Analysis of hospitalization expenses and influencing factors for elderly cancer patients in a tertiary hospital in Dalian, China: a five­year retrospective study.

BACKGROUND: Because the proportion of elderly individuals and the incidence of cancer worldwide are continually increasing, medical costs for elderly inpatients with cancer are being significantly increasing, which puts tremendous financial pressure on their families and society. The current study described the actual direct medical costs of elderly inpatients with cancer and analyzed the influencing factors for the costs to provide advice on the prevention and control of the high medical costs of elderly patients with cancer. METHOD: A retrospective descriptive analysis was performed on the hospitalization expense data of 11,399 elderly inpatients with cancer at a tier-3 hospital in Dalian between June 2016 and June 2020. The differences between different groups were analyzed using univariate analysis, and the influencing factors of hospitalization expenses were explored by multiple linear regression analysis. RESULTS: The hospitalization cost of elderly cancer patients showed a decreasing trend from 2016 to 2020. Specifically, the top 3 hospitalization costs were material costs, drug costs and surgery costs, which accounted for greater than 10% of all cancers according to the classification: colorectal (23.96%), lung (21.74%), breast (12.34%) and stomach cancer (12.07%). Multiple linear regression analysis indicated that cancer type, surgery, year and length of stay (LOS) had a common impact on the four types of hospitalization costs (P < 0.05). CONCLUSION: There were significant differences in the four types of hospitalization costs for elderly cancer patients according to the LOS, surgery, year and type of cancer. The study results suggest that the health administration department should enhance the supervision of hospital costs and elderly cancer patient treatment. Measures should be taken by relying on the hospital information system to strengthen the cost management of cancer diseases and departments, optimize the internal management system, shorten elderly cancer patients LOS, and reasonably control the costs of disease diagnosis, treatment and department operation to effectively reduce the economic burden of elderly cancer patients.

Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection.

BACKGROUND: Despite the increasing application of tolvaptan in cardiac surgery, there is no information on the use of tolvaptan in Stanford patients with type A aortic dissection. This study aimed to evaluate the postoperative clinical effects of tolvaptan in patients with type A aortic dissection  after tafter surgery. METHODS: A retrospective analysis was performed on 45 patients treated for type A aortic dissection in our hospital from 2018 to 2020. These included 21 patients who were treated with tolvaptan (Group T) and 24 patients who received traditional diuretics (Group L). The hospital's electronic health records were used to obtain perioperative data. RESULTS: Group T did not differ significantly from Group L in terms of the duration of mechanical ventilation, postoperative blood required, length of catecholamine use, or the amount of intravenous diuretic drugs administered (all P > 0.05). The development of postoperative atrial fibrillation was significantly less in the tolvaptan group (P = 0.023). The urine volumes and change in body weight loss were slightly higher in group T than in group L but the differences were non-significant (P > 0.05). Serum potassium, creatinine, and urea nitrogen levels did not differ between the groups in the week after surgery, At the same time, sodium was significantly higher in the Group T group on day 7 after transfer from the ICU (P = 0.001). In Group L, sodium levels were also elevated by day 7 (P = 0.001). On days 3 and 7, serum creatinine and urea nitrogen levels increased in both groups (both P < 0.05). CONCLUSIONS: Both tolvaptan and traditional diuretics were found to be effective and safe for patients with acute Stanford type A aortic dissection. Moreover, tolvaptan may be associated with reducing the incidence of postoperative atrial fibrillation.

Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results.

INTRODUCTION: The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. METHODS: One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun's operation. RESULTS: The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun's operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun's operation and two cases of other operations. CONCLUSION: ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.

Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results

ABSTRACT Introduction: The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. Methods: One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun's operation. Results: The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun's operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun's operation and two cases of other operations. Conclusion: ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.

The short-term efficacy of adventitial inversion with graft eversion anastomosis for the reconstruction of the aortic sinus in the root treatment of aortic dissection.

Background: The surgical approaches for a mildly affected aortic sinus (AS) are varied and controversial. Here, the AS was reconstructed using the extended adventitial inversion with graft eversion anastomosis technique before its perioperative and short-term efficacy was compared with that of the vascular grafts that wrap the aortic wall and the right atrial shunt technique, providing a new basis for surgical management strategies. Method: A total of 101 patients with mildly affected AS were enrolled in the clinical trial. The extended adventitial inversion suture and the graft eversion anastomosis technique was performed in group A. Aorta wrapping and the right atrial shunt technique were performed in group B. The primary endpoints were reoperation-related events and fatal events related to the aorta, while the secondary endpoints were the duration of surgery and structural changes in the aortic root. Cardiac ultrasound and aortic computed tomography angiography examinations were performed before surgery, 2 weeks after surgery, and 1 year after surgery. Results: Compared to group B (n = 56), group A (n = 36) had a significantly shorter duration of surgery (the time from skin incision to skin closure) and a reduced time from shutdown to skin closure (P < 0.05). Cardiovascular ultrasound examinations performed at follow-up 12 months after surgery and 2 weeks after surgery revealed a significant increase in the diameter of the aortic sinotubular junction (STJ) of group B (n = 50) (P < 0.05). The extended adventitial inversion suture and the graft eversion anastomosis technique (n = 33) performed better than Aorta wrapping and the right atrial shunt technique in terms of persistence of the false lumen closure effect, anastomotic leakage, and reduction in aortic valve (P < 0.05), and there was a significant difference between the two groups in terms of the incidence of events related to reoperation (P < 0.05). Conclusion: Compared with the aorta wrapping and the right atrial shunt technique, the extended adventitial inversion suture and the graft eversion anastomosis technique allow shortening of the operation time and preventing near-term dilation of the STJ, with improved safety and an improved short-term surgical effect.

MicroRNA-146b-3p regulates the dysfunction of vascular smooth muscle cells via repressing phosphoinositide-3 kinase catalytic subunit gamma.

MicroRNAs are crucial regulators in the phenotype switch of vascular smooth muscle cells (VSMCs). Nonetheless, the role of miR-146b-3p in VSMCs remains unclear. In the present study, platelet-derived growth factor-BB (PDGF-BB) at different concentrations was employed to stimulate VSMCs for different times, to establish the model of VSMC dysfunction. The relative expression of miR-146b-3p was quantified by quantitative real-time polymerase chain reaction (qRT-PCR). The proliferation of VSMCs was measured by BrdU assay. Flow cytometry analysis was employed for the analysis of cell cycle. VSMC migration was detected by Transwell assay. Phosphoinositide-3 kinase catalytic subunit-gamma (PIK3CG) and markers of VSMC differentiation, including α-SMA, SM-22α, SMMHC, and Calponin were examined employing Western blot. The targeting relationship between miR-146b-3p and PIK3CG 3'-UTR was affirmed by dual-luciferase gene assay. We report that the reduction of miR-146b-3p expression was induced by PDGF-BB in a time-dependent and dose-dependent manner (P < 0.05). The overexpression of miR-146b-3p counteracted the effects of PDGF-BB on the proliferation and migration of VSMCs and increased the expressions of differentiation markers (P < 0.05). Additionally, PIK3CG expression was negatively regulated by miR-146b-3p, and the restoration of PIK3CG partly eliminated the effects of miR-146b-3p on VSMCs (P < 0.05). In summary, miR-146b-3p represses the proliferation, migration, and phenotype switch of VSMCs induced by PDGF-BB via targeting PIK3CG. Therefore, miR-146b-3p/PIK3CG may be a potential target for the treatment of atherosclerosis.

Comparison of Mitral Valve Repair versus Replacement for the Progression of Functional Tricuspid Regurgitation.

BACKGROUND: Function tricuspid regurgitation (TR) is frequently observed in patients undergoing mitral valve surgery. It is unclear that mitral valve repair (MVr) or mitral valve replacement (MVR) has influence on the likelihood of late TR progression. METHODS: This study included 193 patients with degenerative mitral valve disease who underwent either MVr or MVR. Detailed preoperative materials, follow-up information, and echocardiographic data were collected and statistically analyzed. RESULTS: At 6 and 12 months postoperatively, MVR patients were more likely to have New York Heart Association (NYHA) class III or IV symptoms than MVr patients (6 mo: 15.2% vs 5.0%, 12 mo: 13.0% vs 4.0%, both P <0.05). At 24 months, the incidence of Grade 1+ TR was significantly higher in MVR patients than MVr patients (25.0% vs 12.9%, P <0.05). In univariate analysis, age (odds ratio [OR] = 1.036, P = 0.036), MVR (OR = 2.256, P = 0.033), and preoperative TR area (TRA; OR = 1.541, P = 0.047) were significant predictors for TR progression. In multivariate logistics analysis, only MVR was independently risk factor (P = 0.006). Subsequently, patients were divided into tricuspid valve repair (TVr) group and untreated group. In both subgroups, MVR patients were associated with significantly larger TRA (P <0.01). CONCLUSION: MVR was an independent risk factor for TR progression, whether tricuspid valve was treated or not.

A mortality risk assessment model for cardiac valve replacement surgery and its application in the use of prophylactic extracorporeal membrane oxygenation.

This study was conducted to establish a quantitative model to predict the risk of in-hospital mortality for patients undergoing cardiac valve replacement and to decrease mortality in patients with predicted high risk using prophylactic extracorporeal membrane oxygenation (PECMO). We retrospectively reviewed the medical records of 4482 patients who underwent cardiac valve replacement from January 1994 to December 2004, at Anzhen Hospital, Beijing, China. A total of 158 patients were going to receive heart valve replacement. Associations between mortality and the demographic, clinical, and laboratory variables of patients were first assessed using univariate analysis. Six of 7 variables in the univariate analysis were statistically significant and were included in the multivariate analysis: renal function; age; left ventricular ejection fraction (EF); coronary artery disease (CAD); pulmonary artery pressure (PAP); and left ventricular end-diastolic diameter (LVEDD). The area under the receiver operating characteristic (ROC) curve (AUC) was 73.58%. Observed mortality in the group with PECMO (5.45%, 3/55) was significantly lower (Pearson Chi2 = 4.314, P = 0.038, P < 0.05) than in the group without PECMO (24.27%, 25/103). With the use of our scoring model, the risk of postoperative mortality in patients planning to undergo valve replacement can be predicted before the procedure is performed. For patients with predicted mortality greater than 10%, the use of PECMO during surgery, in addition to extracorporeal circulation, was found to decrease mortality.