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92) and validation cohort (AUC=0.85) relative to the other models. In the decision curves, if the threshold probability was 0.07-0.87, the use of the radiomics score to distinguish NF-pNET G1 and G2/3 offered more benefit than did the use of a "treat all patients" or a "treat none" scheme in the training cohort of the MRI radiomics model.
The LDA classifier combining multimodality images may be a valuable noninvasive tool for distinguishing NF-pNET grades and avoid unnecessary surgery.
The LDA classifier combining multimodality images may be a valuable noninvasive tool for distinguishing NF-pNET grades and avoid unnecessary surgery.
This study aimed to investigate the feasibility, safety, and efficiency rates of the bleb coiling technique for the treatment of acute ruptured wide-neck bifurcation aneurysm (WBNAs) by comparing it with device-assisted coiling.
Patients with ruptured WNBAs who underwent endovascular treatment (EVT) were reviewed. The study sample was divided into five groups according to treatment type bleb coiling, single catheter coiling, balloon-assisted coiling (BAC), neck remodeling mesh-assisted coiling, and stent-assisted coiling (SAC). The feasibility, safety, efficiency and complication rates of the bleb coiling technique were compared with each group.
This study included 109 patients with ruptured WNBAs. Bleb coiling was performed in 24 blebs of 20 WNBAs. The mean time interval between initial and complementary treatment in the bleb coiling group was 12.53± 5 .27 weeks (min-max 4-23 weeks). No rebleeding occurred during this interval time, and no mortality or new permanent neurologic deficit caused by the bleb coiling technique was noted. The bleb coiling technique had a lower complication rate than other techniques (p <0.05).
The bleb coiling strategy led to favourable clinical outcomes with low complication rates and it can be considered as an alternative treatment option at acute phase of SAH in the endovascular treatment of ruptured WBNAs with coilable-bleb.
The bleb coiling strategy led to favourable clinical outcomes with low complication rates and it can be considered as an alternative treatment option at acute phase of SAH in the endovascular treatment of ruptured WBNAs with coilable-bleb.
To compare abbreviated MRI with mammography and US for screening in women with a personal history of breast cancer. In addition, the first and subsequent rounds of abbreviated MRI were compared.
The Institutional Review Board approved this retrospective study. Nine hundred and thirty-nine abbreviated MRI scans of 710 women with a personal history of breast cancer were included (mean age, 54.1±9.4 years). The diagnostic performances of abbreviated MRI, mammography, and US for the detection of the second breast cancer were compared. When more than one round of abbreviated MRI was performed, we compared the scans of the first and subsequent rounds.
There were 15 (2.1%) cases of second breast cancer. Thirty-nine of the 939 abbreviated MRI scans were diagnosed as positive; of them, 11 were diagnosed as breast cancer, with a PPV
of 28.2% (US, 19.0%; mammography, 28.6%). The AUC, sensitivity, and cancer detection rate (per 1000) were the highest for abbreviated MRI (0.829, 68.8% and 11.7) (US 0.616, 25.0%, and 4.3; mammography 0.560, 12.5%, and 2.1, respectively). Two hundred women underwent multiple rounds of abbreviated MRI. AUC, PPV
, and the cancer detection rates were higher during the subsequent rounds (0.987, 45.5, and 21.8) than during the first round (0.605, 11.1, and 5).
Abbreviated MRI for women with a personal history of breast cancer was more sensitive for the diagnosis of second breast cancer than US or mammography. In addition, subsequent rounds of MRI showed better performance than the first round.
Abbreviated MRI for women with a personal history of breast cancer was more sensitive for the diagnosis of second breast cancer than US or mammography. In addition, subsequent rounds of MRI showed better performance than the first round.
To compare early and midterm outcomes of transcatheter valve-in-valve implantation (ViV-TAVI) and redo surgical aortic valve replacement (re-SAVR) for aortic bioprosthetic valve degeneration.
Patients who underwent ViV-TAVI and re-SAVR for aortic bioprosthetic valve degeneration between January 2010 and October 2018 were retrospectively analyzed. Mean follow-up was 3.0 years.
In-hospital, early, and mid-term outcomes.
Eighty-eight patients were included in the analysis.
Thirty-one patients (37.3%) had ViV-TAVI, and 57 patients (62.7%) had re-SAVR.
In the ViV-TAVI group, patients were older (79.1 ± 7.4 v 67.2 ± 14.1, p < 0.01). The total operative time, intubation time, intensive care unit length of stay, total hospital length of stay, inotropes infusion, intubation >24 hours, total amount of chest tube losses, red blood cell transfusions, plasma transfusions, and reoperation for bleeding were significantly higher in the re-SAVR cohort (p < 0.01). There was no difference regarding in-hospital permanent pacemaker implantation (ViV-TAVI=3.2% v re-SAVR=8.8%, p=0.27), patient-prosthesis mismatch (ViV-TAVI=12 patients [mean 0.53 ± 0.07] and re-SAVR=ten patients [mean 0.56 ± 0.08], p=0.4), stroke (ViV-TAVI=3.2% v re-SAVR=7%, p=0.43), acute kidney injury (ViV-TAVI=9.7% v re-SAVR=15.8%, p=0.1), and all-cause infections (ViV-TAVI=0% v re-SAVR=8.8%, p=0.02), between the two groups. In-hospital mortality was 0% and 7% for ViV-TAVI and re-SAVR, respectively (p=0.08). At three-years' follow-up, the incidence of pacemaker implantation was higher in the re-SAVR group (ViV-TAVI=0 v re-SAVR=13.4%, p < 0.01). LY3009120 There were no differences in reintervention (ViV-TAVI=3.8% v re-SAVR=0%, p=0.32) and survival (ViV-TAVI=83.9% v re-SAVR=93%, p=0.10) between the two cohorts.
ViV-TAVI is a safe, feasible, and reliable procedure.
ViV-TAVI is a safe, feasible, and reliable procedure.Chronic mitral regurgitation leads to a series of downstream pathologic changes, including pulmonary hypertension, right ventricular dilation, tricuspid leaflet tethering, and tricuspid annular dilation, which can result in functional tricuspid regurgitation (FTR). The five-year survival rate for patients with severe FTR is reported to be as low as 34%. While FTR was often left uncorrected during left-heart valvular surgery, under the assumption that correction of the left-sided lesion would reverse the right-heart changes that cause FTR, recent data largely have supported concomitant tricuspid valve repair at the time of mitral surgery. In this review, the authors discuss the potentially irreversible nature of the changes leading to FTR, the likelihood of progression of FTR after mitral surgery, and the evidence for and against concomitant tricuspid valve repair at the time of mitral valve intervention. Lastly, this narrative review also examines advances in transcatheter therapies for the tricuspid valve and the evidence behind concomitant transcatheter tricuspid repair at the time of transcatheter mitral repair.
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