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Abstract Aims Left ventricular assist device (LVAD) implantation, a therapy for end‐stage heart failure, is associated with platelet (PLT) activation. This study aims to evaluate the prognostic impact of PLT count in patients with LVAD implantation. Methods and Results Data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry were investigated, and patients were divided into three groups according to tertiles. The dynamic change of PLT counts and its associations with long‐term outcomes were analysed. The primary outcome was long‐term mortality. A total of 19 517 patients who received the first continuous‐flow LVAD were identified from the INTERMACS registry. The PLT count underwent a dynamic change towards normalization after LVAD implantation. Compared with intermediate, both high (hazard ratio [HR], 1.09, 95% confidence interval [CI]: 1.01 to 1.17, P = 0.033) and low (HR, 1.18, 95% CI: 1.10 to 1.27, P

Background: Evidence regarding the association between malnutrition risk and the prognosis of geriatric heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation is lacking. Our study aims to investigate how malnutrition risk, assessed using the geriatric nutritional risk index (GNRI) values, relates to the outcomes of geriatric HF patients undergoing LVAD, using data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry. Methods: A retrospective analysis was conducted using data from INTERMACS registry. Patients aged 65 and above who received LVAD implantation between 2008 and 2017 were included. The GNRI was used to stratify patients into three groups: absence of risk (GNRI > 98), mild risk (GNRI 92–98), and moderate to severe risk (GNRI

Different clinical medicine programs exist in China, which are mainly the 3-year junior college medical program, the 5-year medical bachelor’s degree program, the 5 + 3 medical master’s degree program, and the 8-year medical doctoral degree program. Medical graduates obtain different degrees from various medical programs, leading to inequality and polarization of the cultivation. The extended length of schooling discourages talented students from pursuing clinical medicine. The current situation has worsened due to the mismatch between clinical competence and promotion, as well as insufficient remuneration. The most critical reform measure is to establish separate degree systems for scientific research skill training and clinical training, which helps clarify the boundaries between these two. Students who receive academic postgraduate education obtain academic degrees, such as the master of medical science and doctor of philosophy; students who take part in the national standardized resident training, specialist training, or general practitioner training obtain professional degrees, such as master of medicine and doctor of medicine. It is imperative to consider shortening the duration of medical education, with an ideal limit of eight years on average. Optimizing the way to promotion and raising the expenditure of remuneration are also crucial. The reform of medical education system in China still has a long way to go and requires gradual adjustment and optimization.

Abstract Aims Current guidelines suggest calcium channel blockers (CCBs) as the second or third option for blood pressure management in patients with left ventricular assist device (LVAD). However, the clinical outcomes of patients with LVAD who receive CCBs remain unclear. Our study aims to analyse the association of CCBs with clinical outcomes in patients after LVAD implantation. Methods and results This is a retrospective analysis based on the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2006 to 2017, and adult patients who were alive with LVAD and CCB treatment information at 6 months after implantation were included. Among 10 717 patients, 1369 received CCBs 6 months after implantation, and there was an increasing trend of CCB use after LVAD. Patients receiving CCB therapy at 6 months had a similar 5 year survival rate to those not receiving CCB [49.6%, 95% confidence interval (CI): 47.5–51.7% vs. 51.1%, 95% CI: 45.3–56.7%]. In both Cox and competing risk regressions after adjusting for confounding factors, CCB treatment at 6 months after implantation was not associated with long‐term mortality [hazard ratio (HR): 1.03, 95% CI: 0.91–1.17, P = 0.624 and subdistribution HR (SHR): 1.07, 95% CI: 0.95–1.22, P = 0.260]. Consistently, in time‐varying models, CCB treatment was not linked to long‐term mortality (HR: 0.97, 95% CI: 0.87–1.09, P = 0.682 and SHR: 1.05, 95% CI: 0.94–1.18, P = 0.359). This null association remained in subgroup analysis according to device strategy and propensity‐matching analyses. Neurological dysfunction, stroke, bleeding, rehospitalization, and renal dysfunction were more likely to occur among those with CCB when compared with those without CCB treatment. Conclusions In patients with LVAD, CCB therapy fails to show benefits in long‐term survival and is associated with increased incidences of neurological dysfunction, bleeding, renal dysfunction, and rehospitalization.

Abstract Background Pediatric cardiac transplantation remains a surgical challenge as a variety of cardiac and vessel malformation are present in patients with congenital heart disease (CHD). Despite limited availability and acceptability of donor hearts, the number of heart transplantations remains on a stable level with improved survival and quality of life. Observation As treatment options for CHD continue to improve and the chances of survival increase, more adult CHD patients are listed for transplantation. This review focuses on the clinical challenges and modified techniques of pediatric heart transplantations. Conclusion Not only knowledge of the exact anatomy, but above all careful planning, interdisciplinary cooperation and surgical experience are prerequisites for surgical success.

PurposeThe advanced lung cancer inflammation index (ALI) is a novel inflammatory and nutritional index that exerts prognostic value in various types of cancer. A previous study demonstrated that ALI at discharge could predict the prognosis in patients with acute decompensated heart failure (ADHF). However, the long-term prognostic value of ALI on admission in elderly heart failure (HF) inpatients remains unclear.Materials and methodsWe retrospectively collected HF inpatients over 65-year-old who were hospitalized in our cardiology center during the whole year of 2015. ALI was calculated as body mass index (BMI) × serum albumin (Alb)/neutrophil-to-lymphocyte ratio (NLR). Patients were divided into two groups by the optimal cutoff value of ALI for predicting all-cause mortality using time-dependent receiver operating characteristic (ROC) curves. The Spearman rank correlation coefficient was computed to evaluate the correlation between ALI and the geriatric nutritional risk index (GNRI). Kaplan–Meier curves, Cox survival analyses, time-dependent ROC analyses, and net reclassification improvement (NRI) analyses were used to assess the prognostic effect of ALI on all-cause mortality and cardiovascular mortality.ResultsOver a 28-month median follow-up, all-cause and cardiovascular mortality occurred in 192 (35.4%) and 132 (24.3%) out of 543 patients, respectively. The optimal cutoff value of ALI for predicting all-cause mortality at 2 years was 25.8. Spearman’s correlation coefficient showed a moderate positive linear correlation between ALI and GNRI (r = 0.44, p < 0.001). The Kaplan–Meier analysis revealed that the cumulative incidences of both all-cause and cardiovascular mortalities were significantly higher in patients with lower ALI (log-rank test, all-cause mortality: p < 0.0001; cardiovascular mortality: p < 0.0001). The multivariate Cox proportional hazard analyses indicated that ALI was an independent predictor for both all-cause mortality (HR 0.550, 95% CI 0.349–0.867, p = 0.01) and cardiovascular mortality (HR 0.536, 95% CI 0.302–0.953, p = 0.034). Time-dependent ROC analyses showed that ALI was comparable to GNRI in predicting long-term all-cause mortality (AUC: ALI 0.625, GNRI 0.641, p = 0.976) and cardiovascular mortality (AUC: ALI 0.632, GNRI 0.626, p = 0.999) at 2 years. However, the estimated NRI indicated that the addition of ALI could not significantly improve risk stratification of base models for all-cause mortality (categorical NRI 4.9%, p = 0.433, continuous NRI 25%, p = 0.022) or cardiovascular mortality (categorical NRI 6.5%, p = 0.223, continuous NRI 27.5%, p = 0.029).ConclusionHigher ALI was significantly associated with lower all-cause and cardiovascular mortalities in elderly HF patients. ALI on admission could be a competent nutrition-inflammation marker with independent predictive value for evaluating the long-term mortality of HF in elder population.

Abstract Background This study aims to quantitatively summary the characteristics of synchronous multiple primary lung cancer (sMPLC), postoperative mortality, long‐term prognosis, and prognostic effects of potential clinical parameters in patients with sMPLC after surgery. Methods PubMed and Embase databases were systematically searched to identify studies that explored the prognosis of patients with sMPLC after surgery. Results Fifty‐two studies with 3486 participants were included, and clinical characteristics were quantitatively summarized. The pooled proportion of sMPLC in lung cancer was 2.0% (95%CI, 1.6%–2.5%) with an increasing trend over time, and postoperative mortality was 1.4% (95%CI, 0.5%–2.7%) with a decreasing trend over time. The 5‐year survival rate was 44.9% (95%CI, 37.4%–52.6%) and all long‐term survival rates showed increasing trends over time. Poor long‐term prognosis was observed in both limited resection (HR = 1.357, 95%CI, 1.047–1.759, p = 0.0210) and pneumonectomy (HR = 2.643, 95%CI, 1.539–4.541, p = 0.0004) by comparison of anatomical resection. Other clinical parameters of age, gender, smoking status, FEV1, and lymph node metastasis significantly impacted the long‐term prognosis (all p

Abstract Background Open stented elephant trunk (SET) or SET with left subclavian artery (LSCA) to left common carotid artery (LCCA) bypass is proven to a potentially alternative treatment for complicated Stanford type B aortic dissection (TBAD). In the current study, we reported our experience with ten consecutive TBAD patients who underwent open SET. Methods Patients with complicated TBAD underwent open SET from May 2016 to November 2018 in our institution were included. Patients’ clinical data were obtained from the electronic medical record system, and long-term clinical outcomes were collected by telephone interviews or outpatient interviews. Results A total of ten patients with nine males and one female were included, and the average age was 47.3 (31–65) years. Increased D-dimer and fibrinogen degradation products were observed in all patients at admission, and two patients had renal insufficiency. The average postoperative mechanical ventilation time, length of stay in intensive care unit, and postoperative hospital length of stay were 46.9 (6.7–151.2) hours, 7.7 (4–17) days, and 15.7 (10–26) days. No postoperative death occurred. Acute kidney injury and other complications were observed, and they were recovered well when discharge. In long-term follow-up, computed tomography angiography indicated that aortas were completely well remodeled, and blood supply of the brachiocephalic trunks was normal without anastomotic complications. All patients lived well. Conclusion SET or SET with subclavian artery correction shows satisfactory clinical outcomes, and it could be considered as an alternative treatment. Well-designed, large-scale studies with long-term follow-up are still needed.

BackgroundAccumulating researches show potential advantages of video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach, and this meta-analysis aims to investigate the efficacy and safety of the subxiphoid approach for anterior mediastinal surgery.MethodsRelevant studies were retrieved by searching Embase and PubMed databases (from the inception to October 1, 2021). Primary outcomes included postoperative pain, intraoperative blood loss, operation time, chest tube duration, and hospital length of stay. All meta-analyses were performed by using random-effects models.ResultsOverall, 14 studies with 1,279 patients were included, with 504 patients undergoing anterior mediastinal surgery via subxiphoid approach and 775 via other approaches. The pooled results indicated that the subxiphoid approach was associated with reduced postoperative pain indicated by visual analog scale [weight mean difference (WMD): 24 h: −2.27, 95% CI, −2.88 to −1.65, p