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Background: Cardiopulmonary resuscitation (CPR) is the cornerstone intervention for cardiac arrest, with extracorporeal CPR (ECPR) demonstrating enhanced survival and neurologic outcomes in in‐hospital cardiac arrest. This study explores the time interval between CPR initiation and the onset of extracorporeal membrane oxygenation (ECMO) in ECPR recipients, investigating its impact on survival outcomes. Methods: This retrospective analysis included 1950 adults who received CPR at a single medical center between March 2019 and April 2023. Data from 198 adult patients who had ECMO inserted during CPR were analyzed. The interval from CPR initiation to ECMO initiation was quantified and categorized as ≤20, 20–40, and >40 min. Cox regression analysis assessed associations between CPR‐to‐ECMO time and short‐ and long‐term mortalities. Results: Among the 198 patients who underwent ECPR, 116 (58.6%) experienced 30‐day mortality. Initiation of ECMO within 20 min occurred in 46 (23.2%), whereas 74 (37.4%) had ECMO initiated after 40 min. Cox regression revealed a significant association between time from CPR to ECMO initiation and 30‐day mortality (adjusted hazard ratio [HR]: 2.20 in >40 min, HR: 2.63 in 20–40 min, p = 0.006) and 6‐month mortality (HR: 1.81, in >40 min, HR: 1.99 in 20–40 min, p = 0.021). Conclusions: This study revealed that, in ECPR recipients, a shorter duration between CPR initiation and ECMO flow commencement is associated with improved short‐ and long‐term patient prognoses. These findings emphasize the critical role of timely ECMO application in optimizing outcomes for patients undergoing ECPR. [ABSTRACT FROM AUTHOR]

Despite recent advances in surgical techniques and perinatal management in obstetrics for reducing intraoperative bleeding, blood transfusion may occur during a cesarean section (CS). This study aims to identify machine learning models with an optimal diagnostic performance for intraoperative transfusion prediction in parturients undergoing a CS. Additionally, to address model performance degradation due to data imbalance, this study further investigated the variation in predictive model performance depending on the ratio of event to non-event data (1:1, 1:2, 1:3, and 1:4 model datasets and raw data).The area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) were evaluated to compare the predictive accuracy of different machine learning algorithms, including XGBoost, K-nearest neighbor, decision tree, support vector machine, multilayer perceptron, logistic regression, random forest, and deep neural network. We compared the predictive performance of eight prediction algorithms that were applied to five types of datasets. The intraoperative transfusion in maternal CS was 7.2% (1020/14,254). XGBoost showed the highest AUROC (0.8257) and AUPRC (0.4825) among the models. The most significant predictors for transfusion in maternal CS as per machine learning models were placenta previa totalis, haemoglobin, placenta previa partialis, and platelets. In all eight prediction algorithms, the change in predictive performance based on the AUROC and AUPRC according to the resampling ratio was insignificant. The XGBoost algorithm exhibited optimal performance for predicting intraoperative transfusion. Data balancing techniques employed to alter the event data composition ratio of the training data failed to improve the performance of the prediction model. [ABSTRACT FROM AUTHOR]

There is limited knowledge regarding covert brain infarctions following coronary angiography and their clinical impact on postoperative complications after coronary artery bypass graft surgery. This study investigates the association between preoperative covert brain infarction following coronary angiography and major adverse cardiac and cerebrovascular events after coronary artery bypass surgery. This cohort study included patients undergoing elective coronary artery bypass surgery between January 2006 and December 2019, who had pre-operative coronary angiography and subsequent brain magnetic resonance imaging. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events within 30 days of coronary artery bypass surgery, including operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. The secondary outcomes included each component of major adverse cardiac and cerebrovascular events and 5-year all-cause mortality. Among 2,476 patients, 212 (8.6%) had covert cerebral infarction after coronary angiography, and 353 (14.3%) patients experienced major adverse cardiac and cerebrovascular events after coronary artery bypass surgery. After performing 1:4 propensity-score matching, a total of 1,057 patients were included in the final analysis. The incidence of major adverse cardiac and cerebrovascular events within 30 days was not significantly different between patients with a covert brain infarction and those without (15.1% [32/212] vs. 15.6% [132/845]; risk difference, -0.5, 95% confidence interval [CI]: -5.6 to 4.4; P=0.851). There were also no significant differences in each component of major adverse cardiac and cerebrovascular events or 5-year all-cause mortality (18.7% vs. 17.0%, respectively, P for stratified log-rank test=0.33). There was no significant association between covert brain infarction following coronary angiography and the occurrence of major adverse cardiac and cerebrovascular events within 30 days and long-term mortality after coronary artery bypass surgery. [ABSTRACT FROM AUTHOR]

Background: A recent study reported a correlation between the muscle mass of male donors and graft failure in living donor liver transplantation (LDLT) recipients. We investigated the association of sex‐specific donor skeletal muscle index (SMI) with mortality and graft failure in LDLT recipients. Methods: We retrospectively analysed 2750 sets of donors and recipients between January 2008 and January 2018. The recipient outcomes were analysed by dividing the data according to donor sex. Cox regression analyses were performed to evaluate the association between donor SMI by sex and 1‐year mortality and graft failure in recipients. Results: In the male donor group, robust donor (increased SMI) was significantly associated with higher risks for mortality (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.00–1.06, p =.023) and graft failure (HR: 1.04, 95% CI: 1.01–1.06, p =.007) at 1 year. In the female donor group, the robust donor was significantly associated with lower risks for mortality (HR: 0.92, 95% CI: 0.87–0.97, p =.003) and graft failure (HR: 0.95, 95% CI: 0.90–1.00, p =.032) at 1 year. Conclusions: Donor SMI was associated with surgical outcomes in recipients. Robust male and female donors were a significant negative and protective factor for grafts respectively. [ABSTRACT FROM AUTHOR]

Background: Cervical epidural steroid injection is associated with rare but potentially catastrophic complications. The contralateral oblique (CLO) view may be a safe and feasible alternative to the lateral (LAT) view for fluoroscopic-guided cervical epidural steroid injection. However, evidence for the clinical usefulness of the CLO view for cervical epidural steroid injection is lacking. We assessed the clinical usefulness of the CLO view for cervical epidural steroid injection in managing cervical herniated intervertebral discs.Methods: Patients were randomly assigned to receive fluoroscopic-guided cervical epidural steroid injection under LAT view or CLO view at 50±5° degrees groups. The primary outcome was the needling time comparison between the two groups. Secondary outcomes were comparison of first-attempt success rate, needle tip visualization and location, total number of needle passes, final success rate, crossover success rate and false-positive/negative loss of resistance. Complications and radiation dose were also compared.Results: The needling time significantly decreased in the CLO than in the LAT group. The first-attempt success rate was significantly higher in the CLO compared with the LAT group. The needle tip was clearly visualized (p<0.001) and located more often on (or just anterior to) the ventral interlaminar line (p<0.001) in the CLO than in the LAT group. There were significantly fewer needle passes (p=0.019) in the CLO than in the LAT group. There were no significant differences in the final success, crossover success, false-positive/negative loss of resistance or radiation dose between the groups. Two (5.9%) cases in the LAT group experienced complications.Conclusion: The CLO view may be recommended for fluoroscopic-guided cervical epidural steroid injection, considering its better clinical usefulness over the LAT view. [ABSTRACT FROM AUTHOR]

Background: Although living donor liver transplantation (LDLT) is the standard treatment option for patients with end‐stage liver disease, it always entails ethical concerns about the risk of living donors. Recent studies have reported a correlation between sarcopenia and surgical prognosis in recipients. However, there are few studies of donor sarcopenia and the surgical prognosis of donors. This study investigated the association between sarcopenia and postoperative acute kidney injury in liver donors. Methods: This retrospective study analysed 2892 donors who underwent donor hepatectomy for LDLT between January 2008 and January 2018. Sarcopenia was classified into pre‐sarcopenia and severe sarcopenia, which were determined to be −1 standard deviation (SD), and −2 SD from the mean baseline of the skeletal muscle index, respectively. Multivariate regression analysis was performed to evaluate the association between donor sarcopenia and postoperative AKI. Additionally, we assessed the association between donor sarcopenia and delayed recovery of liver function (DRHF). Results: In the multivariate analysis, donor sarcopenia was significantly associated a higher incidence of postoperative AKI (adjusted odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.15–6.11, P =.022 in pre‐sarcopenia, OR: 5.59, 95% CI: 1.11–28.15, P =.037 in severe sarcopenia, respectively). Additionally, hypertension and synthetic colloid use were significantly associated with postoperative AKI. In the multivariate analysis, risk factors of DRHF were male gender, indocyanine green retention rate at 15 minutes, and graft type, however, donor sarcopenia was not a risk factor. Conclusions: Donor sarcopenia is associated with postoperative AKI following donor hepatectomy. [ABSTRACT FROM AUTHOR]