effective alternative for eligible patients. However, the choice of anesthesia in emergency EVAR situations remains less explored. Therefore, this study aimed to perform a retrospective analysis to compare the 30-day outcomes of patients who underwent emergency infrarenal EVAR receiving either LA or GA.