We aimed to determine if the severity of computed tomographic coronary angiography (CTCA)‐diagnosed CAD is associated with post‐liver transplantation (LT) myocardial infarction (MI) within 30 days and early mortality. We retrospectively evaluated 2,118 consecutive patients who underwent CAD screening using CTCA. Post‐LT type‐2‐MI, elicited by oxygen supply‐and‐demand mismatch within a month after LT, was assessed according to the severity of CTCA‐diagnosed CAD. Obstructive CAD (>50% narrowing, 9.2% prevalence) was identified in 21.7% of patients with three or more known CAD risk factors of the American Heart Association. Post‐LT MI occurred in 60 (2.8%) of total patients in whom 90‐day mortality rate was 16.7%. Rates of post‐LT MI were 2.1%, 3.1%, 3.4%, 4.3%, and 21.4% for normal, non‐obstructive CAD, 1‐, 2‐, and 3‐vessel obstructive CAD, respectively. Two‐ or 3‐vessel obstructive CAD showed 4.9‐fold higher post‐LT MI risk, compared to normal coronary vessels. The sensitivity and negative predictive value of obstructive CAD in detecting post‐LT MI were respectively 20% and 97.5%. In conclusion, negative CTCA finding in suspected patients can successfully exclude post‐LT MI, whereas proceeding with invasive angiography is needed to further risk‐stratify in patients with significant CTCA‐diagnosed CAD. Prognostic role of CTCA in predicting post‐LT MI needs further research.

The monitoring of arterial blood pressure (ABP) in anesthetized patients is crucial for preventing hypotension, which can lead to adverse clinical outcomes. Several efforts have been devoted to develop artificial intelligence-based hypotension prediction indices. However, the use of such indices is limited because they may not provide a compelling interpretation of the association between the predictors and hypotension. Herein, an interpretable deep learning model is developed that forecasts hypotension occurrence 10 min before a given 90-s ABP record. Internal and external validations of the model performance show the area under the receiver operating characteristic curves of 0.9145 and 0.9035, respectively. Furthermore, the hypotension prediction mechanism can be physiologically interpreted using the predictors automatically generated from the proposed model for representing ABP trends. Finally, the applicability of a deep learning model with high accuracy is demonstrated, thus providing an interpretation of the association between ABP trends and hypotension in clinical practice.

Laparoscopic pylorus-preserving pancreaticoduodenectomy is being performed more frequently because of improved surgical techniques. Although several studies have demonstrated safety and favourable outcomes of laparoscopic pylorus-preserving pancreaticoduodenectomy compared to open pylorus-preserving pancreaticoduodenectomy, few studies have focused on the development of postoperative acute kidney injury. This retrospective study compared the prevalence and risk factors of acute kidney injury following laparoscopic and open pylorus-preserving pancreaticoduodenectomy. Data from 809 patients who underwent pylorus-preserving pancreaticoduodenectomy between February 2012 and September 2016 were analysed. Patients were divided into two groups according to the surgical procedure (open pylorus-preserving pancreaticoduodenectomy [n = 632] vs laparoscopic pylorus-preserving pancreaticoduodenectomy [n = 177]). The Kidney Disease: Improving Global Outcomes criteria were used to define postoperative acute kidney injury and risk factors were investigated using multivariable logistic regression analysis with propensity score matching analysis and standardized mortality ratio weighting to compare outcomes. No significant differences were found in the occurrence of postoperative acute kidney injury and incidence of postoperative ICU admission between open and laparoscopic pylorus-preserving pancreaticoduodenectomy groups after propensity score matching (p = 1.000, p = 0.999, respectivelyand standardized mortality ratio weighted analysis (p = 0.619, p = 0.982, respectively). Hospital stay was significantly shorter in the laparoscopic pylorus-preserving pancreaticoduodenectomy group (propensity matched set, mean [SD], 16.7 [10.0] vs. 18.7 [9.6] days, p = 0.004; standardized mortality ratio, 16.6 [9.9] vs. 18.1 [8.8] days, p = 0.001). There was no significant difference in postoperative acute kidney injury incidence between both groups. Laparoscopic pylorus-preserving pancreaticoduodenectomy is promising with comparable postoperative outcomes to open pylorus-preserving pancreaticoduodenectomy and has the advantage of shorter hospital stay.

Background: Laryngeal microsurgery (LMS) is often accompanied by a sudden increase in blood pressure (BP) during surgery because of stimulation around the larynx. This sudden change in the hemodynamic status is not immediately reflected in a casual cuff-type measurement that takes intermittent readings every 3 to 5 min. Objective: This study aimed to investigate the potential of pulse arrival time (PAT) as a marker for a BP surge, which usually occurs in patients undergoing LMS. Methods: Intermittent measurements of BP and electrocardiogram (ECG) and photoplethysmogram (PPG) signals were recorded during LMS. PAT was defined as the interval between the R-peak on the ECG and the maximum slope on the PPG. Mean PAT values before and after BP increase were compared. PPG-related parameters and the correlations between changes in these variables were calculated. Results: BP surged because of laryngoscopic manipulation (mean systolic BP [SBP] from 115.3, SD 21.4 mmHg, to 159.9, SD 25.2 mmHg; P<.001), whereas PAT decreased significantly (from mean 460.6, SD 51.9 ms, to 405.8, SD 50.1 ms; P<.001) in most of the cases. The change in SBP showed a significant correlation with the inverse of the PAT (r=0.582; P<.001). Receiver-operating characteristic curve analysis indicated that an increase of 11.5% in the inverse of the PAT could detect a 40% increase in SBP, and the area under the curve was 0.814. Conclusions: During LMS, where invasive arterial catheterization is not always possible, PAT shows good correlation with SBP and may, therefore, have the potential to identify abrupt BP surges during laryngoscopic manipulations in a noninvasive manner.