Frailty has been considered to be associated with major mortality and increased length of stay after cardiac surgery. This study aimed to explore the predictive potential of frailty assessment in the prognosis of elderly patients undergoing bypass surgery.
This study assessed the preoperative frailty according to the Fried\'s frailty phenotype, and included 150 frail and 150 non-frail elderly patients (≥ 65 y) who underwent bypass surgery. The present study evaluated the prognosis of elderly patients based on sequential organ failure assessment (SOFA) score, and collected clinical indicators to construct logistic regression models with the prognosis as the dependent variable, to explore the potential predictive ability of preoperative frailty. Moreover, this study focused on the complications and analyzed the relationship between preoperative frailty and postoperative complications.
In the present study, 244 patients were divided into the favorable prognosis group and 56 patients were divided into the unfavorable prognosis group. Logistic regression analysis showed that increased myoglobin and high cardiac function classification were independent risk factors for unfavorable prognosis in elderly patients undergoing bypass surgery. The discrimination of the clinical prediction model was determined by the receiver operating characteristic (ROC) curve, and the area under curve (AUC) was 0.928. After adding preoperative frailty assessment, the AUC was improved to 0.939. This study found a significant correlation between preoperative frailty and postoperative complications, mainly in the circulatory system.
Preoperative frailty assessment could be a predictive factor for the prognosis of elderly patients undergoing coronary artery bypass grafting. According to our study, frailty assessment and appropriate intervention before bypass surgery may be beneficial to the enhanced recovery after cardiac surgery.
The clinical study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (2021-SR-393). All patients signed an informed consent form.

UNASSIGNED: Non-occlusive mesenteric ischemia (NOMI) is a fatal condition with a low survival rate in most cases. The risk factors for perioperative mortality in NOMI cases are unclear. The purpose of this study was to define the risk factors for mortality in patients with NOMI undergoing surgery.
UNASSIGNED: Thirty-eight consecutive patients who underwent surgery for NOMI at Teine Keijinkai Hospital between 2012 and 2020 were included in the study. Patient information, including age, sex, physical findings, comorbidities, laboratory data, and computed tomography and surgical findings were retrospectively analyzed.
UNASSIGNED: Of the 38 patients, 18 (47%) died before discharge. Significant univariate predictors of mortality were a high Sequential Organ Failure Assessment (SOFA) score, high lactate level, low blood pH, and short intestinal length after surgery. In the multivariate analysis, a high SOFA score (odds ratio 1.33, P = 0.036) and short intestine length after surgery (odds ratio 34.7, P = 0.003) were identified as independent risk factors for perioperative mortality.
UNASSIGNED: The preoperative SOFA score and postoperative residual intestinal length may be predictors of death in NOMI surgical patients, not age and the content of comorbidities.

UNASSIGNED: Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome virus, which has affected billions of people across the globe. The pathogenesis of respiratory inflammation involves elevated concentration of interleukin-6; hence, interventions targeting interleukin-6 receptor, such as tocilizumab (TCZ), have been investigated as potential treatment amidst the dilemma of COVID-19 management. The aim of the study is to analyse the efficacy and safety of TCZ and record the outcome in COVID-19 patients.
UNASSIGNED: A retrospective case-control study of 80 patients in each group (N = 160) was carried out in a tertiary care hospital in Vadodara, Gujarat. Non-pregnant COVID-19-positive patients above 12 years of age were included in the study and were divided into case (those given TCZ) and control (those given standard treatment) groups after collecting their history and related data. From each group, further data was collected in the form of general and systemic examination, investigations and calculation of inflammatory and Sequential Organ Failure Assessment (SOFA) scores.
UNASSIGNED: Overall mortality was less in the case group compared to the control group. Patients with moderate to severe disease, age <55 years, patients having no comorbidity and patients with higher oxygen demand had lower deaths when given TCZ. Inflammatory score <3 and SOFA score <6 were associated with reduced mortality in the case group. Additionally, the study found significant results by simultaneously analysing two parameters in combination, which has not been done in any other study to the best of our knowledge.
UNASSIGNED: Adjuvant TCZ therapy had overall mortality benefit compared to standard treatment, with specific benefit observed in those with increasing disease severity, young to middle-age group, absence of comorbidity, higher oxygen requirements and lower inflammatory and SOFA scores.

OBJECTIVE: To identify factors associated with high-flow nasal cannula (HFNC) therapy failure in patients with severe COVID-19.
METHODS: We retrospectively examined clinical and laboratory data upon admission, treatments, and outcomes of patients with severe COVID-19. Sequential Organ Failure Assessment (SOFA) scores were also calculated.
RESULTS: Of 54 patients with severe COVID-19, HFNC therapy was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC therapy failure was more common in patients aged ≥60 years and in men. Compared with patients with successful HFNC therapy, patients with HFNC therapy failure had higher percentages of fatigue, anorexia, and cardiovascular disease; a longer time from symptom onset to diagnosis; higher SOFA scores; a higher body temperature, respiratory rate, and heart rate; more complications, including acute respiratory distress syndrome, septic shock, myocardial damage, and acute kidney injury; a higher C-reactive protein concentration, neutrophil count, and prothrombin time; and a lower arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2). However, male sex, a low PaO2/FiO2, and a high SOFA score were the only independent factors significantly associated with HFNC therapy failure.
CONCLUSIONS: Male sex, a low PaO2/FiO2, and a high SOFA score were independently associated with HFNC therapy failure in patients with severe COVID-19.