Search

In previous decades, seminal theories were advanced addressing the problems of asymmetric information. These scholarly works confirmed a significant positive correlation between insurance coverage and risk in insurance markets. We showed that when regression models were used to analyze the asymmetric information problem, the sample selection bias and chosen regression methods could produce distinct results. Moreover, samples at different quantiles may lead to considerably different levels of information asymmetry. The present research suggests that quantile regression models be employed to better reveal the situation of the insurance market and reduce estimation errors. [ABSTRACT FROM AUTHOR]

The management of blunt abdominopelvic trauma with combined hemoperitoneum and pelvic fractures is challenging for trauma surgeons. Although angioembolization can achieve hemostasis in most visceral organ injuries and pelvic fractures after blunt abdominal trauma, it cannot effectively control hemorrhage in patients with blunt bowel mesenteric injury (BBMI). This study aimed to determine the risk factors associated with hemodynamically unstable patients with BBMI and to test the hypothesis that pelvic fracture is an independent risk factor for patients with unstable BBMI and concomitant pelvic fracture to guide the therapeutic sequence for difficult-to-manage patients. This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2021 and included 158 adult patients with surgically proven BBMI. The patients were divided on the basis of the presence of a shock episode before emergency laparotomy. The shock group included 44.3% of all patients in the study (n = 70). Clinical injury severity and prognosis for patients in the shock group were poorer than those for patients in the non-shock group, and more invasive treatments and transfusions were performed for patients in the shock group than for those in the non-shock group. Pelvic fractures were more frequently associated with the shock group than with the non-shock group (21.4% vs. 5.7%; p = 0.003). In multivariate analysis, the presence of intracerebral hemorrhage (odds ratio [OR] = 10.87, 95% confidence intervals [CIs]: 1.70–69.75) and rib fracture (OR = 5.94, 95% CIs = 1.06–33.45) was identified as an independent predictor of shock, whereas the effect of pelvic fracture did not achieve statistical significance (OR = 2.94, 95% CIs = 0.66–13.13) after adjusting for confounding factors. For patients with BBMI, outcomes need to be improved during early diagnosis, and treatments should be expeditiously performed on the basis of the rapid identification of unstable hemodynamic status. Our results support the recommendation of emergency laparotomy in unstable patients with concomitant pelvic fractures, followed by damage control TAE if needed. [ABSTRACT FROM AUTHOR]

Background: Mixed evidence exists regarding stroke rates when comparing self-expanding valves (SEVs) to balloon-expandable valves (BEVs) in transcatheter aortic valve replacement (TAVR). This study investigates the debris captured by the SENTINEL cerebral protection system (CPS) during TAVR., Methods: Seventy-five consecutive patients who underwent TAVR with CPS from March to December 2023 were recruited. Collected debris underwent histopathologic analysis, categorized by size (< 2 mm, 2-5 mm, > 5 mm) and quantity. Logistic regression analysis was used to identify predictors for the presence of particles > 5 mm in size., Results: Of the 75 patients, 39 received SEVs and 36 received BEVs. Baseline characteristics were similar between the groups. The BEV group had significantly more frequent concomitant percutaneous coronary interventions (p = 0.013), while the SEV group had longer TAVR procedure (p = 0.019) and fluoroscopy times (p = 0.006). All patients had visible debris, predominantly valve tissue (SEV vs. BEV = 79.8% vs. 47.2%; p = 0.308), calcification (SEV vs. BEV = 23.1% vs. 36.1%; p = 0.215), and thrombus (SEV vs. BEV = 15.4% vs. 5.6%; p = 0.855). No significant differences were observed in particle count and particle size < 5 mm between the SEV and BEV groups. However, logistic regression analysis revealed that the patients who received SEVs had a 16.78-fold increased likelihood of having captured debris > 5 mm compared to those who received BEVs., Conclusions: Our study demonstrated that significantly more particles sized > 5 mm were captured by the CPS during TAVR in the SEV group, underscoring the importance of using the CPS during TAVR, especially in younger patients receiving SEVs., Competing Interests: The authors declare that they have no conflict of interest.

Background: The present study aimed to investigate whether proper sizing can improve the procedural and clinical outcomes of transcatheter aortic valve replacement (TAVR) with new-generation self-expanding valves (SEVs) and balloon-expandable valves (BEVs) for treating bicuspid aortic stenosis (BAS)., Methods: We retrospectively evaluated consecutive patients who underwent TAVR with Sapien 3 valves (Edwards Lifesciences, Irvine, CA) or Evolut R/PRO valves (Medtronic, Minneapolis, MN) for severe BAS from 2017 to 2022. The primary endpoints were device success rate and major adverse cardiac and cerebral events (MACCEs), including mortality, nonfatal myocardial infarction or disabling stroke, transcatheter heart valve failure, or clinically relevant valve thrombosis during follow-up. Our team used a complementary approach of supraannular sizing in addition to the conventional annular sizing method (Wei's method) to guide the TAVR procedures., Results: We recruited a total of 75 consecutive patients, of whom 43 (57%) were treated with BEVs from October 2017 to June 2021, and 32 (43%) were treated with SEVs from July 2021 to December 2022. Device success was similar between the BEV and SEV groups (93% vs 94%; p > 0.99), and no cases of annular rupture occurred in either group. Similar rates of moderate-to-severe paravalvular leak were observed in the BEV and SEV groups (5% vs 6%, p > 0.99). At a median follow-up of 464 days, the MACCE rates were comparable between the two groups. In multivariate analysis, the presence of previous percutaneous coronary interventions (hazard ratio: 5.43; p = 0.039) and New York Heart Association functional class III/IV heart failure at 30 days of follow-up after TAVR (hazard ratio: 9.90; p = 0.037) were independently associated with long-term MACCEs., Conclusion: Our results demonstrated comparable efficacy and safety for BAS patients undergoing TAVR using either BEVs or SEVs when using Wei's sizing method., Competing Interests: Conflicts of interest: Dr. Wei-Hsian Yin and Dr. Jeng Wei, editorial board members at the Journal of the Chinese Medical Association , had no role in the peer review process or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2024, the Chinese Medical Association.)