Background: This study aims to systematically review the efficacy of various surgical approaches in the treatment of ischemic mitral regurgitation (IMR). Methods: A comprehensive literature search was conducted using computerized databases, including PubMed, Cochrane Library, Embase, and Web of Science, up to February 2024. In our network meta-analysis, we utilized the Cochrane Handbook tool for quality evaluation, while a consistency model and the odds ratio (OR) were used to compile and analyze the data from the studies included, employing Stata 17.0 software for this purpose. Results: The systematic review included a total of 20 randomized controlled trials (RCTs), which collectively involved 3111 patients and evaluated six different surgical techniques. The network meta-analysis demonstrated that mitral valve repair (MVr) exhibited a significant reduction in 30-day all-cause mortality rates when compared to coronary artery bypass grafting (CABG), mitral valve replacement (MVR), CABG combined with MVR, and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip. Furthermore, probability ranking analysis suggested that MVr may be the most effective approach in reducing 30-day all-cause mortality, while CABG combined with MVr had significantly fewer renal complications compared to CABG combined with MVR. Probability rankings also indicated that CABG+MVr may be the most effective technique in minimizing renal complications. However, there were no statistically significant differences observed in other outcome measures among the different surgical techniques. Conclusions: Current limited evidence indicates that CABG combined with MVr may be the best surgical approach for patients with IMR. However, these conclusions are tentative and require further confirmation from more additional high-quality studies. INPLASY Registration Number: INPLASY202420049. This study can be accessed at the following detailed address: https://inplasy.com/inplasy-2024-2-0049/, last accessed on February 11, 2024.
Randomized controlled trials and non-Randomized controlled trials.Condition being studied: More and more evidences indicate that with the increase of clinical experience and advances in transcatheter technology, transfemoral TAVR is also feasible with Local anesthesia/conscious anesthesia (LA).Previous studies have shown that LA can avoid hemodynamic fluctuations caused by general anesthesia (GA) and lung damage caused by positive pressure ventilation, as well as reduce medical costs.However, in some studies comparing anesthesia selection in patients with transfemoral TAVR, the criteria for choosing LA versus GA remain vague and often depend on institutional and surgeon preferences.
Objective To explore the efficacy of BiPAP ventilator in the treatment of acute respiratory failure in elderly patients with AECOPD.Methods 60 elderly patients with acute respiratory failure were treated with double-level (BiPAP) ventilation.The changes in blood gas,symptoms,and signs were observed after treatment.Results After treatment,PaO2,SaO2,and pH increased,R,HR,PaCO2,and HCO3 decreased,and symptoms were improved in 42 of the patients.The remaining 18 required invasive ventilation because of therapy failure.Conclusions Non-invasive ventilation is effective in managing respiratory failure in most patients with AECOPD.Indications must be selected properly and invasive ventilation should be used if necessary.
Key words:
AECOPD; Acute respiratory failure; Non-invasive ventilation
Objective: Our aim was to investigate the causes of esophageal reflux during general anesthesia.Methods:In74 patients, 16 were critically emergent and 51 underwent near stomach operation. The ASA grade of these 74 patients were from I to Ⅳ. The lower esophageal pressure (LESP), the upper esophageal pressure (UESP), the gastric pressure (GP), the pH of pharynx, and the gastric volume (GV) were measured before and after general anesthesia induction and during the operation. Results: Eight patients had 10 times of reflux. All of them had near stomach performance. The reflux rate was 13.5%. In 16 critically emergent patients, 6 had 8 times of reflux, the reflux rate was 50%. The GP (1.84±0.89 kPa) and GV (1.40±1.12 ml/kg) in critically emergent patients were significantly higher, LESP (3.38±1.90 kPa) and UESP (3.94±1.36 kPa) were lower than patients in good condition (GP 1.27± 2.13 kPa, LESP 4.24± 1.35 kPa,UESP 5.15±1.5 kPa, gastric volume 0.8±0.20 ml/kg).Conclusion: The critically emergent patients had higher gastric content and GP,lower LESP and UESP.They tended to reflux because of more effect from anesthesia.
Background: The relationship between diabetes and heart failure significantly impacts public health. This study assessed the prognostic nutritional index (PNI) as a predictor of heart failure risk in adult diabetic patients. Methods: An analysis was performed on 1823 diabetic adults using data collected from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Serum albumin levels and lymphocyte counts were combined to calculate the PNI. We used descriptive statistics categorized by PNI quartiles and performed multivariate logistic regression to adjust for variables including age, gender, ethnicity, and coexisting medical conditions. Results: The median age (mean ± SD) was 59.942 ± 12.171 years, and the mean value ± SD of the PNI was 52.412 ± 5.430. The prevalence of heart failure was 7.405%. In the fully adjusted model, for each 1-unit increase in PNI, the risk of heart failure decreased by 8.2% (odds ratio (OR), 0.918; 95% confidence interval (CI) 0.884, 0.953). Participants in the highest PNI quartile (Q4) had a 63% reduced risk of heart failure compared to those in the lowest quartile (Q1). Tests for interactions did not reveal any statistically significant differences among these stratified subgroups (p for interaction > 0.05). Conclusions: This study demonstrated that a higher PNI was significantly associated with a decreased prevalence of heart failure in adults with diabetes.
Objective To research a new method of producing acellular dermal matrix (ADM). Methods The non-hair skin grafts with 0.8mm in thickness were acquired from the back of Wistar rats'. Then the grafts were treated with 1M NaCl 4℃ for about 24 hours to rip away the cuticular layers,and the remained dermis were immerged into 0.5%Triton X-100 shaking in normal temperature for about 48 hours to obtain ADM. Took samples of the ADM to do histology observation,and homoplastic tronsplantation. Results There was no cell constituent remained in ADM produced by NaCl-Triton method,and the collagen fibers were in a regular arrangement. ADM had very low immunocompetence and good biocompatibility. Conclusion Using NaCl-Triton method to produce ADM was low-cost and effective,so it was advantageous to populize application.
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