ObjectiveTo investigate the changes of fibrinogen and classical markers of collagen metabolism [carboxy-terminal propeptide of type Ⅰ procollagen (PICP) and carboxy-terminal cross-linked peptide of type Ⅰ collagen (ICTP)] in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and/or heart valve replacement (VR), and to evaluate their relationship with postoperative atrial fibrillation (POAF) after cardiac surgery. MethodsPatients who underwent CABG and/or VR in the Heart Center of Beijing Chao-Yang Hospital from March to June 2021 were included. Peripheral blood and pericardial drainage fluid samples were collected before surgery and at 0 h, 6 h, 24 h and 48 h after surgery to detect PICP, ICTP and fibrinogen levels, and preoperative, intraoperative and postoperative confounding factors were also collected. PICP, ICTP and fibrinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). ResultsA total of 26 patients with 125 blood samples and 78 drainage samples were collected. There were 18 males and 8 females with an average age of 64.04±7.27 years. The incidence rate of POAF was 34.6%. Among the factors, the fibrinogen level in pericardial drainage showed two peaks within 48 h after operation (0 hand 24 h after operation) in the POAF group, while it showed a continuous downward trend in the sinus rhythm (SR) group, and the change trend of fibrinogen in pericardial drainage was significantly different over time between the two groups (P=0.022). Fibrinogen in blood, PICP and ICTP in blood and drainage showed an overall decreasing trend, and their trends over time were not significantly different between the two groups of patients (P>0.05). Univariate analysis showed that fibrinogen at 24 h and 48 h after pericardial drainage, fibrinogen in preoperative blood, PICP immediately after surgery and right atrial long axis diameter were significantly higher or longer in the POAF group than those in the SR group. Multiple regression showed that fibrinogen≥11.47 ng/mL in pericardial drainage 24 h after surgery (OR=14.911, 95%CI 1.371-162.122, P=0.026), right atrial long axis diameter≥46 mm (OR=10.801, 95%CI 1.011-115.391, P=0.049) were independent predictors of POAF. ConclusionThis study finds the regularity of changes in fibrinogen and collagen metabolic markers after CABG and/or VR surgery, and to find that fibrinogen in pericardial drainage 24 h after surgery is a potential novel and predictive factor for POAF. The results provide a new idea for exploring the mechanism of POAF, and provide a research basis for the accurate prediction and prevention of clinical POAF.
Objective To investigate the relationship between miR-3187-5p in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and postoperative atrial fibrillation (POAF). Methods Patients who underwent CABG in the Heart Center of Beijing Chao-Yang Hospital from March to May 2022 were enrolled. Peripheral blood and pericardial drainage were collected at 0 h after surgery (immediate time for patients to return to ICU from operating room) to detect miR-3187-5p, and perioperative confounding factors were also collected. The miR-3187-5p was measured by quantitative real-time PCR and its regulated target genes were analyzed by bioinformatics. Results A total of 15 patients were enrolled, including 9 males and 6 females with an average age of 65.6±8.2 years. The incidence rate of POAF was 40.0%. miR-3187-5p in pericardial drainage at 0 h after surgery was an independent predictor for POAF. A total of 1 642 target genes of miR-3187-5p were predicted. GO function enrichment analysis and KEGG signal pathway enrichment analysis showed that target genes of miR-3187-5p were enriched in TGF-β, MAPK, Wnt and other classical collagen metabolic signal pathways, which might activate collagen metabolism by negatively regulating SMAD6 and other inhibitors of the pathways. Conclusion This study is the first to find that miR-3187-5p in pericardial drainage at 0 h after surgery is a potential, novel, and predictive factor for POAF, which may be related to the regulation of myocardial fibrosis signal pathways like TGF-β, MAPK and Wnt pathways, promoting the early collagen metabolism imbalance after CABG, increasing the collagen deposition in the atrium, and then promoting the early structural reconstruction after CABG and leading to the occurrence of POAF. The result provides a research basis for the accurate prediction and prevention of clinical POAF.
ObjectiveTo explore the predictive value of the pre-treatment systemic immune-inflammation index (SII) for major pathological response (MPR) after neoadjuvant immunochemotherapy (nICT) in esophageal cancer, and to construct a clinical prediction model combined with relevant clinical characteristics. Methods Retrospective collection of clinical data from patients with locally advanced esophageal cancer who received nICT followed by radical surgery at the First People's Hospital of Jining from January 2022 to June 2023. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of pre-treatment SII and neutrophil-lymphocyte ratio (NLR) for the efficacy of nICT in esophageal cancer. The optimal cut-off value was determined based on the maximum Youden index. Further, univariate and multivariate logistic regression analyses were employed to identify predictors for MPR after nICT in esophageal cancer and to construct a nomogram model. The model was evaluated using the area under the ROC curve (AUC), and internal validation was conducted using the Bootstrap method. ResultsA total of 63 patients were included, with 38 males and 25 females, and a median age of 67 (49-79) years. The ROC curve indicated that the optimal cut-off value for pre-treatment SII was 521.7, with an AUC of 0.701 [95%CI (0.564, 0.838)] for predicting MPR after nICT in esophageal cancer. The ROC curve showed that the optimal cut-off value for pre-treatment NLR was 2.32, with an AUC of 0.681 [95%CI (0.544, 0.818)]. Multivariate logistic regression analysis results revealed cT stage [OR=0.232, 95%CI (0.071, 0.759), P=0.016] and SII [OR=5.477, 95%CI (1.584, 18.939), P<0.001] as independent predictors for MPR after nICT in esophageal cancer. Based on the multivariate logistic regression results, a clinical prediction model was constructed, with an AUC of 0.789 on the ROC curve. The calibration plot showed a good agreement between the prediction curve and the ideal curve. ConclusionPre-treatment SII can serve as an independent predictive indicator for MPR in patients with esophageal cancer after nICT. The clinical model, established in combination with cT stage, can better predict the efficacy of nICT in esophageal cancer.