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Objective:To explore the intervention effect of humanistic management on anxiety and depression tendency of visiting physicians.Methods:The visiting physicians who began to further study in Beijing Anzhen Hospital, Capital Medical University from January 2016 to December 2018 were selected for humanistic management, and the visiting physicians from April 2013 to December 2015 were set as reference to conduct a questionnaire survey before and after the refresher training with the Hospital Anxiety and Depression Scale. Therefore, the visiting doctors all had the conventional refresher study management mode. On this basis, the intervention group established an individualized refresher study schedule, equipped the doctors with tutors, regularly visited the doctors and organized symposiums for them, assisted them to join the academic groups of the department, organized and coordinated the doctors to participate in the multi-disciplinary academic ward rounds, conducted negative emotional relief through the Balint groups, and integrated the cultural life of the refresher doctors into the cultural construction of the hospital and follow up the refresher doctors after the refresher training. SPSS 16.0 was used to perform t-test and variance analysis. Results:There was no difference in anxiety and depression scores between the two groups according to gender, type of refresher department, level of source hospital and length of study ( P > 0.05). Compared with the two evaluations in the intervention group, the second scores of anxiety for men and women [(5.90±1.37) vs . (6.48±1.87), (5.92±1.45) vs . (6.73±2.12)], doctors in each department [(5.50±1.23) vs . (6.76±2.35), (6.03±1.36) vs . (6.64±1.75), (5.98±1.50) vs . (6.64±2.15)], doctors from secondary and tertiary hospitals [(5.85±1.29) vs . (6.64±2.02), (6.00±1.50) vs . (6.78± 2.14)], the total score of doctors [(5.92±1.37) vs . (6.64±2.15), (5.92±1.47) vs . (6.68±1.98)] and the total score [(5.92±1.42) vs. (6.66±2.05)] were lower than the first evaluation score ( P<0.05). The second scores of depression for female doctors [(6.15±1.37) vs . (6.68±2.06)], doctors in medical laboratory department [(6.02±1.40) vs . (6.69±1.88)], doctors from tertiary hospital [(6.13±1.41) vs. (6.51±1.90)], doctor with different training durations [(6.04±1.42) vs . (6.50±2.02), (6.12±1.34) vs . (6.57±1.97)] and the total score of doctors [(6.09±1.37) vs . (6.54±1.99)] were lower than those of the first evaluation ( P < 0.05). The anxiety score of the second evaluation in the control group was higher in male physicians [(6.63±1.15) vs . (6.11±1.76)] than the first evaluation ( P < 0.05). Compared with the second evaluation data of doctors in the two groups, in terms of anxiety scores, the scores of doctors at all levels and total scores in the intervention group were lower than those in the control group ( P < 0.05); in terms of depression score, the scores of female visiting doctors, doctors from tertiary hospitals, doctors with refresher training duration of 6 months and total score were lower than those of the control group ( P < 0.05). Conclusion:The application of humanistic management to strengthen the management of refresher physicians can improve the psychological state of refresher doctors to a certain extent, especially alleviate the anxiety state, which is a worthy promotion of refresher management mode.
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Objective:To investigate the incidence of acute kidney injury (AKI) following cardiac surgery and related risk factors in 4 878 patients.Methods:The information from patients who underwent cardiac surgery through March 2015 to October 2015 was collected retrospectively from the electronic database of Beijing Anzhen Hospital. A total of 4 878 patients were divided into AKI group and non-AKI group according to whether AKI occurred within 7 days after cardiac surgery. The incidence of AKI was calculated, and the AKI incidence in different types of cardiac surgeries were compared. Clinical data such as baseline clinical information, operation information, comorbidity, hospital stay time, life ability score in discharge from the hospital, and so on, were compared between AKI group and the non-AKI group using univariate analysis. Risk factors for AKI following cardiac surgery were analyzed using the binary multivariate logistic regression.Results:A total of 933 patients suffered from AKI (19.1%) following cardiac surgery. The time of stay in the hospital was longer in AKI group than that in the non-AKI group [(14.4±8.9) vs (13.7±7.7) d, P<0.05)]. The incidence of AKI in different types of cardiac surgeries varied significantly ( P<0.001). The logistic regression analysis showed that male, diabetes, hypertension, the elevated basic serum creatinine, cardiac dysfunction (NYHA grade≥Ⅲ), cardiopulmonary bypass, a combination of operations≥3, the rethoracotomy exploration and hemostasia, and using an invasive ventilator for over 96 hours were the independent risk factors for the AKI following cardiac surgery (all P<0.05), and the odds ratio (95% confidence interval) were 1.81(1.46-2.24), 1.29(1.03-1.62), 5.85(4.73-7.22), 1.81(1.36-2.40), 4.49(3.60-5.60), 1.84(1.49-2.27), 23.24(18.25-29.59), 2.34(1.45-3.77) and 1.94(1.09-3.43) respectively. Conclusions:The incidence of AKI after cardiac surgery in Beijing Anzhen Hospital is 19.1%. AKI following cardiac surgery prolongs the time of stay in the hospital. Independent risk factors for AKI following cardiac surgery are multiple, and one of the most critical factors is a combination of operations≥3.
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<p><b>OBJECTIVE</b>To investigate the clinical characteristics of pulmonary artery sarcoma (PAS) and to improve doctors' awareness and the early diagnosis of this disease.</p><p><b>METHODS</b>The clinical data of 9 cases confirmed by operation and pathology of PAS from November 2001 to November 2012 in Beijing Anzhen Hospital were reviewed. The clinical characteristics, laboratory tests, imaging manifestation, pathology as well as follow-up were studied. Survival was determined by the Kaplan-Merier method.</p><p><b>RESULTS</b>(1)Main clinical manifestations were chest distress (8/9), palpitation (2/9), syncope (2/9), cough (2/9), weight loss (2/9) and chest pain (1/9). (2)Lactate dehydrogenase (LDH) , high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) were all elevated to different extents, but D-Dimer remained in the normal range. (3) Seven cases received CTPA examination and evidenced filling defect in the main pulmonary artery trunk (6/7), left pulmonary artery (6/7), right pulmonary artery (7/7). 7 cases received TTE examination and showed enlarged right ventricle (6/7) : mean right ventricular end-diastolic diameter was (38.54 ± 16.30) mm; enlarged right atrium (7/7): mean right atrium diameter was (55.11 ± 5.45) mm; and tricuspid insufficiency (7/7) : estimated mean pulmonary artery pressure was (81.14 ± 21.17) mmHg (1 mmHg = 0.133 kPa) , and pulmonary stenosis (5/7) . Four cases received deep venous ultrasound examination and deep venous thrombosis (DVT) was found in 1 patient. Four cases received Ganz catheter examination and the preoperative and postoperative mean pulmonary artery pressure was (52.00 ± 5.23) mmHg and (23.00 ± 5.60) mmHg, respectively. (4) All 9 patients received surgery and intimal sarcoma was diagnosed in all of them. Leiomyosarcoma was diagnosed in 3 cases, leiomyo-angiosarcoma was diagnosed in 1 case, undifferentiated sarcomas was diagnosed in 1 case. (5)The 1-, 3- and 5-month survival was 71.4%, 53.6% and 35.7%, respectively, median survival time was 5 months post surgery.</p><p><b>CONCLUSION</b>PAS is difficult to differentiate with PTE. PAS should be suspected in patient with right atrium, right ventricular enlargement and early appeared right heart failure, and normal D-Dimer level. Outcome for PAS patients is poor despite surgery in this cohort.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Follow-Up Studies , Hemangiosarcoma , Diagnosis , Pathology , Pulmonary Artery , Pathology , Retrospective StudiesABSTRACT
Objective To investigate the relationship between 4G/5G polymorphism in the promotor of plasminogen activator inhibitor-1 (PAI-1) gene and pulmonary thromboembolism (PTE). And to detect whether it plays an important role in the pathogenesis of PTE. Methods The 76 patients with PTE, 74 gender and age matched healthy controls were recruited in this study. Genome DNA was extracted from whole blood using phenol-chloroform. Subjects were genotyped for the 4G/ 5G polymorphism of PAI-1 gene using polymerase chain reaction and restriction fragment length polymorphism analysis. Results Significant difference was found in the frequency of 4G/4G genotype between PTE group and control group (50.0% vs.24.3%,P<0.01). And there were no significant differences in 4G/5G and 5G/5G genotype between the two groups. The 4G allele frequency was higher in PTE group than in control group (72.4% vs. 55.4% , P<0.01) . The recessive allele model was informative and the odd ratio of 4G/4G genotype was much higher than of other two genotypes (OR=3.40, P<0.01). Further stratification showed 4G/4G genotype was associated with high risk of PTE for those individuals without traditional environment risk factors. Conclusions The 4G/5G polymorphism of PAI-1 gene is associated with PTE and 4G allele is recessive. 4G/4G genotype increases the risk of PTE for individuals who have no traditional risk factors of PTE.
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Objective To evaluate the quality of life status in patients aged 70 years and over following off-pump coronary artery bypass (OPCAB) grafting. Methods Seventy-eight patients with coronary heart disease [mean age (74.6 ± 5.3) years, 66 males, 12 females] were investigated retrospectively. Three questionnaires about the quality of life, including Seattle Angina Questionnaire (SAQ), Nottingham Healthy Profile (Part Ⅰ NHP) and Duke Activity Status Index (DASD, were used to investigate patients before and after OPCAB. Results Prior to OPCAB, there was lower quality of life index in males than in females [SAQ: (65.3±5.1) vs. (69.5±8.1); NHP: (89.4±17.3) vs. (125.2±19.9), P＜0.01; DASI: (4. 1±1.1) vs. (4.3± 1.3)]. At the 12th months after OPCABG, there were significant improvements in all patients. The effects were less pronounced in females than in males [SAQ: (83.1 ±5.8) vs. (88.5±4.5), P＜0.05; NHP: (84.7± 11.7) vs.(91.4±13.7), P＜0.05; DASI: (4.7±1.4) vs. (5.4±1.1)]. Conclusions Our study shows that OPCAB improves quality of life in elderly patients with coronary heart disease. The benefits of OPCAB are even more pronounced in male patients.
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Objective To observe the changes of serum levels of inflammatory cytokines in the elder patients with clopidogrel resistance (CLR) after coronary stenting. Methods A total of 93 patients with unstable angina pectoris received coronary stenting were enrolled, and peripheral blood samples were taken before and 24 hours, 1 week and 1 month after surgery. The platelet aggregation (PAG) induced by adenosine diphosphate (ADP) were detected, and all patients were divided into CLR group (n=33) and normal response group (n=60) according to PAG response. At the same time, the levels of C-reactive protein (CRP), soluble fragment of CD40 ligand (sCD40L) and P-selectin were detected by enzyme-linked immunosorbent assay. Results The incidences of CLR were 35. 5% (33/93), 26. 9%(25/93) and 20. 4%(19/93) respectively 24 hours, 1 week and 1 month after surgery. The levels of CRP C(8. 8 ± 2. 5) mg/L at 24 hours, (5. 3 ± 2. 5) mg/L at 1 week], P-selectin [(73. 8±34)×10~(-3) ng/L at 24 hours, (70. 5±31. 6)×10~(-3) ng/L at 1 week, (66. 4±22. 3) ×10~(-3) ng/L at 1 month] and sCD40L C(7. 7 ±2. 3)×10~(-3) ng/L at 24 hours] after surgery in CLR group showed significant differences comparing with pre-surgery and normal response group (all P< 0.05). The CLR at 30 days after coronary stenting was significantly correlated with the level of P-selectin (r=1.334) and smoking (r= 1.053). Conclusions The levels of CRP, P-selectin and sCD40L in some elder patients after coronary stenting are increased and may be correlated with CLR. The levels of P-selectin and smoking are the predictors for CLR.
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Objective To observe the effect of a triptolide-eluting stent(TES)on neointimal hyperplasia in response to vascular injury,inflammation and safety to prevent restenosis after angioplasty.Method Twelve pigs were randomly divided into three groups and received either a bare metal stent(BMS),a sirolimus-eluting stent (SES)or a TES.Each pig was treated with antiplatelet drugs after angioplasty.Biochemistry,vascular morphometry,histopathology and immunohistochemistry were analyzed at 12 weeks after angioplasty.Results The injury scores of the blood vessel were similar in all three groups.There were no differences in minimal lumen diameter or lumen area between the TES[(5.13 ±0.46)mm2;(2.65 ± 0.21)mm]and SES[(5.01±0.54)mm2;(2.65±0.25)mm]groups,but they were significantly(P＜0.01)larger than those in the BMS group[(3.76±0.61)mm2;(2.15 ±0.18)mm].The neointimal area in the TES group was smaller than that in the BMS group,but was similar to that in the SES group.The expression of VEGF,ICAM-1 and α-actinin were significantly lower in the TES group than in the BMS group.In all groups,the proliferation on both edges of the stents was insignificant.No toxicity was found in the TES group.Conclusions TES inhibits neointimal proliferation and the expression of inflammatory factors in pigs.In this study,TES safely and effectively prevented restenosis for 12 weeks.
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Objective To investigate the effect of polymorphism of plasminogen activator inhibitor-1(PAI-1) promotor region gene,plasma tissue plasminogen activator(t-PA)and PAI-1 on patients with acute pulmonary thromboembolism(APTE).Method Fifty-two patients with APTE were divided into two groups according to the presence or absence of traditional enviromnent risk facters,and there were26 patients in each gnup,and auother 57 healthy indiriduals as controls were analyzed.The genotypos of subjects were determined for the 4G/5G polymorphism of PAI-1 gene using polymerase chain reaction based restriction fragment length polymorphism analysis.Plasma PAI-1 and tPA were measured by ELISA.Results(1)The ratio of 4G/4G genotype in group without traditional environment risk factors was much higher than that of the other two groups.(2)Plasma t-PA decreased and plasma PAI-1 elevated significantly in group without traditional environment risk factors compared with that of the other two groups.(3)Except the 5G homozygous,plasma PAI-1 level in group without traditional environgment risk factors was significantly higher than the other two groups.There existed correlation between 4G allele and plasma PAI-1.Conclusions 4G/5G polymorphism of PAI-1 gene is associated with AFFE.4G/4G genotype increases the risk of APTE for individuals without traditional risk factors.There are hypercoagulation and hypofibrinolysis in APTE patients without traditional risk factors.
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Objective To investigate the significance of three electrocardiographic indexes in predicting the myocardial infarct related artery (IRA) in inferior wall of acute myocardial infarction (IAMI) Methods One hundred and twenty patients with IAMI were studied Results (1) IRA was related to right coronary artery (RCA) in 98 (81 7%) case, left circumflex branch (LCX) in 22 (18 3%) cases (2) ST segment depression in lead Ⅰ identified RCA occlusion with a sensitivity of 77 6%, specificity of 90 9% in patient with IAMI, but isoelectric or elevated ST segment in lead Ⅰ identified LCX occlusion with a sensitivity of 90 9%, specificity of 77 6% (3) About QRS wave of lead aVL, S/R≥1/3 identified RCA occlusion with a higher sensitivity of 93 9% and a lower specificity of 63 6% (4) When IRA was RCA, ST segment elevated amplitude Ⅲ≥Ⅱ identified as a diagnostic index no matter the location of occlusion Conclusion Three electrocardiographic indexes have significant value in predicting the infarct related artery in inferior wall acute myocardial infarction