Incidence, Risk Factors and Outcomes of Postoperative Headache After Stanford Type a Acute Aortic Dissection Surgery

Risk assessment and disease burden of extreme precipitation on hospitalizations for acute aortic dissection in a subtropical coastal Chinese city

Background

Extreme precipitation events are becoming more frequent due to climate change. The present study aimed to explore the impacts of extreme precipitation on hospitalizations for acute aortic dissection (AAD) and to identify susceptible populations and quantify the corresponding disease burden.

Methods

The present study used a distributed lag nonlinear model (DLNM) with a quasi-Poisson function to investigate the association between extreme precipitation (≥95th percentile) and the risk of hospitalizations for AAD from 2015 to 2020 in Shantou, Guangdong Province, China.

Results

The significant adverse effects of extreme precipitation (relative to no precipitation) on daily AAD hospitalizations lasted from lag 5 [relative risk (RR): 1.0318, 95% confidence interval (CI): 1.0067-1.0575] to lag 9 (RR: 1.0297, 95% CI: 1.0045-1.0555) and reached its maximum at lag 7 (RR: 1.0382, 95% CI: 1.0105-1.0665). Males and older adult individuals (≥60 years) were more susceptible to extreme precipitation. A total of 3.68% (118 cases) of AAD hospitalizations were due to extreme precipitation.

Conclusion

Extreme precipitation was significantly correlated with AAD hospitalizations. Government departments should actively implement extreme precipitation intervention measures to strengthen the protection of males and the older adult (≥60 years) and effectively reduce AAD hospitalizations.

AdipoRon Inhibits Neuroinflammation Induced by Deep Hypothermic Circulatory Arrest Involving the AMPK/NF-κB Pathway in Rats

Deep hypothermic circulatory arrest (DHCA) can induce systemic inflammatory response syndrome, including neuroinflammation. Finding suitable compounds is necessary for attenuating neuroinflammation and avoiding cerebral complications following DHCA. In the present study, we established DHCA rat models and monitored the vital signs during the surgical process. After surgery, we found significantly increased proinflammatory cytokines (IL-6, IL-1β, and TNF-α) in DHCA rats. Quantitative proteomics analysis was performed for exploring the differentially expressed proteins in hippocampus of DHCA rats and the data showed the adiponectin receptor 1 protein was upregulated. More importantly, administration of AdipoRon, a small-molecule adiponectin receptor agonist, could improve the basic vital signs and attenuate the increased IL-6, IL-1β, and TNF-α in DHCA rats. Furthermore, AdipoRon inhibits the activation of microglia (M1 state) and promotes their transition to an anti-inflammatory state, via promoting the phosphorylation of adenosine monophosphate-activated protein kinase (AMPK), and downregulating nuclear factor kappa B (NF-κB) in DHCA rats. Consistently, we used LPS-treated BV2 cells to mimic the neuroinflammatory condition and found that AdipoRon dose-dependently decreased cytokines, along with increased phosphorylation of AMPK and downregulated NF-κB. In conclusion, our present data supported that AdipoRon inhibited DHCA-induced neuroinflammation via activating the hippocampal AMPK/NF-κB pathway.

Incidence, Risk Factors, and Outcomes of Severe Hypoxemia After Cardiac Surgery

Background

Hypoxemia is common in patients undergoing cardiac surgery, however, few studies about severe hypoxemia (SH) after cardiac surgery exist. The objectives of this study were to clarify the incidence, risk factors, and outcomes of SH after cardiac surgery.

Methods

Patients undergoing cardiac surgery from 2016 to 2019 in a single center were enrolled and were divided into two groups based on whether postoperative SH developed. Independent risk factors for SH were identified by univariate and multivariate analysis. Model selection statistics were applied to help determine the most parsimonious final model.

Results

Severe hypoxemia developed in 222 of the 5,323 included patients (4.2%), was associated with poorer clinical outcomes. Six independent risk factors for SH after cardiac surgery were identified by multivariate analysis, such as surgical types, white blood cell (WBC) count, body mass index (BMI), serum albumin, cardiopulmonary bypass (CPB) time, and intraoperative transfusion of red blood cells (RBCs). After comprehensively considering the discrimination, calibration, and simplicity, the most appropriate and parsimonious model was finally established using four predictors, such as WBC count, BMI, CPB time, and intraoperative transfusion of RBCs. A nomogram and a web-based risk calculator based on the final model were constructed to facilitate clinical practice. Patients were stratified into three risk groups based on the nomogram and clinical practice.

Conclusion

Severe hypoxemia was common after cardiac surgery and was associated with poorer clinical outcomes. A parsimonious final model with good discrimination, calibration, and clinical utility was constructed, which may be helpful for personalized risk assessment and targeted intervention.