The impact of frailty as a critical mediator causing postoperative neurocognitive disorders in postoperative cardiac patients.

Frailty is prevalent in elderly cardiac patients and may be a critical predictor of post-operative neurocognitive disorders (PND). The aim of this review was to demonstrate the correlation of frailty with PND in postsurgical elder patients. A review of published literature and bibliometric analysis was undertaken. Electronic databases from 2009 to 2022 were searched to identify articles that evaluated the relationship between frailty and PND in aging populations. Demographic data, type of surgery performed, frailty measurement, and impact of frailty on PND were extracted from the selected studies. The quality of the studies and risk of bias were assessed by the Newcastle-Ottawa Quality Assessment Scale, and the included articles were assessed as medium to high quality. Eighty-one studies were selected for the Bibliometric review in terms of research trends and hotpots. Additionally, 35 observational studies (prospective and retrospective cohorts) were selected for this review. The mean age ranged from 63 to 84 years and included patients undergoing cardiac, orthopedic, and other surgeries who had cardiac symptoms. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results, and study quality was for associations between frailty and PND. This analysis found a steadily growing focus on frailty and PND research in cardiac and other patients. The observational studies account for the majority of this area, and frailty occurred in the older cardiac patients over 60 years of age, and pre-screening of frailty can be predictive of PND and mortality.

A review regarding the article 'clinical and echocardiographic outcomes of patients undergoing transcatheter edge-to-edge repair for functional vs degenerative mitral valve regurgitation'.

Echocardiography is widely available in most cardiac centers, plays a key role in both the diagnosis and management of IE, is often the first-hand imaging modality, and should be performed immediately when mitral regurgitation is suspected. In addition, it is helpful during therapy and after surgery to assess valve morphology and function, complications, and heart function. In particular, transthoracic echocardiography is useful to detect new silent complications, monitor vegetation size, assess perivalvular abscess formation, pseudoaneurysm, intracardiac fistula and valvular perforation, as well as examine the embolic risk. In addition, echocardiographic outcomes differences among cardiovascular outcomes assessment of the MitraClip percutaneous therapy for heart failure patients with functional mitral regurgitation (COAPT) like and non COAPT-like patients have shown that non COAPT-like patients had higher left ventricular (LV) dimensions and overall contractility therefore, differences in clinical outcomes have been underestimated. Mitral transcatheter edge-to-edge repair (MTEER) is an established therapeutic approach for mitral regurgitation (MR). Recurrence of MR after TEER with MitraClip is a concern due to increased patients' hospital readmission rate and increasing hospital costs. However, little is known about clinical, valvular, or ventricular parameters that may impact postinterventional course and recurrence of MR after TEER. While individual long-term echocardiographic outcomes of functional vs degenerative MR have been described, there is little data on follow-up echocardiographic outcomes comparing functional vs degenerative MR.

Impact of angiotensin receptor-neprilysin inhibition (ARNI) in improving ejection fraction and left and right ventricular remodeling in heart failure.

Angiotensin receptor neprilysin inhibitors (ARNI), a new therapeutic class of agents acting on the renin angiotensin aldosterone system (RAAS) and neutral endopeptidase system has been developed in treatment of ventricular remodeling and has attracted considerable attention. The first in class is LCZ696, which is a molecule that combines Valsartan (ARB) and Sacubitril (neprilysin inhibitor) within a single substance. Sacubitril-Valsartan is the first angiotensin receptor enkephalin inhibitors (ARNI), which can block angiotensin II type 1 receptor (AT1R) while inhibiting enkephalin (NEP) and effectively reverse ventricular remodeling in heart failure patients. It has been recommended by the European and American authoritative guidelines on heart failure as Class I for the treatment of chronic heart failure particularly as intensive care medicine. Sacubitril-Valsartan demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. Sacubitril acts on increased levels of circulating natriuretic peptides by preventing their enzymatic breakdown and Valsartan, which acts to lessen the effects of the RAAS. However, not more research has been done on its effects on the right ventricle remodeling. This review aimed to assess the impact of angiotensin receptor neprilysin inhibitors on left and right ventricular remodeling in heart failure patients.

Role and Interaction Between ACE1, ACE2 and Their Related Genes in Cardiovascular Disorders.

Cardiovascular disease is the greatest health care burden and one of the most common causes of death worldwide. Less is known about the genetic factors that are responsible for predisposition to cardiovascular disease thus; the molecular and genetic mechanisms underlying cardiovascular diseases remain obscure. One important regulator of blood pressure homeostasis is the renin-angiotensin system. The protease renin cleaves angiotensinogen into the inactive decameric peptide angiotensin I (Ang I). Angiotensin-converting enzyme (ACE) catalyzes the cleavage of the Ang I into the active octomer angiotensin II (Ang II). In humans, can ACE polymorphism has been associated with determinants of renal and cardiovascular function and pharmacological inhibition of ACE and Ang II receptors are effective in lowering blood pressure and preventing kidney disease. In addition, inhibition of ACE and Ang II receptors has beneficial effects in heart failure. A homologue of ACE, termed ACE2, has been identified; it is predominantly expressed in the vascular endothelial cells of the kidney and heart. Unlike ACE, ACE2 functions as a carboxypeptidase, cleaving a single residue from AngI, generating Ang1-9, and a single residue from AngII to generate Ang1-7. Nevertheless, the in vivo role of ACE2 in the cardiovascular system and the renin-angiotensin system is not known.

Gene Silencing of Transcription Factor TEAD4 Inhibits Esophageal Cancer Cells by Regulating TCF7.

Background: The procancer effect of TEA domain transcription factor 4 (TEAD4) has been gradually discovered. However, its expression in esophageal cancer (EC) cells and its effect on proliferation and apoptosis have not been reported. In this study, we investigated the possible role of TEAD4 in EC cells. Materials and Methods: TEAD4 messenger RNA and protein expression were assessed in EC cell lines by real-time quantitative-PCR and Western blot. Gene silencing approach was employed to investigate the potential role of TEAD4 in cellular growth, proliferation, migration, and invasion in EC cells. The interaction between TEAD4 and transcription factor 7 (TCF7) was verified by co-immunoprecipitation reaction. The cell apoptosis rates of KYSE-30 cells were detected by flow cytometry. Meanwhile, the expression of apoptosis-related proteins in KYSE-30 cells was detected by Western blot analysis. Results: TEAD4 was significantly increased in EC cell lines, interference of TEAD4 inhibited EC cell viability, invasion, and migration, and promotes apoptosis. TCF7 was found when using STRING website to interact with TEAD4 proteins and TCF7 was significantly increased in EC and knockdown expression of TEAD4 hindered biological function of KYSE-30 cells and this effect was reversed by overexpression of TCF7. Conclusions: The findings concluded that TEAD4 is highly expressed in EC cells and gene silencing of TEAD4 inhibits proliferation and promotes apoptosis of EC cells by regulating TCF7. These findings suggested that TEAD4 might be a novel therapeutic target for the prevention of EC.

Preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are correlated with tumor-node-metastasis stages in patients with non-small cell lung cancer.

Background: The aim of this study is to explore the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for predicting the tumor-node-metastasis (TNM) stages in non-small cell lung cancer (NSCLC) patients. Methods: This retrospective study included 205 NSCLC patients receiving surgical treatment. We used receiver operating curve analysis to confirm the optimal cutoff values of NLR and PLR. Results: The result showed that the thresholds for NLR and PLR were 1.8 and 103.59, respectively. NLR (P = 0.037; relative risk (RR), 3.027; 95% confidence interval (CI): 1.608-8.581) and PLR (P = 0.001; RR, 3.662; 95% CI: 1.342-9.992) were risks factors in predicting advanced TNM stages (Stage III/IV, all P < 0.05). In addition, NLR with T stage- and N stage-dependent increase may be a potential and independent predictive marker for T and N stage (all P < 0.05); the PLR was identified as a marker for T stage (P = 0.028) but not for N stage. Furthermore, we investigated the combination of NLR and PLR (CNP). A risk stratification based on CNP index was carried out as follows: low risk (NLR ≤1.8 and PLR ≤ 103.59), intermediate risk (either NLR >1.8 or PLR > 103.59), and high risk (both NLR >1.8 and PLR >103.59). The probabilities for developing advanced TNM stage were 6.4% for low, 20.4% for intermediate, and 47.1% for high-risk group (P < 0.001). Conclusion: The levels of preoperative NLR and PLR were capable of indicating advanced TNM stages. According to the CNP index, patients were divided into three risk groups with different significance.

The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis.

BACKGROUND: Randomized trials have shown conflicting results regarding differences in outcomes according to anesthesia type on the prevalence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD) in hip surgery patients. The aim of this Meta analysis is to compare the effect of general and regional anesthesia in older patients undergoing hip fracture surgery. METHODS: A literature search for meta-analysis was performed using Pubmed, The Cochrane Library, Embase and Web of Science citation index for randomized controlled trials (RCTs) to compare the regional anesthesia (RA) to general anesthesia (GA) for postoperative outcomes in elderly undergoing hip fracture surgery till June 2022. The primary outcomes were the incidence of POD or POCD at 24 h, 3 days and 7 days postoperatively. The secondary outcomes were 30 days mortality rate and other adverse events. The risk of bias was assessed using the Cochrane methodology. RESULTS: Eight studies including 3555 elderly patients over 65 years old showed that there was no significant difference in the prevalence of POD or POCD between RA and GA at 24 h [OR 0.73; 95% coincidence interval (CI) 0.19, 2.71, I2 = 53%; n = 452; P = 0.63], at 3 days [OR 1.03; 95% CI 0.79, 1.35, I2 = 0%; n = 1362; P = 0.82], at 7 days [OR 0.79; 95% CI 0.41, 1.52, I2 = 51%; n = 1336; P = 0.47], respectively. No significant differences were observed in the incidence of other adverse events. CONCLUSIONS: No significant difference was found in the incidence of cognitive dysfunction after either general or regional anesthesia in elderly patients. Our finding of similar outcomes at 24 h, 3 days and 7 days postoperatively with either technique suggests that anesthesia choices for hip-fracture surgery may be based on the individual characteristics of each patient rather than on anticipated differences in clinical outcomes.

Esophageal Left Subclavian Artery Fistula Caused by The Esophageal Foreign Body: A Case Report.

Left subclavian artery esophageal fistula usually occurs after esophageal cancer surgery, which is a rare complication, and it is even rarer after stent implantation of left subclavian artery pseudo-aneurysm. This paper reports the case of a 21-year-old male patient with left subclavian artery pseudo-aneurysm. Two-plus months after stent implantation, he stopped anticoagulant and antiplatelet drugs and developed pain in his left upper limb. The patient was diagnosed with arterial fistula. He was discharged from the hospital successfully after several operations, such as thoracic aortic stent implantation, left common carotid artery left axillary artery artificial vascular bypass. Conclusion: Early diagnosis and positive treatment lead to a good prognosis for patients with esophageal left subclavian artery fistula.

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients after liver surgery: A systematic review and meta-analysis on randomized comparative studies.

OBJECTIVE: To compare the analgesic efficacy and feasibility of erector spinae plane block (ESPB) with non-block care or other blocks in patients undergoing liver surgery. METHOD: A meta-analysis of randomized controlled trials (RCTs) that compared ESPB to non-block care or local infiltration analgesia (LIA), intrathecal morphine (ITM) and quadratus lumborum block (QLB) for postoperative analgesia in liver surgery patients. RESULTS: Six RCTs containing 392 patients were included. This meta-analysis found that ESPB did not significantly reduce postoperative 8 h [mean standard (MD) 0.20; 95% (confidence interval) CI: -1.62, 2.01; P = 0.83; I2 = 99%] and 24 h [MD 0.10; 95% CI: -0.91, 1.11; P = 0.84; I2 = 97%] resting pain scores in patients undergoing liver surgery compared to control groups. Furthermore, ESPB had no effect on postoperative 24 h cumulative opioid consumption [MD 1.74; 95% CI: 3.43, 6.91; P = 0.51; I2 = 95%] or sleep quality [OR 1.00; 95% CI: 0.43, 2.35; P 0.99; I2 = 0%]. In contrast, ESPB reduced postoperative 48 h resting pain score [MD -0.77; 95% CI -1.56, 0.02; P = 0.05; I2 = 96%], the incidence of postoperative nausea and vomiting (PONV) [OR 0.29; 95% CI 0.18, 0.48; P = 0.001; I2 = 0%]. Interestingly, in two RCTs, ESPB showed a higher incidence of shoulder pain compared to ITM [OR 2.89; 95%CI 1.03 to 8.09; P = 0.04; I2 = 0%]. There have been no reports of complications from ESPB or other blocks. CONCLUSION: Current literature supported that ESPB had no significant difference in analgesic efficacy in liver surgery patients compared to LIA, ITM, and QLB. More evidences, preferably from high quality RCTs are required to confirm these finding.

The Impact of Nutritional Status on the Outcome of Transcatheter Aortic Valve Implantation.

BACKGROUND: The present study aims to evaluate how nutritional status may affect transcatheter aortic valve implantation (TAVI) outcomes. MATERIALS AND METHODS: This is a retrospective study of 383 TAVI patients. In-hospital, 1-month, and 12-month survival was evaluated. Since most patients undergoing TAVI are over 75 years old, the NRI definition for a geriatric population (GNRI) was used. Preoperative baseline clinical and laboratory data were collected and then the corresponding nutritional status was calculated, including Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNRI), and Controlling Nutritional Status Score (CONUT). Survival analysis and receiver operating characteristic curve (ROC) analysis were used to evaluate the correlation between these parameters and TAVI outcome. RESULTS: By CONUT and GNRI scores, 168 (58.9%) and 40 (14.0%) patients were considered to have mild malnutrition, respectively. By using PNI, CONUT, and GNRI scores, 16 (5.7%), 29 (10.3%), and 39 (13.7%) patients were moderately or severely malnourished. Survival analysis showed that patients with worse nutritional status had a worse prognosis regardless of the nutritional score used. Subgroup analysis showed that these differences remained significant in subgroups of patients over age 75. COX multivariate analysis showed that GNRI, PNI, and CONUT were independently associated with all-cause mortality during the follow-up. CONCLUSION: Patients with worse nutritional status had a worse prognosis regardless of the nutritional score used. Subgroup analysis showed that these differences remained significant in subgroups of patients over age 75. GNRI, PNI, and CONUT were independent predictors of all-cause mortality after TAVI.

Research Progress on Coping Strategies of Cognitive Impairment after Cardiac Surgery: A Systematic Review of Literature.

Postoperative cognitive dysfunction (POCD) refers to a complication of neurological dysfunction after surgery, including one or more changes that are significantly lower than those before surgery. The purpose of this study was to review the coping strategies and risk factors of POCD.A systemic research was conducted searching Pubmed, web of science, MEDLINE and other websites with the keywords of cardiac surgery, cognitive impairment and POCD. Multiple factors have been associated with the treatment of POCD, including anesthetic, choice of analgesic drugs, anti-inflammatory drugs, erythropoietin, atherosclerosis, emotional factors, surgical and other factors. Targeted treatments are carried out for risk factors that may affect POCD prevention, such as anesthetic drug prevention, anti-inflammatory drug prevention, and intraoperative prevention and other preventive measures are aimed at reducing the incidence of POCD after cardiac surgery.

Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article.

Paravalvular leak (PVL) is very common after TAVI and has been reported to have a negative impact on both short- and long-term survival. The current study identified incidence, diagnosis, clinical implications, and prevention, management and future perspectives for post-TAVI paravalvular leak. A systematic literature search was conducted using PubMed and EMBASE, using the MeSH terms and key words "paravalvular leak," "diagnostic criteria," "implication," "influencing factors," and "prevention strategies." Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating Paravalvular leak in patients who had TAVI. Thirty articles were selected for inclusion, incidence of PVL across the studies ranged from 7% to 40%. Many factors have been associated with incidence and increased risk of PVL, including AVC volume, larger annulus dimensions, pre-TAVI transvalvular peak velocity, under sizing of the prosthesis, surgical, and other factors. PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. The strength and nature of the association of various degrees of post-TAVI PVL and mortality are still to be further evaluated.

Progress of research in postoperative cognitive dysfunction in cardiac surgery patients: A review article.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication of central nervous system in middle-aged and elderly patients after cardiac surgery. The purpose of this study was to review the progress in diagnosis, pathogenesis and risk factors and control strategy of POCD. METHODS: A systematic literature search was conducted using Pubmed and EMBASE, using the Mesh terms and key words "POCD", "diagnostic criteria", "pathogenesis", "influencing factors" and "prevention strategies". Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating risk factors for POCD in patients who had elective cardiac surgery. Diagnosis of POCD needed to be confirmed using the Diagnostic and Statistical Manual of Montreal Cognitive Assessment (MoCA) Scale and other criteria. RESULTS: "Twenty two articles were selected for inclusion. The incidence of POCD across the studies ranged from 9% to 54%. Multiple factors have been associated with the pathogenesis and increased risk of POCD, including neuroinflammation, dysfunction of cholinergic system, abnormal protein function (ß-amyloid), old age, anesthetic, surgical and other factors." CONCLUSIONS: POCD is a common complication after cardiac surgery in elderly. The highest POCD incidence was observed after open aortic, TAVI and CABG surgery. Age, cognitive function, depression, CPB and anesthetic use are leading risk factors. Further research is needed in determining interventions that will be effective in preventing and treating POCD in cardiac surgical setting.

Right Ventricle Involvement in Hypertrophic Cardiomyopathy and Role of Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy: Review Article.

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease, and its main characteristic is symmetrical or asymmetrical hypertrophy of the left ventricle and/or right ventricle. Most previous studies mainly include the left ventricle for definition of HCM, thus neglecting the right ventricle. But recently, many studies have reported the right ventricular involvement in HCM. Histopathological results showed that similar pathogenic changes in both the right and left ventricles, which suggests common myopathic processes and sarcomere genetic mutations. Cardiovascular magnetic resonance (CMR) is a gold standard imaging modality to assess heart anatomy and function and provides highly accurate and reproducible measurements. CMR is very useful in characterizing the various phenotypes of right and left ventricles in HCM. CMR also can be useful in detecting early and dominant phenotypic expression of HCM. Due to the complex geometry of the right ventricle and its retrosternal position, echocardiography may not provide accurate measurements. CMR also provides more accurate and repeatable right ventricular measurements. Thus, right ventricle evaluation along with left ventricle should routinely be done for better assessment of HCM patients.

The Infective Endocarditis with Recurrent Epistaxis in a Young Patient: A Case Report.

Epistaxis is a common emergency, and its main causes are hypertensive crisis and trauma. Nasal packing is the primary treatment. After active symptomatic treatment, the symptoms of epistaxis effectively can be controlled. In this case report, the patient was treated with epistaxis many times in the outpatient department. After nasal examination, there was a clear bleeding point, and it was treated with gauze packing or silver nitrate cauterization. The symptoms of epistaxis gradually got worse and was accompanied with fever and progressive anemia. After blood culture and color Doppler ultrasound examination, it was confirmed that it was endocarditis caused by defective hypoxic bacterial infection. After active antibacterial and surgical treatment, the symptoms of epistaxis, fever and anemia were relieved.