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.

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.

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 < .001), hypoxemia (AHR = 1.846, 95% CI: 1.118-3.048, 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 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 <0.05) and higher blood glucose (6.21±0.78 (95% CI: 6.09–6.33) vs. 5.59±1.11 (95% CI: 5.43–5.76) mmol/L, t =−5.91, P <0.001). The 95% confidence interval of the volume difference between the 2 groups was 0.017–0.163, the upper limit value was 0.163 <δ=0.2 ( P <0.01). The non-inferiority hypothesis was correct. The 1-h group showed lower incidence of crying, thirst and hypoxia (all P <0.05 vs. 2-h group). There were no differences in ARs between the 2 groups. Conclusions A 1-h fast prior to surgery was not inferior to a 2-h fast in terms of gastric residuals and ARs in pediatric patients with CCHD. Clinical trial registration: http://www.chictr.org.cn/showprojen.aspx?proj=9563 Registration number: ChiCTR-IPR-14005270

Background Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients. Methods We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess. Results A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in body mass index, history of cardiac surgery, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay(P < 0.05). The delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) of the standard deviation of blood glucose was 1.436(P < 0.05). In Model 2, the standard deviation of blood glucose (AHR = 1.418, 95%CI = 1.195–1.681, P < 0.05) remained significant after adjusting for confounders. The area under the curve of the SDBG was 0.763(95%CI = 0.704–0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%. Conclusions Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.

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Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms.Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy.Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes’s PROCESS macro, based on the bootstrapping method.Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = −0.36, 95% CI: (−0.50, −0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β= 0.36, 95% CI: (0.23, 0.50)].Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.