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Effect of Perioperative Glucose-Insulin-Potassium Therapy in Patients Undergoing On-Pump Cardiac Surgery: A Meta-Analysis.
Li, Q, Yang, J, Zhang, J, Yang, C, Fan, Z, Yang, Y, Zheng, T, Yang, J
The heart surgery forum. 2020;(1):E063-E069
Abstract
OBJECTIVE The role of glucose-insulin-potassium (GIK) infusion during cardiac surgery has held interest for so many years without a clear answer. The aim of this meta-analysis was to evaluate the effect of GIK therapy on outcomes in patients undergoing on-pump cardiac surgery. METHODS A comprehensive online review was performed in The Web of Science, Embase, Medline, PubMed, and The Cochrane Library databases from 2000 to 2019. Eligible studies included randomized controlled trials (RCTs) that compared GIK treatment with placebo or standard care during on-pump cardiac surgery. Risk ratios (RR) were used for binary outcomes and mean difference (MD) was used for continuous variables; both with their 95% confidence intervals (CI). RESULTS A total of 18 RCTs involving 2,131 patients met the inclusion criteria. Compared with the control group, the GIK treatment significantly reduced in-hospital mortality (RR = 0.56, 95% CI: 0.32-0.97; P = .04), postoperative myocardial infarctions (MI) (RR = 0.71, 95% CI: 0.56-0.91; P = .006), the use of inotropic support (RR = 0.53, 95% CI: 0.45-0.63; P < .00001), and length of stay in the intensive care unit (ICU) (MD = -0.33, 95% CI: -0.52--0.14; P = .0007). Moreover, GIK treatment seemed to be associated with fewer postoperative atrial fibrillation (AF) (RR = 0.81, 95% CI: 0.64-1.03; P = .09). CONCLUSIONS In patients undergoing on-pump cardiac surgery, GIK infusion has a beneficial role in mortality during hospital stay and demonstrates superior efficacy versus standard care for reduction in postoperative MI, AF, ICU length of stay as well as inotropic agent requirements.
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Effect of Lifestyle Changes after Percutaneous Coronary Intervention on Revascularization.
Wang, Y, Xian, Y, Chen, T, Zhao, Y, Yang, J, Xu, B, Li, W
BioMed research international. 2020;:2479652
Abstract
OBJECTIVE Whether optimal cardiovascular health metrics may reduce the risk of cardiovascular events in secondary prevention is uncertain. The study was conducted to evaluate the influence of lifestyle changes on clinical outcomes among the subjects underwent percutaneous coronary intervention (PCI). METHODS The study group consists of 17,099 consecutive PCI patients. We recorded data on subject lifestyle behavior changes after their procedure. Patients were categorized as ideal, intermediate, or poor CV health according to a modified Life's Simple 7 score (on body mass, smoking, physical activity, diet, cholesterol, blood pressure, and glucose). Multivariable COX regression was used to evaluate the association between CV health and revascularization event. We also tested the impact of cumulative cardiovascular health score on reoccurrence of cardiovascular event. RESULTS During a 3-year median follow-up, 1,583 revascularization events were identified. The observed revascularization rate was 8.0%, 9.3%, and 10.6% in the group of patients with optimal (a modified Life's Simple 7 score of 11-14), average (score = 9 or 10), or inadequate (less or equal than 8) CV health, respectively. After multivariable analysis, the adjusted hazard ratios were 0.83 (95% CI: 0.73-0.94) and 0.89 (95% CI: 0.79-0.99) for patients with optimal and average lifestyle changes comparing with the inadequate tertile (P for trend = 0.003). In addition, each unit increase in above metrics was associated with a decrease risk of revascularization (HR, 0.96; 95% confidence interval, 0.93-0.98; P for trend = 0.003). In addition, each unit increase in above metrics was associated with a decrease risk of revascularization (HR, 0.96; 95% confidence interval, 0.93-0.98. CONCLUSION Ideal CV health related to lower incidence of cardiovascular events, even after the percutaneous coronary intervention. Revascularization can be reduced by lifestyle changes. The cardiovascular health metrics could be extrapolated to secondary prevention and need for further validation.
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[Early outcomes of elective surgery for colon cancer with preoperative mechanical bowel preparation: a randomized clinical trial].
Hu, YJ, Li, K, Li, L, Wang, XD, Yang, J, Feng, JH, Zhang, W, Liu, YW
Nan fang yi ke da xue xue bao = Journal of Southern Medical University. 2017;(1):13-17
Abstract
OBJECTIVE To compared the early outcomes of patients undergoing elective surgeries for colon cancer with and without preoperative mechanical bowel preparation. METHODS Between July, 2014 and February, 2016, patients undergoing elective surgery for colon cancer with primary anastomosis were randomly assigned into control group with mechanical bowel preparation 12 h before surgery and treatment group without mechanical bowel preparation. Baseline data collection was completed within 12 h after the operation. The levels of hemoglobin, total protein, albumin, prealbumin and albumin RESULTS Seventy-six patients were assigned in the treatment group and 72 in the control group. Significant differences were found in the incidence of wound infection and intra-abdominal infection (P<0.05) but not in that of anastomotic leakage or early postoperative bowel obstruction (P>0.05) between the two 2 groups. The first flatus time (P=0.03) and prealbumin level on the first postoperative day (P=0.03) differed significantly between the two groups, but the operation time was similar between them (P=0.06). CONCLUSION In patients undergoing elective surgeries for colon cancer, preoperative mechanical bowel preparation is associated with increased postoperative complications, delayed recovery of intestinal motility and poorer nutrition status early after the operation.
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The role of perioperative oral nutritional supplementation in elderly patients after hip surgery.
Liu, M, Yang, J, Yu, X, Huang, X, Vaidya, S, Huang, F, Xiang, Z
Clinical interventions in aging. 2015;:849-58
Abstract
BACKGROUND The effect of perioperative oral nutritional supplementation (ONS) on elderly patients after hip surgery remains controversial. This study intended to ascertain whether perioperative ONS is beneficial for the rehabilitation of elderly patients after hip surgery. MATERIALS AND METHODS We searched databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials for articles published up to May 2014. Randomized controlled trials of ONS for elderly patients after hip surgery were included. RESULTS The combined trials showed that ONS had a positive effect on the serum total protein (P<0.00001) and led to a significantly decreased number of complications (P=0.0005). Furthermore, data from the infection subgroups showed significant decreases in wound infection (P=0.02), respiratory infection (P=0.04), and urinary tract infection (P=0.03). Clinical observation suggests that the intervention may improve the level of serum albumin, although the data did not reach statistical significance (P=0.48). Regarding mortality, there was no significant statistical difference between the intervention group and the control (P=0.93). CONCLUSION Based on the evidence available, this meta-analysis is consistent with the hypothesis that perioperative ONS can help elderly patients recover after hip surgery and reduce complications.
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Preoperative Intra-abdominal Sepsis, Not Penetrating Behavior Itself, Is Associated With Worse Postoperative Outcome After Bowel Resection for Crohn Disease: A Retrospective Cohort Study.
Zhang, T, Yang, J, Ding, C, Li, Y, Gu, L, Wei, Y, Cao, L, Gong, J, Zhu, W, Li, N, et al
Medicine. 2015;(45):e1987
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Abstract
It is generally believed that penetrating behavior is associated with worse surgical outcomes in Crohn disease (CD). We hypothesized that intra-abdominal sepsis (IAS), but not penetrating behavior itself, contributes to postoperative morbidity in patients undergoing bowel resection for CD.Patients who underwent surgery from April 2010 to April 2014 were retrospectively identified from a prospectively maintained database. Demographic information and preoperative and operative data were collected. The outcomes following surgery in patients who had penetrating disease with or without IAS versus nonpenetrating CD were compared.Of 288 patients, 180 had penetrating CD, including 54 who had IAS. Preoperative characteristics were similar between the groups, except for serum albumin, abdominal drainage, and prior bowel resection. Patients with penetrating CD with IAS were more likely to have a stoma, surgical site complications, postoperative IAS complications, and major complications than patients with penetrating CD without IAS or nonpenetrating CD. There were no significant differences between patients with penetrating CD without IAS and nonpenetrating CD. The postoperative outcome was strengthened after propensity-score matching analysis. Moreover, penetrating CD with IAS (odds ratio [OR], 13.034; P = 0.004) is a risk predictor for major postoperative complications, and preoperative serum albumin (OR, 0.095; P = 0.002) and preoperative enteral nutrition (OR, 0.203, P = 0.049) are protective.Penetrating CD without IAS did not adversely affect postoperative outcome after bowel resection compared with penetrating CD with IAS. These results may revise the notion that all patients with penetrating CD have worse postoperative complications.
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Bone disease in post-transplant patients.
Jeon, HJ, Kim, H, Yang, J
Current opinion in endocrinology, diabetes, and obesity. 2015;(6):452-8
Abstract
PURPOSE OF REVIEW Mineral and bone disorders are common problems in organ transplant recipients. Successful transplantation solves many aspects of abnormal mineral and bone metabolism, but the degree of improvement is frequently incomplete. Posttransplant bone disease can affect long-term outcomes as well as increase the likelihood of fracture. In this article, we reviewed the major posttransplant bone diseases and recent advances in treatment strategies. RECENT FINDINGS Pretransplant bone disease and immunosuppressants are important risk factors for posttransplant bone disease. Corticosteroid withdrawal may result in minimal or no protection against fractures, with increased risk for acute rejection. Vitamin D analogue and bisphosphonate are frequently used to prevent and treat posttransplant osteoporosis. Posttransplant hyperparathyroidism increases the risk for all-cause mortality and graft loss, but not major cardiovascular events. Cinacalcet was well tolerated and effectively controlled hypercalcemic hyperparathyroidism; however, it did not improve bone mineral density and discontinuation led to parathyroid hormone rebound. Six-month paricalcitol supplementation reduced parathyroid hormone levels and attenuated bone remodeling and mineral loss in case of posttransplant hyperparathyroidism. SUMMARY Posttransplant bone diseases present in various forms, including osteoporosis, hyperparathyroidism, adynamic bone disease, and osteonecrosis. Prophylactic and therapeutic approaches to both pretransplant and posttransplant periods should be considered.