Left ventricular recovery after total arterial coronary artery bypass grafting versus conventional coronary artery bypass grafting in patients with multivessel coronary artery disease and reduced left ventricular ejection fraction.

BACKGROUND: We compared total arterial revascularization (TAR) versus conventional revascularization (CR) in terms of left ventricular function recovery in patients with multivessel coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF). METHODS: We conducted a retrospective cohort study of 162 consecutive patients with multivessel CAD and reduced LVEF who underwent isolated coronary artery bypass grafting at our institution between January 2013 and July 2022. We assessed left ventricular function by transthoracic echocardiography at admission, before discharge, and at follow-up of 3, 6, and 12 months, using LVEF, global longitudinal peak strain, end-diastolic volume index, and end-systolic volume index. We also evaluated mitral valve regurgitation and graft patency rate at 1 year. RESULTS: The TAR group had a significantly higher increase in LVEF and global longitudinal peak strain, and a significantly lower decrease in end-diastolic volume index and end-systolic volume index than the CR group at 6 and 12 months after surgery. The TAR group also had a significantly lower degree of mitral valve regurgitation than the CR group at all-time points within 12 months after surgery. The TAR group had a significantly higher graft patency rate than the CR group at 12 months. There was no significant difference in hospital mortality or repeat revascularization between the groups. CONCLUSIONS: TAR was associated with better recovery of left ventricular function than CR in patients with multivessel CAD and reduced LVEF. Further studies are needed to confirm these findings in this high-risk population.

Safety and efficacy of total thoracoscopic surgery for patients with tricuspid regurgitation and reduced right ventricular function after left heart valves replacement: a retrospective comparative study.

BACKGROUND: Tricuspid valve surgery is the standard treatment for tricuspid valve disease refractory to pharmacologic therapy. However, patients with tricuspid regurgitation after previous left heart valves replacement with reduced right ventricular (RV) function are at greater risk of surgery. We compared the clinical outcomes of tricuspid valve replacement in this subgroup of patients through mini-thoracotomy and conventional full-sternotomy approach. METHODS: We identified 44 patients at our institution with tricuspid regurgitation and reduced right ventricular function after left heart valves replacement who underwent either total thoracoscopic tricuspid valve replacement (T-TVR) or conventional tricuspid valve replacement (C-TVR) from December 2014 and May 2021. Patient clinical characteristics, hospital course, and postoperative changes in RV function were retrospectively reviewed and analyzed. RESULTS: Baseline characteristics between T-TVR (n = 25) and C-TVR (n = 19) were comparable including a high incidence of liver dysfunction and renal insufficiency. There were no statistically differences between the two groups in terms of hospital mortality (8.0% vs. 21.1%, P = .211). Patients in the T-TVR group had less total drainage volume (201.60 ± 77.05 ml vs. 614.74 ± 182.31 ml, p < .001), required fewer postoperative blood product transfusions, and had a lower total length of hospital stay (15(15-16) vs. 16(14-17) days, P = .019) compared to the C-TVR group. T-TVR was associated with better and faster recovery of tricuspid annular plane systolic excursion (TAPSE) and right ventricle fractional area change (RVFAC) (adjusted ß = 0.154, 95% CI: 0.037 to 0.271, p = .010 and adjusted ß = 0.003, 95% CI: 0.000 to 0.005, p = .024; respectively) within the first 3 months postoperatively compared with C-TVR. CONCLUSIONS: T-TVR represents a viable alternative to current surgical strategies as a potentially sicker cohort demonstrated similar hospital mortality compared to conventional surgery, with reduced length of hospital stay, fewer blood transfusions, and more favorable in promoting RV functional recovery in the early period. Future prospective, randomized-controlled trials with longer follow-up durations are needed to validate these findings.

Comparison of post-operative pain and quality of life between total thoracoscopic surgery and conventional full-sternotomy for aortic valve replacement.

BACKGROUND: To compare the post-operative pain and quality of life of patients who underwent total thoracoscopic surgery (TTS) or conventional full-sternotomy (CFS) for aortic valve replacement (AVR). METHODS: We reviewed the records of 223 consecutive AVR patients with either TTS or CFS from January 2018 to December 2022. We used a visual analogue scale (VAS) and the Short Form-36 Health Survey (SF-36) to measure the post-operative pain and quality of life, respectively. We also compared the operative data and clinical outcomes between the two groups. RESULTS: The TTS group had lower adjusted mean VAS scores than the CFS group at all time points after surgery (at 1 to 3 days and at 3 and 6 months, p < .001 for all comparisons), indicating less pain. The TTS group also had higher mean SF-36 scores than the CFS group up to 6 months after surgery (p < .001 for all comparisons), indicating better quality of life. The operative time was similar between the two groups (p = .224), but the TTS group had longer cardiopulmonary bypass time and aortic cross-clamp time than the CFS group (p < .001). The TTS group had more pulmonary complications than the CFS group (p = .023). However, there were no significant differences in other major complications or mortality between the two groups. CONCLUSIONS: TTS is a safe and effective alternative to CFS for AVR. TTS resulted in less pain and better quality of life, especially in the early recovery period. However, further prospective randomized controlled studies are needed to confirm our findings.

Comparison of temporal-to-frontal horn shunt and ventriculo-peritoneal shunt for treatment of trapped temporal horn: a retrospective cohort study.

As a localized hydrocephalus, trapped temporal horn (TTH) can be effectively resolved via cerebrospinal fluid shunting. In addition to conventional ventriculo-peritoneal shunt (VPS), temporal-to-frontal horn shunt (TFHS) has been described as a less complex and invasive procedure with promising results; however, there is limited data comparing VPS to TFHS regarding patient outcomes. This study aims to compare TFHS versus VPS for treatment of TTH. We conducted a comparative cohort study with patients undergoing TFHS or VPS for TTH after surgery of trigonal or peritrigonal tumors between 2012 and 2021. The primary outcome was revision rates at 30-day, 6-month, and 1-year. Secondary outcomes included operative duration, postoperative pain, hospital stay, overdrainage, and cost for shunt placement and revision. A total of 24 patients included, with 13 (54.2%) patients receiving TFHS and 11 (45.8%) receiving VPS. Both cohorts shared similar baseline characteristics. There were no significant differences between TFHS and VPS in 30-day (7.7% vs 9.1%, p > 0.99), 6-month (7.7% vs 18.2%, p = 0.576), or 1-year (8.3% vs 18.2%, p = 0.590) revision rates. There were no significant differences in terms of operative duration (93.5 ± 24.1 vs 90.5 ± 29.6 min, p = 0.744), surgical site pain (0 vs 18.2%, p = 0.199), or postoperative length of stay (4.8 ± 2.6 vs 6.9 ± 4.0 days, p = 0.157) between the two groups. For the TFHS cohort, no patient experienced shunt related overdrainage, and there was a trend towards fewer overdrainage (0% vs 27.3%, p = 0.082) compared with VPS. TFHS offered significant reduction in cost for initial shunt (¥20,417 vs ¥33,314, p = 0.030) and total costs for shunt and revision (¥21,602 vs ¥43,196, p = 0.006) compared to VPS. As a technique of valveless shunt and without abdominal incision, TFHS is cosmetic, cost-effective, and completely free of overdrainage with similar revision rates as compared with VPS.

Aortic remodeling after false lumen occlusion using an atrial septal occluder in chronic DeBakey IIIb aortic dissection.

OBJECTIVE: Retrograde false lumen flow through distal entry tears poses a challenge in the treatment of chronic DeBakey IIIb aneurysms. In the present report, we have described the feasibility and outcomes of false lumen occlusion using an atrial septal occluder (ASO) in chronic DeBakey IIIb dissection associated with a descending aneurysm. METHODS: All the patients who had undergone thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection at our institution from January 2014 to November 2020 were retrospectively reviewed. The primary endpoints were technical success and in-hospital postoperative results. The secondary endpoints included the midterm survival status and aortic remodeling outcomes. RESULTS: A total of 37 patients (age, 56.24 ± 10.47 years) with persistent retrograde false lumen perfusion and aneurysm formation at the thoracic segment were treated using an ASO for false lumen occlusion. We achieved 100% technical success. No spinal cord ischemia or in-hospital death was observed. The median follow-up time was 36 months (interquartile range, 24-51 months). After the procedure, three patients (8.1%) had had an endoleak (type Ia in two patients and type II in one patients), and five patients had required late reintervention. The overall 5-year survival rate was 71%. One aortic-related death (2.7% of the total cohort) occurred during follow-up at 9 months. Complete thrombosis of the false lumen along the treated aortic segment was recorded postoperatively in 34 patients (91.9%) at the final follow-up using computed tomography angiography. In a mixed-effects model, a diameter analysis revealed that the thoracic true lumen diameter had increased and the thoracic false lumen diameter had decreased significantly (0.256 mm/mo, P < .001; and -0.512 mm/mo, P < .001, respectively). CONCLUSIONS: The combination of standard thoracic endovascular aortic repair and false lumen occlusion using the ASO to promote false lumen thrombosis and remodeling in the treated segments is a technically feasible and effective alternative treatment of chronic DeBakey IIIb dissection with an associated descending aneurysm. This approach yielded satisfactory midterm survival outcomes and a low incidence of aortic-related death in our patients. However, further studies with more subjects and a prospective design should verify our findings before routine clinical implementation of this technique.

Cavernous sinus dural arteriovenous fistula complicated by hippocampus venous congestion: A case report.

BACKGROUND: Hippocampal venous congestion is a rare complication associated with cavernous sinus dural arteriovenous fistulas (CS-DAVFs). CASE DESCRIPTION: A 74-year-old woman was admitted to the hospital with a swollen left eye. Isolated lesions were found in the left hippocampus and the middle cerebellar peduncle. Cerebral angiography revealed retrograde venous drainage of the bilateral inferior petrosal sinuses from the left CS-DAVF. The patient underwent transcatheter arterial embolization, resulting in complete resolution of the hippocampal lesions and neurological symptoms. CONCLUSION: Hippocampal injury is a rare complication of CS-DAVF. Attentive diagnosis and treatment can effectively prevent adverse consequences.

Effects of allopurinol pretreatment on the risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials
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BACKGROUND: Treatment with allopurinol has been suggested to reduce the incidence of contrast-induced acute kidney injury (CI-AKI). However, results of previous randomized controlled trials (RCTs) are not consistent. We performed a meta-analysis to evaluate the influence of allopurinol on the risk of CI-AKI. MATERIALS AND METHODS: Related RCTs were identified via systematic search of electronic databases including PubMed, Embase, and Cochrane's Library. The influence of allopurinol on the incidence of CI-AKI was defined as the primary outcome. Results were pooled using a random-effects model or a fixed-effects model according to the heterogeneity. RESULTS: Five RCTs with 754 patients who underwent percutaneous coronary intervention (PCI) were included. All patients received preprocedural hydration therapy with intravenous normal saline. Pooled results showed that allopurinol significantly reduced the incidence of CI-AKI (risk ratio (RR): 0.37, p = 0.01). Subgroup analyses demonstrated that allopurinol significantly reduced the incidence of CI-AKI in high-risk patients (incidence of CI-AKI ≥ 30%, RR: 0.10, p = 0.04) but not in low-risk patients (incidence of CI-AKI < 30%, RR: 0.67, p = 0.14). Moreover, allopurinol significantly prevented the increment of serum creatinine (weighted mean difference (WMD): -0.13 mg/dL, p < 0.001) and attenuated the loss of estimated glomerular filtration rate (WMD: 4.78 mL/min, p = 0.04). However, serum uric acids were not significantly affected (WMD: -0.26 mg/dL, p = 0.72). CONCLUSION: Pretreatment with allopurinol reduces the incidence of CI-AKI in patients undergoing contrast exposure in PCI. The benefits of allopurinol on CI-AKI may be more remarkable in high-risk patients.

Risk factors and control of seizures in 778 Chinese patients undergoing initial resection of supratentorial meningiomas.

This retrospective study explored the risk factors for the occurrence of seizures in the pre- and postoperative period in patients undergoing supratentorial meningiomas surgery to investigate those who are likely to benefit from prophylactic antiepileptic drugs (AEDs). We reviewed the medical records of 778 supratentorial meningiomas patients who were operated at our institution between 2011 and 2012. A total of 100 (12.9%) patients experienced preoperative seizures; 41 patients (5.3%) experienced postoperative in-hospital seizures, and 91 (13.5%, n = 673) patients experienced postoperative seizures after discharge. Multivariate analysis revealed that motor cortex involvement (odds ratio [OR] 3.243, P < 0.001) and peritumoral edema ≥ 1 cm (OR 3.936, P < 0.001) were significant risk factors of preoperative seizures. Whereas presenting with headache (OR 0.259, P < 0.001) and age ≥ 55 years at surgery (OR 0.514, P = 0.009) showed decreased incidence of preoperative seizures. The involvement of motor cortex (OR 3.290, P = 0.003), postoperative Karnofsky Performance Scale (KPS) ≤ 70 (OR 5.389, P < 0.001), preoperative seizure (OR 4.003, P < 0.001), and occurrence of any medical/surgical complication (OR 3.925, P = 0.001) were significant risk factors for postoperative in-hospital seizures. Postoperative seizures after discharge were associated with tumor maximal diameter ≥ 3.5 cm (OR 1.903, P = 0.022), preoperative seizures (OR 4.350, P < 0.001), postoperative in-hospital seizures (OR 6.385, P < 0.001), and tumor recurrence/progression (OR 7.642, P < 0.001). The probability of seizure freedom in the 5-year follow-up was roughly 59% among patients with preoperative seizures, and 87% among patients without preoperative seizures. Cox regression analysis showed that tumor recurrence/progression (relative risk 2.987, 95% CI 1.517, 5.879, P = 0.002) was the only predictor of postoperative seizures in patients without a history of preoperative epilepsy. The use of postoperative prophylactic antiepileptic drug (AED) did not reduce the incidence of seizures in our analysis. Understanding the risk factors for seizures might help clinicians to predict their occurrence and develop effective anti-epileptic treatment strategies. Further prospective randomized controlled trials are needed to determine the risk factors for seizures and the efficacy of AED prophylaxis.

Probucol for the prevention of contrast-induced acute kidney injury in patients undergoing coronary angiography or percutaneous coronary intervention: A meta-analysis of randomized controlled trials
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BACKGROUND: The results of pilot randomized controlled trials (RCTs) evaluating probucol treatment on the risk of contrast-induced acute kidney injury (CI-AKI) are inconsistent. We aimed to perform a meta-analysis of RCTs to systematically evaluate the influence of probucol on the incidence of CI-AKI. MATERIALS AND METHODS: Related RCTs were identified via searching of PubMed, Embase, and Cochrane's Library databases. Results were pooled using a random-effect model or a fixed-effect model according to the heterogeneity. RESULTS: Five RCTs with 1,367 patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) were included. Meta-analysis indicated that probucol in addition to periprocedural hydration significantly reduced the incidence of CI-AKI (risk ratio (RR): 0.37, 95% confidence interval (CI): 0.24 - 0.56, p < 0.001) with insignificant heterogeneity (I2 = 0%). Moreover, treatment with probucol significantly lowered the increment of serum creatinine (weighted mean difference (WMD): -0.04 mg/dL, 95% CI: -0.07 to -0.02 mg/dL, p < 0.001) and preserved the loss of estimated glomerular filtrating rate (WMD: 2.46 mL/min, 95% CI: 0.84 - 4.07 mL/min, p = 0.003) as compared with control treatment. No significant publication bias was noticed. CONCLUSION: Treatment with probucol reduces the incidence of CI-AKI in patients undergoing contrast exposure during CAG or PCI. The influence of probucol on the clinical outcome in these patients deserves further investigation.
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Characteristic features and proposed classification in 69 cases of intracranial microcystic meningiomas.

Microcystic meningioma (MM) is a rare subtype of intracranial meningiomas, with clinical and radiologic features not well characterized in the literature. Based on our experience, we propose a classification system of intracranial MMs. We reviewed the medical records, radiographic studies, and operative notes of a group of consecutive patients with intracranial MM. The mean age of the 69 patients was 46.8 ± 10.6 years (range, 21-75 years). Three types of intracranial MMs could be identified. Type 1 MMs presented as a solid lesion, hypointense or isointense on T1WI, hyperintense on T2WI, and homogeneous or heterogeneous enhancement, and were found in 43 patients (67.2%). Type 2 MMs represented signals similar to CSF both on T1WI and T2WI, and faint reticular enhancement with marginal enhancement, and these were found in 7 patients (10.9%). Type 3 MMs consisted of cystic-solid or cystic lesion and were found in 14 patients (21.9%). Significant differences were observed among the different types of MMs for the following variables: sex, presence of severe peritumoral brain edema (PTBE), and extent of tumor resection. Females were found in all of patients with type 2 MMs, but were only 35.7% of those with type 3 MMs (P = 0.018). Severe PTBEs were more common among patients with type 1 MMs (55.8%) than among those with type 2 (14.3%) and type 3 MMs (14.3%) (P = 0.007). Type 1 MMs (97.7%) were associated with a significantly higher rate of gross total resection compared with the other two types (71.4 and 78.6%) (P = 0.019). Total length of hospital stay after craniotomy ranged from 4 to 30 days (median, 8 days). There were no significant differences in progression-free survival among the three types of MMs (P = 0.788). The current classification identifies three distinct types of intracranial MM based on their radiological findings and growth patterns. The type 1 MMs are more commonly associated with severe PTBE. Type 2 and Type 3 MMs have a higher predilection towards parasaggital location with venous involvement and therefore have a lower rate of gross total resection.

Thoracoscope-Assisted Mitral Valve Replacement with a Small Incision in the Right Chest: A Chinese Single Cardiac Center Experience.

BACKGROUND The aim of this study was to investigate the safety, feasibility, and clinical effectiveness of thoracoscopy-assisted mitral valve replacement via thoracic right-anterior minimal incision. MATERIAL AND METHODS A retrospective analysis was conducted of 225 patients with mitral valve lesions who were treated in our hospital from August 2012 to August 2015. Group A included 105 patients undergoing thoracoscopy-assisted mitral valve replacement via a thoracic right-anterior minimal incision, and group B included 120 patients undergoing conventional mitral valve replacement. We collected and analyzed clinical data from both groups. RESULTS The procedures were successful in patients of both groups. No severe complications or mortality were reported. Postoperative mechanical ventilation time (8.6±2.4 h vs. 12.4±3.2 h), duration of intensive care (1.7±1.2 d vs. 2.8±1.3 d), duration of postoperative analgesia use (28.7±8.9 h vs. 36.3±7.5 h), postoperative length of hospital stay (8.2±2.2 d vs. 12.8±2.1 d), pleural fluid drainage (210.5±60.5 ml vs. 425.4±75.6 ml), blood transfusion amount (420.5±80.4 ml vs. 658.3±96.7 ml), and operative incision length (4.7±1.1 cm vs. 22.4±2.5 cm) were significantly shorter (or lower) in group A than in group B. There were different advantages and disadvantages in the 2 kinds of operative procedure in terms of postoperative complications. CONCLUSIONS Thoracoscopy-assisted mitral valve replacement via thoracic right-anterior minimal incision has the same clinical efficacy, safety, and feasibility as conventional mitral valve replacement.

Transthoracic Balloon Pulmonary Valvuloplasty for Treatment of Congenial Pulmonary Atresia Patients with Intact Ventricular Septum.

BACKGROUND To summarize our clinical experience in performing transthoracic balloon pulmonary valvuloplasty for the treatment of patients suffering from congenial pulmonary atresia with intact ventricular septum (PA/IVS). MATERIAL AND METHODS Between April 2009 and April 2016, 38 patients with PA/IVS underwent transthoracic balloon pulmonary valvuloplasty in our hospital. All of them were combined with patent ductus arteriosus, tricuspid insufficiency, and atrial septal defect or patent foramen ovale. The valvuloplasty was performed from the right ventricular outflow tract through a median sternotomy incision under TEE guidance for all cases. RESULTS Thirty-five patients were successfully discharged, and 3 patients died after the operation. The 35 surviving patients were followed up. Spo2 in the 35 patients was 88-96% after the operation. The transpulmonary valvular gradient pressure was less than or equal to 30 mmHg in 31 patients and between 36 and 52 mmHg in the other 4 patients. After the surgery, tricuspid regurgitation was significantly reduced. We found only 4 patients with moderate regurgitation, 5 patients with mild to moderate regurgitation, and mild regurgitation in the remaining 26 patients. Five patients underwent a second-stage operation, including biventricular repair in 4 patients and ligation of ductus arteriosus in 1 patient. CONCLUSIONS The application of transthoracic balloon pulmonary valvuloplasty for the treatment of PA/IVS is minimally invasive and safe, which has great significance for improving the curative effect for this condition and reducing operation mortality.

Clinical Characteristics and Natural History of Quasi-Moyamoya Disease.

BACKGROUND: Quasi-moyamoya disease (quasi-MMD) is a rare cerebrovascular disease and its clinical features and natural history remain unclear. The aim of the study is to describe the clinical characteristics and the natural histories of this disease, with analysis of the risk factors for future cerebrovascular events. METHODS: We identified 64 patients with quasi-MMD from 693 moyamoya vasculopathy patients referred to our hospital between 2011 and 2015. Demographic data, associated disorders, clinical manifestation, angiographic findings, natural history, and risk factors for cerebrovascular events were analyzed. RESULTS: Patients included in the study had a mean age of 31.5 years. A unimodal age distribution was noted. Atherosclerosis was the most frequently associated disorder. Forty-five (70.3%) patients had ischemic events as their initial clinical manifestation and 14 (21.9%) patients presented as hemorrhagic stroke. The majority of patients presented with Suzuki grades 3 and 4 (20.3% and 42.2%). The annual risk of cerebrovascular events was 19.4% per patient-year. Prior hemorrhage (HR 2.77, 95% CI 1.20-6.41) and ischemic stroke (HR 2.77, 95% CI 1.26-6.07) were 2 risk factors for future events. CONCLUSIONS: Several clinical characteristic differences were observed in our mainland China cohort compared with the Japanese and European cohorts. The annual risk of cerebrovascular events was relatively high in quasi-MMD patients. Patients with prior hemorrhage and ischemic stroke were inclined to have future cerebrovascular events. Close follow-up is needed for these patients.

Orthostatic hypotension and the risk of incidental cardiovascular diseases: A meta-analysis of prospective cohort studies.

OBJECTIVE: To quantitatively estimate the prospective associations between orthostatic hypotension (OH) and cardiovascular diseases, including coronary heart disease (CHD) and stroke. METHODS: Relevant prospective cohort studies were identified by searching of Medline and Embase databases. We applied fixed or random effect model to estimate the overall effects depending on the heterogeneity among the included studies. RESULTS: Eight published articles from 7 cohorts, consisting of 64,782 participants, were included. During a mean follow-up of 15.2years, 5719 CHD events and 3657 stroke events occurred. The overall results of the meta-analysis indicated that OH was associated with significant increased risk for incident CHD (adjusted hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.12-1.56) and stroke (HR: 1.19, 95% CI 1.08-1.30), which were independent of conventional risk factors. Stratified analyses by ages suggested that the associations between OH and CHD and stroke were significant for both the middle-aged and the old participants. CONCLUSION: Presence of OH was independently related to significantly increased risk for incidence of CHD and stroke. Further, studies regarding the mechanisms and potential treatments for OH may be important for understanding whether the associations between OH and cardiovascular diseases are causative.

Does B-type natriuretic peptide-guided therapy improve outcomes in patients with chronic heart failure? A systematic review and meta-analysis of randomized controlled trials.

The role of B-type natriuretic peptide (BNP) in the management of patients with chronic heart failure (CHF) was uncertain. The aim of this meta-analysis was to comprehensively evaluate the effect of BNP-guided therapy in CHF. Relevant randomized controlled trials were identified by searching of Pubmed, Embase and the Cochrane Library databases. Fixed or randomized effect models were applied to combine the data according to the heterogeneity of the included studies. Fourteen studies with 3,004 CHF patients were included. Results of our meta-analyses suggested that compared with clinical group, BNP-guided treatment significantly decreased the risk of heart failure-related hospitalization (RR 0.79, 95 % CI 0.63-0.98, p = 0.03), although did not significantly affect the risk of all-cause mortality (RR 0.94, 95 % CI 0.81-1.08, p = 0.39) or all-cause hospitalization (RR 0.97, 95 % CI 0.89-1.07, p = 0.56). Furthermore, between-group BNP changes seemed to be a significant modifier to the effects of BNP-guided therapy on clinical outcomes, and BNP-guided therapy may improve the clinical outcomes of CHF patients if substantial reduction of BNP can be achieved. In addition, BNP-guided therapy was not associated with increased risk for serious adverse events. BNP-guided therapy may improve the clinical outcomes of CHF patients if substantial reduction of BNP can be achieved. BNP-guided therapy seemed to be safe and promising for CHF patients, and future studies with well-designed BNP-guided medication up-titration strategies are needed to confirm these results.

Development and validation of prediction model for prolonged mechanical ventilation after total thoracoscopic valve replacement: a retrospective cohort study.

Total thoracoscopic valve replacement (TTVR) is a minimally invasive alternative to traditional open-heart surgery. However, some patients undergoing TTVR experience prolonged mechanical ventilation (PMV). Predicting PMV risk is crucial for optimizing perioperative management and improving outcomes. We conducted a retrospective cohort study of 2,319 adult patients who underwent TTVR at a tertiary care center between January 2017 and May 2024. PMV was defined as mechanical ventilation exceeding 72 h post-surgery. A Fine-Gray competing risks regression model was developed and validated to identify predictors of PMV. Significant predictors of PMV included cardiopulmonary bypass time, ejection fraction, New York Heart Association grading, serum albumin, atelectasis, pulmonary infection, pulmonary edema, age, need for postoperative dialysis, hemoglobin levels, and PaO2/FiO2. The model demonstrated good discriminative ability, with areas under the receiver operating characteristic curves of 0.747 in the training set and 0.833 in the validation set. Calibration curves showed strong agreement between predicted and observed PMV probabilities. Decision curve analysis indicated clinical utility across a range of threshold probabilities. Our predictive model for PMV following TTVR demonstrates strong performance and clinical utility. It helps identify high-risk patients and tailor perioperative management to reduce PMV risk and improve outcomes. Further validation in diverse settings is recommended.

Targeting metabolism of breast cancer and its implications in T cell immunotherapy.

Breast cancer is a prominent health issue amongst women around the world. Immunotherapies including tumor targeted antibodies, adoptive T cell therapy, vaccines, and immune checkpoint blockers have rejuvenated the clinical management of breast cancer, but the prognosis of patients remains dismal. Metabolic reprogramming and immune escape are two important mechanisms supporting the progression of breast cancer. The deprivation uptake of nutrients (such as glucose, amino acid, and lipid) by breast cancer cells has a significant impact on tumor growth and microenvironment remodeling. In recent years, in-depth researches on the mechanism of metabolic reprogramming and immune escape have been extensively conducted, and targeting metabolic reprogramming has been proposed as a new therapeutic strategy for breast cancer. This article reviews the abnormal metabolism of breast cancer cells and its impact on the anti-tumor activity of T cells, and further explores the possibility of targeting metabolism as a therapeutic strategy for breast cancer.

Clinical Outcomes and Left Ventricular Functional Remodeling after Extracorporeal Membrane Oxygenation Assisted Percutaneous Coronary Intervention in Patients with Ischemic Cardiomyopathy: A Single-Center Retrospective Observational Study of 76 Cases.

Background: Ischemic cardiomyopathy (ICM) is a common condition that leads to left ventricular (LV) functional remodeling and poor prognosis. Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and facilitate percutaneous coronary intervention (PCI) in patients with ICM and hemodynamic instability. However, the impact of ECMO-assisted PCI on LV functional remodeling and clinical outcomes in ICM patients is unclear. Methods: We retrospectively analyzed 76 patients with ICM who underwent ECMO-assisted PCI at our institution between January 2013 and December 2022. We assessed the changes in LV functional remodeling using echocardiography at baseline and 12 months after the procedure. We also evaluated the incidence of major adverse cardiac and cerebrovascular events (MACCEs) and ECMO-related complications during hospitalization and at one-year follow-up. Results: The mean baseline left ventricular ejection fraction (LVEF) was 29.98 ± 2.65%. The rate of complete revascularization was 58%. The median duration of ECMO support was 38.99 hours. The most common ECMO-related complications were bleeding (8%) and lower extremity ischemia (5%). The one-year mortality rate was 30%. The overall freedom from MACCEs at 12 months was 59% (95% confidence interval (CI): 49-71%). LVEF increased significantly after the procedure from baseline to 6 months, yet decreased slightly at 12 months, although it was still higher than the baseline value. Wall motion score index (WMSI), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI) decreased significantly from baseline to 12 months, indicating an improvement in LV function and a reduction in LV size. Conclusions: In a high-volume tertiary center with extensive experience in advanced heart failure therapies and a dedicated ECMO team, ECMO-assisted PCI demonstrated feasibility and safety in patients with ischemic cardiomyopathy. However, the rate of complete revascularization was modest at 58%. Despite the high-risk profile of the patients, ECMO-assisted PCI was associated with a significant improvement in LV functional remodeling and a favorable 12-month survival rate. Further prospective studies are needed to confirm these findings and to identify the optimal patient and device selection criteria for ECMO-assisted PCI.

Shunt, endoscopic, and microsurgical management of trapped temporal horn following resection of lateral ventricle trigonal or peritrigonal tumors: A retrospective multicenter study.

OBJECTIVE: To investigate the surgical management and outcomes of trapped temporal horn (TTH) following resection of lateral ventricle trigonal or peritrigonal tumors. METHODS: Patients who underwent surgical treatment for TTH in three different tertiary centers between 2012 and 2022 were retrospectively studied. The primary outcome was reoperation rate. RESULTS: Thirty-one patients were included for analysis. The underlying pathology was meningioma in 17 patients, central neurocytoma in 7, glioma in 4, ependymoma in 2, and cavernous malformation in 1. The median KPS score was 50 (range 10-90) and the mean volume of TTH was 53.1 ± 29.9 cm³ (range 14.8-118.6). Six patients (19.3 %) required multiple operations. A total of 39 procedures were performed, including 28 CSF shunting, 2 endoscopic septostomy, 3 microsurgical fenestration or temporal tip lobectomy via craniotomy, 2 decompressive craniectomy (DC), and 4 shunt revisions. Reoperation rates according to procedure were as follows: 10.7 % (3/28) for CSF shunting, 50 % (1/2) for endoscopic septostomy, 100 % (2/2) for DC, and 0 (0/3) for microsurgical fenestration or temporal tip lobectomy. CSF shunting tended to have a lower reoperation rate compared to other surgical approaches (p = 0.079). The reoperation rate was significantly higher for DC than for other surgical techniques (p = 0.025). CONCLUSION: CSF shunting was the most frequently used technique with a relatively low revision rate. Long-term patency can be achieved through endoscopic septostomy in selected patients. Microsurgical fenestration or temporal tip lobectomy should be reserved for refractory cases. DC has limited effectiveness and should not be recommended.