Elevated level of high-sensitivity cardiac troponin I as a predictor of adverse cardiovascular events in patients with heart failure with preserved ejection fraction / 中华医学杂志(英文版)

BACKGROUND@#The relationship between the elevation of cardiac troponin and the increase of mortality and hospitalization rate in patients with heart failure with reduced ejection fraction is clear. This study investigated the association between the extent of elevated levels of high-sensitivity cardiac troponin I (hs-cTnI) and the prognosis in heart failure with preserved ejection fraction patients.@*METHODS@#A retrospective cohort study consecutively enrolled 470 patients with heart failure with preserved ejection fraction from September 2014 to August 2017. According to the level of hs-cTnI, the patients were divided into the elevated level group (hs-cTnI >0.034 ng/mL in male and hs-cTnI >0.016 ng/mL in female) and the normal level group. All of the patients were followed up once every 6 months. Adverse cardiovascular events were cardiogenic death and heart failure hospitalization.@*RESULTS@#The mean follow-up period was 36.2 ± 7.9 months. Cardiogenic mortality (18.6% [26/140] vs. 1.5% [5/330], P <0.001) and heart failure (HF) hospitalization rate (74.3% [104/140] vs. 43.6% [144/330], P <0.001) were significantly higher in the elevated level group. The Cox regression analysis showed that the elevated level of hs-cTnI was a predictor of cardiogenic death (hazard ratio [HR]: 5.578, 95% confidence interval [CI]: 2.995-10.386, P <0.001) and HF hospitalization (HR: 3.254, 95% CI: 2.698-3.923, P <0.001). The receiver operating characteristic curve demonstrated that a sensitivity of 72.6% and specificity of 88.8% for correct prediction of adverse cardiovascular events when a level of hs-cTnI of 0.1305 ng/mL in male and a sensitivity of 70.6% and specificity of 90.2% when a level of hs-cTnI of 0.0755 ng/mL in female were used as the cut-off value.@*CONCLUSION@#Significant elevation of hs-cTnI (≥0.1305 ng/mL in male and ≥0.0755 ng/mL in female) is an effective indicator of the increased risk of cardiogenic death and HF hospitalization in heart failure with preserved ejection fraction patients.

Anterior tibial artery perforator flap for repairing distal foot damage with skin and soft tissue defects / 中华整形外科杂志

Objective@#To investigate the effect of repairing the skin and soft tissue defects of foot with the anterior tibial artery perforator flap.@*Methods@#Nine patients received the operation using the anterior tibial artery periosteal perforator flap to repair distal foot lesion with skin and soft tissue defects.There were six males and three females.All cases were the distal foot defects of skin and soft tissue with tendon and bone exposure, including traffic accident injury in 5 cases, crush injury in 3 cases, other causes of injury in 1 case. The defects ranged from 5 cm×3 cm to 9 cm×6 cm. The flaps ranged from 7 cm×5 cm—11 cm×8 cm. The donor sites were repaired with direct suture or full-thickness skin grafts.@*Results@#All the flaps were survived, without vascular crisis, congestion and blisters. 1 case had partial necrosis of flap margin, which was cured after dressing. All cases were followed up for 6 months to 34 months(mean 18 months). The appearance and function recovery of flaps were satisfactory.@*Conclusions@#It is an ideal flap donor site for repairing soft tissue defects of the distal foot with the anterior tibial artery perforator flap, which has the advantages of simple operation, less trauma, high skin flap survival rate and good appearance.

Treatment of acute volar plate avulsion fracture of proximal interphalangeal joint with double thread compression suture fixation / 中华骨科杂志

Objective To investigate the treatment and surgical results of acute volar plate avulsion fracture of proximal interphalangeal joint.Methods From August 2013 to June 2016,data of 15 cases of acute volar plate avulsion fracture of proximal interphalangeal joint were retrospectively analyzed.There were 8 males and 7 females aged 18-43 years old with an average of 28.6 years old.There were 4 cases of index finger,6 cases of middle finger,2 cases of ring finger and 3 cases of little finger.Eight injuries resulted from falls,four from finger breaking and three from crushing.The time from injury to operation was 5-9 days,with an average of 6.7 days.The acute volar plate avulsion fracture of proximal interphalangeal joint were treated by double thread compression suture fixation,and Kirschner wires were used to obliquely fix the interphalangeal joint.After the operation,the fore arm was fixed by plaster for 3-4 weeks.After the removal of the plaster,the flexion and extension function of the distal interphalangeal joint and the metacarpophalangeal joint was performed under the guidance of the rehabilitation instructor in a state of no weight.The finger was evaluated by X-ray every 2 weeks until the fracture healing.After 5-8 weeks,the Kirschner wire was removed when the fracture line disappeared,and the active flexion and extension of the proximal interphalangeal joint was guided by the rehabilitation instructor.Resuts In this group of 15 patients,all the incisions healed at the first stage.There was no surgical complications such as skin necrosis,and needle path infection and no abnormal finger feeling or blood circulation disorder.All patients were followed up for 8-32 months (mean,21.7 months).8 months after operation,the DASH score was 1.5 to 7.0 points with an average of 4.6 points.At the latest follow-up,there was no pain,swelling and joint contracture in the proximal interphalangeal joints.The dorsal extension of joints were stable,and the degree of active joint activity was:90°±7° of the metacarpophalangeal joint,80°±6° of the proximal interphalangeal joint,78°±7° of the distal interphalangeal joint,and 248°±22° of total active activity.According to TAM system assessment criteria:there was excellent in 12 cases,good in 2 cases,fair in 1 case,and excellent rate was 93.3％(14/15).Conclusion Double thread compression suture fixation for the treatment of acute volar plate avulsion fracture of proximal interphalangeal joints could reduce the damage to the accessory structure of the joint,and reach adequate exposure in the operationfor fixing the bone block firmly.After operation,good fracture healing and good finger function could be achieved,so the double thread compression suture fixation is an effective surgical method.

The application of pedicled anterolateral thigh propeller flaps in reconstruction of inguinal skin and soft tissue defects / 中华显微外科杂志

Objective To discuss the effectiveness of anterolateral thigh propeller flaps for treatment of inguinal skin and soft tissue defects.Methods From June,2009 to October,2014,12 patients with inguinal skin and soft tissue defects were treated with anterolateral thigh propeller flaps pedicled with perforator of descending branch of lateral circumflex femoral artery.Of them there were 8 males and 4 females,aged from 22 to 51 years.The left side was involved in 3 cases and right side 9 cases.Defects were caused by traffic accident injury in 5 cases,crash injury of heavy object in 7 cases.There were mere skin and soft tissue in 2 cases,combined with bone fractures,nerves,vessels and muscles injury in 10 cases.The area of defects ranged from 9.0 cm×5.0 cm to 22.0 cm×9.0 cm.During operation,anterolateral thigh propeller flaps ranging from 11.0 cm×7.0 cm to 24.0 cm×1 1.0 cm were used to repair the wounds.Results All flaps and skingrafts survived after operation and the wounds obtained primary healing.After 8-24 months follow-up,all flaps were characterized by soft texture,good color,and satisfactory appearance.According to the Britain's Medical Research Council at 8 months after operation,the sensation of the flaps were recovered to S2 ～ S3+,No obvious scar contracture and chromatosis were observed at donor site.Conclusion Anterolateral thigh propeller flaps pedicled with artery descending branch of lateral circumflex femoral perforator is an ideal choice for the reconstruction for inguinal skin and soft tissue defects.

Transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defects at leg / 中华整形外科杂志

Methods@#To explore the transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defect at leg.@*Method@#12 cases with leg composite tissue defects were reconstructed by flow-through anterolateral thigh flaps combined with fibular flaps. The skin defects ranged from 6 cm×12 cm to 12 cm×20 cm. The bone defects were 4-10 cm in length.The size of flow-through anterolateral thigh flaps was 14 cm×8 cm to 23 cm×13 cm and the fibular osteocutaneous flaps were 6 cm×4 cm to 12 cm×6 cm. The fibular bone was harvested as 7 cm to 13 cm in length.@*Results@#All the flaps survived in 12 cases. Bony reunion was achieved in all the cases. Vascular crisis happened in 2 cases 1 day after operation. Margin necrosis occurred in distal end of one flap, which healed after dressing. All the flaps had soft texture with satisfactory cosmetic and functional result . There was no complication in donor sites.@*Conclusions@#Flow-through anterolateral thigh flap combined with fibular flap can reconstruct soft tissue defect and bone defect simultaneously. It is the ideal method for leg composite tissue defects.

Prognostic values of dynamical monitoring of early weight change in patients with severe trauma / 中华创伤杂志

Objective To investigate the association between body weight daily fluctuation and prognosis in severe trauma patients and evaluate the values of dynamical monitoring of early weight change in treatment of severe trauma.Methods A prospective cohort study was made on 65 patients with severe trauma treated between June 2015 and December 2015.There were 41 males and 24 females,with age of (54 ± 17)years.When admitted to the emergency intensive care unit (EICU),the patients were with body mass index (BMI) for (22.0 ±2.7) kg/m2,injury severity score (ISS) for (22 ±5) points,as well as acute physiology and chronic health evaluation (APACHE) Ⅱ for (15 ± 6)points.According to the survival status during hospitalization,the patients were distributed to death group (9 patients) and survival group (56 patients).Daily body weight was measured from admission by using a weighing scale to evaluate the difference of daily body weight change between two groups.The correlation between daily body weight change and volume change as well as the relationship between daily body weight change tendency and prognosis were evaluated.Results Overall,the variation of weight was negatively correlated with ICU stay in two groups.The weight variations in death group and survival group were 0.4 (0.2,0.8) kg and-0.2 (-0.7,0.2) kg,respectively (P ＜ 0.01).The cumulative weight variation between two groups within one week was 5.02 kg (95％ CI 3.97-6.07,P ＜0.01).The change of body weight was moderately correlated with corresponding fluid balance (r =0.69,P ＜ 0.01).According to the Logistic regression analysis,daily weight gain within one week was found to be positively associated with ICU mortality (OR =3.05,P ＜ 0.05).Conclusions The body weight is negatively correlated with ICU stay in severe trauma patients.The body weight change within one week in EICU is closely correlated with fluid balance and body weight increase may elevate the risk of ICU mortality.

Comparison of percutaneous left and right radial approach for coronary angiography in Elderlyaged patients / 中国医师进修杂志

Objective To explore the safety and feasibility of coronary angiography (CAG) via percutaneous left radial artery approach (LRA) compared with right radial artery approach (RRA) in aged patients, and determine whether LRA is a valid alternative for CAG. Methods A total of 502 consecutive patients who were aged 65 or older underwent diagnostic CAG were recruited and randomized to the LRA group (240 patients) or RRA group (262 patients). The study end points included total procedural duration, coronary time, fluoroscopy time, dose of radiation including cumulative air kerma and dose area product, contrast volume, and the incidence of vascular complications. Results Coronary procedural success rate was 96.2%(231/240) in LRA group and 96.2%(252/262) in RRA group. There was no significant difference (P>0.05). The radial cannulation time, fluoroscopy time, look through time, dose of radiation, contrast volume and the percentage of hydrophilic wire used in two group had no significant difference (P > 0.05). The catheter in place time in LRA was significantly shorter than that in RRA group:(2.7 ± 2.5) min vs. (3.3 ± 3.3) min, P=0.036). There was a trend toward shorter procedural duration in LRA group than that in RRA group, but there was no significant difference: (13.3 ± 6.1) min vs. (14.3 ± 6.2) min, P=0.075. Conclusions LRA approach has similar safety and feasibility in terms of performing coronary angiography compared with RRA.It seems to be a feasible alternative for CAG in aged patients.

Carotid plaque characteristics detected with 3.0T high resolution nuclear magnetic resonance imaging in patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the value of detecting the compositional features of carotid atherosclerotic plaques by 3.0T high resolution magnetic resonance imaging (MRI) in patients with coronary artery disease (CAD).</p><p><b>METHODS</b>Consecutive 104 patients with coronary atherosclerosis confirmed by coronary angiography were prospectively recruited from January 2013 to January 2015 in Tiantan hospital. All patients were imaged with 3.0T high resolution MRI system. After exclusion patients with poor image quality, 97 patients were divided into 3 groups according to the degree of coronary artery stenosis: coronary atherosclerosis group (coronary stenosis between 1%-49%, n=16); single-vessel lesion group (single vessel lesion with stenosis between 50%-100%, n=48); multi-vessel lesion group (two or three vessel lesions with stenosis between 50%-100% or left main stem disease, n=33). The prevalence of total carotid plaque, calcified plaque, lipid-rich necrotic core, intra-plaque hemorrhage, plaque ulcer and rupture were compared among 3 groups.</p><p><b>RESULTS</b>The prevalence of total carotid plaque (81.3%(13/16), 72.9%(35/48), and 93.9%(31/33)) and calcified plaque (50.0%(8/16), 35.4%(17/48), and 42.4%(14/33)) were similar among the 3 groups (both P>0.05). The prevalence of carotid lipid-rich necrotic core in coronary atherosclerosis group was significantly lower than in single-vessel lesion group (18.8%(3/16) vs. 64.6%(31/48), P<0.01) and multi-vessel lesion group(18.8%(3/16) vs. 69.7%(23/33), P<0.01), but there was no significant difference between single-vessel lesion group and multi-vessel lesion group(P>0.05). Intra-plaque hemorrhage was detected in 2 patients of multi-vessel lesion group. There was no plaque ulcer or rupture in this cohort.</p><p><b>CONCLUSION</b>Carotid plaque features are associated with the severity of coronary atherosclerosis in CAD patients.</p>

The hemodynamics study and application of the reversed descending branch of lateral circumflex femoral artery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the hemodynamics evidence of the descending branch of lateral circumflex femoral artery in a reversed way. To explore the clinical result of using the reversed descending branch of the lateral circumflex femoral artery as the receipt artery for free flaps for reconstruction of the leg soft-tissue defect.</p><p><b>METHODS</b>From October 2005 to February 2012, 38 patients with severe leg soft-tissue defects were treated. The proximal antegrade and retrograde mean artery pressure of the descending branch of the lateral circumflex femoral artery in 16 of 38 patients were recorded during operation. All wounds had osteomyelitis, bone and tendon exposure requiring coverage reconstruction. And there was no recipient artery in the injured lower leg for free flaps in all 38 patients. Reversed descending branches of lateral femoral circumflex arteries were used as recipient arteries for free flaps (free latissimus dorsi flap, free thoracoumbilical flap, and free anterolateral thigh flap) in all patients. The flap donor site was closed directly or with the skin graft.</p><p><b>RESULTS</b>The proximal antegrade mean artery pressure of the descending branch of lateral circumflex femoral artery was(81.6 +/- 12.4) mmHg. The proximal retrograde pressure was(48.2 +/- 10.7) mmHg. The proximal retrograde mean artery pressure was 59.07 percent of the proximal antegrade pressure. The donor skin graft survived and wound healed primarily. After operation, 2 flaps had distal partial necrosis and healing was achieved after dressing change. All the other flaps survived completely without vascular problems. All the patients were followed up for 11 months to 2.5 years (mean, 1.6 years). The flap appearance was satisfactory. The texture and color of flaps in all cases were good.</p><p><b>CONCLUSIONS</b>The reverse descending branch of lateral circumflex femoral artery is a reliable recipient artery for the free flaps. It is an easy and simple technique that can be used for reconstruction of the defects in the lower leg, with the reversed descending branch of lateral circumflex femoral artery as recipient artery.</p>

Comparison Study on Determination of Trace Element Content in Peach Pulp between Wet Digestion Method and Carbonize Acid Dissolution Method / 世界科学技术-中医药现代化

This study was aimed to determine trace elements in Peach pulp . The wet digestion method and car-bonize acid dissolution method were applied to digest the sample, and flame atomic absorption spectroscopy was used to determine the content of trace elements (Fe, Cu, Mn) in Peach pulp . The results showed that the content is not consistent among different pretreatment methods. However, the metalion content among these three methods are in the order of Fe > Mn > Cu, with the average recovery rate between 92.6% and 119.6%. The RSD is less than 2.86%. It was concluded that this method is with high accuracy and stability as well as reliable accurate re-sults. It also proved that Peach pulp . is rich in Fe, Cu and Mn. It provides some useful information for further pharmacological study of Peach pulp .