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A case of adenocarcinoma presenting with cystic lesion and recurrent pneumothoraces. 一例腺癌伴囊性病变和复发性气胸。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03111-0
Long Yu, Yang Lou, Dan Zhu

Background: In this paper, a rare case is reported, where the patient is a 74-year-old man. He suffered from recurrent pneumothorax within half a year and experienced a relapse after receiving conservative treatments.

Case presentation: Diagnostic workup revealed a cystic lesion in the right middle lobe, which has been interpreted as a bulla during the initial chest CT scan. Due to recurrent pneumothorax and poor response to the conservative treatments, the patient underwent bullectomy and pleurodesis. The pathology showed that the wall of the cystic lesion was invasive adenocarcinoma.

Conclusions: This case highlights the importance of monitoring cystic lesions in the lungs, especially in patients with a history of smoking and emphysema.

背景:本文报告了一例罕见病例,患者是一名 74 岁的男性。他在半年内反复出现气胸,在接受保守治疗后复发:诊断性检查发现右肺中叶有囊性病变,在最初的胸部 CT 扫描中被解释为鼓室。由于气胸复发且保守治疗效果不佳,患者接受了鼓室切除术和胸膜穿刺术。病理结果显示,囊壁病变为浸润性腺癌:本病例强调了监测肺部囊性病变的重要性,尤其是对有吸烟史和肺气肿的患者。
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引用次数: 0
Successful occluder removal and reocclusion of an atrial septal defect after occluder immigration to aortic arch: a case report. 成功移除封堵器并在封堵器移入主动脉弓后重新封堵房间隔缺损:病例报告。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03107-w
Zaiqiang Zhang, Jiawang Ding

Background: Atrial septal defect (ASD) is a common congenital heart disease, and currently, transcatheter intervention is the most common clinical treatment method. However, certain complications still occur during the percutaneous process, among which occluder loss and displacement are rare but serious complication. Although the probability of occluder loss and displacement is low, severe cases can endanger life.

Case presentation: Here, we report the case of a patient who underwent ASD closure in which the occluder fell off into the aortic arch, the detached occluder was recovered through catheter intervention, and the patient underwent ASD closure again.

Conclusions: In this case report, we highlight that although percutaneous closure of an ASD is regarded as a routine procedure, clinicians should remember the possibility of complications, especially occluder loss and displacement. Therefore, interventionist should carefully evaluate the situation before intervention closure, establish standardized interventional treatment procedures, and provide timely treatment follow-up.

背景:房间隔缺损(ASD)是一种常见的先天性心脏病,目前经导管介入治疗是最常见的临床治疗方法。然而,经皮介入治疗过程中仍会出现一些并发症,其中封堵器脱落和移位是罕见但严重的并发症。虽然封堵器脱落和移位的概率较低,但严重者会危及生命:在此,我们报告了一例接受 ASD 封堵术的患者,其封堵器脱落至主动脉弓,通过导管干预找回了脱落的封堵器,患者再次接受了 ASD 封堵术:在本病例报告中,我们强调虽然经皮闭合 ASD 被视为常规手术,但临床医生应牢记并发症的可能性,尤其是闭塞器脱落和移位。因此,介入医师在介入封堵前应仔细评估情况,建立规范的介入治疗程序,并及时提供治疗随访。
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引用次数: 0
Activation of the AMPK/Nrf2 pathway ameliorates LPS-induced acute lung injury by inhibiting oxidative stress and reducing inflammation. 通过抑制氧化应激和减少炎症,激活 AMPK/Nrf2 通路可改善 LPS 诱导的急性肺损伤。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03020-2
Haoxuan Li, Yiting Nie, Hongyu Hui, Xinxin Jiang, Yuanyuan Xie, Cong Fu

Background: Numerous diseases-related acute lung injury (ALI) contributed to high mortality. Currently, the therapeutic effect of ALI was still poor. The detailed mechanism of ALI remained elusive and this study aimed to elucidate the mechanism of ALI.

Method: This study was performed to expose the molecular mechanisms of AMPK/Nrf2 pathway regulating oxidative stress in LPS-induced AMI mice. The mouse ALI model was established via intraperitoneal injection of LPS, then the lung tissue and blood samples were obtained, followed by injection with Dimethyl fumarate (DMF). Finally, Western blot, HE staining, injury score, lung wet/dry ratio, reactive oxygen species (ROS) and ELISA were used to elucidate the mechanism of AMPK/Nrf2 pathway in LPS -induced acute lung injury by mediating oxidative stress.

Results: The lung tissue injury score was evaluated, showing higher scores in the model group compared to the AMPK activator and control groups. DCFH-DA indicated that LPS increased ROS production, while AMPK activator DMF reduced it, with the model group exhibiting higher ROS levels than the control and AMPK activator groups. The lung wet/dry ratio was also higher in the model group. Western blot analysis revealed LPS reduced AMPK and Nrf2 protein levels, but DMF reversed this effect. ELISA results showed elevated IL-6 and IL-1β levels in the model group compared to the AMPK activator and control groups.

Conclusion: CONCLUSION: Activating the AMPK/Nrf2 pathway can improve LPS-induced acute lung injury by down-regulation of the oxidative stress and corresponding inflammatory factor level.

背景:与多种疾病相关的急性肺损伤(ALI)导致了很高的死亡率。目前,ALI 的治疗效果仍然不佳。ALI的详细机制仍然难以捉摸,本研究旨在阐明ALI的机制:本研究旨在揭示 AMPK/Nrf2 通路调节 LPS 诱导的 AMI 小鼠氧化应激的分子机制。通过腹腔注射 LPS 建立小鼠 ALI 模型,获取肺组织和血液样本,然后注射富马酸二甲酯(DMF)。最后,利用 Western 印迹、HE 染色、损伤评分、肺干湿比、活性氧(ROS)和 ELISA 等方法阐明了 AMPK/Nrf2 通路通过介导氧化应激在 LPS 诱导的急性肺损伤中的作用机制:结果:对肺组织损伤评分进行了评估,结果显示模型组的评分高于 AMPK 激活剂组和对照组。DCFH-DA 表明 LPS 增加了 ROS 的产生,而 AMPK 激活剂 DMF 则减少了 ROS 的产生,模型组的 ROS 水平高于对照组和 AMPK 激活剂组。模型组的肺干湿比也更高。Western 印迹分析显示,LPS 降低了 AMPK 和 Nrf2 蛋白水平,但 DMF 逆转了这一效应。ELISA结果显示,与AMPK激活剂组和对照组相比,模型组的IL-6和IL-1β水平升高:结论:激活 AMPK/Nrf2 通路可通过下调氧化应激和相应的炎症因子水平来改善 LPS 诱导的急性肺损伤。
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引用次数: 0
Assessment of intercostal nerve block analgesia and local anesthetic infiltration for thoracoscopic pulmonary bullae resection: a comparative study. 胸腔镜肺大泡切除术中肋间神经阻滞镇痛和局麻药浸润的评估:一项比较研究。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03095-x
Bing Huang, Jing Shi, Yingtong Feng, Jianfu Zhu, Sen Li, Ning Shan, Ying Xu, Yujing Zhang

Objective: The purpose of this study was to compare the analgesic effects of intercostal nerve block (ICNB) and local anesthetic infiltration (LAI) on postoperative pain and recovery following thoracoscopic resection of pulmonary bullae.

Methods: A total of 160 patients undergoing thoracoscopic pulmonary bullae resection were randomly assigned to receive either ICNB (n = 80) or LAI (n = 80). An experienced anesthesiologist administered ultrasound guided ICNB at the T4 and T7 levels with 5 mL of 0.375% ropivacaine hydrochloride for the ICNB group. Instead, the LAI group received 10 mL of the same concentration of ropivacaine hydrochloride at the same concentration used for ICNB for infiltration anesthesia at the incision sites. Out of the initial cohort, 146 patients completed the study (ICNB group, n = 71; LAI group, n = 75). The collected data included preoperative clinical characteristics, visual analog scale (VAS) scores for pain at various time points post-surgery (6, 12, 24, 48, and 72 h). Additionally, the Quality of Recovery-15 (QoR-15) questionnaire was administered 24 h after surgery, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI).

Results: No significant differences were found in drainage volume, use of additional analgesics, duration of chest tube placement, or hospital stay between the two groups. However, the ICNB group had significantly lower VAS scores and QoR-15 scores 24 h postoperatively (p < 0.05), indicating better pain management and recovery. The ICNB group also reported better sleep quality, as reflected by lower PSQI scores.

Conclusion: ICNB provides superior analgesia compared to LAI after thoracoscopic resection of pulmonary bullae, significantly improving postoperative recovery.

研究目的本研究旨在比较肋间神经阻滞(ICNB)和局麻药浸润(LAI)对胸腔镜肺大泡切除术后疼痛和恢复的镇痛效果:共有 160 名接受胸腔镜肺大泡切除术的患者被随机分配接受 ICNB(80 人)或 LAI(80 人)治疗。ICNB组由一名经验丰富的麻醉师在超声引导下在T4和T7水平进行ICNB,使用5毫升0.375%盐酸罗哌卡因。而 LAI 组则使用 10 mL 浓度与 ICNB 相同的盐酸罗哌卡因对切口部位进行浸润麻醉。在初始组群中,146 名患者完成了研究(ICNB 组,n = 71;LAI 组,n = 75)。收集的数据包括术前临床特征、术后不同时间点(6、12、24、48 和 72 小时)的疼痛视觉模拟量表(VAS)评分。此外,还在术后 24 小时进行了恢复质量-15(QoR-15)问卷调查,并使用匹兹堡睡眠质量指数(PSQI)评估了睡眠质量:结果:两组患者在引流量、额外镇痛药的使用、胸腔置管时间和住院时间上没有明显差异。然而,ICNB 组术后 24 小时的 VAS 评分和 QoR-15 评分明显低于 ICNB 组(p 结论:ICNB 可提供更佳的镇痛效果:与 LAI 相比,ICNB 在胸腔镜肺大泡切除术后的镇痛效果更佳,可显著改善术后恢复。
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引用次数: 0
Overdiagnosing giant bullous emphysema as metastatic adenocarcinoma: a case report. 将巨型大泡性肺气肿误诊为转移性腺癌:一份病例报告。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03112-z
Jiyun Lee, Eunsu Park

Background: Giant bullous emphysema is characterized by large bullae occupying at least one-third of the hemithorax and leading to compression of the surrounding lung parenchyma. Overdiagnosis can occur because of the atypical appearance of hyperplastic type II pneumocytes, which may be mistaken for malignant cells.

Case presentation: A 48-year-old male with a history of smoking and occupational exposure presented with dyspnea and drowsiness. Initial chest X-ray revealed a tension pneumothorax, and subsequent chest CT revealed extensive bullous emphysema and lung cancer in the right middle lobe (RML). Pathologic examination initially indicated resected bullae to metastatic adenocarcinoma, but upon review, it was determined that the reactive alveolar cells were misdiagnosed as malignant.

Conclusions: This case emphasizes the need for thorough histopathological assessment and prudent interpretation of atypical cellular morphology.

背景:巨型鼓泡性肺气肿的特征是巨大的鼓泡占据至少三分之一的半胸腔,并导致周围肺实质受压。由于增生的 II 型肺细胞外观不典型,可能被误认为是恶性细胞,因此会出现过度诊断的情况:一名 48 岁男性,有吸烟史和职业接触史,因呼吸困难和嗜睡而就诊。最初的胸部 X 光检查显示有张力性气胸,随后的胸部 CT 显示右中叶(RML)有广泛的鼓泡性肺气肿和肺癌。病理检查最初显示切除的肺大泡为转移性腺癌,但复查后发现反应性肺泡细胞被误诊为恶性肿瘤:本病例强调了对非典型细胞形态进行全面组织病理学评估和审慎解读的必要性。
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引用次数: 0
Predictive value of the left atrioventricular coupling index for recurrence after radiofrequency ablation of paroxysmal atrial fibrillation. 左房室耦合指数对阵发性心房颤动射频消融术后复发的预测价值。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03070-6
Aoshuang Li, Mingyang Zhang, Bin Ning

Background: Although patients with paroxysmal atrial fibrillation (PAF) are preferred to undergo catheter ablation (CA), the high possibility of recurrence following surgery is still concerning. We aimed to evaluate the ability of the left atrioventricular coupling index (LACI), which is the ratio of the left atrium end-diastolic volume to the left ventricle end-diastolic volume, to predict PAF recurrence after CA.

Methods: Patients with PAF undergoing CA for the first time between January 2018 and June 2021 were admitted and grouped by recurrence within a year. LACI was measured before CA using ultrasonography. Risk factors identified by multivariable logistic regression analysis, and the area under the receiver operating characteristic (ROC) curve was used to assess the ability of LACI to predict PAF recurrence after CAP.

Results: Among the 204 patients treated at our hospital, 164 patients were included in the research after eliminating those who were lost to follow-up. Among them, 56 individuals had recurrence following a 90-day blanking period. Recurrence is more likely in elderly patients with high blood pressure. Patients who suffered recurrence exhibited lower left atrial ejection fraction and increased LACI, left atrial volume minimum, and left atrium volume index maximum. LACI was an independent risk factor for postoperative recurrence (OR: 1.526, 95% CI: 1.325-1.757, P < 0.001), and ROC displayed remarkable predictive value [area under the curve (AUC) = 0.868].

Conclusions: High LACI is significantly associated with postoperative recurrence in PAF patients, and LACI has incremental prognostic value to predict recurrence.

背景:尽管阵发性心房颤动(PAF)患者首选接受导管消融术(CA),但手术后复发的可能性仍然很高,这一点令人担忧。我们旨在评估左房室耦合指数(LACI)(即左心房舒张末期容积与左心室舒张末期容积之比)预测 PAF 在 CA 术后复发的能力:收治2018年1月至2021年6月期间首次接受CA治疗的PAF患者,并按一年内复发情况分组。CA 前使用超声波测量 LACI。通过多变量逻辑回归分析确定风险因素,并使用接收器操作特征曲线下面积(ROC)评估LACI预测CAP后PAF复发的能力:在我院接受治疗的 204 名患者中,剔除失去随访的患者后,有 164 名患者被纳入研究范围。其中,56 人在 90 天空白期后复发。高血压老年患者更容易复发。复发患者的左心房射血分数较低,左心房容积指数(LACI)、左心房容积最小值和左心房容积指数最大值升高。左心房容积指数是术后复发的独立风险因素(OR:1.526,95% CI:1.325-1.757,P 结论:高左心房容积指数与术后复发显著相关:高 LACI 与 PAF 患者的术后复发明显相关,LACI 在预测复发方面具有增量预后价值。
{"title":"Predictive value of the left atrioventricular coupling index for recurrence after radiofrequency ablation of paroxysmal atrial fibrillation.","authors":"Aoshuang Li, Mingyang Zhang, Bin Ning","doi":"10.1186/s13019-024-03070-6","DOIUrl":"10.1186/s13019-024-03070-6","url":null,"abstract":"<p><strong>Background: </strong>Although patients with paroxysmal atrial fibrillation (PAF) are preferred to undergo catheter ablation (CA), the high possibility of recurrence following surgery is still concerning. We aimed to evaluate the ability of the left atrioventricular coupling index (LACI), which is the ratio of the left atrium end-diastolic volume to the left ventricle end-diastolic volume, to predict PAF recurrence after CA.</p><p><strong>Methods: </strong>Patients with PAF undergoing CA for the first time between January 2018 and June 2021 were admitted and grouped by recurrence within a year. LACI was measured before CA using ultrasonography. Risk factors identified by multivariable logistic regression analysis, and the area under the receiver operating characteristic (ROC) curve was used to assess the ability of LACI to predict PAF recurrence after CAP.</p><p><strong>Results: </strong>Among the 204 patients treated at our hospital, 164 patients were included in the research after eliminating those who were lost to follow-up. Among them, 56 individuals had recurrence following a 90-day blanking period. Recurrence is more likely in elderly patients with high blood pressure. Patients who suffered recurrence exhibited lower left atrial ejection fraction and increased LACI, left atrial volume minimum, and left atrium volume index maximum. LACI was an independent risk factor for postoperative recurrence (OR: 1.526, 95% CI: 1.325-1.757, P < 0.001), and ROC displayed remarkable predictive value [area under the curve (AUC) = 0.868].</p><p><strong>Conclusions: </strong>High LACI is significantly associated with postoperative recurrence in PAF patients, and LACI has incremental prognostic value to predict recurrence.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three-dimensional printed titanium chest wall reconstruction for tumor removal in the sternal region. 用于胸骨区肿瘤切除的三维打印钛胸壁重建。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03078-y
Wenzhang Wang, Shiyan Yang, Menghu Han, Haifeng Liu, Qing Feng, Yonglin Su, Yi Han, Jin Wang

Resection of thoracic wall tumors results in significant defects in the chest wall, leading to various complications. In recent years, the use of three-dimensional (3D) printed titanium alloy prostheses in clinical practice has demonstrated enhanced outcomes in chest wall reconstruction surgery. A cohort of seven patients with sternal tumors was identified for this study. Following a helical CT scan, a digital model was generated for the design of the prosthesis. Subsequently, the tumors were then removed together with the affected sternum and ribs. The chest wall was then reconstructed using 3D-printed titanium alloy prosthesis for bone reconstruction, mesh for pleural reconstruction, and flap for soft tissue reconstruction. Patients were monitored for a period of one year post-surgery. In the seven cases examined, the tumors were found in various locations with varying degrees of invasion. Based on the scope of surgical resection and the size of the defect, 3D-printed titanium alloy prosthesis was custom-designed for chest wall reconstruction. Prior to bone reconstruction, pleural reconstruction was achieved with Bard Composix E/X Mesh, while soft tissue repair involved muscle flap and musculocutaneous flap procedures. A one-year follow-up assessment revealed that the utilization of the 3D-printed titanium alloy prosthesis led to secure fixation, favorable histocompatibility, and enhanced lung function. The findings demonstrate that the utilization of 3D printed titanium alloy prostheses represents a significant advancement in the field of chest wall reconstruction and thoracic surgical procedures.

胸壁肿瘤切除术会造成胸壁严重缺损,导致各种并发症。近年来,三维(3D)打印钛合金假体在临床实践中的应用已证明可提高胸壁重建手术的效果。本研究选取了七名胸骨肿瘤患者作为研究对象。在进行螺旋 CT 扫描后,生成了设计假体的数字模型。随后,肿瘤连同受影响的胸骨和肋骨一起被切除。然后使用三维打印钛合金假体重建胸壁的骨骼,使用网片重建胸膜,使用皮瓣重建软组织。患者在手术后接受了为期一年的监测。在接受检查的七例患者中,肿瘤发生在不同部位,侵犯程度各不相同。根据手术切除范围和缺损大小,为胸壁重建定制了3D打印钛合金假体。在骨重建之前,胸膜重建采用了 Bard Composix E/X Mesh,软组织修复则采用了肌皮瓣和肌皮瓣手术。为期一年的随访评估显示,使用三维打印钛合金假体可实现安全固定、良好的组织相容性和增强肺功能。研究结果表明,使用三维打印钛合金假体代表了胸壁重建和胸外科手术领域的一大进步。
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引用次数: 0
Airway management for right thoracoscopic tracheal tumour resection after left pneumonectomy assisted by cardiopulmonary bypass: a case report. 心肺旁路辅助左肺切除术后右侧胸腔镜气管肿瘤切除术的气道管理:病例报告。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03053-7
Xue Jiang, Zixuan Li, Rukun Xu, Xiaoliang Wang, Lei Xu

Background: The incidence of secondary tracheal tumours following lung cancer surgery is notably low. Patients with tracheal tumours typically present with symptoms such as coughing, sputum production, haemoptysis, wheezing, stridor, and dyspnoea. In cases of peripheral structure invasion, symptoms may further extend to hoarseness and dysphagia. Initial symptoms may be notably non-distinct. However, the development of pronounced airway symptoms often signifies a critical condition.

Case presentation: A 70-year-old male with severe chest tightness and asthma was transferred to our hospital for emergency treatment. He had undergone left pneumonectomy for non-small cell carcinoma of the left upper lobe of the lung 3 years prior. The examination confirmed that a secondary tumour originated from the left main bronchus and extended to the carina, occupying 90% of the diameter of the tracheal lumen. To relieve the patient's emergency airway, we chose right thoracoscopic resection of the tracheal tumour assisted by cardiopulmonary bypass (CPB), which provides extracorporeal lung support and a good surgical field.

Conclusion: In patients with secondary tracheal tumours after left pneumonectomy for lung cancer, perioperative airway management is challenging for anaesthesiologists, and patients' oxygenation should receive close attention. This article describes the airway management process of this patient for reference.

背景:肺癌手术后继发性气管肿瘤的发病率非常低。气管肿瘤患者通常会出现咳嗽、咳痰、咯血、喘息、呼吸困难等症状。在周围结构受侵的情况下,症状可能会进一步扩展到声音嘶哑和吞咽困难。最初的症状可能并不明显。然而,出现明显的气道症状往往意味着病情危重:一名患有严重胸闷和哮喘的 70 岁男性被转到我院接受急诊治疗。3 年前,他因左肺上叶非小细胞癌接受了左肺切除术。检查证实,继发性肿瘤源于左主支气管并延伸至心尖,占据了气管腔直径的 90%。为了缓解患者的紧急气道问题,我们选择了在心肺旁路(CPB)辅助下进行右胸腔镜下气管肿瘤切除术,这样可以提供体外肺支持和良好的手术视野:结论:对于肺癌左肺切除术后继发气管肿瘤的患者,围手术期的气道管理对麻醉医生来说具有挑战性,患者的氧合应得到密切关注。本文介绍了该患者的气道管理过程,以供参考。
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引用次数: 0
Evaluating the predictive efficacy of real-time 3D echocardiography in cardiac resynchronization therapy. 评估实时三维超声心动图在心脏再同步化治疗中的预测效果。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03058-2
Zhong-Yin Zhou, Jian-Xiang Zhu, Dong-Sheng Zhao, Bing-Qian Ding, Jia-Ling Wang, Gang Lin

Background: The aim of this study is to assess the predictive efficacy of real-time three-dimensional echocardiography (RT-3DE) and QRS wave duration in determining the response to cardiac resynchronization therapy (CRT) and assessing left ventricular systolic function pre- and post-CRT device implantation.

Method: A total of 51 patients with heart failure undergoing CRT at the Second Affiliated Hospital of Nantong University between January 1, 2013, and October 31, 2020, were enrolled in this study. Traditional two-dimensional echocardiography and RT-3DE were performed pre and post-CRT, with QRS wave width data from electrocardiograms and additional clinical information collected. Patients were categorized into CRT responder (n = 36) and CRT non-responder (n = 15) groups based on their response to CRT device implantation. Comparative analyses were conducted on the general characteristics of both groups, as well as the predictive efficacy of RT-3DE and QRS wave width for CRT responsiveness and left ventricular systolic function. Data on the standard deviation (Tmsv16-SD, Tmsv12-SD, Tmsv6-SD) and maximum difference (Tmsv16-Dif, Tmsv12-Dif, Tmsv6-Dif) of left ventricular end-systolic volume (LVESV) at segments 16, 12, and 6, as well as QRS wave width, were collected and analyzed.

Results: The indicators Tmsv6-Dif, Tmsv12-Dif, Tmsv16-Dif, Tmsv6-SD, Tmsv12-SD, Tmsv16-SD, and QRS wave width exhibited significantly higher values in the CRT responder group when compared to the CRT non-responder group (P < 0.05). Among these, Tmsv16-SD demonstrated superior predictive performance for post-CRT response, with a sensitivity of 88.9%, specificity of 80.0%, and a diagnostic cut-off value of 6.19%. This predictive capability exceeded that of the conventional indicator, QRS wave width.

Conclusion: RT-3DE enables accurate prediction of post-CRT patient response and significantly facilitates quantitative assessment of CRT therapy efficacy.

研究背景本研究旨在评估实时三维超声心动图(RT-3DE)和QRS波持续时间在确定心脏再同步化治疗(CRT)反应和评估CRT装置植入前后左室收缩功能方面的预测效果:方法:南通大学附属第二医院在2013年1月1日至2020年10月31日期间共纳入51例接受CRT治疗的心衰患者。CRT前后均进行了传统的二维超声心动图和RT-3DE检查,并收集了心电图的QRS波宽度数据和其他临床信息。根据患者对植入 CRT 设备的反应,将其分为 CRT 反应者组(36 人)和 CRT 非反应者组(15 人)。对两组患者的一般特征以及RT-3DE和QRS波宽度对CRT反应性和左心室收缩功能的预测效果进行了比较分析。收集并分析了第 16、12 和 6 段左心室收缩末期容积(LVESV)的标准差(Tmsv16-SD、Tmsv12-SD、Tmsv6-SD)和最大差值(Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)以及 QRS 波宽度的数据:结果:与 CRT 非应答组相比,CRT 应答组的 Tmsv6-Dif、Tmsv12-Dif、Tmsv16-Dif、Tmsv6-SD、Tmsv12-SD、Tmsv16-SD 和 QRS 波宽度等指标的值均显著升高(P 结论:RT-3DE 能够准确预测 CRT 后的心律失常:RT-3DE 能够准确预测 CRT 后患者的反应,并极大地促进了对 CRT 疗效的定量评估。
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引用次数: 0
The path to sustainable cardiac surgery in Rwanda: analysis of costs for consumables used during cardiac surgery for a non-governmental organization. 卢旺达心脏外科手术的可持续发展之路:对一家非政府组织心脏外科手术期间所用消耗品的成本分析。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03087-x
Hannah Rando, Maurice Musoni, Bonnie C Greenwood, Lambert Ingabire, Sam Van Hook, Ceeya Patton Bolman, R Morton Bolman, Yihan Lin

Background: Until local healthcare infrastructure is strengthened, cardiac surgical care in low- and middle-income countries is often provided by non-governmental organizations by way of visiting healthcare teams. This is generally considered to be a cost-effective alternative to transporting patients to high income countries for surgical care, but the costs of cardiac surgery consumables under this model are poorly understood. Our objective was to identify the per-patient cost of cardiac surgery consumables used in single and double valve replacements performed by a non-governmental organization in Rwanda.

Methods: Financial data from 2020 were collected from Team Heart, a non-governmental organization that supports cardiac surgical care in Rwanda. A comprehensive list of consumables was generated, including surgical, perfusion, anesthesia, and inpatient supplies and medications. Acknowledging the variability in perioperative needs, the quantities of consumables were calculated from an average of six patients who underwent single or double-valve replacement in 2020. Total costs were calculated by multiplying purchasing price by average quantity per patient. Costs absorbed by the local hospital were excluded from the calculations.

Results: The total cost per patient was estimated at $9,450. Surgical supplies comprised the majority of costs ($6,140 per patient), with the most substantial cost being that of replacement valves ($3,500 per valve), followed by surgical supplies ($1,590 per patient).

Conclusions: This preliminary analysis identifies a cost of just over $9,000 per patient for consumables used in cardiac valve surgery in Rwanda, which is lower than the estimated costs of transporting patients to centers in high income countries. This work highlights the relative cost effectiveness of cardiac surgical care in low- and middle- income countries under this model and will be instrumental in guiding the allocation of local and international resources in the future.

背景:在当地医疗基础设施得到加强之前,中低收入国家的心脏外科护理通常由非政府组织通过巡回医疗小组的方式提供。人们普遍认为,与将病人运送到高收入国家接受手术治疗相比,这是一种具有成本效益的替代方式,但人们对这种模式下心脏手术耗材的成本却知之甚少。我们的目标是确定卢旺达一家非政府组织在单瓣膜和双瓣膜置换术中使用的心脏手术耗材的人均成本:方法:我们从支持卢旺达心脏手术治疗的非政府组织 Team Heart 收集了 2020 年的财务数据。编制了一份全面的消耗品清单,包括手术、灌注、麻醉和住院患者的用品和药物。考虑到围术期需求的差异性,耗材数量是根据 2020 年接受单瓣膜或双瓣膜置换术的六名患者的平均数量计算得出的。总成本通过采购价格乘以每位患者的平均数量计算得出。计算结果不包括当地医院承担的费用:每位患者的总成本估计为 9450 美元。手术用品占大部分成本(每位患者 6,140 美元),其中更换瓣膜的成本最高(每个瓣膜 3,500 美元),其次是手术用品(每位患者 1,590 美元):这项初步分析表明,在卢旺达,每名患者在心脏瓣膜手术中使用的耗材成本略高于 9,000 美元,低于将患者运送到高收入国家的中心所需的估计成本。这项工作凸显了在这种模式下,中低收入国家心脏外科护理的相对成本效益,将有助于指导未来当地和国际资源的分配。
{"title":"The path to sustainable cardiac surgery in Rwanda: analysis of costs for consumables used during cardiac surgery for a non-governmental organization.","authors":"Hannah Rando, Maurice Musoni, Bonnie C Greenwood, Lambert Ingabire, Sam Van Hook, Ceeya Patton Bolman, R Morton Bolman, Yihan Lin","doi":"10.1186/s13019-024-03087-x","DOIUrl":"10.1186/s13019-024-03087-x","url":null,"abstract":"<p><strong>Background: </strong>Until local healthcare infrastructure is strengthened, cardiac surgical care in low- and middle-income countries is often provided by non-governmental organizations by way of visiting healthcare teams. This is generally considered to be a cost-effective alternative to transporting patients to high income countries for surgical care, but the costs of cardiac surgery consumables under this model are poorly understood. Our objective was to identify the per-patient cost of cardiac surgery consumables used in single and double valve replacements performed by a non-governmental organization in Rwanda.</p><p><strong>Methods: </strong>Financial data from 2020 were collected from Team Heart, a non-governmental organization that supports cardiac surgical care in Rwanda. A comprehensive list of consumables was generated, including surgical, perfusion, anesthesia, and inpatient supplies and medications. Acknowledging the variability in perioperative needs, the quantities of consumables were calculated from an average of six patients who underwent single or double-valve replacement in 2020. Total costs were calculated by multiplying purchasing price by average quantity per patient. Costs absorbed by the local hospital were excluded from the calculations.</p><p><strong>Results: </strong>The total cost per patient was estimated at $9,450. Surgical supplies comprised the majority of costs ($6,140 per patient), with the most substantial cost being that of replacement valves ($3,500 per valve), followed by surgical supplies ($1,590 per patient).</p><p><strong>Conclusions: </strong>This preliminary analysis identifies a cost of just over $9,000 per patient for consumables used in cardiac valve surgery in Rwanda, which is lower than the estimated costs of transporting patients to centers in high income countries. This work highlights the relative cost effectiveness of cardiac surgical care in low- and middle- income countries under this model and will be instrumental in guiding the allocation of local and international resources in the future.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Journal of Cardiothoracic Surgery
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