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Coronary artery bypass grafting in octogenarians: a nomogram for predicting all-cause mortality. 八旬老人的冠状动脉旁路移植术:预测全因死亡率的提名图。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 DOI: 10.1186/s13019-024-03054-6
Saeed Davoodi, Mohammad Sadeq Najafi, Ahmad Vakili-Basir, Arash Jalali, Zahra Karimi, Elnaz Shahmohamadi, Mohadese Dashtkoohi, Aryan Ayati, Alireza Hadizadeh, Shahram Momtahan, Mahmoud Shirzad, Jamshid Bagheri

Background: The benefits and risks of coronary artery bypass grafting (CABG) in octogenarians remain unclear. This study aimed to identify the predictors of increased risk of all-cause mortality in octogenarian patients after CABG.

Methods: We retrospectively analyzed the data of 1636 octogenarians who underwent isolated elective on-pump CABG between 2007 and 2016. The primary endpoint was mortality from any cause. The Kaplan-Meier curve was generated for mortality. A univariate Cox regression was performed for preprocedural and procedural variables. The Akaike information criterion (AIC) using the Cox proportional hazard model was applied to determine the strongest predictors. We designed a nomogram based on the selected variables to calculate the mortality risk after one, five, and ten years. The bootstrap resampling based on the C-index was performed to validate the final model. Calibration plots were created at different time points.

Results: The mean age of the patients was 82.03 years (SD = 1.74), and 74% were male. In a median follow-up of 9.2 (95% CI 9.0,9.5) years, 626 (38.2%) patients died. After the selection of best predictors based on AIC, the multivariable Cox regression showed that ejection fraction < 40 (HR 1.41, 95% CI 1.21-1.65, P < 0.001), two-vessel disease (HR: 0.59, 95% CI 0.40-0.89, P = 0.012), peripheral vascular disease (HR 1.52, 95% CI 1.05-2.21, P = 0.027), and valvular heart disease (HR 1.45, 95% CI 1.24-1.69, P < 0.001) were the significant predictors of all-cause mortality.

Conclusion: Octogenarians who undergo CABG have a high mortality risk, influenced by several preprocedural and procedural risk factors. The proposed nomogram can be considered for optimizing the management of this vulnerable age group. Clinical registration number IR.TUMS.THC.REC.1400.081.

背景:八旬老人接受冠状动脉旁路移植术(CABG)的益处和风险仍不明确。本研究旨在确定八旬老人接受冠状动脉旁路移植术后全因死亡风险增加的预测因素:我们回顾性分析了2007年至2016年间接受孤立选择性泵上CABG的1636名八旬老人的数据。主要终点是任何原因导致的死亡率。死亡率采用 Kaplan-Meier 曲线。对术前和手术变量进行了单变量 Cox 回归。采用柯克斯比例危险模型的阿凯克信息准则(AIC)来确定最强的预测因子。我们根据所选变量设计了一个提名图,以计算一年、五年和十年后的死亡风险。我们根据 C 指数进行了引导重采样,以验证最终模型。在不同的时间点绘制了校准图:患者的平均年龄为 82.03 岁(SD = 1.74),74% 为男性。在中位 9.2(95% CI 9.0,9.5)年的随访中,626 名(38.2%)患者死亡。根据 AIC 筛选出最佳预测因子后,多变量 Cox 回归结果显示,射血分数是预测死亡的关键因素:接受 CABG 手术的八旬老人有很高的死亡风险,这受到术前和手术风险因素的影响。建议的提名图可用于优化对这一脆弱年龄组的管理。临床注册号:IR.TUMS.THC.REC.1400.081。
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引用次数: 0
Patients undergoing emergent surgery for type A intramural hematomas or type A aortic dissections have similar outcomes. 因 A 型膜内血肿或 A 型主动脉夹层而接受急诊手术的患者,其预后相似。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 DOI: 10.1186/s13019-024-03101-2
Sorasicha Nithikasem, Abhishek Chakraborty, Hirohisa Ikegami, Manabu Takebe, Gengo Sunagawa, Antonio Chiricolo, Ashok Chaudhary, Alexander Rahimi, Simran Agarwala, Mark Russo, Leonard Y Lee, Anthony Lemaire

Objective: Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic Arch repair.

Methods: This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending- or Arch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p < 0.05.

Results: A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of postoperative pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n = 4] vs. 3% [n = 2]; p = 0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits.

Conclusions: Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic Arch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. These findings better elucidate the standard of care for patients with acute Intramural Hematoma undergoing Ascending Aortic Arch repair.

目的:室壁内血肿和主动脉夹层都是急性主动脉综合征,尽管病理过程存在主要差异,但两者都采用类似的手术技术进行修复。本研究旨在确定壁内血肿患者与主动脉夹层患者接受升主动脉弓修补术的手术效果差异:这项对前瞻性收集数据的回顾性研究纳入了2018年1月至2023年5月期间在一家学术机构接受急诊升主动脉弓或主动脉弓修复术的所有急性壁内血肿或A型主动脉夹层患者。主要结果包括术中死亡率、30 天死亡率和术后住院时间。次要结果包括术后并发症。结果采用Chi-squared、Fisher's Exact和t检验进行分析,显著性设定为p 结果:共纳入 107 例患者,其中 27 例(25%)有壁内血肿,80 例(75%)有 A 型主动脉夹层。术前特征(如年龄、性别和合并症)无差异,围手术期特征(如病例长度、心肺旁路、主动脉交叉钳夹和循环停止时间)也无差异。在比较术后结果时,与主动脉夹层队列相比,室壁内血肿队列术后需要开心包窗的心包积液率更高(15% [n = 4] vs. 3% [n = 2];P = 0.02)。术中死亡率、30 天死亡率和术后住院时间等其他主要结果没有差异。术后并发症的发生率也没有差异,如需要再次手术的出血、脑血管意外、心房颤动、需要胸腔穿刺的胸腔积液以及手术相关的急诊就诊率:我们的分析表明,室壁内血肿和 A 型主动脉夹层患者接受升主动脉弓修补术的结果相似。尽管室壁内血肿队列中术后需要开心包窗的比例较高,但总体主要结果仍具有可比性。这些发现更好地阐明了对急性壁内血肿患者进行主动脉弓升部修补术的护理标准。
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引用次数: 0
Association between inflammatory biomarkers and postoperative acute kidney injury after cardiac surgery in patients with preoperative renal dysfunction: a retrospective pilot analysis. 术前肾功能不全患者心脏手术后炎症生物标志物与术后急性肾损伤之间的关系:一项回顾性试验分析。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 DOI: 10.1186/s13019-024-03067-1
Wuhua Jiang, Yi Fang, Xiaoqiang Ding, Zhe Luo, Dong Zhang, Xialian Xu, Jiarui Xu

Background: Acute kidney injury (AKI) represents a significant post-cardiac surgery complication, particularly prevalent among individuals with pre-existing renal dysfunction. Chronic kidney disease (CKD) is frequently accompanied by persistent, low-grade inflammation, which is known to exacerbate systemic stress responses during surgical procedures. This study hypothesizes that these inflammatory responses might influence the incidence and severity of postoperative acute kidney injury (AKI), potentially serving as a protective mechanism by preconditioning the kidney to stress.

Methods: This retrospective study enrolled patients with preoperative renal dysfunction (eGFR between 15 and 60 ml/min/1.73 m²) who underwent cardiac surgery between January 2020 and December 2022. Preoperative inflammatory biomarkers were evaluated. The primary outcome was the incidence of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariate regression models and sensitivity analyses were conducted to ascertain the relationship between inflammatory biomarkers and AKI. Restricted cubic spines (RCS) was conducted to explore nonlinear associations between inflammatory biomarkers and AKI.

Results: AKI occurred in 53.4% (392/734) of patients, accompanied by significant mortality and length of hospital stay increases in cases of AKI (P < 0.005). After full adjustment of confounders, neutrophil percentage-to-albumin ratio (OR = 0.28), systemic inflammation response index (OR = 0.70), systemic immune inflammation index (OR = 0.69), neutrophil-to-lymphocyte ratio (OR = 0.70), monocyte/high-density lipoprotein cholesterol ratio (OR = 0.53), neutrophil/high-density lipoprotein cholesterol ratio (OR = 0.43) demonstrated an inverse association with AKI. Sensitivity analyses revealed that patients in the highest quartile of these biomarkers exhibited a significantly lower prevalence of AKI compared to those in the lowest quartile (p for trend < 0.05). The RCS analysis suggested an "Inverted U-shaped" association of both LnNPAR and LnSIRI with AKI.

Conclusions: This study identified an inverse association between preoperative inflammatory biomarkers and postoperative AKI in patients with preoperative renal dysfunction. The findings implied that preoperative inflammation may play a protective role against postoperative AKI in this patient population undergoing cardiac surgery.

背景:急性肾损伤(AKI)是心脏手术后的一种重要并发症,在原有肾功能不全的患者中尤为普遍。慢性肾脏病(CKD)经常伴有持续的低度炎症,众所周知,炎症会加剧手术过程中的全身应激反应。本研究假设,这些炎症反应可能会影响术后急性肾损伤(AKI)的发生率和严重程度,有可能通过对肾脏进行应激预处理而成为一种保护机制:这项回顾性研究纳入了 2020 年 1 月至 2022 年 12 月期间接受心脏手术的术前肾功能不全(eGFR 在 15 至 60 毫升/分钟/1.73 平方米之间)患者。对术前炎症生物标志物进行了评估。主要结果是术后 AKI 的发生率,根据肾脏疾病:改善全球预后 (KDIGO) 标准定义的术后 AKI 发生率。为确定炎症生物标志物与 AKI 之间的关系,进行了多变量回归模型和敏感性分析。为了探索炎症生物标志物与 AKI 之间的非线性关系,还进行了限制性立方棘(RCS)分析:53.4%的患者(392/734)发生了 AKI,AKI 病例的死亡率和住院时间显著增加(P 结论:该研究发现了炎症生物标志物与 AKI 之间的反向关系:本研究发现,术前肾功能不全的患者术前炎症生物标志物与术后 AKI 呈反向关系。研究结果表明,术前炎症可能对接受心脏手术的这类患者的术后 AKI 起保护作用。
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引用次数: 0
Use of ultra-low contrast dose CT aortography for the management of aortic aneurysmal disease. 使用超低造影剂 CT 主动脉造影术治疗主动脉瘤疾病。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-03 DOI: 10.1186/s13019-024-03099-7
Philip Borkowski, Eugene Ng, Mauro Vicaretti, Noel Young

Purpose: Computed tomography aortography (CTA) is used in the assessment of aortic pathologies and planning of surgical intervention. However, its dependence on iodinated contrast can result in development of contrast-induced acute kidney injury (CI-AKI). The potential concern of CI-AKI has spurred research into the potential of administration of low contrast volumes in CTA investigations while maintaining overall diagnostic appeal. Several studies have shown that CTA using contrast volumes as low as 30 mL (equivalent to 10.5 g of iodine) can still yield scans of diagnostic quality. We present a retrospective pilot study to evaluate the feasibility of utilising an ultra-low volume of iodinated intravenous contrast in a population of patients with severe renal insufficiency with referral from our vascular surgery unit for CTA evaluation of the thoracic and abdominal aorta.

Methods: This retrospective pilot study examined 12 CTA scans performed with 20 mLs of iodinated contrast and assessed image quality with both quantitative and qualitative markers. All scans were performed on a Siemens SOMATOM Force dual-source CT scanner. Quantitative assessment values were measured via attenuation values at eight aortoiliac locations and used to calculate a signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each location. Qualitative analysis of image quality and viability for surgical intervention was obtained from subjective clinical assessment by an interventional radiologist and vascular surgeon.

Results: Obtained quantitative assessment values included mean attenuation 189.9 HU, mean SNR 9.6 and mean CNR 8.0. All 12 scans demonstrated individual mean SNR values above predetermined quality thresholds while only five scans produced individual mean CNR values above threshold. Eleven of 12 scans were determined to be of sufficient quality for diagnosis and planning of surgical intervention.

Conclusions: Our results suggest that CTA utilising an ultra-low contrast dose of 20 mLs (6 g iodine) yields scans of diagnostic quality for therapeutic decision-making in vascular surgical intervention.

目的:计算机断层扫描主动脉造影术(CTA)用于评估主动脉病变和制定手术干预计划。然而,CTA 对碘造影剂的依赖可能导致造影剂诱发急性肾损伤(CI-AKI)。对 CI-AKI 的潜在担忧促使人们研究在 CTA 检查中使用低造影剂的可能性,同时保持整体诊断吸引力。多项研究表明,使用低至 30 毫升(相当于 10.5 克碘)造影剂的 CTA 仍能获得具有诊断质量的扫描结果。我们进行了一项回顾性试验研究,评估在血管外科转诊的严重肾功能不全患者中使用超低剂量碘静脉注射造影剂进行胸腹主动脉 CTA 评估的可行性:这项回顾性试验研究对使用 20 毫升碘对比剂进行的 12 次 CTA 扫描进行了检查,并通过定量和定性指标对图像质量进行了评估。所有扫描均在西门子 SOMATOM Force 双源 CT 扫描仪上进行。定量评估值通过八个主动脉髂骨位置的衰减值进行测量,并用于计算每个位置的信噪比(SNR)和对比度-噪声比(CNR)。介入放射科医生和血管外科医生通过主观临床评估对图像质量和手术干预的可行性进行定性分析:获得的定量评估值包括平均衰减 189.9 HU、平均信噪比 9.6 和平均 CNR 8.0。所有 12 张扫描图像的单个平均信噪比值均高于预定的质量阈值,而只有 5 张扫描图像的单个平均 CNR 值高于阈值。12次扫描中,有11次被确定为足以进行诊断和手术干预计划:我们的研究结果表明,使用 20 毫升(6 克碘)的超低造影剂进行 CTA 扫描可获得高质量的诊断结果,用于血管外科干预的治疗决策。
{"title":"Use of ultra-low contrast dose CT aortography for the management of aortic aneurysmal disease.","authors":"Philip Borkowski, Eugene Ng, Mauro Vicaretti, Noel Young","doi":"10.1186/s13019-024-03099-7","DOIUrl":"10.1186/s13019-024-03099-7","url":null,"abstract":"<p><strong>Purpose: </strong>Computed tomography aortography (CTA) is used in the assessment of aortic pathologies and planning of surgical intervention. However, its dependence on iodinated contrast can result in development of contrast-induced acute kidney injury (CI-AKI). The potential concern of CI-AKI has spurred research into the potential of administration of low contrast volumes in CTA investigations while maintaining overall diagnostic appeal. Several studies have shown that CTA using contrast volumes as low as 30 mL (equivalent to 10.5 g of iodine) can still yield scans of diagnostic quality. We present a retrospective pilot study to evaluate the feasibility of utilising an ultra-low volume of iodinated intravenous contrast in a population of patients with severe renal insufficiency with referral from our vascular surgery unit for CTA evaluation of the thoracic and abdominal aorta.</p><p><strong>Methods: </strong>This retrospective pilot study examined 12 CTA scans performed with 20 mLs of iodinated contrast and assessed image quality with both quantitative and qualitative markers. All scans were performed on a Siemens SOMATOM Force dual-source CT scanner. Quantitative assessment values were measured via attenuation values at eight aortoiliac locations and used to calculate a signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each location. Qualitative analysis of image quality and viability for surgical intervention was obtained from subjective clinical assessment by an interventional radiologist and vascular surgeon.</p><p><strong>Results: </strong>Obtained quantitative assessment values included mean attenuation 189.9 HU, mean SNR 9.6 and mean CNR 8.0. All 12 scans demonstrated individual mean SNR values above predetermined quality thresholds while only five scans produced individual mean CNR values above threshold. Eleven of 12 scans were determined to be of sufficient quality for diagnosis and planning of surgical intervention.</p><p><strong>Conclusions: </strong>Our results suggest that CTA utilising an ultra-low contrast dose of 20 mLs (6 g iodine) yields scans of diagnostic quality for therapeutic decision-making in vascular surgical intervention.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"582"},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365359","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
Apatinib monotherapy for early non-small cell lung cancer: a case report. 阿帕替尼单药治疗早期非小细胞肺癌:病例报告。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03088-w
Jiafang Xu, Qingjie Hu, Siqi Yin, Huifang He, Hai Li, Ruiqi Yang, Meizi Song, Chaoqun Wang, Yu Liu

Stage I non-small cell lung cancer (NSCLC) accounts for about 15% of incident cancer cases. Prognosis is poor, with a metastasis and recurrence rate of 38% within 2 years of surgery and an overall 5-year survival rate of 54-60%. Here, we report successful apatinib monotherapy of early NSCLC in a patient who had declined surgery, radiofrequency ablation, and immunotherapy. The patient received apatinib for 64 months without clinical, laboratory, or radiographic evidence of disease progression. The curative effect was judged to be stable and safe.The role of apatinib as monotherapy for patients with early stage NSCLC who are not candidates for surgery or radiotherapy, or as an adjunct to standard therapy, deserves further study.

I 期非小细胞肺癌(NSCLC)约占癌症病例的 15%。其预后较差,手术后两年内的转移和复发率为 38%,总体 5 年生存率为 54-60%。在此,我们报告了一位拒绝手术、射频消融和免疫疗法的患者成功接受阿帕替尼单药治疗早期NSCLC的情况。该患者接受阿帕替尼治疗 64 个月,没有出现临床、实验室或影像学上的疾病进展迹象。阿帕替尼作为不适合手术或放疗的早期NSCLC患者的单药治疗,或作为标准疗法的辅助治疗,其作用值得进一步研究。
{"title":"Apatinib monotherapy for early non-small cell lung cancer: a case report.","authors":"Jiafang Xu, Qingjie Hu, Siqi Yin, Huifang He, Hai Li, Ruiqi Yang, Meizi Song, Chaoqun Wang, Yu Liu","doi":"10.1186/s13019-024-03088-w","DOIUrl":"10.1186/s13019-024-03088-w","url":null,"abstract":"<p><p>Stage I non-small cell lung cancer (NSCLC) accounts for about 15% of incident cancer cases. Prognosis is poor, with a metastasis and recurrence rate of 38% within 2 years of surgery and an overall 5-year survival rate of 54-60%. Here, we report successful apatinib monotherapy of early NSCLC in a patient who had declined surgery, radiofrequency ablation, and immunotherapy. The patient received apatinib for 64 months without clinical, laboratory, or radiographic evidence of disease progression. The curative effect was judged to be stable and safe.The role of apatinib as monotherapy for patients with early stage NSCLC who are not candidates for surgery or radiotherapy, or as an adjunct to standard therapy, deserves further study.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"557"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361509","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
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。
{"title":"A case of adenocarcinoma presenting with cystic lesion and recurrent pneumothoraces.","authors":"Long Yu, Yang Lou, Dan Zhu","doi":"10.1186/s13019-024-03111-0","DOIUrl":"10.1186/s13019-024-03111-0","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusions: </strong>This case highlights the importance of monitoring cystic lesions in the lungs, especially in patients with a history of smoking and emphysema.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"576"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361558","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
Non-invasive remote ischemic preconditioning for patients with heart failure undergoing cardiac catheterization: a network meta-analysis of randomized controlled trials. 对接受心导管检查的心力衰竭患者进行无创远程缺血预处理:随机对照试验的网络荟萃分析。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03082-2
Li-Jun Cao, Wen-Juan Wang, Qin-Xue Zhou

Objective: This study aimed to evaluate the efficacy of six non-invasive remote ischemic preconditioning (RIPC) interventions during the nursing care of patients with heart failure (HF) prior to cardiac catheterization.

Methods: A comprehensive search of nine Chinese and English online databases was conducted from the date of their inception to June 2023 to identify randomized controlled trials (RCTs) investigating RIPC in patients with HF prior to cardiac catheterization. Two independent investigators screened the articles, extracted data, and assessed their quality. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and a network meta-analysis was conducted using R software.

Results: Four trials involving 511 patients with a low risk of bias were included in the analysis. Six non-invasive RIPC interventions were identified, all demonstrating effectiveness in reducing the incidence of contrast-induced acute kidney injury (CI-AKI). Among these, Intervention F (applying up to 50 mmHg above the resting systolic pressure for 5 min to the dominant leg or upper limb, repeated three times with an 18-minute interval) was deemed optimal, although the timing of the procedure was not specified. Intervention D (applying up to 200 mmHg pressure to the upper limb for 5 min, repeated four times with 5-minute intervals, within 45 min prior to cardiac catheterization, ) was considered suboptimal.

Conclusion: Although Intervention D was recommended as the preferred option, none of the four trials examined its impact on the cardiac function of patients with HF. Large-scale, multi-center RCTs are required, with outcome indicators including cardiac function and the occurrence of CI-AKI, to better understand the therapeutic effects of RIPC on HF and reduce the incidence of CI-AKI. This will provide a more robust foundation for clinical practice.

研究目的本研究旨在评估心导管检查前心力衰竭(HF)患者护理过程中六种无创远程缺血预处理(RIPC)干预措施的疗效:方法:对九个中英文在线数据库进行了全面检索,检索时间从数据库建立之日起至2023年6月,目的是找出研究心导管检查前心衰患者远程缺血预处理的随机对照试验(RCT)。两名独立研究人员筛选了文章、提取了数据并评估了文章质量。使用Cochrane偏倚风险工具评估了偏倚风险,并使用R软件进行了网络荟萃分析:纳入分析的四项试验涉及 511 名患者,偏倚风险较低。确定了六种无创 RIPC 干预方法,所有方法都能有效降低造影剂诱发急性肾损伤(CI-AKI)的发生率。其中,干预方法 F(对优势腿或上肢施加高于静息收缩压 50 mmHg 的压力,持续 5 分钟,重复三次,每次间隔 18 分钟)被认为是最佳干预方法,但没有明确说明操作的时间。干预措施 D(在心导管检查前 45 分钟内,对上肢施加高达 200 mmHg 的压力,持续 5 分钟,重复 4 次,每次间隔 5 分钟)被认为是次优方案:结论:尽管干预措施 D 被推荐为首选方案,但四项试验均未研究其对心房颤动患者心脏功能的影响。为了更好地了解 RIPC 对心房颤动的治疗效果并降低 CI-AKI 的发生率,需要进行大规模、多中心的 RCT 试验,其结果指标包括心功能和 CI-AKI 的发生率。这将为临床实践提供更坚实的基础。
{"title":"Non-invasive remote ischemic preconditioning for patients with heart failure undergoing cardiac catheterization: a network meta-analysis of randomized controlled trials.","authors":"Li-Jun Cao, Wen-Juan Wang, Qin-Xue Zhou","doi":"10.1186/s13019-024-03082-2","DOIUrl":"10.1186/s13019-024-03082-2","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy of six non-invasive remote ischemic preconditioning (RIPC) interventions during the nursing care of patients with heart failure (HF) prior to cardiac catheterization.</p><p><strong>Methods: </strong>A comprehensive search of nine Chinese and English online databases was conducted from the date of their inception to June 2023 to identify randomized controlled trials (RCTs) investigating RIPC in patients with HF prior to cardiac catheterization. Two independent investigators screened the articles, extracted data, and assessed their quality. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and a network meta-analysis was conducted using R software.</p><p><strong>Results: </strong>Four trials involving 511 patients with a low risk of bias were included in the analysis. Six non-invasive RIPC interventions were identified, all demonstrating effectiveness in reducing the incidence of contrast-induced acute kidney injury (CI-AKI). Among these, Intervention F (applying up to 50 mmHg above the resting systolic pressure for 5 min to the dominant leg or upper limb, repeated three times with an 18-minute interval) was deemed optimal, although the timing of the procedure was not specified. Intervention D (applying up to 200 mmHg pressure to the upper limb for 5 min, repeated four times with 5-minute intervals, within 45 min prior to cardiac catheterization, ) was considered suboptimal.</p><p><strong>Conclusion: </strong>Although Intervention D was recommended as the preferred option, none of the four trials examined its impact on the cardiac function of patients with HF. Large-scale, multi-center RCTs are required, with outcome indicators including cardiac function and the occurrence of CI-AKI, to better understand the therapeutic effects of RIPC on HF and reduce the incidence of CI-AKI. This will provide a more robust foundation for clinical practice.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"573"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361589","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
Outcome of patient undergoing redo mitral valve surgery with incidence rate of mitral valve infective endocarditis. 二尖瓣感染性心内膜炎发病率与重做二尖瓣手术患者的预后。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03063-5
Basel A Jobeir, Abdelkarim E De Vol, Ziyad M Alanazi, Domenico Galzerano, Anas A Jobeir, Aly M Alsanei, Bandar Alamro, Mohammed Alamri, Zohair Y AlHalees, Feras H Khaliel

Background: The incidence of infective endocarditis (IE) in patients undergoing redo mitral valve (MV) surgery was evaluated. The outcomes of all the patients and the patients' specific characteristics were recorded. The patients were analyzed to further the research of IE in this population.

Method: This was a retrospective review of patients admitted for redo MV surgery with a prospective follow-up of electronic medical records at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, from 2009 to 2019. Pre/intra/post-operative factors contributing to mortality, morbidity, and freedom of adverse events were analyzed.

Result: A total of 211 patients underwent redo MV surgery, and 41 patients (19.4%) had IE; and 51% of this subset of patients, 21 individuals, developed IE after the initial MV surgery. MV stenosis was moderate/severe in 50 patients. Furthermore, MV regurgitation was present in 89 patients. Multivariate analysis of the data revealed multiple factors influencing mortality: age, peripheral vascular disease, concomitant procedures, peripheral vascular disease, red blood cell transfusions, preoperative mechanical valves, and active IE. In-hospital Mortality was 10.9%. The one-, five-, and ten-year survival was 88%, 79%, and 69% across all patients.

Conclusion: Although redo MV surgery has acceptable outcomes; the presence of IE or concomitant procedures is a significant health detriment in these patients. Our study highlights the need for careful patient management and more in-depth research in this area to improve patient outcomes.

背景:对接受重做二尖瓣手术的患者感染性心内膜炎(IE)的发生率进行了评估。记录了所有患者的治疗结果和患者的具体特征。对患者进行分析,以进一步研究该人群中的感染性心内膜炎:这是对沙特阿拉伯利雅得费萨尔国王专科医院和研究中心 2009 年至 2019 年期间收治的重做二尖瓣手术患者进行的回顾性研究,并对电子病历进行了前瞻性随访。研究分析了导致死亡率、发病率和不良事件发生率的术前/术中/术后因素:共有 211 名患者接受了中风再手术,其中 41 名患者(19.4%)出现了 IE;在这部分患者中,有 21 人(51%)在初次中风手术后出现了 IE。50名患者的中压狭窄程度为中度/重度。此外,89 名患者存在中压反流。对数据进行的多变量分析显示了影响死亡率的多种因素:年龄、外周血管疾病、并发症、外周血管疾病、输血、术前机械瓣膜和活动性 IE。院内死亡率为 10.9%。所有患者的一年、五年和十年生存率分别为88%、79%和69%:结论:虽然重做中风手术的结果可以接受,但存在 IE 或同时进行手术对这些患者的健康极为不利。我们的研究强调了对患者进行精心管理和在该领域进行更深入研究以改善患者预后的必要性。
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引用次数: 0
Characterization of prognostic signature related with twelve types of programmed cell death in lung squamous cell carcinoma. 与肺鳞癌十二种程序性细胞死亡相关的预后特征描述
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03039-5
Saiyu Li, Bing Ding, Duanli Weng

Objective: This study aimed to develop a prognostic cell death index (CDI) based on the expression of genes related with various types of programmed cell death (PCD), and to assess its clinical relevance in lung squamous cell carcinoma (LUSC).

Methods: PCD-related genes were gathered and analyzed in silico using the transcriptomic data from the LUSC cohorts of The Cancer Genome Atlas (TCGA) and Clinical Proteomic Tumor Analysis Consortium (CPTAC). Differentially expressed PCD genes were analyzed, and a prognostic model was subsequently constructed. CDI scores were calculated for each patient, and their correlations with clinical features, survival outcomes, tumor mutation burden, gene clusters, and tumor microenvironment were investigated. Unsupervised consensus clustering was performed based on CDI model genes. Furthermore, the correlation of CDI for sensitivity of targeted drugs, chemotherapy efficacy, and immunotherapy responses was assessed.

Results: Based on 351 differentially expressed PCD genes in LUSC, a CDI signature comprising FGA, GAB2, JUN, and CDKN2A was identified. High CDI scores were significantly associated with poor survival outcomes (p < 0.05). Unsupervised clustering revealed three distinct patient subsets with varying survival rates. CDKN2A exhibited significantly different mutation patterns between patients with high and low CDI scores (p < 0.01). High CDI scores were also linked to increased immune cell infiltration of specific subsets and altered expression of immune-related genes. Patients with high-CDI showed reduced sensitivity to several chemotherapeutic drugs and a higher Tumor Immune Dysfunction and Exclusion (TIDE) score, indicating potential resistance to immunotherapy.

Conclusion: The CDI signature based on PCD genes offers valuable prognostic insights into LUSC, reflecting molecular heterogeneity, immune microenvironment associations, and potential therapeutic challenges. The CDI holds potential clinical utility in predicting treatment responses and guiding the selection of appropriate therapies for patients with LUSC. Future studies are warranted to further validate the prognostic value of CDI in combination with clinical factors and to explore its application across diverse patient cohorts.

研究目的本研究旨在根据各种类型程序性细胞死亡(PCD)相关基因的表达建立预后细胞死亡指数(CDI),并评估其在肺鳞癌(LUSC)中的临床意义:方法:利用癌症基因组图谱(TCGA)和临床肿瘤蛋白质组分析联盟(CPTAC)的肺鳞癌队列中的转录组数据,收集与PCD相关的基因并进行硅分析。对差异表达的 PCD 基因进行了分析,随后构建了预后模型。计算了每位患者的 CDI 分数,并研究了它们与临床特征、生存结果、肿瘤突变负荷、基因簇和肿瘤微环境的相关性。根据 CDI 模型基因进行了无监督共识聚类。此外,还评估了CDI与靶向药物敏感性、化疗疗效和免疫疗法反应的相关性:结果:基于LUSC中351个差异表达的PCD基因,确定了由FGA、GAB2、JUN和CDKN2A组成的CDI特征。高 CDI 评分与不良生存预后显著相关(p 结论:基于 PCD 基因的 CDI 特征与不良生存预后显著相关:基于 PCD 基因的 CDI 特征为 LUSC 的预后提供了有价值的见解,反映了分子异质性、免疫微环境关联和潜在的治疗挑战。CDI 在预测治疗反应和指导 LUSC 患者选择适当疗法方面具有潜在的临床实用性。未来的研究需要进一步验证 CDI 与临床因素相结合的预后价值,并探索其在不同患者队列中的应用。
{"title":"Characterization of prognostic signature related with twelve types of programmed cell death in lung squamous cell carcinoma.","authors":"Saiyu Li, Bing Ding, Duanli Weng","doi":"10.1186/s13019-024-03039-5","DOIUrl":"10.1186/s13019-024-03039-5","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a prognostic cell death index (CDI) based on the expression of genes related with various types of programmed cell death (PCD), and to assess its clinical relevance in lung squamous cell carcinoma (LUSC).</p><p><strong>Methods: </strong>PCD-related genes were gathered and analyzed in silico using the transcriptomic data from the LUSC cohorts of The Cancer Genome Atlas (TCGA) and Clinical Proteomic Tumor Analysis Consortium (CPTAC). Differentially expressed PCD genes were analyzed, and a prognostic model was subsequently constructed. CDI scores were calculated for each patient, and their correlations with clinical features, survival outcomes, tumor mutation burden, gene clusters, and tumor microenvironment were investigated. Unsupervised consensus clustering was performed based on CDI model genes. Furthermore, the correlation of CDI for sensitivity of targeted drugs, chemotherapy efficacy, and immunotherapy responses was assessed.</p><p><strong>Results: </strong>Based on 351 differentially expressed PCD genes in LUSC, a CDI signature comprising FGA, GAB2, JUN, and CDKN2A was identified. High CDI scores were significantly associated with poor survival outcomes (p < 0.05). Unsupervised clustering revealed three distinct patient subsets with varying survival rates. CDKN2A exhibited significantly different mutation patterns between patients with high and low CDI scores (p < 0.01). High CDI scores were also linked to increased immune cell infiltration of specific subsets and altered expression of immune-related genes. Patients with high-CDI showed reduced sensitivity to several chemotherapeutic drugs and a higher Tumor Immune Dysfunction and Exclusion (TIDE) score, indicating potential resistance to immunotherapy.</p><p><strong>Conclusion: </strong>The CDI signature based on PCD genes offers valuable prognostic insights into LUSC, reflecting molecular heterogeneity, immune microenvironment associations, and potential therapeutic challenges. The CDI holds potential clinical utility in predicting treatment responses and guiding the selection of appropriate therapies for patients with LUSC. Future studies are warranted to further validate the prognostic value of CDI in combination with clinical factors and to explore its application across diverse patient cohorts.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"569"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361575","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
Clinical effects of hybrid debranching technique for acute Stanford type A aortic dissection. 混合去瓣技术治疗急性斯坦福A型主动脉夹层的临床效果。
IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1186/s13019-024-03108-9
Jian-Jun Gu, Xiao-Chao Tian, Ji-Qiang Bu, Zi-Ying Chen

Background: To investigate the clinical effects and safety of the hybrid debranching technique for patients with acute Stanford type A aortic dissection (AD).

Methods: One hundred nine patients with acute Stanford type a AD were selected and divided into observation group and control group according to the different surgical methods. Fifty-five patients in the observation group were treated with hybrid debranching, and 54 patients in the control group were treated with Sun's operation. The operation duration, clamp time, cardiopulmonary bypass duration, volume of blood transfusion, ventilator application duration, duration of stay in the intensive care unit, aortic rupture, second thoracotomy due to hemorrhage, gastrointestinal hemorrhage, stroke, paraplegia, renal failure, and all-cause mortality were recorded. Postoperative follow-up was conducted. The number of cases that underwent follow-up and the number of cases with complete thrombosis of the false aneurysm cavity detected by computed tomography angiography (CTA) was recorded.

Results: The surgical success rate was 100% in both groups, and there were no cases with unplanned secondary surgery. Compared with the control group, only the difference in the volume of blood transfusion was not significantly significant between the two groups (P = 0.052), while the rest of the observation indicators were significantly lower in the observation group than in the control group (P < 0.001 for all). The proportion of cases with complete thrombosis of the false aneurysm cavity was significantly higher in the observation group than in the control group at 3 and 6 months after surgery (P < 0.05).

Conclusion: In patients with acute Stanford type A AD involving the arch, the hybrid debranching technique was safe and effective. It was recommended for patients with advanced age and a high risk of intolerance to deep hypothermic circulatory arrest.

背景:探讨混合去瓣技术对急性斯坦福A型主动脉夹层(AD)患者的临床效果和安全性:目的:探讨杂交去瓣技术治疗急性斯坦福A型主动脉夹层(AD)患者的临床效果和安全性:方法:选取 109 例急性斯坦福 A 型主动脉夹层患者,按照不同的手术方法分为观察组和对照组。观察组 55 例患者采用杂交去瓣术治疗,对照组 54 例患者采用孙氏手术治疗。记录了手术时间、钳夹时间、心肺旁路时间、输血量、呼吸机应用时间、重症监护室住院时间、主动脉破裂、大出血导致的二次开胸、消化道出血、中风、截瘫、肾功能衰竭和全因死亡率。进行了术后随访。记录了接受随访的病例数以及通过计算机断层扫描血管造影(CTA)发现假瘤腔完全血栓形成的病例数:结果:两组患者的手术成功率均为 100%,无计划外二次手术病例。与对照组相比,两组患者仅输血量差异无显著性(P=0.052),其余观察指标观察组均显著低于对照组(P 结论:两组患者的手术成功率均为100%,无一例意外二次手术:对于累及足弓的急性斯坦福A型AD患者,混合去骨瓣技术安全有效。推荐用于高龄和不耐受深低温循环骤停的高风险患者。
{"title":"Clinical effects of hybrid debranching technique for acute Stanford type A aortic dissection.","authors":"Jian-Jun Gu, Xiao-Chao Tian, Ji-Qiang Bu, Zi-Ying Chen","doi":"10.1186/s13019-024-03108-9","DOIUrl":"10.1186/s13019-024-03108-9","url":null,"abstract":"<p><strong>Background: </strong>To investigate the clinical effects and safety of the hybrid debranching technique for patients with acute Stanford type A aortic dissection (AD).</p><p><strong>Methods: </strong>One hundred nine patients with acute Stanford type a AD were selected and divided into observation group and control group according to the different surgical methods. Fifty-five patients in the observation group were treated with hybrid debranching, and 54 patients in the control group were treated with Sun's operation. The operation duration, clamp time, cardiopulmonary bypass duration, volume of blood transfusion, ventilator application duration, duration of stay in the intensive care unit, aortic rupture, second thoracotomy due to hemorrhage, gastrointestinal hemorrhage, stroke, paraplegia, renal failure, and all-cause mortality were recorded. Postoperative follow-up was conducted. The number of cases that underwent follow-up and the number of cases with complete thrombosis of the false aneurysm cavity detected by computed tomography angiography (CTA) was recorded.</p><p><strong>Results: </strong>The surgical success rate was 100% in both groups, and there were no cases with unplanned secondary surgery. Compared with the control group, only the difference in the volume of blood transfusion was not significantly significant between the two groups (P = 0.052), while the rest of the observation indicators were significantly lower in the observation group than in the control group (P < 0.001 for all). The proportion of cases with complete thrombosis of the false aneurysm cavity was significantly higher in the observation group than in the control group at 3 and 6 months after surgery (P < 0.05).</p><p><strong>Conclusion: </strong>In patients with acute Stanford type A AD involving the arch, the hybrid debranching technique was safe and effective. It was recommended for patients with advanced age and a high risk of intolerance to deep hypothermic circulatory arrest.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"577"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361576","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
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Journal of Cardiothoracic Surgery
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