Deucravacitinib improves outcomes in patients with psoriasis arthritis: Study

Psoriatic arthritis is a chronic and debilitating autoimmune disease which leads to significant physical disability and diminished quality of life. The traditional treatments often come with various side effects and this highlights the need for safer and more effective options. A recent phase 2 trial published in the Arthritis Care & Research journal showed the potential benefits of Deucravacitinib, a TYK-2 inhibitor, from the perspective of the patient with psoriatic arthritis (PsA).

This double-blind trial included a total of 203 participants to assess the efficacy and patient-reported outcomes (PROs) of the two dosage levels of Deucravacitinib when compared to a placebo. The participants in the trial were randomly assigned to receive either 6 mg or 12 mg of Deucravacitinib once daily or a placebo, over a 16-week period.

The study primarily focused on the change from baseline in the Health Assessment Questionnaire Disability Index (HAQ-DI) and the 36-item Short Form Health Survey (SF-36) physical component summary (PCS) score at Week 16. These measures were crucial in assessing physical function and overall health status that provides insight into the impact of treatment from the patient’s view.

The results found that both dosages of Deucravacitinib significantly outperformed the placebo in improving HAQ-DI and SF-36 PCS scores. The adjusted mean difference in HAQ-DI score at Week 16 was −0.26 (P = 0.0020) for the 6 mg dose and −0.28 (P = 0.0008) for the 12 mg dose indicated a notable improvement in physical function. Similarly, the SF-36 PCS scores improved by 3.3 points (P = 0.0062) and 3.5 points (P = 0.0042) for the 6 mg and 12 mg doses, respectively which suggests enhanced quality of life.

Moreover, a significant percentage of patients reported improvements in patient-reported outcomes that included fatigue, pain and mental health after reaching or exceeding the minimum clinically important differences (MCIDs) or achieving normative values. This indicates that Deucravacitinib not only improve the physical health but also positively affects the overall wellbeing.

Overall, these findings underscore the potential of Deucravacitinib as a transformative treatment for psoriatic arthritis. The significant and clinically meaningful improvements in patient-reported outcomes that highlight its capacity to address both the physical and psychological aspects of the disease.

Reference:

Strand, V., Gossec, L., Coates, L. C., Ogdie, A., Choi, J., Becker, B., Zhuo, J., Lehman, T., Nowak, M., Elegbe, A., Mease, P. J., & Deodhar, A. (2024). Improvements in patient‐reported outcomes after treatment with deucravacitinib in patients with psoriatic arthritis: results from a randomized phase 2 trial. In Arthritis Care & Research. Wiley. https://doi.org/10.1002/acr.25333

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Artificial Intelligence tool successfully predicts ventricular arrhythmia from standard heart tracings: Study

In a Leicester study that looked at whether artificial intelligence (AI) can be used to predict whether a person was at risk of a lethal heart rhythm, an AI tool correctly identified the condition 80 per cent of the time.

The findings of the study, led by Dr Joseph Barker working with Professor Andre Ng, Professor of Cardiac Electrophysiology and Head of Department of Cardiovascular Sciences at the University of Leicester and Consultant Cardiologist at the University Hospitals of Leicester NHS Trust, have been published in the European Heart Journal-Digital Health.

Ventricular arrhythmia (VA) is a heart rhythm disturbance originating from the bottom chambers (ventricles) where the heart beats so fast that blood pressure drops which can rapidly lead to loss of consciousness and sudden death if not treated immediately.

NIHR Academic Clinical Fellow Dr Joseph Barker co-ordinated the multicentre study at the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre,  and co-developed an AI tool with Dr Xin Li, Lecturer in Biomedical Engineering, School of Engineering. The tool examined Holter electrocardiograms (ECGs) of 270 adults taken during their normal daily routine at home.  

These adults had the Holter ECGs taken as part of their NHS care between 2014 and 2022. Outcomes for these patients were known, and 159 had sadly experienced lethal ventricular arrhythmias, on average 1.6 years following the ECG.

The AI tool, VA-ResNet-50, was used to retrospectively examine ‘normal for patient’ heart rhythms to see if their heart was capable of the lethal arrythmias.

Professor Ng said: “Current clinical guidelines that help us to decide which patients are most at risk of going on to experience ventricular arrhythmia, and who would most benefit from the life-saving treatment with an implantable cardioverter defibrillator are insufficiently accurate, leading to a significant number of deaths from the condition.

“Ventricular arrhythmia is rare relative to the population it can affect, and in this study we collated the largest Holter ECG dataset associated with longer term VA outcomes.

“We found the AI tool performed well compared with current medical guidelines, and correctly predicted which patient’s heart was capable of ventricular arrhythmia in 4 out of every 5 cases.

“If the tool said a person was at risk, the risk of lethal event was three times higher than normal adults.

“These findings suggest that using artificial intelligence to look at patients’ electrocardiograms while in normal cardiac rhythm offers a novel lens through which we can determine their risk, and suggest appropriate treatment; ultimately saving lives.”

He added: “This is important work, which wouldn’t have been possible without an exceptional team in Dr Barker and Dr Xin Li, and their belief and dedication to novel methods of analysis of historically disregarded data.”

Reference:

Joseph Barker, Xin Li, Ahmed Kotb, Akash Mavilakandy, Ibrahim Antoun, Chokanan Thaitirarot, Ivelin Koev, Sharon Man, Fernando S Schlindwein, Harshil Dhutia, Shui Hao Chin, Ivan Tyukin, William B Nicolson, G Andre Ng, Artificial intelligence for ventricular arrhythmia capability using ambulatory electrocardiograms, European Heart Journal – Digital Health, 2024;, ztae004, https://doi.org/10.1093/ehjdh/ztae004

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Retinal Ischemic Perivascular lesions Linked to Myocardial Infarction Risk in CAD Patients: Study

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, with myocardial infarction (MI) posing a significant risk for affected individuals. While various cardiovascular risk factors are well-documented, emerging evidence suggests a potential link between retinal ischemic perivascular lesions (RIPLs) and MI in CAD patients.

Retinal ischemic perivascular lesions (RIPLs) have garnered attention as potential biomarkers for retinal ischemia, reflecting underlying vascular pathology. However, their association with MI among CAD patients remains poorly understood. A recent retrospective cross-sectional study aimed to investigate this relationship using macular spectral domain optical coherence tomography (SD-OCT) imaging. This study was published in the American Journal Of Ophthalmology. The study was conducted by Elodie B. and colleagues.

The study included 317 consecutive CAD patients who underwent SD-OCT imaging of the macula. Patients with a history of MI were compared to those without MI. RIPLs were assessed by two independent graders, and medical records were reviewed. Multivariate logistic regression analysis was conducted to evaluate the association between RIPLs and MI, adjusting for relevant covariates.

The key findings of the study were:

• Prevalence of RIPLs: Among CAD patients, 17% had a history of MI, with a significantly higher prevalence of RIPLs observed in the MI group compared to the non-MI group (59.3% vs. 35.7%; p<0.001).

• Association with MI: Presence of RIPLs was strongly associated with MI, with an odds ratio of 3 (95% CI: 1.91-4.74; p<0.001), after adjusting for age, gender, smoking status, hypertension, diabetes, dyslipidemia, and body mass index.

The study findings highlight a significant association between RIPLs detected via SD-OCT imaging and MI in CAD patients. RIPLs may serve as valuable biomarkers for identifying individuals at heightened risk of cardiovascular events within this population. The incorporation of RIPL evaluation into routine clinical assessments could enhance risk stratification and inform targeted interventions to mitigate cardiovascular risk in CAD patients.

These findings underscore the importance of comprehensive cardiovascular evaluations in CAD patients, including assessment of retinal vascular changes. Early detection of RIPLs may facilitate proactive management strategies aimed at reducing the incidence of MI and improving patient outcomes in this high-risk population.

In conclusion, the presence of retinal ischemic perivascular lesions (RIPLs), as assessed by SD-OCT, is significantly associated with myocardial infarction in patients with coronary artery disease. These findings underscore the potential clinical utility of RIPL evaluation as part of the medical management of CAD, offering valuable insights into cardiovascular risk assessment and personalized intervention strategies. Further research is warranted to validate these findings and elucidate the underlying mechanisms linking RIPLs to MI in CAD patients.

Reference:

Bousquet, E., Santina, A., Au, A., Somisetty, S., Abraham, N., Voichanski, S., Estawro, R., Fouad, Y. A., Romero-Morales, V., Bakhoum, M. F., & Sarraf, D. (2024). Retinal Ischemic Perivascular Lesions are associated with myocardial infarction in patients with coronary artery disease. American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2024.03.017

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Compared to single-layer closure, double-layer closure may not exhibit superior reproductive outcomes after first cesarean delivery: Study

The increasing prevalence of cesarean deliveries has raised concerns about long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecologic issues and obstetric complications in subsequent pregnancies. Despite its importance, there’s uncertainty regarding the optimal uterine closure technique.

Niche formation, or defects in the uterine scar, can lead to gynecologic complaints and complications in future pregnancies. The debate over single-layer vs. double-layer uterine closure techniques persists, with conflicting evidence on which approach is superior for preventing long-term complications.

This study was published in the Journal Of Obstretrics & Gynaecology by Carry Verberkt and colleagues. A multicenter, double-blind, randomized controlled trial conducted in the Netherlands aimed to assess the impact of single-layer vs. double-layer closure of the uterine incision on long-term outcomes in women undergoing their first cesarean delivery. The primary outcome was live birth rate at a 3-year follow-up, with secondary outcomes including fertility, gynecologic, and obstetrical outcomes.

Key Findings:

• The study included 2292 women, with 830 in the single-layer closure group and 818 in the double-layer closure group.

• At the 3-year follow-up, there were no significant differences in live birth rates between the two closure techniques.

• Secondary outcomes, including pregnancy rate, need for fertility treatments, mode of delivery, and obstetrical complications, also showed no significant differences between the groups.

• Both groups reported high rates of gynecologic symptoms, including spotting, dysmenorrhea, and sexual dysfunction.

The study did not find superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first cesarean delivery. This challenges the current recommendation favoring double-layer closure, suggesting that surgeons can choose their preferred technique. Additionally, the high prevalence of gynecologic symptoms after cesarean delivery highlights the importance of discussing these risks with patients.

Surgeons should consider individual patient factors and preferences when choosing uterine closure techniques during cesarean deliveries. Patient counseling regarding the potential for gynecologic symptoms post-delivery is crucial for informed decision-making. Further research may be needed to elucidate the long-term effects of different closure methods on maternal health and reproductive outcomes.

Reference:

Verberkt, C., Stegwee, S. I., Van der Voet, L. F., Van Baal, W. M., Kapiteijn, K., Geomini, P. M. A. J., Van Eekelen, R., de Groot, C. J. M., de Leeuw, R. A., Huirne, J. A. F., van Baal, M., Klerkx, W., Bekker, M. N., de Boer, K., Boormans, E. M. A., van Eijndhoven, H. W. F., Feitsma, H., Hehenkamp, W. J. K., Hemelaar, M., … de Vleeschouwer, M. Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study). American Journal of Obstetrics and Gynecology,2023. https://doi.org/10.1016/j.ajog.2023.12.032

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ChatGPT may help dental students retain knowledge and enhance performance, suggests research

 A study aiming to utilize current dental course materials, syllabi, and textbooks to investigate ChatGPT’s potential benefits for dental students. was presented at the 102nd General Session of the IADR, which was held in conjunction with the 53rd Annual Meeting of the American Association for Dental, Oral, and Craniofacial Research and the 48th Annual Meeting of the Canadian Association for Dental Research, on March 13-16, 2024, in New Orleans, LA, USA.

The abstract, “ChatGPT to Help Dental Students Retain Knowledge and Enhance Performance” was presented during the “SCADA: Clinical Science/Public Health Research” Poster Session that took place on Thursday, March 14, 2024 at 11 a.m. Central Standard Time (UTC-6).

The study, by Ihunna Amugo of Meharry Medical College, Nashville, TN, USA, conducted an extensive literature review, analyzing previous studies in different educational contexts to evaluate ChatGPT’s efficacy in dental education. Questions aligned with dental course materials and objectives were formulated to ensure ChatGPT’s relevance to the specific needs of dental students. The research encompassed various dental courses, including operative dentistry, nutrition, periodontics, oral radiology, and biology of disease.

By applying ChatGPT in these courses, its capabilities were harnessed to generate step-by-step instructions, summaries, and questions to supplement traditional learning methods. Data on students’ interactions with ChatGPT were collected and analyzed, assessing usage patterns, engagement levels, and perceived benefits.

The study’s results indicated that ChatGPT has the potential to enhance students’ understanding and knowledge retention. In addition, ChatGPT can effectively provide instructional support and generate relevant content for dental students. 

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Aspirin Plus Clopidogrel Better Than Just Aspirin In Managment of Acute Stroke: RCT

In a recent  RCT published in JAMA Neurology, researchers form China have discovered that a combination of clopidogrel and aspirin can significantly reduce early neurologic deterioration in patients with acute mild to moderate ischemic stroke who are not eligible for reperfusion therapies. 

Ischemic stroke, caused by a blockage in the blood vessels supplying the brain, is a leading cause of disability and death worldwide. While reperfusion therapies such as thrombolysis and endovascular treatment have proven effective in treating acute ischemic stroke, many patients are not eligible due to a limited therapeutic window and access to specialized care. This leaves a significant proportion of patients with mild to moderate ischemic stroke without optimal treatment options.

The ATAMIS trial, a multicenter, open-label, blinded end point, randomized clinical trial conducted across 66 sites in China, sought to address this unmet need. The study enrolled 3000 patients with acute ischemic stroke (NIHSS score 4-10) who were not eligible for reperfusion therapies and presented within 48 hours of symptom onset. Patients were randomly assigned to receive either clopidogrel plus aspirin or aspirin alone.

The primary end point of the study was the occurrence of early neurologic deterioration at 7 days, defined as an increase in NIHSS score of 2 or more points compared with baseline. Secondary outcomes included excellent functional outcome (mRS 0-1) at 90 days, shift in mRS distribution at 90 days, change in NIHSS score at 14 days, new ischemic or hemorrhagic stroke within 90 days, and other vascular events or death within 90 days.

The results of the study were promising. In the modified intention-to-treat population (n=2915), early neurologic deterioration at 7 days occurred in 4.8% of patients in the clopidogrel plus aspirin group compared with 6.7% in the aspirin alone group. This finding remained significant after adjustment for prespecified prognostic variables, indicating that the combination of clopidogrel and aspirin is superior to aspirin alone in reducing early neurologic deterioration.

Interestingly, subgroup analysis revealed that the benefit of dual antiplatelet therapy was more pronounced in patients treated within 24 hours of symptom onset. This finding underscores the importance of early intervention in the management of acute ischemic stroke.

While the study did not find significant differences in the secondary outcomes between the two groups, including 90-day functional outcomes, the reduction in early neurologic deterioration is a crucial step forward. Early neurologic deterioration is associated with poor long-term outcomes, and preventing its occurrence can have a substantial impact on a patient’s quality of life.

Importantly, the safety profile of the dual antiplatelet therapy was comparable to that of aspirin alone. Adverse events, including bleeding complications, were similar between the two groups, indicating that the short-term use of clopidogrel plus aspirin is safe in this patient population.

The findings of the ATAMIS trial have significant implications for the management of acute mild to moderate ischemic stroke. The study provides evidence that dual antiplatelet therapy with clopidogrel plus aspirin is a viable treatment option for patients who are not candidates for reperfusion therapies and present within 48 hours of symptom onset. The short-term use of this combination therapy appears to be safe and effective in reducing early neurologic deterioration, particularly when initiated early.

Reference:

Chen H, Cui Y, Wang X, et al. Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke: The ATAMIS Randomized Clinical Trial. JAMA Neurol. Published online March 11, 2024.

doi:10.1001/jamaneurol.2024.0146

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Combining prostate MRI with a blood test may help avoid unnecessary prostate biopsies, highlights JAMA research

Researchers  New Brigham have found in a new study that MRI of the prostate, combined with a blood test, can help determine if a prostate lesion is clinically significant cancer.

A new meta-analysis by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, suggests that doctors and patients can avoid unnecessary prostate biopsies by combining MRI of the prostate findings with prostate-specific antigen (PSA) density. This new approach to diagnosing clinically significant prostate cancer can decrease patient harm and health care costs of prostate biopsies. Their results are published  in JAMA Network Open.

An enlarged prostate or potential prostate cancer is a common issue for older men. There will be approximately 300,000 new cases of prostate cancer in the U.S. this year. But not all those cancers require treatment-or even need to be biopsied.

“In the workup of men suspected of having prostate cancer, prostate MRI findings combined with PSA density measurement can help doctors decide which patients to biopsy,” said senior author Ramin Khorasani, MD, MPH, Radiology Vice Chair for Quality and Safety at Brigham and Women’s Hospital and Mass General Brigham and Philip H. Cook Professor of Radiology at Harvard Medical School. “With this new analysis, we looked to see how MRI can help urologists decide which patients to biopsy and which patients may not need aggressive diagnosis and treatment.”

Researchers have known for a long time that not all prostate cancer is dangerous. However, telling which cancers need treatment without a biopsy can be difficult. Biopsies, especially those of the prostate, can be uncomfortable, invasive, and expensive.

To doctors, clinically significant prostate cancer (csPCa) is prostate cancer that has a high chance of threatening a patient’s life. They have cells that look more aggressive, or cancer is found outside of the prostate gland.

“Prostate cancer is the second most common cancer in men worldwide, but we need to be able to identify patients who require prostate biopsy while avoiding unnecessary procedures and minimizing the risk of missing clinically significant prostate cancer,” Adam Kibel, MD, chair of the Department of Urology and co-author of the study. “These findings suggest that patient-tailored prostate biopsy decisions based on information from MRI and blood tests could prevent unnecessary procedures while maintaining high sensitivity.”

MRI of the prostate can provide some of this information. Still, a biopsy is traditionally needed to determine how aggressive the cancer cells look. This study tested a new approach: combining MRI-based prostate imaging reporting and data system (PI-RADS) scores with prostate-specific antigen (PSA) density to determine which cancers were likely to be clinically significant without including information from a biopsy. PI-RADS scores the prostate lesion from 1 (highly unlikely to be clinically significant) to 5 (cancer is highly likely to be clinically significant). PSA density (PSAD) is the PSA blood level divided by the prostate’s volume (as determined by MRI).

The JAMA Network Open study builds upon previous findings from a similar study using data only obtained at Brigham Women’s Hospital, published in the Journal of the American College of Radiology in 2022. That study found that an analysis using PI-RADS and PSAD cutoffs could pinpoint up to 50% of cases in which a biopsy would be unnecessary. The new study, whose first and second authors are Arya Haj-Mirzaian, MD, MPH, and Kristine S. Burk, MD, did the same analysis on data from 72 previously published studies of men with prostate cancer, including their PI-RADS results, prostate-specific antigen density testing, and determination of clinical significance from a biopsy.

The meta-analysis gave them a dataset of more than 36,000 patients to determine if their earlier findings at BWH held in a more diverse sample set. They found that prostate biopsies may be unnecessary for patients with a PI-RADS under 4 and a PSAD below 0.10 ng/ml2. The researchers found that using specific PI-RADS and PSAD cutoffs, doctors could confidently skip 50% of biopsies while only missing 5% of clinically significant cancers, or they could skip 30% and only miss 3%.

“These data give us the confidence to say that in some cases, we can safely follow men with testing rather than aggressively pursue a biopsy in all cases,” Kibel said. “By making this information available to physicians and patients, we can help them make a more informed decision about undergoing a biopsy.”

The next step in this research is using the analysis to create an easy-to-use patient-level scoring system that urologists can use to evaluate their patient’s need for a biopsy.

Reference:

Haj-Mirzaian A, Burk KS, Lacson R, et al. Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(3):e244258. doi:10.1001/jamanetworkopen.2024.4258.

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Adults in small towns face higher impact of diabetes complications: Study

A comprehensive study highlighted the significant disparities in the health outcomes of diabetes patients across the United States by focusing the impact of living in rural areas versus urban centers. The key findings of the study were published in the Diabetes Care journal.

This study utilized data from the OptumLabs Data Warehouse which included a deidentified dataset of U.S. commercial and Medicare Advantage beneficiaries to illuminate the relative dangers of diabetes complications along the rural-urban continuum. The retrospective cohort study followed a total of 2,901,563 adults who were diagnosed with diabetes from January 2012 to December 2021 to understand how geographic location affects the prevalence of both acute and chronic complications associated with the condition. This research by Kyle Steiger and team classified the areas into three categories based on population size; the cities (population over 50,000), small towns (population 2,500–50,000) and remote areas (population under 2,500).

The findings from the study indicate that residents of small towns are at a significantly higher risk of undergoing the wide range of diabetes complications when compared to their urban counterparts. The adjusted hazard ratios (HRs) for residents of small towns showed increased risks of hyperglycemia, hypoglycemia, end-stage kidney disease, myocardial infarction, heart failure, amputation, other lower-extremity complications and revascularization. Also, these individuals had a slightly reduced risk of stroke.

There was a marked higher risk of myocardial infarction and revascularization in the remote areas and the residents experienced lower risks of hyperglycemia and stroke when compared to city dwellers. Also, when comparing remote areas to small towns, the data suggested lower hazards for hyperglycemia, hypoglycemia and heart failure among the former. The study found no significant geographical variation in the risks of developing retinopathy and atrial fibrillation/flutter that suggests some complications of diabetes are uniformly distributed regardless of residential location.

The implications of these findings highlight a clear need for targeted healthcare policies and interventions that address the unique challenges underwent by diabetes patients living in small towns and remote areas. The outcomes behind the study call for further investigation into the underlying reasons for these geographic disparities, with the goal of developing more effective strategies to reduce the increased risks by these populations. Overall, this research underscores the importance of considering geographical context in the management and prevention of diabetes complications that urge healthcare providers and policymakers to adapt their approaches to the diverse needs of patients.

Source:

Steiger, K., Herrin, J., Swarna, K. S., Davis, E. M., & McCoy, R. G. (2024). Disparities in Acute and Chronic Complications of Diabetes Along the U.S. Rural-Urban Continuum. In Diabetes Care. American Diabetes Association. https://doi.org/10.2337/dc23-1552

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Higher readmission rates after PCI versus CABG for left main coronary artery disease: EXCEL trial

USA: Findings from a 5-year follow-up of the EXCEL trial revealed that surgery has the upper hand over angioplasty for revascularization for left main coronary disease concerning hospital readmission rates.

The study was published online in the Journal of the American College of Cardiology.

In the EXCEL trial, readmission during 5-year follow-up after revascularization for left main coronary artery disease (LMCAD) was common and more frequent after percutaneous coronary intervention (PCI) than coronary artery bypass grafting (CABG). Readmissions were tied to an increased risk of all-cause death, more so after PCI than with CABG.

“This thought-provoking analysis highlights the risks and implications of late readmissions after revascularization for unprotected left main coronary artery disease,” Wayne B. Batchelor and Abdulla A. Damluji from Inova Schar Heart and Vascular in Falls Church, Virginia, wrote in an accompanying editorial.

The frequency of and the relationship between hospital readmissions and outcomes following revascularization for left main coronary artery disease are unknown. Ioanna Kosmidou, from Cardiovascular Research Foundation in New York, New York, USA, and colleagues aimed to study the predictors, incidence, and clinical impact of readmissions following PCI and coronary artery bypass grafting for LMCAD.

In the EXCEL trial, 1,905 patients with LMCAD were randomized to percutaneous coronary intervention versus coronary artery bypass grafting.

The cumulative incidence of readmissions was analyzed with multivariable Anderson-Gill and joint frailty models to consider recurrent events and the competing risk of death. A time-adjusted Cox proportional hazards model determined the impact of readmission on subsequent mortality within 5-year follow-up.

The study led to the following findings:

  • Within 5 years, 1,868 readmissions occurred in 45.2% of hospital survivors (2.2 ± 1.9 per patient with readmission[s], range 1-16), approximately one-half for cardiovascular causes and one-half for noncardiovascular causes (49.6% and 50.4%, respectively).
  • One or more readmissions occurred in 48.6% of PCI patients versus 41.8% of CABG patients.
  • After multivariable adjustment, PCI remained an independent predictor of readmission (adjusted HR: 1.22), along with female sex, comorbidities, and the extent of CAD.
  • Readmission was independently associated with subsequent all-cause death, with interaction testing indicating a higher risk after PCI than CABG (adjusted HR: 5.72 vs adjusted HR: 2.72, respectively).

“PCI was an independent predictor of readmission and associated with a higher readmission rate than CABG,” the study authors concluded.

Reference:

DOI: https://www.jacc.org/doi/10.1016/j.jacc.2024.01.012

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Use of microneedles may promote diabetic wounds healing, suggests study

The global population of patients with diabetic wounds is expected to rise to between 9.1 million to 26.1 million by 2030. Diabetic wounds severely impact patients’ quality of life, both physically and mentally while also imposing a substantial economic burden on healthcare systems.

Current treatment methods for diabetic wounds include surgical debridement, negative pressure wound therapy, vascularized flaps and different types of local dressings. Among these dressings, commonly used options include gauze, metal ion dressings, hydrogel dressings and platelet-rich plasma dressings. However, traditional dressings have limited drug loading capacity and permeability, and are unable to deliver active medications to the deep wound bed.

In recent years, microneedles have become a research focus in wound management due to their advantages of high drug load/delivery capabilities, minimal invasiveness, convenience and strong adhesion. These attributes significantly reduce patient discomfort and improve compliance. Microneedles enhance the efficiency and permeability of transdermal drug delivery by penetrating the skin barrier and incorporating drugs, proteins, nanoparticles and other therapeutic agents, effectively transporting them to the wound bed.

At present, there is a lack of summary articles on the application of microneedles of different structures and materials to diabetic wounds. This also hampers the development of microneedle dressings related to diabetic wounds.

To that end, in a review published in the KeAi journal Chinese Journal of Plastic and Reconstructive Surgery, a group of researchers from China summarizes the materials of microneedles, techniques, structure, design, release mechanism, classification of delivered substances and their effects on different stages of wound healing.

“The structural composition and material selection of microneedles influence their efficacy in treating diabetic wounds,” explains corresponding author of the study, Youbai Chen, a professor in plastic and reconstructive surgery at the First Medical Center of Chinese PLA General Hospital in Beijing. “Microneedles can promote diabetic wound healing through several mechanisms, such as antibacterial, anti-inflammatory, antioxidant, hypoglycemic and angiogenic activities at different stages of the healing process.”

“In conclusion, microneedles are promising drug delivery systems for the treatment of diabetic wounds,” adds first author Chun Liang. “We hope that our summary will be enlightening and instructive for further research on microneedle dressings.”

Reference:

Chun Liang, Ren Wang, Tian He, Dongsheng Chen, Guangliang Zhang, Xiangye Yin, Hongyu Wang, Jiale Xie, Yujing Li, Youbai Chen, Revolutionizing diabetic wound healing: The power of microneedles, Chinese Journal of Plastic and Reconstructive Surgery, https://doi.org/10.1016/j.cjprs.2023.12.004.

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