Clinical Effects of Surgical Left Atrial Reduction and Concomitant Mitral Valve Replacement in Patients with Giant Left Atrium

ABSTRACT Introduction: A giant left atrium may cause respiratory dysfunction and hemodynamic disturbance postoperatively. This retrospective study aimed to evaluate clinical effects of surgical left atrial reduction in concomitant cardiac valves operations. Methods: One hundred and thirty-five patients with heart valve diseases and giant left atriums from January 2004 to July 2021 were enrolled into this research. They were divided into the folded group (n=63) and the unfolded group (n=72). Patients in the folded group had undergone cardiac valve operations concomitantly with left atrial reductions. The perioperative characteristics were compared between both groups, and subgroup analysis was performed. Results: There were five deaths in the folded group and 25 deaths in the unfolded group (P<0.001). Complications including pneumonia, sepsis, multiple organs dysfunction syndrome, low cardiac output syndrome, and the use of continuous renal replacement therapy were significantly fewer in the folded group. The receiver operating characteristic curve of left atrial max. diameter predicting mortality was significant (area under the curve=0.878, P=0.005), and the cutoff point was 96.5 mm. The stratified analysis for sex showed that more female patients died in the unfolded group. Logistic regression for mortality showed that the left atrium unfolded, left atrial max. diameter, cardiopulmonary bypass time, and mechanical ventilation time increased the risk of death. Conclusion: Surgical left atrial reduction concomitantly with valves replacement could decrease mortality and was safe and effective in giant left atrium patients.

Depression status of 136 patients with adjuvant radiotherapy after reconstruction of the oral cancer flap and analysis of influencing factors / 口腔疾病防治

Objective@#To explore the depression and influencing factors of patients with adjuvant radiotherapy after reconstruction of oral cancer flaps and to provide evidence for postoperative care.@*Methods@#One hundred thirty-six patients with oral cancer who had undergone adjuvant radiotherapy after reconstruction of skin flaps at 4 affiliated hospitals in Harbin Medical University were selected by convenience sampling. The basic information of the patients with adjuvant radiotherapy after reconstruction of skin flaps was collected, a self-rating scale for depression was used to assess depression, and a questionnaire was used to assess symptom distress. Depression and its influencing factors were determined by multiple stepwise regression analysis. @*Results@#The average score of depression in patients with oral cancer after skin flap reconstruction was (52.32±13.11): 33.1% of the patients showed mild depression, 21.3% showed moderate depression, and 2.2% showed severe depression. Postoperatively, the patients had pain, dysphagia, taste disorders, temporomandibular joint and salivary gland dysfunction, as well as marital and financial problems. The results showed that dysphagia (P < 0.001), taste disorder (P < 0.001), marital status (P=0.004) and family income per month (P= 0.011) could be the influencing factors of depression in patients with oral cancer during radiotherapy, and a significant correlation was found between them.@*Conclusion @#Patients with adjuvant radiotherapy after reconstruction of oral cancer flaps have depressive symptoms, which will seriously affect the quality of life. Therefore, the care of such patients should focus on improving the postoperative depression of patients.

Clinical implications of elevated serum soluble CD137 levels in patients with acute coronary syndrome

OBJECTIVES: Atherosclerosis is a chronic inflammatory disease. Research has focused on identifying specific serum biomarkers to detect vulnerable plaques. These markers serve as diagnostic tools for acute coronary syndrome and assist in identifying high-risk patients. However, the existing data are limited and conflicting. This study tested the hypothesis that CD137 levels identify patients with acute coronary syndrome who are at a heightened risk for recurrent cardiac events. METHODS: The levels of soluble CD137 (sCD137) were measured using ELISA in 180 patients with acute coronary syndrome and 120 patients with acute chest pain. Platelet activation was assessed by flow cytometry. Receiver operating characteristic curve analysis was performed to evaluate the prognostic characteristics of sCD137. RESULTS: The levels of sCD137 were elevated in 75 patients with acute coronary syndromes and 20 patients with acute chest pain (>35.0 ng/ml). In patients with acute coronary syndrome, elevated sCD137 levels (>35.0 ng/ml) indicated an increased risk for major adverse cardiovascular events (OR =1.93, 95% CI: 1.39-2.54). Elevated serum levels of sCD137 and cTnT were correlated with a significantly increased risk of major adverse cardiovascular events in both groups after 30 days, six months and nine months of follow-up. The increased sCD137 levels were significantly correlated with the levels of troponin I (r = 0.4799, p<0.001). Importantly, 26 patients with normal cTnI levels had acute coronary syndrome. However, elevated sCD137 levels identified these patients as a being high-risk subgroup (OR = 2.14, 95% CI: 1.25-4.13). CONCLUSIONS: Elevated sCD137 levels indicate an increased risk of cardiovascular events in patients with acute coronary syndrome. Soluble CD137 may be a useful prognostic marker or indicator for adverse events in patients with acute coronary syndrome.