Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.

Changes in macular thickness following glaucoma surgery

Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assessed changes in macular thickness following such intervention.Our aim was to investigate the impact of intraocular pressure(IOP)reduction after glaucoma surgery on total macular thickness

Acute postoperatory visual loss following bilateral lung transplantation surgery:a case series

Dear Editor,I am Rosa Gutiérrez Bonet,former ophthalmology resident at Puerta de Hierro University Hospital,Madrid,Spain.I write to present four cases of cortical blindness（CB）after bilateral lung transplant（LT）.

Comparison of neoadjuvant chemotherapy followed by surgery vs.surgery alone for locally advanced gastric cancer:a meta-analysis

Background:The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer,but the effects on safety and survival are still controversial.The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery(NACS)and surgery alone(SA)for locally advanced gastric cancer.Methods:Databases(PubMed,Embase,Web of Science,Cochrane Library,and Google Scholar)were explored for relative studies from January 2000 to January 2021.The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale,respectively.The Review Manager software(version 5.3)was used to perform this meta-analysis.The overall survival was evaluated as the primary outcome,while perioperative indicators and post-operative complications were evaluated as the secondary outcomes.Results:Twenty studies,including 1420 NACS cases and 1942 SA cases,were enrolled.The results showed that there were no significant differences in overall survival(P=0.240),harvested lymph nodes(P=0.200),total complications(P=0.080),and 30-day post-operative mortality(P=0.490)between the NACS and SA groups.However,the NACS group was associated with a longer operation time(P<0.0001),a higher R0 resection rate(P=0.003),less reoperation(P=0.030),and less anastomotic leakage(P=0.007)compared with SA group.Conclusions:Compared with SA,NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage.While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.

Chemoradiotherapy followed by surgery could improve the efficacy of treatments in patients with resectable esophageal carcinoma

Background The effectiveness of chemoradiotherapy followed by surgery （CRTS） in patients with resectable esophageal carcinoma remains controversial.We performed a systematic review of the literature with meta-analysis.Methods Electronic databases were used to identify published studies between January 1992 and April 2012.Pooled relative risk （RR） with 95％ confidence interval （95％ CI） was utilized to estimate the strength of the association between CRTS and surgery alone （SA） survival of the resectable esophageal carcinoma patients.Heterogeneity and publication bias were also assessed in the present study.Results The final analysis of 2755 resectable esophageal carcinoma cases from 21 randomized controlled trials （RCTs） are presented.Compared to the SA group,the 1,3-and 5-year survival rates were significantly higher in the CRTS group （all P ＜0.05）; the 3-and 5-year survival rates for the Eastern patients,Western patients,patients undergoing concurrent chemoradiotherapy,patients with squamous cell carcinoma,patients undergoing High-dose radiotherapy （≥40 Gy）,and patients given either ＂cisplatin ＋ Fluorouracil＂ or ＂cisplatin ＋ paclitaxel＂ chemotherapy were significantly higher in the CRTS group （all P ＜0.05）.There were no statistical significances in the 3-and 5-year survival rates for patients undergoing sequential chemoradiotherapy or patients with adenocarcinoma between the two groups （all P ＞0.05）.Compared to the RCTS group,the surgery rate in the SA group was higher （P ＜0.05）,while the CRTS group had significantly higher radical resection rate,R0 resection rate and lower postoperative local recurrence rate （all P ＜0.05）.The differences in postoperative complication incidence,post-operative distant metastasis and postoperative mortality rate were not statistically significant between the two groups （all P ＞0.05）.Conclusion CRTS can significantly improve the survival and surgical conditions of patients with resectable esophageal carcinoma.