Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction

BackgroundCoronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%).MethodsWe analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively.ResultsIn 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]).ConclusionsHeart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization.     

The prognostic value of elevated neutrophil–lymphocyte ratio for cardiac surgery-associated acute kidney injury: A systematic review and meta-analysis

Background

Patients undergoing cardiac surgery are at significant risk of developing postoperative acute kidney injury (AKI). Neutrophil–lymphocyte ratio (NLR) is a widely available inflammatory biomarker which may be of prognostic value in this setting.

Methods

We conducted a systematic review and meta-analysis of studies reporting associations between perioperative NLR with postoperative AKI. We searched Medline, Embase and the Cochrane Library, without language restriction, from inception to May 2022 for relevant studies. We meta-analysed the reported odds ratios (ORs) with 95% confidence intervals (CIs) for both elevated preoperative and postoperative NLR with risk of postoperative AKI and need for renal replacement therapy (RRT). We conducted a meta-regression to explore inter-study statistical heterogeneity.

Results

Twelve studies involving 10,724 participants undergoing cardiac surgery were included, with eight studies being deemed at high risk of bias using PROBAST modelling. We found statistically significant associations between elevated preoperative NLR and postoperative AKI (OR 1.45, 95% CI 1.18–1.77), as well as postoperative need for RRT (OR 2.37, 95% CI 1.50–3.72). Postoperative NLR measurements were not of prognostic significance.

Conclusions

Elevated preoperative NLR is a reliable inflammatory biomarker for predicting AKI following cardiac surgery.     

D-二聚体和中性粒细胞/淋巴细胞比值评估卵巢癌预后的临床价值

目的:研究D-二聚体（D-dimer,D-D）和中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）与卵巢癌临床病理特征及预后的关系。方法:回顾性分析2012年1月至2015年12月于我院妇科行手术治疗的卵巢恶性肿瘤患者387例和卵巢良性肿瘤患者250例临床资料。比较血清D-D和外周血NLR在卵巢良、恶性肿瘤中的表达水平；确定D-D和NLR临界值，D-D+NLR=0（D-D≤0.555 mg/L和NLR≤2.792）,D-D+NLR=1（D-D>0.555 mg/L或NLR>2.792），D-D+NLR=2（D-D>0.555 mg/L和NLR>2.792），分析两者联合的评分系统与卵巢癌临床病理特征和预后的关系。结果:血清D-D和外周血NLR在卵巢良、恶性肿瘤患者中的表达水平有统计学差异（P＜0.001）。D-D高水平组与低水平组相比，患者的分期、分级、淋巴结转移、腹水、CA125水平、残余瘤大小有统计学差异（P＜0.05）。NLR高水平组与低水平组相比，患者的年龄、分期、淋巴结转移、腹水、CA125水平、残余瘤大小有统计学差异（P＜0.05）。D-D+NLR为0、1、2分的平均总生存期（OS）分别为70个月、58个月、40个月。D-D+NLR评分是影响OS的独立预后因素。结论:术前血清D-D和外周血NLR与卵巢癌临床病理特征和OS相关，D-D+NLR评分可以作为评估卵巢癌预后的指标。     

Aminotransferases During Treatment Predict Long-Term Survival in Patients With Autoimmune Hepatitis Type 1: A Landmark Analysis

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抗PD-(L)1、抗CTLA-4免疫治疗标志物研究进展

免疫检查点抑制剂已经改变了包括肺癌、黑色素瘤等许多肿瘤的治疗情况，并且在一些难治性肿瘤中表现出持久的应答率，然而在部分接受治疗的患者中表现出无反应及严重免疫相关副作用。为了优化免疫疗法的使用，可能需要多种临床应答的预测性标志物。本研究回顾了几种潜在有效生物标志物的可用数据，通过免疫组化检测肿瘤细胞和免疫细胞中PD-L1的表达，提示其是一种临床疗效的良好预测标志物;且PD-L1表达阴性者经免疫治疗后仍可获益。PD-L1表达在肿瘤内是动态和异质性的:在原发性灶和转移灶之间或在穿刺标本和大体标本之间表达不一致。肿瘤突变负荷与新抗原的高比率可获得持久获益。外周血标志物也可作为潜在标志物，增加的绝对淋巴细胞计数（ALC）与疾病控制和生存显著相关。在这篇综述中，我们旨在讨论抗PD-（L）1与抗CTLA-4 免疫治疗相关标志物研究现状，为临床运用提供指导，以便能够准确筛选出从这些治疗中获益更多的患者。     

2015—2017年解放军总医院抗震颤麻痹药物的使用情况分析

目的 了解解放军总医院抗震颤麻痹药物的应用情况与用药趋势。方法 采用世界卫生组织（WHO）推荐的以限定日剂量（DDD）为指标的分析方法，对2015-2017年解放军总医院抗震颤麻痹药物的销售金额、用药频度（DDDs）、日均费用（DDC）及排序比（B/A）等进行统计分析。结果 普拉克索、多巴丝肼和恩他卡朋的用药金额始终处于前3位，普拉克索的用药金额逐渐上升，卡比多巴/左旋多巴的用药金额逐渐下降；DDDs排序列前2位的是多巴丝肼和司来吉兰，多巴丝肼的DDDs逐年上升，一直处于第1位；2015-2016年各种抗震颤麻痹药物的DDC较为稳定，2016-2017年各种抗震颤麻痹药物的DDC开始略有下降；除普拉克索和恩他卡朋的B/A始终小于1.00，其他抗震颤麻痹药物的B/A均在1.00以上波动。结论 解放军总医院抗震颤麻痹药物的使用较为合理，其中多巴丝肼、普拉克索和司来吉兰具有很好的市场前景。