Background: Since January 12005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-G...Background: Since January 12005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg.?Methods: Data are collected in an online data bank. Data collection began in 2005 for the results of Roux-en-Y Gastric Bypass (RYGB). In addition to primary bariatric operations, data regarding the complications and the amelioration of comorbidities have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany.?Results: Roux-en-Y Gastric Bypass is the most popular bariatric operation in Germany. There were 5115 operations performed from 2005 to 2010. A circular anastomosis was performed in 1587 patients, and a linear anastomosis was performed in 2734 patients. In 783 patients the hand-sewn technique was used. The leakage rate for the linear technique is 1.6%, and the leakage rate is 1.2% for circular anastomosis and 1.4% for hand-sewn technique. The overall postoperative complication rate was significantly higher using the circular technique than using the linear or hand-sewn approach.?Conclusion: RYGB is a popular procedure in Germany. The complication rate has decreased since 2005. A comparison of hand sewn versus linear and versus circular anastomosis indicated a higher complication rate in circular gastrojejunal junctions.展开更多
Background:We aimed to evaluate the medium-term efficacy of sleeve gastrectomy(SG)vs.Roux-en-Y gastric bypass(RYGB)on remission of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM...Background:We aimed to evaluate the medium-term efficacy of sleeve gastrectomy(SG)vs.Roux-en-Y gastric bypass(RYGB)on remission of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods:We identified severely obese patients[body mass index(BMI)>35 kg/m^(2)]with NAFLD(as defined by the Longitudinal Assessment of Bariatric Surgery Study)and T2DM(as defined by the American Association of Clinical Endocrinologists and the American College of Endocrinology)who underwent SG or RYGB in a single university surgical centre.The cohorts were match-paired and data were analysed after at least 3 years of follow up.The key outcomes measured were:(I)the improvement of liver function tests and NAFLD markers;(II)glycemic control and insulin resistance.Results:Ninety-six patients were investigated;44(45.8%)were women.The mean pre-operative BMI was 45.2 kg/m2 in the SG and 42.0 kg/m^(2) in the RYGB group.SG and RYGB both significantly reduced serum liver enzyme concentrations.NAFLD markers resolved 2 years after SG in all patients.In contrast,only 78%and 80%of patients achieved remission of NAFLD 2 and 3 years after RYBG respectively.Both procedures resulted in comparable rates of remission of T2DM.Conclusions:Bariatric surgery with SG may be preferable to RYGB for obese patients with NAFLD and T2DM based on the rates of remission of markers of these co-morbidities.However,our results need to be confirmed in prospective trials.Understanding the metabolic effects of specific bariatric surgical procedures may facilitate the development of a personalised approach to weight-loss surgery.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
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
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
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
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
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 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
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
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 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
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
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
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
目的:探讨人文关怀理论指导下的护理配合早期心脏康复护理在冠状动脉旁路移植术(CABG)患者中的应用效果。方法:研究对象为2024年1月—12月收治的150例拟行冠状动脉旁路移植术(CABG)患者,采用随机数字表法分为对照组和观察组各75例。对...目的:探讨人文关怀理论指导下的护理配合早期心脏康复护理在冠状动脉旁路移植术(CABG)患者中的应用效果。方法:研究对象为2024年1月—12月收治的150例拟行冠状动脉旁路移植术(CABG)患者,采用随机数字表法分为对照组和观察组各75例。对照组行常规护理,观察组在此基础上行人文关怀理论指导下的护理配合早期心脏康复护理;比较两组患者术后康复指标、并发症发生情况、生活质量[采用生活质量综合评定问卷(GQOLI-74)]及心理状态[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)]、满意度。结果:观察组术后康复指标均优于对照组(P<0.01),并发症总发生率低于对照组(P<0.05);观察组术后7 d SAS、SDS评分低于对照组(P<0.01);观察组GQOLI-74各维度评分、满意度评分高于对照组(P<0.01,P<0.05)。结论:将人文关怀理论指导下的护理配合早期心脏康复护理应用于CABG患者,能有效缩短患者康复时间,降低术后并发症发生率,改善患者心理状态和生活质量,提高护理满意度。展开更多
文摘Background: Since January 12005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg.?Methods: Data are collected in an online data bank. Data collection began in 2005 for the results of Roux-en-Y Gastric Bypass (RYGB). In addition to primary bariatric operations, data regarding the complications and the amelioration of comorbidities have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany.?Results: Roux-en-Y Gastric Bypass is the most popular bariatric operation in Germany. There were 5115 operations performed from 2005 to 2010. A circular anastomosis was performed in 1587 patients, and a linear anastomosis was performed in 2734 patients. In 783 patients the hand-sewn technique was used. The leakage rate for the linear technique is 1.6%, and the leakage rate is 1.2% for circular anastomosis and 1.4% for hand-sewn technique. The overall postoperative complication rate was significantly higher using the circular technique than using the linear or hand-sewn approach.?Conclusion: RYGB is a popular procedure in Germany. The complication rate has decreased since 2005. A comparison of hand sewn versus linear and versus circular anastomosis indicated a higher complication rate in circular gastrojejunal junctions.
文摘Background:We aimed to evaluate the medium-term efficacy of sleeve gastrectomy(SG)vs.Roux-en-Y gastric bypass(RYGB)on remission of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods:We identified severely obese patients[body mass index(BMI)>35 kg/m^(2)]with NAFLD(as defined by the Longitudinal Assessment of Bariatric Surgery Study)and T2DM(as defined by the American Association of Clinical Endocrinologists and the American College of Endocrinology)who underwent SG or RYGB in a single university surgical centre.The cohorts were match-paired and data were analysed after at least 3 years of follow up.The key outcomes measured were:(I)the improvement of liver function tests and NAFLD markers;(II)glycemic control and insulin resistance.Results:Ninety-six patients were investigated;44(45.8%)were women.The mean pre-operative BMI was 45.2 kg/m2 in the SG and 42.0 kg/m^(2) in the RYGB group.SG and RYGB both significantly reduced serum liver enzyme concentrations.NAFLD markers resolved 2 years after SG in all patients.In contrast,only 78%and 80%of patients achieved remission of NAFLD 2 and 3 years after RYBG respectively.Both procedures resulted in comparable rates of remission of T2DM.Conclusions:Bariatric surgery with SG may be preferable to RYGB for obese patients with NAFLD and T2DM based on the rates of remission of markers of these co-morbidities.However,our results need to be confirmed in prospective trials.Understanding the metabolic effects of specific bariatric surgical procedures may facilitate the development of a personalised approach to weight-loss surgery.
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 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 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.
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.
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 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.
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.
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 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.
文摘目的:探讨人文关怀理论指导下的护理配合早期心脏康复护理在冠状动脉旁路移植术(CABG)患者中的应用效果。方法:研究对象为2024年1月—12月收治的150例拟行冠状动脉旁路移植术(CABG)患者,采用随机数字表法分为对照组和观察组各75例。对照组行常规护理,观察组在此基础上行人文关怀理论指导下的护理配合早期心脏康复护理;比较两组患者术后康复指标、并发症发生情况、生活质量[采用生活质量综合评定问卷(GQOLI-74)]及心理状态[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)]、满意度。结果:观察组术后康复指标均优于对照组(P<0.01),并发症总发生率低于对照组(P<0.05);观察组术后7 d SAS、SDS评分低于对照组(P<0.01);观察组GQOLI-74各维度评分、满意度评分高于对照组(P<0.01,P<0.05)。结论:将人文关怀理论指导下的护理配合早期心脏康复护理应用于CABG患者,能有效缩短患者康复时间,降低术后并发症发生率,改善患者心理状态和生活质量,提高护理满意度。
