黄凌晨
中国医学科学院阜外医院 血管外科
BACKGROUND:The association between homeostatic model assessment (HOMA2-IR) and mortality in obese and non-obese populations has not been clearly explained.METHODS:A total of 7,085 individuals aged ≥ 20 years from the 1999-2006 National Health and Nutrition Examination Survey were included in the study. Study endpoints were all-cause and cardiovascular mortality. Multivariate Cox proportional hazards regression models with restricted cubic spline analysis were used for analysis.RESULTS:In the study populations, a total of 1666 all-cause deaths and 555 cardiovascular (CV) deaths were recorded during a mean follow-up of 195.53 months. Notably, a significant difference in obesity was observed in the association between HOMA2-IR and mortality. After adjustment for multiple variables, HOMA2-IR was positively associated with all-cause mortality in all participants, in those with normal BMI, and in those with obesity. Conversely, tertile 2 of HOMA2-IR was associated with a lower risk of all-cause mortality in participants with obesity compared with tertile 1 (adjusted hazard ratio, 0.68; 95% confidence interval, 0.52-0.89; P = 0.005). Results from restricted cubic spline analysis showed a J-shaped association between HOMA2-IR and all-cause and CV mortality. In addition, a nonlinear U-shaped correlation with all-cause (P for nonlinear < 0.001) and CV (P for nonlinear = 0.002) mortality was observed in the population with obesity, with inflection points of HOMA2-IR identified at 1.85 and 1.75. Below the inflection point of 1.85, a negative relationship between HOMA2-IR and all-cause mortality was observed.CONCLUSIONS:Elevated HOMA2-IR showed a notable correlation with increased risk of all-cause mortality. It was noteworthy that excessively reduced levels of insulin resistance showed a distinct association with increased mortality in individuals with obesity.
BMC public health 2024
Background:This study was designed to evaluate the clinical outcomes of our modified cuff wrapping Bentall (M-Bentall) procedure, which uses a cuff wrapping technique with remnant aortic root tissue.Methods:From July 2017 to December 2021, a total of 136 patients met the inclusion criteria for this study. Among them, patients who underwent the modified Bentall procedure using the cuff wrapping technique were included in the M-Bentall group (n=46), while patients who underwent the classic Bentall (C-Bentall) procedure were categorized into the C-Bentall group (n=90). To reduce baseline differences between the two groups, 1:1 nearest-neighbor propensity score matching (PSM) was performed. Demographic and perioperative data were documented and compared between the two groups.Results:Ninety patients were successfully matched (45 pairs). In-hospital mortality was not significantly different between the two groups after PSM (P=1). No differences were found in serious adverse events. The cardiopulmonary bypass (CPB) time was longer in the M-Bentall group than in the C-Bentall group (154 vs. 126 min, P=0.018). The same was also observed for the aortic cross-clamp time (113 vs. 92 min, P=0.009). Postoperatively, the peak value of D-dimer showed a significant difference, with higher values in the C-Bentall group (4.73 vs. 2.89 mg/L, P=0.019). The incidence of postoperative contrast extravasation at the aortic root (P=0.030) was higher in the C-Bentall group. The incidence of persistent aortic-right atrial shunts showed an increased tendency in the C-Bentall group (8.89% vs. 0%, P=0.117).Conclusions:The cuff wrapping technique is a safe and effective method to facilitate hemostasis of the aortic root in the modified Bentall procedure.
Journal of thoracic disease 2023
