BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their gly...BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.展开更多
Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectanc...Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectancy.2,3 One common approach for treating obesity and its associated comorbidities is gastric bypass surgery.However,it is not without complications,and one of the most significant postoperative concerns is reflux esophagitis.Gastroesophageal reflux disease(GERD)is a prevalent problem among obese patients,and providing care is a significant factor in bariatric surgery.4 Roux-en-Y gastric bypass(RYGB)is frequently considered the preferable surgical treatment for individuals with GERD because of its efficacy in reducing reflux symptoms.展开更多
The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discov...The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discovery.[2]Due to its rarity,knowledge mainly comes from case reports and small case series,though some decision algorithms have been proposed in systematic reviews.展开更多
BACKGROUND Cardiopulmonary bypass(CPB)is a life-support technology widely used in surgery.Review articles reflect research advances in a certain topic or field within a certain period of time.AIM To perform a bibliome...BACKGROUND Cardiopulmonary bypass(CPB)is a life-support technology widely used in surgery.Review articles reflect research advances in a certain topic or field within a certain period of time.AIM To perform a bibliometric analysis of the review articles that focused on CPB for cardiovascular surgery.METHODS This study was based on a bibliometric analysis.Data were acquired from the Web of Science and basic bibliometric parameters were analyzed and visualized using VOSviewer and Excel.RESULTS We identified 141 review articles on CPB.Generally,the number of publications increased,and most of them were published in the 2010s(n=57,40.4%)and the 2020s(n=45,31.9%).There were 113(80.1%)narrative review articles,21(14.9%)meta-analysis studies and 7(5.0%)systematic review papers.The United States(n=25,17.7%)and China(n=21,14.9%)were the leading countries in terms of publication number.The articles were published in 98 different journals.The Journal of Cardiothoracic and Vascular Anesthesia(n=14,10.0%)and Perfusion-United Kingdom(n=11,7.8%)were preferred by the authors.The high-frequency keywords included inflammatory response,children,acute kidney injury,meta-analysis and off-pump,except for CPB and cardiac surgery.Inflammatory response had the closest relationship with CPB during cardiac surgery.The complications of CPB,including inflammatory response,kidney injury and ischemia,caught lots of concern.CONCLUSION The rapid increase of review papers shows that the research on CPB in cardiac surgery is increasingly being emphasized by scholars and clinical staff worldwide.Meta-analysis has been widely conducted to analyze clinical controversies and further guide clinical practice.Strategies to improving the outcomes of patients undergoing cardiac surgery with CPB are the hot spots in this field.展开更多
Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in le...Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.展开更多
BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,lim...BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,limiting its use in other regions.AIM To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft(CABG)surgery at a hospital in Bogotá,Colombia.METHODS An observational,analytical study of a retrospective cohort was designed.All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included.In-hospital mortality was the primary outcome evaluated.Furthermore,the performance of EuroSCORE II was assessed in this population.RESULTS A total of 1009 patients were included[median age 66 years IQR=59-72,78.2%men].The overall in-hospital mortality was 5.5%(n=56).The median mortality predicted using EuroSCORE II was 1.29(IQR=0.92-2.11).Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis(54.1%),followed by ST-segment elevation myocardial infarction(19.1%)and unstable angina(14.3%).Urgent surgery was performed in 87.3%of the patients(n=881).Mortality rates in each group were as follows:Low risk 6.0%(n=45,observed-to-expected(O/E)ratio,5.6),moderate risk 3.0%(n=5,O/E ratio 1.17),high risk 5.0%(n=4,O/E ratio 0.94),and very high risk 7.6%(n=2,O/E ratio 0.71).The overall O/E ratio was 4.2.The area under the curve of EuroSCORE II was 0.55[95%confidence interval:0.48-0.63]CONCLUSION EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability.This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment.Moreover,unlike the population in which this tool was originally developed,most patients were not electively admitted for the surgery.展开更多
Objective Placental dysfunction induced by fetal cardiopulmonary bypass(CPB)imposes limitations on the clinical application of this procedure.The potential impact of microRNA-mediated autophagy in placental endothelia...Objective Placental dysfunction induced by fetal cardiopulmonary bypass(CPB)imposes limitations on the clinical application of this procedure.The potential impact of microRNA-mediated autophagy in placental endothelial cells on overall placental function remains elusive,necessitating a comprehensive exploration of the underlying mechanisms involved.Methods We established fetal sheep CPB models and employed immunohistochemistry to assess the placental expression of ATG7.Bioinformatic analysis,coupled with dual-luciferase reporter assays,was used to elucidate the intricate relationship between miR-320a and ATG7.Changes in ATG7 expression were further investigated through Western blotting and quantitative polymerase chain reaction(qPCR).Human umbilical vein endothelial cells(HUVECs)were cultured,and in vitro experiments were conducted to evaluate their regulatory effects on endothelial function.Immunoblotting was used to measure the expression levels of ATG7,endothelin-1(ET-1),SIRT1,and FOXO1,whereas enzyme-linked immunosorbent assay(ELISA)was used to quantify nitric oxide(NO)production.Results Sixty minutes after CPB,a substantial decrease in ATG7 expression in placental tissue was observed.The downregulation of ATG7 expression led to increased ET-1 production in HUVECs,concomitant with decreased NO production.miR-320a was identified as a specific regulator of ATG7 expression,with subsequent experiments demonstrating a significant reduction in placental ATG7 levels upon injection of the miR-320a agomir compared with the miR-320a antagomir during fetal sheep CPB.In HUVECs,miR-320a downregulated ATG7,resulting in increased ET-1 production and diminished NO production.Treatment with the miR-320a mimic/miR-320a inhibitor revealed that miR-320a inhibited the SIRT1/FOXO1 pathway in HUVECs by downregulating ATG7 expression,culminating in increased ET-1 production and reduced NO levels.Conclusion The observed downregulation of placental ATG7 expression subsequent to fetal CPB is intricately associated with endothelial dysfunction.Furthermore,our findings underscore the specific regulatory role of miR-320a in modulating ATG7 expression within the placenta.At the cellular level,increasing the level of miR-320a has emerged as a potential strategy for modulating endothelial function through the inhibition of ATG7 and the SIRT1/FOXO1 pathway.展开更多
BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-ter...BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.展开更多
BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestina...BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.展开更多
BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Pos...BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Posterior pericardiotomy(PP),a surgical technique involving incision of the posterior pericardium to allow drainage,has been suggested as a preventive measure.However,its overall efficacy and safety profile,including potential risks like pleural effusion,require comprehensive evaluation amid varying study qualities.We hypothesized that PP reduces key post-CABG complications compared to standard care.AIM To determine the efficacy of PP in reducing postoperative complications following CABG.METHODS This systematic review and meta-analysis included randomized controlled trials(RCTs)from PubMed,Cochrane,ClinicalTrials.gov,and Ovid,comparing PP vs no PP in adult CABG patients.Studies were conducted in tertiary care hospital settings.Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria.The intervention involved intraoperative PP.Primary outcome was postoperative atrial fibrillation(POAF);secondary outcomes included effusions,tamponade,hospital/intensive care unit stay,and bleeding revisions.Risk ratios(RRs),mean differences,and 95%confidence intervals(CIs)were calculated using random-effects models;heterogeneity assessed via I^(2) statistic.RESULTS Twenty RCTs analyzed 5331 patients(2665 with PP vs 2666 without).PP significantly lowered POAF(10%vs 21%;RR=0.48,95%CI:0.36-0.65,P<0.00001;I^(2)=70%),cardiac tamponade(0.5%vs 3%;RR=0.16,95%CI:0.08-0.34,P<0.00001;I^(2)=0%),early pericardial effusion(2%vs 6%;RR=0.31,95%CI:0.14-0.68,P=0.004;I^(2)=96%),and late pericardial effusion(1%vs 9%;RR=0.11,95%CI:0.05-0.21,P<0.00001;I^(2)=0%).Hospital stay decreased(mean difference=-1.23 days,95%CI:-1.87 to-0.59,P=0.0002;I^(2)=85%).Pleural effusion risk increased(25%vs 17%;RR=1.46,95%CI:1.21-1.76,P<0.0001;I^(2)=0%).No significant effects on mortality(RR=0.92,95%CI:0.48-1.76,P=0.80;I^(2)=0%),intensive care unit stay,or bleeding revisions.CONCLUSION PP effectively reduces POAF,pericardial effusions,tamponade,and hospital stay in CABG patients,though it increases pleural effusion risk and shows heterogeneity in some outcomes.展开更多
The aerodynamic pressure disturbances induced by middle air shafts and bypass ducts in subway tunnels pose significant challenges to enhancing train operational speeds.A comprehensive series of full-scale experiments ...The aerodynamic pressure disturbances induced by middle air shafts and bypass ducts in subway tunnels pose significant challenges to enhancing train operational speeds.A comprehensive series of full-scale experiments are employed to examine the impact of these structural elements on the aerodynamic pressure characteristics of platform screen doors(PSDs)in high-speed subway stations.The experimental results reveal that peak pressures manifest on PSDs surfaces during two distinct scenarios in high-speed subway systems equipped with middle air shafts.One is compression pressure waves propagated from trains traversing the air shaft,and the other is train nearby flow when trains pass the PSDs directly.The peak positive pressures caused by train passing PSDs are much greater than compression pressure waves.Closing middle air shaft can reduce the passing pressure waves.The installation of bypass ducts at overtaking station entrances effectively mitigates peak negative pressures during train-PSD interactions,achieving a maximum reduction efficiency of 8%.These findings provide valuable insights for optimizing the structural design of high-speed subway tunnel systems.展开更多
Objective:The objective of this study was to understand intraoperative risk factors for post-Norwood extracorporeal membrane oxygenation(ECMO)in patients with hypoplastic left heart syndrome(HLHS).Methods:We conducted...Objective:The objective of this study was to understand intraoperative risk factors for post-Norwood extracorporeal membrane oxygenation(ECMO)in patients with hypoplastic left heart syndrome(HLHS).Methods:We conducted a retrospective,single-institution reviewof all patients with HLHS who underwent a Norwood procedure(nadir cardiopulmonary bypass temperature≤22◦C)over a 12-year period with quantitative and qualitative analysis.Results:Of 102 Norwood patients,14(13.7%)required ECMO.ECMO patients had longer median cardiopulmonary bypass(CPB)times(276 vs.172 min,p<0.001)and myocardial ischemic times(98.5 vs 83 min,p=0.021).Longer CPB time was associated with ECMO(OR 1.04,p=0.001);the converse was true for myocardial ischemic time(OR 0.94,p=0.029).For patients with long CPB times(>205 min),41.9%(13/31)required ECMO.A narrative review for patients with long CPB times revealed suboptimal surgical management in 76.9%(10/13)of ECMO cases,with incorrect problem assessment leading to unnecessary revisions being most common.Conclusion:The qualitative analysis of prolonged CPB time and ECMO highlighted critical surgical decision-making,including consideration for extension of ischemic vs non-ischemic approaches to optimize surgical repair.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous gra...BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.展开更多
BACKGROUND Diabetes mellitus(DM)is linked to an earlier onset and heightened severity of urinary complications,particularly bladder dysfunction,which profoundly impacts patient quality of life.Overactive bladder(OAB)i...BACKGROUND Diabetes mellitus(DM)is linked to an earlier onset and heightened severity of urinary complications,particularly bladder dysfunction,which profoundly impacts patient quality of life.Overactive bladder(OAB)is a common storage disorder of the lower urinary tract and is characterized by urgency,frequency,and nocturia.Several factors contribute to bladder dysfunction in diabetic individuals,including changes in urothelial signaling,detrusor morphology,and central nervous system regulation.The transient receptor potential vanilloid type 1 channel,expressed by bladder urothelial cells,is upregulated in OAB and plays a crucial role in ATP release during bladder filling.This ATP release subsequently activates purinergic receptor P2X3,further exacerbating OAB symptoms.AIM To clarify the mechanism of Roux-en-Y gastric bypass(RYGB)metabolic surgery to improve OAB in type 2 DM(T2DM).METHODS The model of T2DM was induced by feeding a high-fat diet to mice for 16 weeks.After 16 weeks,sham operation and RYGB operation were performed.The related indexes of glucose metabolism were also detected to evaluate the therapeutic effect,and the recovery degree of bladder function and micturition behavior of mice was assessed by urodynamics and micturition spot analysis.RESULTS Compared with the normal mice in the sham group,T2DM mice had increased urine spot count,uncontrolled urination behavior,shortened urination interval,and reduced bladder capacity.Immunohistochemistry and immunofluorescence costaining showed that Transient receptor potential vanilloid type 1(TRPV1)and purinergic receptor P2X3 were both expressed in mouse bladder epithelial layer,and they had the same localization.In the bladder of T2DM mice,the mRNA and protein expression of TRPV1 and P2X3 were significantly increased.The ATP content in urine of T2DM mice was significantly higher than that of the sham group.After RYGB operation,the glucose metabolism index of the RYGB group was significantly improved compared with the OAB group.Comparing the results of urine spots,urodynamics,and histology,it was found that the function and morphological structure of the bladder in the RYGB group also recovered obviously.Compared with the OAB group,the expression of TRPV1 and P2X3 in the RYGB group was downregulated,and the level of inflammatory factors was significantly decreased.RYGB significantly decreased the content of ATP in urine and activated AMPK signaling.CONCLUSION RYGB downregulated the expression of TRPV1 by inhibiting inflammatory factors,thus inhibiting the enhancement of P2X3 by TRPV1.RYGB directly inhibited the activity of P2X3 by inhibiting ATP synthesis in the bladder epithelium to improve OAB.展开更多
BACKGROUND Coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)are well-established treatments for multivessel coronary artery disease(CAD),a condition where multiple heart arteries are nar...BACKGROUND Coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)are well-established treatments for multivessel coronary artery disease(CAD),a condition where multiple heart arteries are narrowed.A newer approach,fractional flow reserve(FFR)-guided PCI,uses a specialized measurement to select which artery blockages to treat,aiming to enhance patient outcomes.Despite its adoption,the comparative effectiveness of FFR-guided PCI vs CABG remains unclear,particularly regarding key health outcomes such as survival,heart-related complications,and the need for further procedures.AIM To evaluate the safety and effectiveness of FFR-guided PCI compared to CABG in patients with multivessel CAD.METHODS This meta-analysis followed standard reporting guidelines and included randomized controlled trials(RCTs)comparing FFR-guided PCI with CABG in patients with multivessel CAD.We searched medical databases,including PubMed,EMBASE,ScienceDirect,and ClinicalTrials.gov,from their start to May 2025.We calculated combined risk ratios(RRs)with 95%confidence intervals(95%CIs)to analyze the data.RESULTS Three RCTs were analyzed.There was no notable difference in all-cause mortality between FFR-guided PCI and CABG(RR=1.01,95%CI:0.78-1.31,P=0.93).However,FFR-guided PCI showed higher rates of major adverse cardiac events(MACEs;RR=1.30,95%CI:1.11-1.52,P=0.001),myocardial infarction(RR=1.49,95%CI:1.11-2.01,P=0.009),and repeat revascularization(RR=2.25,95%CI:1.78-2.85,P<0.00001).Stroke rates were comparable between the two treatments(RR=0.80,95%CI:0.54-1.20,P=0.28).CONCLUSION FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD.However,CABG results in fewer MACEs,myocardial infarctions,and repeat procedures.展开更多
Background Acute kidney injury(AKI)is a common and serious complication following coronary artery bypass grafting(CABG),with an incidence rate ranging from 4%to 28%.The estimated plasma volume status(ePVS)-a novel mar...Background Acute kidney injury(AKI)is a common and serious complication following coronary artery bypass grafting(CABG),with an incidence rate ranging from 4%to 28%.The estimated plasma volume status(ePVS)-a novel marker calculated from routine hematocrit and hemoglobin levels-reflects both volume overload and hemodilution,which are potential contributors to renal impairment.Nevertheless,the relationship between ePVS and AKI in patients undergoing CABG remains poorly understood.Therefore,this study aimed to investigate the association of ePVS with the risk of AKI in adult patients who underwent CABG.Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care(MIMIC)-IV database,covering the period from 2008 to 2019.The primary outcome was the occurrence of AKI following admission to the intensive care unit(ICU).Hematocrit and hemoglobin levels were measured within 24 hours after ICU admission.The ePVS was calculated using the Strauss-derived Duarte formula:ePVS=[100-hematocrit(%)]/hemoglobin(g/dL).AKI was defined in accordance with the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression models were used to adjust for demographics,comorbidities,and critical laboratory markers.Patients were stratified into three groups based on the ePVS tertiles(low:≤6.30;middle:6.30-8.08;high:>8.08).Multivariate logistic regression and subgroup analyses were applied to explore the association of the ePVS with the risk of AKI.Furthermore,we also examined the association of ePVS with AKI by employing generalized additive models.Results A total of 3,388 patients were included in the final analysis,of whom 2,573(75.94%)developed AKI.Following multivariable adjustment,each unit increase in ePVS was associated with a 9%increase in the odds of AKI(OR:1.09,95%CI:1.05-1.14;P<0.001).When analyzed by ePVS tertiles,the highest tertile demonstrated a significantly elevated AKI risk compared with the lowest tertile(OR:1.48,95%CI:1.18-1.86,P=0.0007),with a significant dose-response relationship observed across tertiles(P for trend<0.001).Subgroup analyses further indicated that the association between ePVS and AKI was more pronounced among patients with pre-existing renal or peripheral vascular disease and was statistically significant only in White patients.Conclusions ePVS was independently associated with an increased risk of AKI in adults undergoing CABG.These findings supported the potential utility of ePVS as a simple,economical clinical tool for early identification of patients at high risk for AKI following cardiac surgery.展开更多
Background Acute kidney injury(AKl)is a common and serious complication following coronary artery bypass grafting(CABG),with reported incidence rates ranging from 4%to 28%.Red cell distribution width(RDW),calculated a...Background Acute kidney injury(AKl)is a common and serious complication following coronary artery bypass grafting(CABG),with reported incidence rates ranging from 4%to 28%.Red cell distribution width(RDW),calculated as the standard deviation of erythrocyte size divided by mean corpuscular volume,reflects the heterogeneity in red blood cell volume.Easily obtained from routine blood tests,RDW is increasingly recognized as a prognostic marker for various adverse clinical outcomes.Previous studies have also indicated a correlation between elevated RDW levels and declining renal function,as measured by estimated glomerular filtration rate.However,the specific relationship between RDW and the risk of AKI in patients undergoing CABG remains inadequately characterized.This study aimed to investigate the association between RDW and AKI incidence in this surgical population.Methods I n this secondary retrospective cohort study,data of patients who underwent CABG were extracted from the Medical Information Mart for Intensive Care(MIMIC)-IV database(2008-2019).The primary outcome was the occurrence of AKI as a postoperative complication following CABG,which was identified after intensive care unit(ICU)admission.RDW was measured within 24 hours on admission to ICU.AKI was defined according to Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression models were used to adjust for demographics,comorbidities,and critical laboratory markers.Patients were stratified into RDW tertiles(T1:≤13.1%;T2:13.1%-13.8%;T3:≥13.8%).Multivariate logistic regression and subgroup analyses were applied to explore the association of the RDW with the risk of AKI.Furthermore,we also examined the association of RDW with AKI by employing restricted cubic splines(RCS).Results A total of 3,388 patients who underwent CABG were included in this study,of whom 2563(75.65%)had AKI.According to the multivariate regression models,the RDW demonstrated a significant positive correlation with the risk of AKI after comprehensive covariate adjustment.When each unit of RDW was increased,the risk of AKI in patients with CABG increased 10%(OR:1.10,95%CI:1.03-1.18,P=0.0063).In addition,When the RDW was analyzed by tertiles,patients in the high tertile(OR:1.33,95%CI:1.08-1.64,P=0.0072)presented a progressively higher risk of AKI than those in the low tertile,with a significant dose-response trend(P for trend<0.01).The subgroup analysis demonstrated that the positive association between elevated RDW and increased risk of AKI following CABG was robust and consistent across most major patient subgroups defined by demographics and comorbidities.The strength of this association was notably amplified in patients with pre-existing renal disease and in older patients(>65 years)and White race(P<0.05),suggesting a particularly prominent relationship between RDW and AKI risk in these specific populations.The lack of statistical significance in peripheral vascular disease subgroups required further investigation(P>0.05).Conclusions In ICU patients who received coronary revascularization by CABG,an elevated RDW demonstrated an positive correlation with the risk of AKI.[S Chin J Cardiol 2025;26(4):228238]展开更多
Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in...Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in multivessel coronary artery disease(CAD).The pooled analysis found no significant difference in all-cause mortality or stroke,yet CABG was superior in reducing myocardial infarction,major adverse cardiac events,and repeat revascularization.These results confirm CABG’s durability even in the era of physiological lesion assessment and second-generation drug-eluting stents.From a traditional Chinese medicine(TCM)perspective,multivessel CAD corresponds to syndromes such as“heart vessel obstruction”and“Qi and blood stagnation”,in which local blockage is compounded by systemic imbalance.While revascularization addresses the structural impediment to blood flow,TCM approaches,including herbal medicine,acupuncture,and lifestyle therapy,aim to improve microcirculation,reduce inflammation,and support recovery,potentially mitigating recurrent ischemic events.This commentary argues that future research should integrate optimal revascularization strategies with rigorously evaluated TCM interventions to address both the anatomical and systemic dimensions of CAD and improve long-term patient outcomes.展开更多
BACKGROUND Ciprofol is a novel agent for intravenous general anesthesia.In February 2022,it was approved by the National Medical Products Administration for general anesthesia induction and maintenance.It has the adva...BACKGROUND Ciprofol is a novel agent for intravenous general anesthesia.In February 2022,it was approved by the National Medical Products Administration for general anesthesia induction and maintenance.It has the advantages of fast onset,fast elimination,stable circulation,and few adverse reactions.However,the efficacy and safety of ciprofol in cardiac surgery with cardiopulmonary bypass have not been reported.Here we describe a case where ciprofol was successfully used for anesthesia in cardiac surgery with cardiopulmonary bypass.CASE SUMMARY A 72-year-old man(height 176 cm;weight 70 kg)was diagnosed with coronary atherosclerotic cardiomyopathy requiring coronary artery bypass grafting and left ventricular aneurysmectomy.Ciprofol was administered for induction(0.4 mg/kg)and maintenance(0.6-1.0 mg/kg/h)of general anesthesia.During the entire operation,the bispectral index,hemodynamics,and blood oxygen saturation were maintained at normal levels.The patient recovered well after surgery,with no serious adverse events related to ciprofol.CONCLUSION Ciprofol is safe and effective for anesthesia in cardiac surgery with cardiopulmonary bypass.展开更多
基金Supported by National Natural Science Foundation of China,No.82360168 and No.81960154Natural Science Foundation of Jiangxi Province,No.20212BAB206020the Foundation of Health Commission of Jiangxi Province,No.SKJP220225830.
文摘BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.
基金supported by the Ministry of Education and Science of the Republic of Kazakhstan(Grant No.AP23490186).
文摘Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectancy.2,3 One common approach for treating obesity and its associated comorbidities is gastric bypass surgery.However,it is not without complications,and one of the most significant postoperative concerns is reflux esophagitis.Gastroesophageal reflux disease(GERD)is a prevalent problem among obese patients,and providing care is a significant factor in bariatric surgery.4 Roux-en-Y gastric bypass(RYGB)is frequently considered the preferable surgical treatment for individuals with GERD because of its efficacy in reducing reflux symptoms.
文摘The incidence of saphenous vein graft aneurysms(SVGAs)after coronary artery bypass grafting(CABG)is approximately 0.07%;[1]however,the true incidence is likely underreported because of their frequent incidental discovery.[2]Due to its rarity,knowledge mainly comes from case reports and small case series,though some decision algorithms have been proposed in systematic reviews.
文摘BACKGROUND Cardiopulmonary bypass(CPB)is a life-support technology widely used in surgery.Review articles reflect research advances in a certain topic or field within a certain period of time.AIM To perform a bibliometric analysis of the review articles that focused on CPB for cardiovascular surgery.METHODS This study was based on a bibliometric analysis.Data were acquired from the Web of Science and basic bibliometric parameters were analyzed and visualized using VOSviewer and Excel.RESULTS We identified 141 review articles on CPB.Generally,the number of publications increased,and most of them were published in the 2010s(n=57,40.4%)and the 2020s(n=45,31.9%).There were 113(80.1%)narrative review articles,21(14.9%)meta-analysis studies and 7(5.0%)systematic review papers.The United States(n=25,17.7%)and China(n=21,14.9%)were the leading countries in terms of publication number.The articles were published in 98 different journals.The Journal of Cardiothoracic and Vascular Anesthesia(n=14,10.0%)and Perfusion-United Kingdom(n=11,7.8%)were preferred by the authors.The high-frequency keywords included inflammatory response,children,acute kidney injury,meta-analysis and off-pump,except for CPB and cardiac surgery.Inflammatory response had the closest relationship with CPB during cardiac surgery.The complications of CPB,including inflammatory response,kidney injury and ischemia,caught lots of concern.CONCLUSION The rapid increase of review papers shows that the research on CPB in cardiac surgery is increasingly being emphasized by scholars and clinical staff worldwide.Meta-analysis has been widely conducted to analyze clinical controversies and further guide clinical practice.Strategies to improving the outcomes of patients undergoing cardiac surgery with CPB are the hot spots in this field.
基金supported by the National Cancer Institute(T32,CA 236621-5).
文摘Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.
文摘BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,limiting its use in other regions.AIM To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft(CABG)surgery at a hospital in Bogotá,Colombia.METHODS An observational,analytical study of a retrospective cohort was designed.All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included.In-hospital mortality was the primary outcome evaluated.Furthermore,the performance of EuroSCORE II was assessed in this population.RESULTS A total of 1009 patients were included[median age 66 years IQR=59-72,78.2%men].The overall in-hospital mortality was 5.5%(n=56).The median mortality predicted using EuroSCORE II was 1.29(IQR=0.92-2.11).Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis(54.1%),followed by ST-segment elevation myocardial infarction(19.1%)and unstable angina(14.3%).Urgent surgery was performed in 87.3%of the patients(n=881).Mortality rates in each group were as follows:Low risk 6.0%(n=45,observed-to-expected(O/E)ratio,5.6),moderate risk 3.0%(n=5,O/E ratio 1.17),high risk 5.0%(n=4,O/E ratio 0.94),and very high risk 7.6%(n=2,O/E ratio 0.71).The overall O/E ratio was 4.2.The area under the curve of EuroSCORE II was 0.55[95%confidence interval:0.48-0.63]CONCLUSION EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability.This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment.Moreover,unlike the population in which this tool was originally developed,most patients were not electively admitted for the surgery.
基金supported by the National Key Research and Development Program of China(No.2022YFC2407406)Guangzhou Science and Technology Planning Project(No.2023B03J0596)2023 Stability Support for Innovative Capacity Building of Guangdong Provincial Scientific Research Institutions(No.KD022023019).
文摘Objective Placental dysfunction induced by fetal cardiopulmonary bypass(CPB)imposes limitations on the clinical application of this procedure.The potential impact of microRNA-mediated autophagy in placental endothelial cells on overall placental function remains elusive,necessitating a comprehensive exploration of the underlying mechanisms involved.Methods We established fetal sheep CPB models and employed immunohistochemistry to assess the placental expression of ATG7.Bioinformatic analysis,coupled with dual-luciferase reporter assays,was used to elucidate the intricate relationship between miR-320a and ATG7.Changes in ATG7 expression were further investigated through Western blotting and quantitative polymerase chain reaction(qPCR).Human umbilical vein endothelial cells(HUVECs)were cultured,and in vitro experiments were conducted to evaluate their regulatory effects on endothelial function.Immunoblotting was used to measure the expression levels of ATG7,endothelin-1(ET-1),SIRT1,and FOXO1,whereas enzyme-linked immunosorbent assay(ELISA)was used to quantify nitric oxide(NO)production.Results Sixty minutes after CPB,a substantial decrease in ATG7 expression in placental tissue was observed.The downregulation of ATG7 expression led to increased ET-1 production in HUVECs,concomitant with decreased NO production.miR-320a was identified as a specific regulator of ATG7 expression,with subsequent experiments demonstrating a significant reduction in placental ATG7 levels upon injection of the miR-320a agomir compared with the miR-320a antagomir during fetal sheep CPB.In HUVECs,miR-320a downregulated ATG7,resulting in increased ET-1 production and diminished NO production.Treatment with the miR-320a mimic/miR-320a inhibitor revealed that miR-320a inhibited the SIRT1/FOXO1 pathway in HUVECs by downregulating ATG7 expression,culminating in increased ET-1 production and reduced NO levels.Conclusion The observed downregulation of placental ATG7 expression subsequent to fetal CPB is intricately associated with endothelial dysfunction.Furthermore,our findings underscore the specific regulatory role of miR-320a in modulating ATG7 expression within the placenta.At the cellular level,increasing the level of miR-320a has emerged as a potential strategy for modulating endothelial function through the inhibition of ATG7 and the SIRT1/FOXO1 pathway.
文摘BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.
文摘BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.
文摘BACKGROUND Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting(CABG),contributing to increased morbidity and prolonged hospital stays.Posterior pericardiotomy(PP),a surgical technique involving incision of the posterior pericardium to allow drainage,has been suggested as a preventive measure.However,its overall efficacy and safety profile,including potential risks like pleural effusion,require comprehensive evaluation amid varying study qualities.We hypothesized that PP reduces key post-CABG complications compared to standard care.AIM To determine the efficacy of PP in reducing postoperative complications following CABG.METHODS This systematic review and meta-analysis included randomized controlled trials(RCTs)from PubMed,Cochrane,ClinicalTrials.gov,and Ovid,comparing PP vs no PP in adult CABG patients.Studies were conducted in tertiary care hospital settings.Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria.The intervention involved intraoperative PP.Primary outcome was postoperative atrial fibrillation(POAF);secondary outcomes included effusions,tamponade,hospital/intensive care unit stay,and bleeding revisions.Risk ratios(RRs),mean differences,and 95%confidence intervals(CIs)were calculated using random-effects models;heterogeneity assessed via I^(2) statistic.RESULTS Twenty RCTs analyzed 5331 patients(2665 with PP vs 2666 without).PP significantly lowered POAF(10%vs 21%;RR=0.48,95%CI:0.36-0.65,P<0.00001;I^(2)=70%),cardiac tamponade(0.5%vs 3%;RR=0.16,95%CI:0.08-0.34,P<0.00001;I^(2)=0%),early pericardial effusion(2%vs 6%;RR=0.31,95%CI:0.14-0.68,P=0.004;I^(2)=96%),and late pericardial effusion(1%vs 9%;RR=0.11,95%CI:0.05-0.21,P<0.00001;I^(2)=0%).Hospital stay decreased(mean difference=-1.23 days,95%CI:-1.87 to-0.59,P=0.0002;I^(2)=85%).Pleural effusion risk increased(25%vs 17%;RR=1.46,95%CI:1.21-1.76,P<0.0001;I^(2)=0%).No significant effects on mortality(RR=0.92,95%CI:0.48-1.76,P=0.80;I^(2)=0%),intensive care unit stay,or bleeding revisions.CONCLUSION PP effectively reduces POAF,pericardial effusions,tamponade,and hospital stay in CABG patients,though it increases pleural effusion risk and shows heterogeneity in some outcomes.
基金Project(51808460)supported by the National Natural Science Foundation of ChinaProject(2021YFG0214)supported by the Sichuan Science and Technology Program,China。
文摘The aerodynamic pressure disturbances induced by middle air shafts and bypass ducts in subway tunnels pose significant challenges to enhancing train operational speeds.A comprehensive series of full-scale experiments are employed to examine the impact of these structural elements on the aerodynamic pressure characteristics of platform screen doors(PSDs)in high-speed subway stations.The experimental results reveal that peak pressures manifest on PSDs surfaces during two distinct scenarios in high-speed subway systems equipped with middle air shafts.One is compression pressure waves propagated from trains traversing the air shaft,and the other is train nearby flow when trains pass the PSDs directly.The peak positive pressures caused by train passing PSDs are much greater than compression pressure waves.Closing middle air shaft can reduce the passing pressure waves.The installation of bypass ducts at overtaking station entrances effectively mitigates peak negative pressures during train-PSD interactions,achieving a maximum reduction efficiency of 8%.These findings provide valuable insights for optimizing the structural design of high-speed subway tunnel systems.
文摘Objective:The objective of this study was to understand intraoperative risk factors for post-Norwood extracorporeal membrane oxygenation(ECMO)in patients with hypoplastic left heart syndrome(HLHS).Methods:We conducted a retrospective,single-institution reviewof all patients with HLHS who underwent a Norwood procedure(nadir cardiopulmonary bypass temperature≤22◦C)over a 12-year period with quantitative and qualitative analysis.Results:Of 102 Norwood patients,14(13.7%)required ECMO.ECMO patients had longer median cardiopulmonary bypass(CPB)times(276 vs.172 min,p<0.001)and myocardial ischemic times(98.5 vs 83 min,p=0.021).Longer CPB time was associated with ECMO(OR 1.04,p=0.001);the converse was true for myocardial ischemic time(OR 0.94,p=0.029).For patients with long CPB times(>205 min),41.9%(13/31)required ECMO.A narrative review for patients with long CPB times revealed suboptimal surgical management in 76.9%(10/13)of ECMO cases,with incorrect problem assessment leading to unnecessary revisions being most common.Conclusion:The qualitative analysis of prolonged CPB time and ECMO highlighted critical surgical decision-making,including consideration for extension of ischemic vs non-ischemic approaches to optimize surgical repair.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
基金Supported by National Natural Science Foundation of China,No.81860268 and No.82201000Ningxia Natural Science Foundation,No.2021AAC02025+3 种基金Ningxia Science and Technology Innovation Leading Talent Training ProjectNo.2020GKLRLX06 and No.2020GKLRLX11Ningxia Medical University Research Project,No.XJKF240315Ningxia Key Research and Development Project,No.2023BEG03021 and No.2021BEB04034.
文摘BACKGROUND Diabetes mellitus(DM)is linked to an earlier onset and heightened severity of urinary complications,particularly bladder dysfunction,which profoundly impacts patient quality of life.Overactive bladder(OAB)is a common storage disorder of the lower urinary tract and is characterized by urgency,frequency,and nocturia.Several factors contribute to bladder dysfunction in diabetic individuals,including changes in urothelial signaling,detrusor morphology,and central nervous system regulation.The transient receptor potential vanilloid type 1 channel,expressed by bladder urothelial cells,is upregulated in OAB and plays a crucial role in ATP release during bladder filling.This ATP release subsequently activates purinergic receptor P2X3,further exacerbating OAB symptoms.AIM To clarify the mechanism of Roux-en-Y gastric bypass(RYGB)metabolic surgery to improve OAB in type 2 DM(T2DM).METHODS The model of T2DM was induced by feeding a high-fat diet to mice for 16 weeks.After 16 weeks,sham operation and RYGB operation were performed.The related indexes of glucose metabolism were also detected to evaluate the therapeutic effect,and the recovery degree of bladder function and micturition behavior of mice was assessed by urodynamics and micturition spot analysis.RESULTS Compared with the normal mice in the sham group,T2DM mice had increased urine spot count,uncontrolled urination behavior,shortened urination interval,and reduced bladder capacity.Immunohistochemistry and immunofluorescence costaining showed that Transient receptor potential vanilloid type 1(TRPV1)and purinergic receptor P2X3 were both expressed in mouse bladder epithelial layer,and they had the same localization.In the bladder of T2DM mice,the mRNA and protein expression of TRPV1 and P2X3 were significantly increased.The ATP content in urine of T2DM mice was significantly higher than that of the sham group.After RYGB operation,the glucose metabolism index of the RYGB group was significantly improved compared with the OAB group.Comparing the results of urine spots,urodynamics,and histology,it was found that the function and morphological structure of the bladder in the RYGB group also recovered obviously.Compared with the OAB group,the expression of TRPV1 and P2X3 in the RYGB group was downregulated,and the level of inflammatory factors was significantly decreased.RYGB significantly decreased the content of ATP in urine and activated AMPK signaling.CONCLUSION RYGB downregulated the expression of TRPV1 by inhibiting inflammatory factors,thus inhibiting the enhancement of P2X3 by TRPV1.RYGB directly inhibited the activity of P2X3 by inhibiting ATP synthesis in the bladder epithelium to improve OAB.
文摘BACKGROUND Coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)are well-established treatments for multivessel coronary artery disease(CAD),a condition where multiple heart arteries are narrowed.A newer approach,fractional flow reserve(FFR)-guided PCI,uses a specialized measurement to select which artery blockages to treat,aiming to enhance patient outcomes.Despite its adoption,the comparative effectiveness of FFR-guided PCI vs CABG remains unclear,particularly regarding key health outcomes such as survival,heart-related complications,and the need for further procedures.AIM To evaluate the safety and effectiveness of FFR-guided PCI compared to CABG in patients with multivessel CAD.METHODS This meta-analysis followed standard reporting guidelines and included randomized controlled trials(RCTs)comparing FFR-guided PCI with CABG in patients with multivessel CAD.We searched medical databases,including PubMed,EMBASE,ScienceDirect,and ClinicalTrials.gov,from their start to May 2025.We calculated combined risk ratios(RRs)with 95%confidence intervals(95%CIs)to analyze the data.RESULTS Three RCTs were analyzed.There was no notable difference in all-cause mortality between FFR-guided PCI and CABG(RR=1.01,95%CI:0.78-1.31,P=0.93).However,FFR-guided PCI showed higher rates of major adverse cardiac events(MACEs;RR=1.30,95%CI:1.11-1.52,P=0.001),myocardial infarction(RR=1.49,95%CI:1.11-2.01,P=0.009),and repeat revascularization(RR=2.25,95%CI:1.78-2.85,P<0.00001).Stroke rates were comparable between the two treatments(RR=0.80,95%CI:0.54-1.20,P=0.28).CONCLUSION FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD.However,CABG results in fewer MACEs,myocardial infarctions,and repeat procedures.
基金supported by the Guangdong Provincial Medical Science and Technology Research Fund Program(No.2024112010149612)。
文摘Background Acute kidney injury(AKI)is a common and serious complication following coronary artery bypass grafting(CABG),with an incidence rate ranging from 4%to 28%.The estimated plasma volume status(ePVS)-a novel marker calculated from routine hematocrit and hemoglobin levels-reflects both volume overload and hemodilution,which are potential contributors to renal impairment.Nevertheless,the relationship between ePVS and AKI in patients undergoing CABG remains poorly understood.Therefore,this study aimed to investigate the association of ePVS with the risk of AKI in adult patients who underwent CABG.Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care(MIMIC)-IV database,covering the period from 2008 to 2019.The primary outcome was the occurrence of AKI following admission to the intensive care unit(ICU).Hematocrit and hemoglobin levels were measured within 24 hours after ICU admission.The ePVS was calculated using the Strauss-derived Duarte formula:ePVS=[100-hematocrit(%)]/hemoglobin(g/dL).AKI was defined in accordance with the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression models were used to adjust for demographics,comorbidities,and critical laboratory markers.Patients were stratified into three groups based on the ePVS tertiles(low:≤6.30;middle:6.30-8.08;high:>8.08).Multivariate logistic regression and subgroup analyses were applied to explore the association of the ePVS with the risk of AKI.Furthermore,we also examined the association of ePVS with AKI by employing generalized additive models.Results A total of 3,388 patients were included in the final analysis,of whom 2,573(75.94%)developed AKI.Following multivariable adjustment,each unit increase in ePVS was associated with a 9%increase in the odds of AKI(OR:1.09,95%CI:1.05-1.14;P<0.001).When analyzed by ePVS tertiles,the highest tertile demonstrated a significantly elevated AKI risk compared with the lowest tertile(OR:1.48,95%CI:1.18-1.86,P=0.0007),with a significant dose-response relationship observed across tertiles(P for trend<0.001).Subgroup analyses further indicated that the association between ePVS and AKI was more pronounced among patients with pre-existing renal or peripheral vascular disease and was statistically significant only in White patients.Conclusions ePVS was independently associated with an increased risk of AKI in adults undergoing CABG.These findings supported the potential utility of ePVS as a simple,economical clinical tool for early identification of patients at high risk for AKI following cardiac surgery.
文摘Background Acute kidney injury(AKl)is a common and serious complication following coronary artery bypass grafting(CABG),with reported incidence rates ranging from 4%to 28%.Red cell distribution width(RDW),calculated as the standard deviation of erythrocyte size divided by mean corpuscular volume,reflects the heterogeneity in red blood cell volume.Easily obtained from routine blood tests,RDW is increasingly recognized as a prognostic marker for various adverse clinical outcomes.Previous studies have also indicated a correlation between elevated RDW levels and declining renal function,as measured by estimated glomerular filtration rate.However,the specific relationship between RDW and the risk of AKI in patients undergoing CABG remains inadequately characterized.This study aimed to investigate the association between RDW and AKI incidence in this surgical population.Methods I n this secondary retrospective cohort study,data of patients who underwent CABG were extracted from the Medical Information Mart for Intensive Care(MIMIC)-IV database(2008-2019).The primary outcome was the occurrence of AKI as a postoperative complication following CABG,which was identified after intensive care unit(ICU)admission.RDW was measured within 24 hours on admission to ICU.AKI was defined according to Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression models were used to adjust for demographics,comorbidities,and critical laboratory markers.Patients were stratified into RDW tertiles(T1:≤13.1%;T2:13.1%-13.8%;T3:≥13.8%).Multivariate logistic regression and subgroup analyses were applied to explore the association of the RDW with the risk of AKI.Furthermore,we also examined the association of RDW with AKI by employing restricted cubic splines(RCS).Results A total of 3,388 patients who underwent CABG were included in this study,of whom 2563(75.65%)had AKI.According to the multivariate regression models,the RDW demonstrated a significant positive correlation with the risk of AKI after comprehensive covariate adjustment.When each unit of RDW was increased,the risk of AKI in patients with CABG increased 10%(OR:1.10,95%CI:1.03-1.18,P=0.0063).In addition,When the RDW was analyzed by tertiles,patients in the high tertile(OR:1.33,95%CI:1.08-1.64,P=0.0072)presented a progressively higher risk of AKI than those in the low tertile,with a significant dose-response trend(P for trend<0.01).The subgroup analysis demonstrated that the positive association between elevated RDW and increased risk of AKI following CABG was robust and consistent across most major patient subgroups defined by demographics and comorbidities.The strength of this association was notably amplified in patients with pre-existing renal disease and in older patients(>65 years)and White race(P<0.05),suggesting a particularly prominent relationship between RDW and AKI risk in these specific populations.The lack of statistical significance in peripheral vascular disease subgroups required further investigation(P>0.05).Conclusions In ICU patients who received coronary revascularization by CABG,an elevated RDW demonstrated an positive correlation with the risk of AKI.[S Chin J Cardiol 2025;26(4):228238]
文摘Kataveni et al’s meta-analysis offers an important contemporary synthesis of randomized evidence comparing fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass grafting(CABG)in multivessel coronary artery disease(CAD).The pooled analysis found no significant difference in all-cause mortality or stroke,yet CABG was superior in reducing myocardial infarction,major adverse cardiac events,and repeat revascularization.These results confirm CABG’s durability even in the era of physiological lesion assessment and second-generation drug-eluting stents.From a traditional Chinese medicine(TCM)perspective,multivessel CAD corresponds to syndromes such as“heart vessel obstruction”and“Qi and blood stagnation”,in which local blockage is compounded by systemic imbalance.While revascularization addresses the structural impediment to blood flow,TCM approaches,including herbal medicine,acupuncture,and lifestyle therapy,aim to improve microcirculation,reduce inflammation,and support recovery,potentially mitigating recurrent ischemic events.This commentary argues that future research should integrate optimal revascularization strategies with rigorously evaluated TCM interventions to address both the anatomical and systemic dimensions of CAD and improve long-term patient outcomes.
文摘BACKGROUND Ciprofol is a novel agent for intravenous general anesthesia.In February 2022,it was approved by the National Medical Products Administration for general anesthesia induction and maintenance.It has the advantages of fast onset,fast elimination,stable circulation,and few adverse reactions.However,the efficacy and safety of ciprofol in cardiac surgery with cardiopulmonary bypass have not been reported.Here we describe a case where ciprofol was successfully used for anesthesia in cardiac surgery with cardiopulmonary bypass.CASE SUMMARY A 72-year-old man(height 176 cm;weight 70 kg)was diagnosed with coronary atherosclerotic cardiomyopathy requiring coronary artery bypass grafting and left ventricular aneurysmectomy.Ciprofol was administered for induction(0.4 mg/kg)and maintenance(0.6-1.0 mg/kg/h)of general anesthesia.During the entire operation,the bispectral index,hemodynamics,and blood oxygen saturation were maintained at normal levels.The patient recovered well after surgery,with no serious adverse events related to ciprofol.CONCLUSION Ciprofol is safe and effective for anesthesia in cardiac surgery with cardiopulmonary bypass.
