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Background Stress plays an important role in the pathogenesis of depression through functional changes to the hypothalamic-pituitary-adrenal (HPA) axis, a key output of which is the stress hormone cortisol. But the precise relationship between HPA axis activity and depression remains unclear, in part because mostly cortisol measurement only provides reflect acute or short-term fluctuations. In this study, hair cortisol and its metabolite cortisone were measured in a prospective, pre and post follow-up study of working stress and depressive symptoms in Chinese fishermen. We evaluated HPA activity, work stress, and depression symptoms before and after fishing to determine whether cortisol and cortisone in hair can moderate the work stress and depression symptoms of Chinese fishermen. Methods Hair cortisol, hair cortisone, work stress, and depression were measured in Chinese fishermen (n=229; age 16–65) before and after 1–3 months at sea. A week after the fishermen returned, they provided 2–4 cm hair segments closest to the scalp. We measured hair cortisol and hair cortisone using high-performance liquid chromatography–tandem mass spectrometry. Results The work stress and hair cortisol of fishermen before fishing were significantly higher than those after fishing, while hair cortisone was lower. There was no significant difference in depressive symptoms. Fishermen with low hair cortisol or high hair cortisone were more likely to show depressive symptoms after experiencing stress, and were less likely to show depressive symptoms when faced with lower levels of work stress, consistent with the differential susceptibility model. Limitations The assumption of an average hair growth of 1 cm/month may cause time overlap between pre- and post-fishing, and time error between the hormone data and questionnaire collection. The present study evaluated only two observation points. The use of self-report scales may affect interpretability of the results. Finally, the study used a limited sample of marine fishermen working out of a single location in Hainan province, China. Conclusions Hair cortisol and hair cortisone appear to have a moderating role in the relationship between work stress and depressive symptoms among fishermen, which fits with the differential susceptibility model of depression. However, their mechanisms of moderation are not the same, which may reflect the complexity of physiological indicators.

We conducted a prospective, observational study to determine the incidence of feeding intolerance (FI) within seven days of initiating enteral nutrition (EN) in patients undergoing cardiopulmonary bypass (CPB), and to evaluate the association between FI and a poor prognosis. Patients who underwent CPB surgery at Fujian Medical University Union Hospital between March 2020 and June 2020 were enrolled. According to the presence or absence of FI within seven days after EN, patients were divided into FI and non-FI groups. According to the occurrence of a poor prognosis (death, gastrointestinal haemorrhage, acute kidney injury, liver insufficiency, neurological events [cerebral infarction, cerebral haemorrhage, epilepsy], and prolonged mechanical ventilation [>48 hours]), patients were divided into poor prognosis and good prognosis groups. The mean (standard deviation) age of the 237 CPB patients, including 139 men and 98 women, was 53.80 ± 12.25 years. The incidence of FI was 64.14%. There were 152 cases in the FI group and 85 cases in the non-FI group. Multivariate logistic regression analysis showed factors independently associated with poor prognosis after CPB included FI (odds ratio [OR], 2.138; 95% confidence interval [CI], 1.058-4.320), age (OR, 1.033; 95% CI, 1.004-1.063), NYHA class III - IV cardiac function (OR, 2.410; 95% CI, 1.079-5.383), macrovascular surgery (OR, 5.434; 95% CI, 1.704-17.333), and initial sequential organ failure assessment score (OR, 1.243; 95% CI, 1.010-1.530). Thus, the incidence of FI within seven days of EN after CPB was high, which was associated with a poor prognosis.

Purpose Postoperative delirium (POD) is a very common and serious neurological complication in patients admitted to the cardiothoracic surgical intensive care unit (CSICU). We aimed to identify a novel potential sleep-based marker for POD and investigate the relevance between atypical sleep and POD. Patients and Methods This was a prospective, observational study of patients admitted to the CSICU between December 2019 and February 2020 at our center. Sleep characteristics from 21:00 on postoperative day 1 to 07:00 on postoperative day 2 were assessed using polysomnography (PSG). POD from the end of PSG monitoring until postoperative day 5 was evaluated using the Confusion Assessment Method for the Intensive Care Unit. Results This analysis included 20 patients admitted to the CSICU. The incidence of atypical sleep was 45.0%. Compared to patients without delirium, those with delirium had less delta power, less percentage REM sleep, and a higher proportion of atypical sleep and REM sleep loss (P < 0.05). Conclusion The presence of atypical sleep and the absence of REM sleep were associated with POD in patients admitted to the CSICU.

Background Neurological complications is a common complication following novel triple-branched stent graft implantation in patients with Stanford type A aortic dissection (AAD). But the incidence and risk factors of postoperative delirium (POD) are not completely clear. The aim of this study was to investigate the incidence and risk factors of POD after novel triple-branched stent graft implantation. Methods An observational study of AAD patients who underwent novel triple-branched stent graft implantation between January 2017 and July 2019 were followed up after surgery. Patients’ delirium was screened by the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit from the first day after the operation, lasted 5 days. The risk factors of POD were analyzed by the Cox proportional hazard models. Results A total of 280 AAD patients were enrolled in this research, the incidence of POD was 37.86%. Adjusting for age, body mass index, and mechanical ventilation duration, multivariate Cox regression analysis model revealed that non-manual work (adjusted hazard ratio [AHR] = .554; 95% CI: 0.335–0.915; P = .021), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores > 20 (AHR = 3.359, 95% CI: 1.707–6.609, P P = .017), and more than two types of analgesics and sedatives were independently associated with POD. Conclusions This study showed that risk factors independently associated with POD were APACHE-II score > 20, hypoxemia, and more types of analgesics and sedatives, and non-manual work was the protective factor. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900022408; Date: 2019/4/10).

Background Emergency surgery for acute type A aortic dissection (AAAD) is associated with a high risk for posttraumatic stress disorder (PTSD), and the risk factors for PTSD symptoms development in AAAD patients of different sexes remain unclear. Objective To identify the risk factors for PTSD symptoms separately in the females and males following AAAD. Methods A sample population of 214 patients who had AAAD surgery was recruited. Patients’ sociodemographic and disease-specific data were collected during hospitalization. Results In this study, PTSD symptoms was present in 22.1% of the male patients and 20.0% of the female patients (P = 0.739). For the male patients with AAAD, PTSD symptoms were significantly positively associated with HADS-D score (P = 0.029), while those with university education and above (P = 0.039), stronger subjective support (P = 0.010) and greater optimism (P = 0.001) had significantly lower possibility for the presence of PTSD symptoms. For the female patients with AAAD, support availability (P = 0.031) was significantly negatively associated with PTSD symptoms while HADS-D score (P = 0.033) was significantly positively associated with PTSD symptoms. Conclusion Risk factors for PTSD symptoms differ in male patients and female patients following AAAD.

Background: Prolonged mechanical ventilation (PMV) among acute type A aortic dissection (AAAD) may affect the prognosis, but poorly known about the direct economic burden of PMV in patients with AAAD. The present study was contributing to filling this knowledge gap.Methods: This present study was a retrospective cohort study. Age, gender, payment methods, and postoperative complications were matched at a 1:1 ratio by using a propensity score analysis of AAAD patients. The direct economic burden was expressed as the median 1:1 differences of various hospital costs and length of stay (LOS). The Wilcoxon signed-rank tests were used to compare the difference of direct economic burden at mechanical ventilation (MV) and PMV patients.Results: A total of 464 patients, PMV occurred in 142(30.6%) patients, and 218 patients were enrolled in the matched analysis. The estimated total direct economic burden of PMV was $4970.28(PP < 0.05).Conclusions: Postoperative PMV was associated with increased economic burden among AAAD patients. This study emphasizes the need for early detection and management of PMV to reduce the economic burden.

Aim: The aim of the study was to evaluate the relationship between lymphocyte to monocyte ratio (LMR) at admission and in-hospital mortality of patients with acute type A aortic dissection (AAAD). Patients & methods: We enrolled 536 patients with AAAD between June 2013 and December 2017. Patients were divided into two groups: the deceased group and the survival group. Results: In multivariable analysis, the association between LMR and in-hospital mortality was still significant. When the Q4 was set as the reference value, the odds ratios values of Q1, Q2 and Q3 were 4.4 (95% CI: 2.2–8.9; p < 0.001), 1.4 (95% CI: 1.1–3.4; p = 0.03) and 1.7 (95% CI: 0.8–2.9; p = 0.158). Conclusion: Lower LMR may be independently associated with in-hospital mortality in AAAD.

OBJECTIVESTo investigate the rate of returning to work within 12 months after open triple-branched stent graft placement in acute type A aortic dissection (AAAD) patients and the reasons why patients did not return to work.METHODSWe conducted this cohort study of AAAD patients who were discharged alive from the hospital at Fujian Cardiac Center during the period 2013–2018. The collected data included the patients’ baseline characteristics, employment status at 12 months after AAAD and variables classifying the potential reasons for those who did not return to work at 12 months. We applied logistic regression to estimate the factors associated with returning to work at 12 months.RESULTSOne year after AAAD hospitalization, of the 326 AAAD patients, 81 (24.8%) returned to work, 231 (70.9%) did not and 14 (4.3%) died. Among the 231 patients who did not return to work, 105 (45.5%) were unable to work because of AAAD and 36 (15.6%) lost job owing to AAAD. After adjustment for other risk factors, age, female sex, type of work, operating time, aortic cross-clamp time and length of intensive care unit (ICU) stay were still significantly associated with a lower chance of returning to work.CONCLUSIONSLess than 25% of the previously employed patients returned to work at 12 months after AAAD. Older age, female sex, manual or semi-skilled professional work, a longer operating time, a longer aortic cross-clamp time and a longer length of ICU stay were associated with a lower likelihood of returning to work.

Background Neuromuscular electrical stimulation (NMES) is a possible adjunctive therapy applied to cardiac surgery patients to improve physical function, but the results are still controversial. A systematic review and meta-analysis was conducted to investigate the effects of NMES on functional capacity and quality of life (QoL) in cardiac surgery patients. Methods The following databases PubMed, Embase, Medicine, CINAHL, and the Cochrane Central Register of Controlled Trials were searched for the English language from inception up to March 2021. A systematic targeted literature search evaluating the effects of NMES on physical function and QoL in cardiac surgery patients. The effect size of NMES was presented as the mean difference (MD)/standardized mean difference (SMD) and its 95% confidence interval using fixed/random effect models according to heterogeneity. Two reviewers independently screened and appraised each study by using the Cochrane Risk of Bias Tool. Results Six studies were included involving 400 cardiac surgery patients. The meta-analysis showed that NMES had effect on knee extensor strength (SMD=1.68; p=0.05), but had no effects on 6-minute walking distance (MD=44.08; p=0.22), walking speed (MD=0.05; p=0.24), grip strength (MD=3.01; p=0.39), or QoL (SMD=0.53; p=0.19). Conclusions NMES use in cardiac surgery patients is limited by low to moderate quality. Existing evidence shows that NMES is safe and effective for improving knee extensor strength.

BACKGROUND Surgery is the primary option of acute type A aortic dissection (AAAD) treatment. However, the unique traumatic stress of cardiovascular disease and surgery brings physical and psychological suffering to the patients and causes post-traumatic stress disorder (PTSD). The aim of this study was to investigate the rate of PTSD in AAAD patients after surgery and identify the risk factors of this complication. METHODS A prospective cohort design was used. All patients who underwent AAAD surgery from September 2017 to June 2019 were included. Resilience, anxiety, and depression level were assessed before patients discharged from the hospital. Additionally, the PTSD symptoms were assessed three months after discharge from hospital. The data were analyzed by SPSS 24.0 (IBM, Armonk, NY, USA) and P

As a new surgical method for older adults with cardiac insufficiency, transapical mitral valve clamp surgery requires the cooperation of practitioners across multiple disciplines to ensure appropriate treatment and nursing care. This study aimed to explore the utility of a multidisciplinary team nursing model in the clinical treatment and nursing care of patients undergoing transapical mitral valve clamping.Our sample of ten patients included four men (40%) and six women (60%), with a mean age of 71.4 ± 5.2 years. The multidisciplinary team comprised nurses that specialized in severe illness, cardiac health, rehabilitation, psychology, nutrition, and pain. The team engaged in comprehensive discussions regarding problems specific to the patients undergoing transapical mitral valve surgery, allowing them to formulate individualized nursing measures and implement precise policies.No serious postoperative complications occurred in any of the ten patients included in this study, and a significant improvement was noted in the cardiac status of all the patients. Color ultrasound findings at discharge indicated that the degree of reflux of all the patients was ≤2+. Among the ten patients, the Activity of Daily Living Scale scores at discharge were significantly higher than before the operation (69.0 ± 4.6 vs. 55.0 ± 5.8). In addition, the 6-min walking test results at discharge were significantly better than those observed before the operation (318.0 ± 21.7 m vs. 295.2 ± 18.4 m).Utilization of a multidisciplinary team allows nurses across various specialties to provide more comprehensive and systematic care for patients undergoing a mitral valve clamping operation, thus promoting patient recovery.RéSUMé: CONTEXTE: en tant que nouvelle méthode chirurgicale pour le traitement de l’insuffisance cardiaque chez les personnes âgées, la chirurgie par pince de la valve mitral aiguë nécessite la collaboration de médecins multidisciplinaires pour assurer un traitement et des soins appropriés. OBJECTIFS: étudier l’application du modèle de soins en équipe multidisciplinaire dans le traitement clinique et les soins aux patients atteints de la valve mitral par pince. MéTHODE: sur 10 patients, 4 hommes (40%) et 6 femmes (60%) ont un âge moyen de 71.4 à 5.2 ans. L’équipe multidisciplinaire est. composée d’infirmiers spécialisés dans les maladies graves, la santé cardiaque, la réadaptation, la psychologie, la nutrition et la douleur. L’équipe a mené une discussion approfondie sur les problèmes spécifiques des patients soumis à une opération de la valve mitral transspiroptérale, a élaboré des mesures de soins personnalisées et a mis en œuvre des politiques précises. RéSULTATS: aucune complication postoperatoire grave n’a été observée chez les 10 patients de ce groupe, et les défaillances cardiaques ont été nettement améliorées chez tous les patients. Une double échographie en couleur a montré que le degré de regurgitation mitral était inférieur ou égal à 2+ dans 10 patients sortant de cette étude; Les scores sur l’échelle des activités de la vie quotidienne à la sortie de l’hôpital étaient nettement plus élevés dans 10 cas que dans le cas préopératoire (69.0 ± 4.6 contre 55.0 ± 5.8). En outre, les résultats d’un essai de marche de 6 min à la sortie de l’hôpital étaient nettement supérieurs à ceux observés avant l’opération (318.0 ± 21.7 m contre 295.2 ± 18.4 m). CONCLUSION: le recours à des équipes multidisciplinaires permet aux infirmiers/infirmières spécialisés de fournir des soins plus complets et systématiques aux patients soumis à la chirurgie par compression de la valve mitral, ce qui facilite leur réadaptation.

Background Abnormal body mass index (BMI) has been related to a higher risk of adverse outcomes in patients undergoing cardiac surgery. However, the effects of BMI in patients with acute type A aortic dissection (AAAD) on postoperative outcomes remain unclear. This study aimed to explore the relationships between BMI and in-hospital major adverse outcomes (MAO) in AAAD patients. Methods Patients who underwent AAAD surgery at Cardiac Medical Center of Fujian Province from June 2013 to March 2020 were retrospectively evaluated. They were divided into three groups on the basis of Chinese BMI classification established by the World Health Organization: normal weight group (BMI 18.5–23.9 kg/m2), overweight group (BMI 24–27.9 kg/m2), and obese group (BMI >28 kg/m2). Patients’ baseline characteristics, preoperative, operative, and postoperative data were collected. A multivariable logistic regression analysis model was performed to identify the association between BMI and MAO in AAAD patients. Results Of 777 cases, 31.9% were normal weight, 52.5% were overweight, and 15.6% were obese. A total of 160(20.6%) patients died in-hospital. There was a significant difference between the three groups for MAO (62.9% vs 72.1% vs 77.7%, respectively, P = 0.006). The incidence of postoperative complications did not differ among the three groups, except for postoperative bleeding, and prolonged mechanical ventilation, the proportion of which were higher in the overweight and obese groups. Besides, multivariable logistic regression analysis demonstrated that a higher risk of MAO in the overweight [odds ratios (ORs):1.475, 95%CI:1.006–2.162], and obese patients (ORs:2.147, 95%CI:1.219–3.782) with reference to the normal weight patients, and age, white blood cell, prior stroke and cardiopulmonary bypass time were also associated with in-hospital MAO (P Conclusions BMI is independently associated with higher in-hospital MAO in patients who underwent AAAD surgery.

Objective The purpose of this study was to explore the value of continuous nursing in patients after cardiac valve replacement. Methods The clinical data of 116 patients after cardiac mechanical valve replacement from January 2017 to January 2018 were analysed retrospectively. According to the nursing mode, the patients were divided into two groups: the continuous nursing group (group A, n = 56) and the conventional nursing group (group B, n = 60). Results The continuous nursing group exhibited significantly decreased SAS and SDS scores 1 year after surgery compared to the preoperative SAS and SDS scores(P P Conclusion Continuous nursing improves patient compliance with treatment and reduces the occurrence of postoperative anticoagulation complications. The patient also receives proper psychological evaluations, which relieve patient anxiety and depression.

Background Guidelines recommend a clear liquid fasting time of 2 h before surgery, which is often exceeded, leading to adverse reactions (ARs) such as discomfort, thirst, and dehydration. We assessed the gastric contents and ARs after oral glucose water administration 1 h prior to surgery in children with cyanotic congenital heart disease (CCHD). Material/Methods This was a non-inferiority randomized controlled trial of children with CCHD enrolled at the Fujian Medical University Union Hospital from 09/2014 to 05/2017 and randomized to receive oral glucose water (10 g of glucose in 100 ml of warm water, 5 ml/kg) 2 h (2-h group, n=174) or 1 h (1-h group, n=170) before surgery. The primary endpoint was gastric volume. Secondary endpoints included pH of gastric content, preoperative blood glucose, and risk factors for aspiration pneumonia. Pre- and intraoperative ARs were recorded. Results The 1-h group showed smaller gastric content volumes (0.34±0.35 (95% CI: 0.29–0.39) vs. 0.43±0.33 (95% CI: 0.38–0.48) ml/kg, t=2.55, P

Markers of prothrombotic state and inflammation are associated with the prognosis of patients with acute type A aortic dissection (AAAD). However, it is unclear that the relationship between these biomarkers and their combined impact on risk stratification. The present study evaluated the prognostic value of platelet counts, lymphocyte to neutrophil ratio (LNR), and lymphocyte to monocyte ratio (LMR), alone and in combination. A retrospective analysis of clinical data of 744 AAAD patients was conducted to identify whether these biomarkers were related to the 30-day mortality risk. A Kaplan-Meier analysis and log-rank test were used to compare survival between groups. A Cox hazard regression multivariable analysis was performed for 30-day mortality. Individual biomarker (platelet count, LNR, or LMR) was unable to predict 30-day mortality. However, combinations of all three biomarkers provided additive predictive value over either marker alone, the receiver operating characteristic (ROC) model had a prediction probability of 0.739 when platelet counts, LNR, and LMR were included. Cox hazard regression multivariable analysis showed that combinations of all three biomarkers were the strongest predictor of 30-day mortality (p<0.021). Combined with these three easily measurable biomarkers at admission, they could help identify AAAD patients with a high risk of 30-day mortality.

Since mechanical ventilation after cardiac surgery increases the risk of ventilator-associated pneumonia (VAP), we conducted a prospective randomized controlled trial to investigate the effect of preoperative 0.2% chlorhexidine on postoperative VAP. Ninety-four patients scheduled for heart surgery were randomized to a chlorhexidine group (N = 47) or control (saline) group (N = 47). On the day before surgery, patients gargled three times with 0.2% chlorhexidine or saline 30 min after each meal and 5 min after teeth brushing at bedtime. VAP occurred in 8.5% of the chlorhexidine group and in 23.4% of the controls. Preoperative chlorhexidine mouthwash reduced the incidence of postoperative VAP significantly.