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Objective·To explore the correlation between body compositions and cardiovascular fitness(CRF)in patients with coronary heart disease(CHD).Methods·The CHD patients(CHD group)who underwent elective percutaneous coronary intervention treatment at Renji Hospital,Shanghai Jiao Tong University School of Medicine from October 2022 to June 2023 as well as healthy people(control group)were selected.All the participants completed cardiopulmonary exercise testing(CPET)to determine CRF and bioelectrical impedance analysis(BIA)to determine body compositions on the same day.Results·A total of 191 patients with coronary heart disease and 188 healthy individuals were included.There was no statistically significant difference in baseline characteristics between the two groups.Compared with the control group,the CRF indicators of the CHD group were significantly reduced(all P<0.05).In terms of body composition indicators,the trunk muscle mass(TMM)of the CHD group was significantly lower than that of the control group(P<0.01),and the trunk fat mass(TFM)was significantly higher than that of the control group(P<0.01).Correlation analysis showed that TMM(R=0.538),lower limbs muscle mass(LMM)(R=0.754),and lower limbs fat mass(LFM)(R=0.593)were positively correlated with peak oxygen uptake per kilogram of bodyweight(VO2peak/kg)in the CHD group(all P<0.01),while TFM(R=-0.563)was negatively correlated with VO2peak/kg(P<0.01).There was no statistically significant correlation between other body composition indicators and VO2peak/kg.According to VO2peak/kg,the CHD patients were divided into low CRF group,medium CRF group,and high CRF group.The results showed that there were statistically significant differences in LMM,TMM,LFM,and TFM among the three groups of patients(all P<0.05).Multiple linear regression analysis suggested that age,gender,TMM,TFM,LMM,and LFM were related factors of VO2peak/kg in the patients with CHD.The VO2peak/kg of CHD patients increased with the increase of TMM,LMM,and LFM and the decrease of age and TFM;the female patients had lower VO2peak/kg compared to the males.Conclusion·The CRF of CHD patients is significantly lower than that of the healthy population,with higher TFM and lower TMM;in the CHD patients,CRF is negatively correlated with TFM and positively correlated with TMM,LMM,and LFM.
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Objective·To analyze the differences and classify hypertrophic cardiomyopathy(HCM)patients and healthy controls(HC)using short-axis cine cardiac magnetic resonance(CMR)images-derived radiomics features.Methods·One hundred HCM subjects were included,and fifty HC were randomly selected at 2∶1 ratio during January 2018 to December 2021 in the Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine.The CMR examinations were performed by experienced radiologists on these subjects.CVI 42 post-processing software was used to obtain left ventricular morphology and function measurements,including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV)and left ventricular end-diastolic mass(LVEDM).The 3D radiomic features of the end-diastolic myocardial region were extracted from short-axis images CMR cine.The distribution of the radiomic features in the two groups was analysed and machine learning models were constructed to classify the two groups.Results·One hundred and seven 3D radiomic features were selected and extracted.After exclusion of highly correlated features,least absolute shrinkage and selection operator(LASSO)was used,and a 5-fold cross-validation was performed.There were still 11 characteristics with non-zero coefficients.The K-best method was used to decide the top 8 features for subsequent analysis.Among them,four features were significantly different between the two groups(all P<0.05).Support vector machine(SVM)and random forest(RF)models were constructed to discriminate the two groups.The results showed that the maximum area under the curve(AUC)for the single-feature model(first order grayscale:entropy)was 0.833(95%CI 0.685?0.968)and the maximum accuracy for the multi-feature model was 83.3%with an AUC of 0.882(95%CI 0.705?0.980).Conclusion·There are significant differences in both left ventricular function and left ventricular morphology between HCM and HC.The 3D myocardial radiomic features of the two groups are also significantly different.Although single feature is able to distinguish the two groups,the combination of multi-features show better classification performance.
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Objective:To construct an intervention program of sports and medical integration for patients with acute myocardial infarction (AMI) in phase Ⅱ cardiac rehabilitation, so as to provide reference for the effective implementation of physical activity behavior change in AMI patients during phase Ⅱ cardiac rehabilitation.Methods:Before the research, we browsed relevant literature and guidelines published from July 2016 to June 2021, made a retrospective study on the influencing factors of cardiac rehabilitation behavior for AMI patients, and carried out a qualitative interview on cognitive and compliance motivations for AMI patients. Furthermore based on trans-theoretical model, the first draft of the intervention program was developed and and the expert consultation questionnaire was formed. From February to April 2022, Delphi method was used in 16 experts from 10 hospitals and 1 nursing college in 4 provinces. After 2 rounds of expert consultations on the importance and operability of items, the intervention program was finally determined.Results:The effective recovery rates of the 2 rounds of expert consultations questionnaires were both 16/16. The authority coefficient of expert consultation was 0.90, the judgment basis coefficient was 0.96, and the familiarity degree was 0.84. After the second round of expert consultation, the coefficient of variation of the importance of each item was (0.0-13.4)%, and the coefficient of variation of operability was (0.0-18.1)%. The final intervention program of sports and medical integration for patients with AMI in phase Ⅱ cardiac rehabilitation had 37 items, containing precontemplation stage (8 items), contemplation stage (7 items), preparation stage (5 items), action stage (9 items) and maintenance stage (8 items).Conclusions:The construction process of the intervention program of sports and medical integration for patients with AMI in phase Ⅱ cardiac rehabilitation is scientific and feasible. The content is focused on the patient-centred conception and the whole-process management for the exercise rehabilitation of AMI patients in phase Ⅱ cardiac rehabilitation. This intervention program may improve the safety, feasibility, participation and compliance in phase Ⅱ cardiac rehabilitation in patients with AMI. So it is recommended to be popularized and used in phase Ⅱ cardiac rehabilitation.
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Objective·To compare the physical activities of stroke population and non-stroke population based on the baseline survey of the elderly population cohort in Shanghai communities,and explore the participation in different types of physical activities of stroke population.Methods·The subjects were screened from Shanghai Community Elderly Cohort constructed from February to August,2019 according to the admission criteria.The subjects were divided into non-stroke group and stroke group according to whether they had reported a history of stroke by themselves,and the two groups were matched 2 to 1 by controlling age and sex with propensity score matching.The baseline characteristics of the two groups were collected,and the physical activities related to sports,transportation and housework in the last week were investigated with the International Physical Activity Questionnaire(IPAQ).Pittsburgh Sleep Quality Index(PSQ1)was used to evaluate the sleep quality of the subjects.Generalized Anxiety Disorder(GAD-7)and Patient Health Questionnaire-9(PHQ-9)were used to evaluate anxiety and depression of the subjects,respectively.The above characteristics were compared between the stroke group and non-stroke group,and the participation of different types of physical activities were compared between the two groups by multivariate Logistic regression model.Results·Among the 17 948 people included,there were 993(5.5％)in the stroke group and 16 955(94.5％)in the non-stroke group.After propensity score matching,there were 1 984 people(66.7％)in the non-stroke group and 992 people(33.3％)in the stroke group.There were significant differences in education level,pre-retirement occupation,waist circumference,body mass index,sleep status,anxiety symptoms,depression symptoms and disease history between the two groups(all P＜0.05).In terms of physical activities,the female stroke group had shorter daily moderate exercises time,fewer riding and walking days in one week,and shorter daily riding time,compared with the non-stroke people,with statistical significance(all P＜0.05).Compared with the non-stroke people,the weekly housework days and daily housework time in the male and female stroke groups were lower than those in the non-stroke group,while the daily sedentary time was longer,with statistical significance(all P=0.000).In terms of physical activity level,the proportions of men and women in the stroke group who reached medium or high level were lower than those in the non-stroke group,and the differences were statistically significant(all P=0.000).After adjusting for gender,age,occupation,anxiety symptoms,history of hyperlipidemia,history of atrial fibrillation,history of chronic gastritis and history of hip fracture by multivariate Logistic regression model,the level of vigorous exercise participation in the stroke group was lower,the proportions of no housework in the last week and sedentary time greater than 180 min per day were higher,and the proportion at medium and high activity levels was lower(all P＜0.05).Conclusion·The frequency and duration of housework participation and the physical activity level of elderly people with a history of stroke in Shanghai communities are at a lower level than those without stroke,and they also have a longer sedentary time.
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Objective:To develop an evaluation index system for community screening and referral procedure of patients with chronic heart failure.Methods:Experts in fields of medical education, health administration and various clinical specialties were selected from Shanghai through the purpose sampling method. Two rounds of expert consultation with Delphi method were conducted during October 2020 to February 2021, the contents of consultation included the importance and availability of the index system. According to the consultation results, the index system for community screening and referral procedure of patients with chronic heart failure was developed.Results:A total of 16 experts participated in the consultation, among whom 15 held senior or associate senior titles and 14 had worked for 20 years. The recovery rates of valid questionnaires of two rounds expert of consultation were 16/16. The familiarity and judgment coefficient were 0.82 and 0.90 in the first round of expert consultation, and 0.86 and 0.90 in the second round. The expert consultation coordination coefficient of the importance in the community screening and referral procedure were 0.652 and 0.462 for the first consultation; 0.741 and 0.525 for the second consultation. In the final version of the evaluation index system there were 7 first-level indicators, 15 secondary indicators and 3 conditions for screening; and 2 first-level indicators, 5 secondary indicators and 1 condition for referral.Conclusion:In this study the positivity coefficient and authority degree of experts are high; the opinions are relatively concentrated. The consultation results have a high rationality and feasibility, which would be applicable for assessment of community screening and referral procedure of patients with chronic heart failure.
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In order to provide efficient medical care to atrial fibrillation patients in the community, the Huamu Community Health Service Center in association with its medical consortium, Renji Hospital have developed a novel atrial fibrillation management system. With the collaboration of general practitioners and specialist team from the tertiary hospital, a special clinic for atrial fibrillation has been set up in the community health service center, which is based on the internet technology and the medical consortium platform. This article introduces the development of this novel system and the initial outcome of the measures, to provide a reference for the management of atrial fibrillation patients in the community.
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RAS, a member of the small GTPase family, functions as a binary switch by shifting between inactive GDP-loaded and active GTP-loaded state. RAS gain-of-function mutations are one of the leading causes in human oncogenesis, accounting for ∼19% of the global cancer burden. As a well-recognized target in malignancy, RAS has been intensively studied in the past decades. Despite the sustained efforts, many failures occurred in the earlier exploration and resulted in an 'undruggable' feature of RAS proteins. Phosphorylation at several residues has been recently determined as regulators for wild-type and mutated RAS proteins. Therefore, the development of RAS inhibitors directly targeting the RAS mutants or towards upstream regulatory kinases supplies a novel direction for tackling the anti-RAS difficulties. A better understanding of RAS phosphorylation can contribute to future therapeutic strategies. In this review, we comprehensively summarized the current advances in RAS phosphorylation and provided mechanistic insights into the signaling transduction of associated pathways. Importantly, the preclinical and clinical success in developing anti-RAS drugs targeting the upstream kinases and potential directions of harnessing allostery to target RAS phosphorylation sites were also discussed.
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Objective:To observe the clinical efficacy of modified Huqianwan combined with auricular acupressure with seeds on girls with central precocious puberty （CPP） due to Yin deficiency and fire hyperactivity. Method:A total of 150 cases were randomly divided into three groups （A group，B group， and C group），with 50 cases in each group. The cases received modified Huqianwan，Zhibo Dihuangwan，and modified Huqianwan combined with auricular acupressure with seeds， respectively， for 12 weeks. The traditional Chinese medicine （TCM） symptoms，bone age difference/chronological age difference （ΔBA/ΔCA）， predicted adult height （PAH），ovarian volume，uterine volume，breast nodule index，serum sex hormones ［follicle-stimulating hormone （FSH），luteinizing hormone （LH），and estradiol （E<sub>2</sub>）］，and serum kisspeptin-1 （KISS-1）/G protein-coupled receptor 54 （GPR54）/hypothalamic gonadotropin-releasing hormone （GnRH） signaling pathway of the three groups were observed before and after treatment. The clinical efficacy and safety of the three groups were evaluated. Result:The total effective rate was 97.9% in the C group， which was higher than 81.3% in the A group （<italic>χ</italic><sup>2</sup>=4.516，<italic>P</italic><0.05） and 71.4% in the B group （<italic>χ</italic><sup>2</sup>=5.162，<italic>P</italic><0.05）. Compared with the results in the A group after treatment，TCM syndrome，ΔBA/ΔCA，E<sub>2</sub>，LH，KISS-1，GPR54，and GnRH decreased（<italic>P</italic><0.05），and ovarian volume，uterine volume，and breast nodule index were reduced （<italic>P</italic><0.05），but PAH increased in the C group （<italic>P</italic><0.05）. Compared with the B group after treatment，the C group showed decreased TCM syndrome，ΔBA/ΔCA， FSH，E<sub>2</sub>，LH，KISS-1，GPR54，and GnRH （<italic>P</italic><0.05），reduced ovarian volume，uterine volume，and breast nodule index （<italic>P</italic><0.05），and increased PAH（<italic>P</italic><0.05）. During the study，there was one case of anorexia in the A group，and no obvious adverse reactions were found in the B group and the C group. Conclusion:Modified Huqianwan combined with auricular acupressure with seeds can significantly increase the PAH of girls with CPP due to Yin deficiency and fire hyperactivity and improve the serum sex hormones and the KISS-1/GPR54/GnRH signaling pathway.
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Objective:To observe the therapeutic effect of modified Fuyuanwan combined with auricular acupressure bean on stage Ⅱ， Ⅲ diabetic nephropathy and its effect on serum janus kinase （JAK）/ signal transducer and activator of tranions （STAT） signaling pathway. Method:A total of 180 cases were randomly divided into control group and observation group， 90 cases in each group. Losartan potassium， modified Fuyuanwan combined with auricular acupressure bean were given respectively for 12 weeks. Renal function indexes ［blood urea nitrogen （BUN）， serum creatinine （SCr）， urinary albumin excretion rate （UAER）， 24 h urinary protein quantitative （24 h Upor）］， relative abundance of intestinal flora （verruca microflora， scleriobacteriae， deferribacter， proteobacteria）， oxidative stress indicators ［advanced oxidation protein products （AOPPs）， reactive oxygen species （ROS）， glutathione peroxidase （GSH-Px）， total superoxide dismutase （TSOD）］， renal blood flow index ［end-diastolic blood flow velocity （EDV）， peak systolic value （PSV）， pulse index （PI）， blood flow resistance index （RI）］， JAK/STAT signaling pathway ［JAK， phosphorylated JAK （p-JAK）， STAT， phosphorylated STAT （p-STAT） were observed before and after treatment. The safety indexes of two groups were evaluated after treatment. The efficacy was observed after treatment and followed up for 1 years and 2 years. Result:After treatment and follow-up for 1， 2 years， the total effective rates of patients in observation group were 97.8% （87/89）， 81.6% （71/87）， 59.8% （49/82）， respectively， observation group which were significantly higher than those in control group of 79.3%（69/87），57.8%（48/83），37.2%（29/78） （<italic>χ</italic><sup>2</sup>=4.016， <italic>χ</italic><sup>2</sup>=4.503， <italic>χ</italic><sup>2</sup>=4.769， <italic>P</italic><0.05）. Compared with control group after treatment， UAER， BUN， SCr， 24 h Upor， firmicutes， actinobacillus， proteobacteria， AOPPs， ROS， PI， RI， p-JAK， p-STAT3 in observation group were significantly decreased （<italic>P</italic><0.05，<italic>P</italic><0.01）， microflora verruca， GSH-PX， TSOD， JAK， STAT3 were significantly increased （<italic>P</italic><0.05，<italic>P</italic><0.01）， EDV and PSV were significantly accelerated （<italic>P</italic><0.05，<italic>P</italic><0.01）. The incidence of adverse reactions was 1.1% （1/89） in observation group， lower than 13.8% （12/87） in control group （<italic>χ</italic><sup>2</sup>=5.127， <italic>P</italic><0.05）. Conclusion:Modified Fuyuanwan combined with auricular acupressure bean can significantly improve the curative effect of stage Ⅱ， Ⅲ diabetic nephropathy， and its mechanism of action may be related to the serum JAK/STAT signaling pathway.
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Objective:To observe the effects of modified Huangqi Biejiatang combined with auricular acupressure on diabetic peripheral neuropathy （DPN） due to Qi and Yin deficiency and serum myeloid differentiation factor 88/inhibitor of nuclear factor-<italic>κ</italic>B （MyD88/I<italic>κ</italic>B） signaling pathway. Method:One hundred and forty cases were randomly divided into an observation group （<italic>n</italic>=70） and a control group （<italic>n</italic>=70）. In addition to routine treatments like dietary intervention and the regulation of fasting blood glucose （FBG） and blood pressure， the modified Huangqi Biejiatang combined with auricular acupressure was further provided in the observation group， while mecobalamine was administered in the control group. After four-week intervention， the toronto clinical scoring system （TCSS） score， traditional Chinese medicine （TCM） syndrome score， the conduction velocities of motor and sensory nerves （median nerve， common peroneal nerve， tibial nerve， and ulnar nerve）， glucose metabolism indexes ［fasting plasma glucose （FPG）， 2 h postprandial blood glucose （2 h PG）， and hemoglobin A1c （HbA1c）］， intestinal genera （<italic>Clostridium</italic>， <italic>Prauserella</italic>， <italic>Bacteroides</italic>， and <italic>Faecalibacterium</italic>）， as well as the serum MyD88， I<italic>κ</italic>B<italic>α</italic>， and phosphorylated I<italic>κ</italic>B<italic>α </italic>（p-I<italic>κ</italic>B<italic>α</italic>） levels in the MyD88/I<italic>κ</italic>B signaling pathway before and after treatment were observed in the two groups， for comparing their clinical efficacy and safety. Result:The total effective rate of the observation group was 85.3% （58/68）， which was higher than 48.5% （32/66） of the control group （<italic>χ</italic><sup>2</sup>=6.143， <italic>P</italic><0.05）. The comparison with the control group revealed that the scores of TCSS and TCM syndrome， the levels of FPG， 2 h PG， HbA1c， MyD88， and p-I<italic>κ</italic>B<italic>α</italic>， as well as the abundances of <italic>Clostridium</italic> and <italic>Prauserella</italic> in the observation group were decreased （<italic>P</italic><0.05）， while the conduction velocities of motor and sensory nerves （median nerve， common peroneal nerve， tibial nerve， and ulnar nerve） were significantly accelerated （<italic>P</italic><0.05）. Besides， the abundances of <italic>Bacteroides</italic> and <italic>Faecalibacterium</italic> and I<italic>κ</italic>B<italic>α</italic> level were significantly elevated （<italic>P</italic><0.05）. The incidence of adverse reactions in the observation group was 1.5% （1/68）， lower than 12.1% （8/66） in the control group （<italic>χ</italic><sup>2</sup>=4.328， <italic>P</italic><0.05）. Conclusion:The modified Huangqi Biejiatang combined with auricular acupressure alleviates DPN due to Qi and Yin deficiency， which may be attributed to the regulation of serum MyD88/I<italic>κ</italic>B signaling pathway.
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Objectives:To explore the feasibility of applying virtual reality (VR) technology to surgical skills training for postgraduate students with VR technology and to evaluate its training effect.Methods:Taking the VR software for nephrectomy as an example, the VR software was applied to the surgical training of the surgery postgraduates, and compared with the traditional teaching methods to evaluate its training effect. Meanwhile the questionnaires about the performance characteristics and technological advantages of VR software were distributed to participators.Results:The examination performances in group with VR training were significantly better than that with traditional teaching methods (92.17±0.38 vs. 87.94±0.43, P<0.001). A total of 35 valid questionnaires were collected back. More than 82% of participators considered that VR surgery teaching had advantages of realistic training mode, strong three-dimensional effect, friendly interface, easy manipulation, favorable interaction, convenient full-scale viewing, splendid and plentiful course content, wonderful training effect and stimulating training interest. All of participators confirmed that VR surgery teaching can replace the traditional surgery training methods. Conclusions:It is feasible to apply VR technology in surgical skills training for postgraduates. The effect of surgical skills training with VR technology for postgraduates is significantly superior to the traditional training methods, which is worth further popularization and application.
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Objective:To explore the feasibility of quantitative evaluation of extracellular volume (ECV) fraction in acute ST-segment elevation myocardial infarction (STEMI) by dual-layer spectral detector CT.Methods:The clinical and imaging data of 20 patients with STEMI who underwent cardiac contrast-enhanced CT and MRI from January to October 2019 in Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed.The dual spectral detector was used in the enhanced CT scan of the coronary artery with retrospectively gate and the late iodine enhancement with prospective gate. Conventional image and holographic spectral image were obtained by iterative and spectral reconstruction. The short axis image of the heart matched with MR image was obtained by multiplanar reconstruction. Based on the data of spectral based image, the IDD map was reconstructed for the calculation of myocardial CT-ECV during the late iodine enhancement. ECV of infarcted myocardium, salvageable myocardium and remote myocardium based on CT and MRI were calculated respectively. Bland-Altman consistency test and intra group correlation coefficient analysis (ICC) were used to compare the consistency of two measurements and different methods. The correlation between CT-ECV and MRI-ECV was compared by Spearman method.Results:The CT-ECV values of infarcted, salvageable, and remote myocardium were 51.21 (49.27, 53)%, 38.64 (36.17, 40)%, and 51.21 (49.27, 53)%, respectively. The difference was statistically significant ( H= 43.17, P<0.01). The CT-ECV value of infarcted myocardium was significantly higher than that of salvageable myocardium and remote myocardium ( Z=-24.60, 35.40, P<0.01), but there was no significant difference between salvageable myocardium and remote myocardium ( Z= 10.80, P=0.15). The T 1 values of infarcted myocardium, salvageable myocardium and remote myocardium were (1 554.85±70.94), (1 443.85±67.28) and (1 307.05±91.73) ms respectively, the difference was statistically significant ( F=51.35, P<0.01). The T 1 value of infarcted myocardium was higher than that of salvageable myocardium and remote myocardium ( t=-5.07, 9.55, P<0.01), and salvageable myocardium was significantly higher than that of remote myocardium ( t=5.38, P<0.01). The MRI-ECV values of infarcted myocardium, salvageable myocardium and remote myocardium were 55.00 (49.27, 57.75)%, 33.50 (29.00, 35.00)%,and 27.00 (26.00, 29.00)%, respectively. The difference was statistically significant ( Z= 47.12, P<0.01). MRI-ECV of infarcted myocardium was significantly higher than that of salvageable myocardium and remote myocardium ( Z=37.45, -20.30, P< 0.01), and salvageable myocardium was significantly higher than that of remote myocardium ( Z = 17.15, P<0.05). The difference between CT-ECV and MRI-ECV measured by two physicians was good. The bias of Bland-Altman analysis was -0.1% (95% CI:-5.5%-5.2%), 0.8% (95% CI:-9.8%-8.2%), and the ICC values were 0.92 and 0.94, respectively. The bias of Bland-Altman analysis in CT-ECV and MRI-ECV consistency test was 4.00% (95% CI:-9.0%-16.9%) and ICC value was 0.88, which had a good correlation ( r=0.75, P=0.001). Conclusions:The iodine density based ECV fromdual-layer spectral detector CT can be used to quantitatively evaluate the changes of extracellular space after acute STEMI, which is helpful to quantitatively evaluate the histological changes after myocardial ischemia.
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Objective To compare the perioperative application of sufentanil and oxycodone in patients undergoing laparoscopic surgery for gastric or colorectal cancer. Methods 59 patients were selected and randomly divided into group O and group S. Anesthesia was induced with sufentanil 0.3 μg/kg in group S and oxycodone 0.3 mg/kg in group O. Anesthesia was maintained with sevoflurane balanced anesthesia. When heart rate or blood pressure reached 20% over the baseline, additional dose of oxycodone 0.1 mg/kg was given in group O and sufentanil 0.1 μg/kg in group S. 30 minutes before the end of surgery, patients in group S received sufentanil 0.1 μg/kg and group O with oxycodone 0.1 mg/kg separately. Two hours in the PACU, a rescue dose of sufentanil 0.1 μg/kg or oxycodone 0.1 mg/kg was given to the patients with VAS score bigger than 4. Hemodynamic index, VAS score, Ramsay score, adverse responses and analgesics rescue were recorded. Results No difference was found in hemodynamic index, VAS score and analgesics rescue between the two groups (P>0.05). Ramsay score of group S is lower than that of group O (P=0.014). Induction period bucking incidence in group O was obviously lower than that in group S(P=0.002). The incidence of emergency agitation in group O was significantly lower than that in group S(P=0.045).There was no significant difference in respiratory depression, postoperative nausea and vomiting between two groups (P>0.05). Conclusion Compared with sufentanil, oxycodone significantly reduced the incidence of bucking and emergency agitation. Oxycodone provided better sedation to patients who received laparoscopic surgery for gastric or colorectal cancer.
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Objective To compare the role on determining the functional location of primary hyperaldosteronism (PHA)by multi-slice spiral CT (MSCT)and by adrenal vein sampling (AVS),and to discuss the reasonable method to use MSCT and AVS in localization diagnosis of PHA.Methods Clinical data of 78 patients with PHA were analyzed retrospectively.These patients were diagnosed in our department from June 2014 to June 2018.There were 27 male and 51 female patients.With mean age of (47.5 ± 11.2) years old.The mean systolic blood pressure was (190 ± 24)mmHg and mean diastolic blood pressure was (111 ± 16) mmHg.The mean history of hypertension was (6.0 ± 6.0) years.The mean serum potassium was (2.4 ± 0.6) mmol/L.The mean plasma aldosterone concentration (PAC) was (415.7 ± 235.4) pg/ml.The mean plasma renin activity (PRA) was (3.2 ± 5.7) ng/(ml · h).The mean aldosterone/renin ratio (ARR) was 409.0 ± 434.9.All PHA patients underwent MSCT and AVS,the accuracy on determining the functional location of PHA by MSCT and by AVS were evaluated based on the pathological results and clinical outcomes.The influence of adrenal size and character on the accuracy of determining the functional location of PHA by MSCT were analyzed.Results The rate of accuracy of determining the location of PHA by AVS was higher than that by MSCT[100.0％ (78/78) vs.71.8％ (56/78),P ＜ 0.05].When MSCT indicated:adrenal hyperplasia,adrenal tumor volume less than 1 cm,1 cm ＜ adrenal tumor volume ≤ 2 cm,adrenal tumor volume ＞ 2 cm,the rate of accuracy in localization diagnosis with MSCT was 50.0％ (4/8),81.0％ (17/21),92.9％ (26/28),100.0％ (9/9) respectively.Its trend has statistical significance (P ＜ 0.05).The diagnostic accuracy rate of MSCT for aldosterone adenoma was 79.6％ (43/54),while that of adrenal hyperplasia was 58.3 ％ (7/12).There was no statistical significance between two diagnostic accuracy rate of MSCT(P ＞ 0.05).Conclusions AVS is the gold standard for localization diagnosis.When MSCT indicates that there is no obvious abnormality in the adrenal gland,adrenal hyperplasia,small tumor (≤ 2 cm),and bilateral adrenal lesions,AVS should be examined at the same time,which can be considered as the gold standard for localization diagnosis.For isolated adrenal tumor (＞ 2 cm) in PHA,the accuracy of localization diagnosis in MSCT is very high and the AVS is unnecessary.
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To study influence of different interventional opportunity on advanced aged patients with acute coronary syndrome non‐ST elevation type (ACS‐NSTE).Methods : The180 advanced aged ACS‐NSTE patients from our hospital , were randomly and equally divided into group A , B and C , and they received interventional surgery within 1d ,2～3d and 3d later after hospitalization respectively .Serum levels of cystatin C (CysC ) , lipoprotein a [Lp (a)] , ApoA , hsCRP and vascular endothelial function indexes before and 7d after intervention , cardiac func‐tion indexes before and two months after intervention , and incidence of major adverse cardiovascular events (MACE) within two years after intervention were observed and compared among three groups .Results : Compared with group A and C on 7d after intervention , there were significant reductions in levels of CysC [ (0. 97 ± 0.13) mg／L vs .(1.08 ± 0.15) mg／L vs.(0.90 ± 0.11) mg／L] , Lp (a) [ (175.74 ± 18.18) mg／L vs.(197.89 ± 20. 15) mg／L vs .(163. 98 ± 16.54) mg／L] , hsCRP [ (1. 44 ± 0.20) mg／L vs.(2.34 ± 0.25) mg／L vs.(0.79 ± 0.09) mg／L] , plasma von Willebrand factor [vWF , (158. 79 ± 16.28)% vs.(174.68 ± 18. 28)% vs .(142.87 ± 14. 31)%] and endothelin‐1 [ET‐1 , (93. 28 ± 9.34) ng／L vs.(99.10 ± 9.94) ng／L vs .(86.43 ± 8.71) ng／L] , and significant rise in levels of ApoA [ (0.91 ± 0. 16) mg／L vs.(0. 82 ± 0.14) mg／L vs.(1.03 ± 0.17) mg／L] and NO [ (59. 92 ± 5. 93) mol／L vs.(55. 33 ± 5.48) mol／L vs.(64. 29 ± 6. 42) mol／L] in group B , P＜0. 01 all.After two months , com‐pared with group A and C , there were significant reductions in LVEDd [ (47.87 ± 4.72) mm vs.(50.58 ± 5.11) mm vs.(44. 68 ± 4. 50) mm] and LVESd [ (37.87 ± 3.82) mm vs .(40.57 ± 4. 19) mm vs.(34.98 ± 3. 52) mm] , and significant rise in LVEF [ (52. 87 ± 5.38)% vs.(49.04 ± 5. 02)% vs.(55. 89 ± 5.62)%] in group B , P＜0. 01 all.On two years after intervention , incidence rate of MACE in group B was significantly lower than those of group A and C (3.33% vs.15. 00% vs .31.67%, P＜0.05 or ＜0.01).Conclusion : Interventional therapy on 2～3d after hospitalization can significantly reduce inflammatory factor level , improve vascular endothelial function and cardiac function , and reduce incidence rate of MACE in ACS‐NSTE patients .
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Objective:To compare arm circumference (AC) and upper limb volume (ULV) in assessment of breast cancer related lymphedema (BCRL). Methods:From November, 2013 to February, 2015, 281 women with one-sided breast cancer accepting radiotherapy were consecutively enrolled. AC was measured as the means of circumference 10 cm above and 5 cm below the most eminent midpoint of olecranon. ULV was measured as the water displacement volume when the water surface reached at 15 cm above the midpoint of olecranon. Univariate and multivariable linear regressions were used between AC and ULV. Results:All the correlated coefficients between AC and In(ULV) were above 0.959 (P < 0.001). For linear equations, the R2 > 0.90. The consistency of diagnoses of BCRL with AC and ULV were above 90% (Kappa > 0.492, P < 0.001). Conclusions:AC and ULV are consistent in measurement of BCRL. AC is reliable and easier.
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Objective To retrospectively analyze the postoperative morbidity of patients with complex intracranial aneurysms treated by stent-assisted coiling and investigate the causes and treatment strategy of postoperative morbidity. Methods 62 SAH patients with intracranial aneurysm were treated by stent-assisted coiling, 53 cases of single aneurysms, 9 cases of multi-aneurysms (8 cases of 2 aneurysms, 1 cases of 3 aneurysms), amount to 72 aneurysms, 71 aneurysms were treated by stent-assisted coiling. Results Completed embolization 53 cases were completed with embolization partial embolization (74.64％), Nearly all embolization 17 cases were nearly all embolization (23.94％), partial embolization and 1case was s (1.42％) . According to GOS, 52 patients with a score of GOS 5, 6 patients with a score of GOS 4, 3 patients with a score of GOS 3, 2 patients with a score of GOS 1. 58 (93.5％) patients survived favorably. 9 patients with complications (14.5％), 3 patients with acute thrombosis; 2 patients with rupture of aneurysms during surgery; 3 patients with cerebral angiospasm; There was no obvious abnormality during the surgery in 1 patient, and there was a focal ischemic change followed by a mild neurological deficiency. Conclusions Stent assisted coil embolization of intracranial ruptured aneurysm is safe, effective and feasible, but we should improve clinical skills, summarize the analysis in the clinical operation experience of clinical treatment so as to reduce complications. Timely and correct treatment is also very important when complications occur.
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Drug-coated balloons (DCB) have emerged as a new application in percutaneous coronary intervention. It is developed to circumvent some of the limitations faced by drug-eluting stents (DES). DES has some limitations, as follows: it could not be implanted in some lesions; bleeding risks are associated with prolonged dual antiplatelet therapy; risks of late and very late stent thrombosis increase. Many clinical trials had confirmed the efficacy and safety of DCB, particularly, the application of DCB in coronary small vessel diseases. This review discussed the basic concept, development, evolution of DCB and some clinical studies associated with the application of DCB in coronary small vessel diseases.
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Objective To discuss whether the content and method of pre-job training meet the need of medical trainees and to give some advice on its reformation. Methods 350 trainees enrolled by The First Affiliated Hospital of Chongqing Medical University attended the two-day standardized pre-job training in September, 2016. The self-designed satisfaction questionnaires on contents and method of pre-job training were distributed to all trainees after training, and then the statistical analysis was completed by SPSS 11.0 software. The satisfaction rate higher than80% was deemed as satisfactory, and the satisfaction rate lower than80% was regarded as unsatisfactory. Results 350 questionnaires were distributed in total, with 335 valid responses returned.. The result showed that the number of trainees who were satisfied with the training contents of medical law and rules and regulations, writing norms of medical documents, infection control, medical information technology, medical insurance policy, fire control and personal security and the use of library resources were 321(95.82%), 318(94.93%), 310(92.54%), 302(90.15%), 251(74.93%), 234(69.85%) and 220 (65.67% ) respectively. There were 254 (75.82% ) trainees who were satisfied with the training methods. Conclusions All medical trainees were satisfied with most contents of current pre-job training. However, the trainings on the extension of clinical expertise and the improvement of clinical skills should be added. Almost all trainees were dissatisfied with the training method, which should be diversified. Fur-ther improvement on contents and methods for current pre-job training will be conducive to enhancing the quality of medical trainees.
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Objective To analyze the main causes for unplanned re-operation of pheochromocytoma (PCC) and explore the countermeasures on reducing the re-operation rate.Methods The clinical data of 6 patients with pheochromocytoma who underwent an unplanned re-operation were analyzed retrospectively between September 2011 and December 2016 in our hospital.There were 4 males and 2 females with a mean age of 46 years,ranged from 24 to 60 years.Only 1 patient had paroxysmal hypertension and headache,and the other 5 patients had no symptoms or atypical symptoms.Tumors of 3 cases were located in adrenal,and 3 were extra-adrenal PCCs.The average size of tumors was 5.25cm,ranged from 3 to 10 cm.Among the 6 cases,2 cases were diagnosed as PCC preoperatively and underwent adequate preparationwith stable hemodynamics during the first operation,who encountered post-operative bleeding soon after the surgery.Four cases were misdiagnosed,with poor preoperative preparation and operation was aborted.One case was misdiagnosed as bladder carcinoma and underwent transurethral resection.Results All 6 re-operations were performed by urologists.The main causes for unplanned re-operation were as follows:perioperative hemodynamic unstability (50％,3/6),post-operative bleeding (33.3％,2/6),uncertainty of surgical outcome (16.7％,1/6).Conclusions A precise diagnosis and an adequate preoperative preparation are the key to prevent a second-look surgery.An appropriate surgical approach and a complete surgical hemostasis could help lowering the re-operation rate.