Predicting major adverse cardiovascular events after orthotopic liver transplantation using a supervised machine learning model: A cohort study

Prevention of Open Surgical Treatment Complications of Patients with Occlusive Lesions of the Aortoiliac Segment

INTRODUCTION

Surgical procedures on large arteries are associated with an increased likelihood of complications and a long rehabilitation period, making it extremely important to reduce the risks of such operations. The study aims to examine various aspects of preventing complications of surgical treatment, including preoperative preparation, intraoperative management, postoperative observation, and analysis of factors that determine treatment outcomes.

METHODS

The present study used clinical data from 300 patients undergoing surgical treatment of aortoiliac segment occlusion to evaluate the effectiveness of preoperative correction. The study was conducted over 3 ys, from 2018 to 2023, at the university clinic of the nonprofit joint-stock company Semey Medical University.

RESULTS

The study found that preoperative optimization, including medical correction of diabetes mellitus and chronic obstructive pulmonary disease, led to improved functional performance in patients. In the group of patients who underwent preoperative correction, intraoperative complications were recorded in only 12% of patients, while in the control group, where such correction was not performed, this figure reached 24%. A similar trend was observed concerning postoperative complications: 18% compared to 34% in the control group.

CONCLUSIONS

Multiple logistic analyses confirmed the critical role of diabetes mellitus and chronic obstructive pulmonary disease as risk factors for postoperative complications, emphasizing the need to address these conditions before surgery. The practical significance of the study is to confirm the need for preoperative drug correction to reduce the risk of intraoperative and postoperative complications and improve the outcomes of surgical treatment of aortoiliac segment occlusion.

Palliative care for end-stage liver disease and acute on chronic liver failure: A systematic review

BACKGROUND

End stage liver disease (ESLD) represents a growing health concern characterized by elevated morbidity and mortality, particularly among individual ineligible for liver transplantation. The demand for palliative care (PC) is pronounced in patients grappling with ESLD and acute on chronic liver failure (ACLF). Unfortunately, the historical underutilization of PC in ESLD patients, despite their substantial needs and those of their family caregivers, underscores the imperative of seamlessly integrating PC principles into routine healthcare practices across the entire disease spectrum.

AIM

To comprehensively investigate the evidence surrounding the benefits of incorporating PC into the comprehensive care plan for individuals confronting ESLD and/or ACLF.

METHODS

A systematic search in the Medline (PubMed) database was performed using a predetermined search command, encompassing studies published in English without any restrictions on the publication date. Subsequently, the retrieved studies were manually examined. Simple descriptive analyses were employed to summarize the results.

RESULTS

The search strategies yielded 721 references. Following the final analysis, 32 full-length references met the inclusion criteria and were consequently incorporated into the study. Meticulous data extraction from these 32 studies was undertaken, leading to the execution of a comprehensive narrative systematic review. The review found that PC provides significant benefits, reducing symptom burden, depressive symptoms, readmission rates, and hospital stays. Yet, barriers like the appeal of transplants and misconceptions about PC hinder optimal utilization. Integrating PC early, upon the diagnosis of ESLD and ACLF, regardless of transplant eligibility and availability, improves the quality of life for these patients.

CONCLUSION

Despite the substantial suffering and poor prognosis associated with ESLD and ACLF, where liver transplantation stands as the only curative treatment, albeit largely inaccessible, PC services have been overtly provided too late in the course of the illness. A comprehensive understanding of PC's pivotal role in treating ESLD and ACLF is crucial for overcoming these barriers, involving healthcare providers, patients, and caregivers.