With the increase in the number of single-arm clinical trials and lack of head-to-head clinical studies, the application of unadjusted indirect comparisons and network meta-analysis methods has been limited. Matching-adjusted indirect comparison (MAIC) is an alternative method to fully utilize individual patient data from one study and balance potential bias caused by baseline characteristics differences in different trials through propensity score matching with aggregated data reported in other studies, and complete the comparison of the efficacy between target interventions. This study introduced the concept and principles of MAIC. In addition, we demonstrated how to use the anchored MAIC method based on R language for survival data, which has been widely used in anti-cancer drug evaluation. This study aimed to provide an alternative method to inform evidence-based decisions.
ObjectiveTo examine the safety, efficacy and durability of totally endoscopic minimally invasive mitral valve repair (TEMI) in Barlow’s disease (BD). MethodsA retrospective study was performed on patients who underwent mitral valve repair (MVP) for BD from January 2010 to June 2022 in the Guangdong Cardiovascular Institute. The patients were divided into a MS group and a TEMI group according to the surgery approaches. A comparison of the clinical data between the two groups was conducted. ResultsA total of 196 patients were enrolled, including 133 males and 63 females aged 43.8±14.9 years. There were 103 patients in the MS group and 93 patients in the TEMI group. No hospital death was observed. There was a higher percentage of artificial chordae implantation in the TEMI group compared to the MS group (P=0.020), but there was no statistical difference between the two groups in the other repair techniques (P>0.05). Although the total operation time between the two groups was not statistically different (P=0.265), the TEMI group had longer cardiopulmonary bypass time (P<0.001) and aortic clamp time (P<0.001), and shorter mechanical ventilation time (P=0.025) and postoperative hospitalization time (P<0.001). No statistical difference between the two groups in the adverse perioperative complications (P>0.05). The follow-up rate was 94.2% with a mean time of 0.2-12.4 (4.0±2.4) years. Two patients in the MS group died with non-cardiac reasons during the follow-up period. The 3-year, 5-year and 10-year survival rates of all patients were 99.2%, 99.2%, and 82.6%, respectively. Compared with the MS group, there was no statistical difference in the survival rate, recurrence rate of mitral regurgitation, reoperation rate of mitral valve or adverse cardiovascular and cerebrovascular events in the TEMI group (P＞0.05). ConclusionTEMI approach is a safe, feasible and effective approach for BD with a satisfying long-term efficacy.
According to the evidence pyramid model, systematic review (SR)/meta-analysis (MA) is one of the essential sources with a high level of clinical evidence. A high-quality SR/MA can effectively guide clinical decision-making and practice. The preferred reporting items for systematic reviews and meta-analyses extension for Chinese herbal medicines (PRISMA-CHM) were officially published in 2020. In this study, based on research cases, the features of PRISMA-CHM were interpreted in detail, so as to help domestic users accurately grasp the details of the reports, in order to improve the quality of the reports of SR/MA of traditional Chinese medicine.
Objective To investigate the relationship between two-lung ventilation (TLV) with single-lumen endotracheal tube (SLT), one-lung ventilation (OLV) with double-lumen endotracheal tube (DLT) and postoperative pulmonary complications (PPCs) after total thoracoscopic cardiac surgery. Methods The clinical data of patients who underwent totally thoracoscopic cardiac surgeries in the Guangdong Provincial People’s Hospital from October 2019 to October 2021 were retrospectively analyzed. The patients were divided into 2 group according to the type of endotracheal tube, including a SLT group and a DLT group. Baseline data, surgical variables and PPCs were compared. The influencing factors of PPCs in the two groups were analyzed by binary logistic regression analysis. Results Finally 349 patients were enrolled, including 180 males and 169 females with an average age of (50.0±14.8) years. There were 219 patients in the SLT group and 130 patients in the DLT group. There was no statistical difference in baseline data, surgical variables or PPCs between the two groups (P＞0.05). Binary logistic regression analysis showed that PPCs were related to body mass index in the SLT group (OR=0.778, 95%CI 0.637 to 0.951, P=0.014) and preoperative smoking history in the DLT group (OR=0.058, 95%CI 0.004 to 0.903, P=0.042). Conclusion For the patients who undergo totally thoracoscopic cardiac surgery, TLV with SLT and OLV with DLT show no significant association with PPCs. At the same time, PPCs are associated with body mass index in the SLT group, while associated with preoperative smoking history in the DLT group.
Objective To develop a novel transcatheter tricuspid valve replacement device and test its performance. MethodsThe transcatheter tricuspid valve stent consisted of double-layer self-expanding nitinol stent, biotissue-derived bovine pericardial leaflets, and PTFE woven. The delivery system, mainly consisting of a handle control unit and a delivery sheath, was sent to the correct position via right atrium or jugular vein. The sheath had a visualization feature, and the handle control unit could realize the functions of stable release and partial recovery of the interventional valve. In addition, this study performed animal survival experiments on the basis of in vitro experiments. A large-white pig was used as the experimental animal. Cardiopulmonary bypass was established through median thoracotomy, then the right atrium was opened, and the interventional valve was released under direct vision without cardiac arrest. Approximately 1 month after interventional valve implantation, the maneuverability and stability of the interventional tricuspid device were evaluated by autopsy. ResultsThrough the animal experiment, the interventional valve was successfully released, and the anchoring was satisfactory. Postoperative transthoracic echocardiography showed that the interventional valve opened and closed well, the flow rate of tricuspid valve was 0.6 m/s, and there was no obvious tricuspid regurgitation. One month after the operation, we dissected the large-white pig and found the interventional valve was not deformed or displaced, the leaflets were well aligned, and there was thrombus attachment in the groove between the inner and outer layers of the interventional valve. ConclusionAnimal experiment shows that the novel device can stably and firmly attach to the tricuspid annulus, with good anchoring effect, and effectively reduce paravalvular leakage.
Objective To investigate the early warning value of urinary selenium binding protein 1 (SBP1) in acute kidney injury (AKI) and its risk factor exposure, and compare it with urinary neutrophil gelatinase-associated lipocalin (NGAL). Methods Adult AKI inpatients and medical workers from the Department of Nephrology of the Second Affiliated Hospital of Xi’an Jiaotong University between April 2023 and April 2024 were selected. Patients who underwent percutaneous coronary intervention (PCI) in the Department of Cardiology of the Second Affiliated Hospital of Xi’an Jiaotong University were selected in June 2023. Patients who received cisplatin treatment in the Respiratory Department of the Second Affiliated Hospital of Xi’an Jiaotong University were selected in June 2023. Urinary SBP1 and NGAL levels of patients and medical workers were detected by enzyme-linked immunosorbent assay. Results A total of 14 medical workers and 36 AKI patients were included. Except for gender, alanine aminotransferase, aspartate aminotransferase, total cholesterol (P>0.05), there were statistically significant differences in other indicators between the medical workers and the AKI patients (P<0.05). The urine SBP1 [100.30 (71.50, 138.75) vs.75.60 (65.90, 80.08) pg/mL; U=2.918, P=0.004] and NGAL [423.70 (73.93, 839.80) vs. 14.80 (5.83, 29.98) ng/mL; U=4.668, P<0.001] levels in the AKI group were higher than those in the control group. But the area under the curve of receiver operative characteristic curve of urine SBP1 was smaller than that of urine NGAL (0.768 vs. 0.929). The urine SBP1 level in AKI patients was positively correlated with alanine aminotransferase, aspartate aminotransferase, serum creatinine, and serum glucose (P＜0.05), but negatively correlated with estimated glomerular filtration rate and total cholesterol (P＜0.05). A total of 14 patients who underwent PCI were included. The urinary SBP1/creatinine levels of PCI patients increased 6 hours after surgery compared to preoperative levels [(39.54 ± 8.00) vs. (19.34±2.90) pg/μmol; F=8.862, P=0.011]. The urea nitrogen level decreased 72 hours after surgery compared to preoperative levels (P=0.036), while there were no statistically significant differences in other indicators at other time points (P>0.05). There was no significant change in urinary NGAL levels before and after PCI treatment in patients. A total of 19 patients received cisplatin treatment were included. After cisplatin treatment, the level of urinary SBP1 increased compared to before treatment (P=0.024), while there was no significant change in the level of urinary NGAL after treatment compared to before treatment (P=0.350). After treatment, the levels of urea nitrogen (P=0.041) and cystatin C (P=0.002) increased compared to before surgery, while there was no statistically significant difference in blood creatinine and estimated glomerular filtration rate compared to before treatment (P>0.05). Conclusions Urinary SBP1 levels have certain diagnostic value for AKI, but the diagnostic efficacy is not as good as urinary NGAL. Urinary SBP1 is more sensitive to renal tubular injury caused by nephrotoxic drugs than urinary NGAL.