Comparison of the outcomes between open and hybrid approaches in the treatment of thoracoabdominal aortic aneurysms repair / 北京大学学报(医学版)

OBJECTIVE@#Thoracoabdominal aortic aneurysm is one of the most challenging aortic diseases. Open surgical repair remains constrained with considerable perioperative morbidity and mortality. The emergence of a hybrid approach utilizing visceral debranching with endovascular aneurysm repair has brought an alternative for high-risk patients. This study aimed to compare the short- and long-term outcomes between hybrid and open repairs in the treatment of thoracoabdominal aortic aneurysms.@*METHODS@#In this retrospectively observational study, patients with thoracoabdominal aortic aneurysm treated in a single center between January 2008 and December 2019 were reviewed, of whom 11 patients with hybrid repair, and 18 patients with open repair were identified. Demographic characteristic, operative data, perioperative morbidity and mortality, freedom from reintervention, and long-term survival were compared between the two groups.@*RESULTS@#In the hybrid repair group, the patients with dissection aneurysm, preoperative combined renal insufficiency, and American Society of Anesthesiologists (ASA) score of 3 or more were significantly overwhelming than in the open repair group. The operation time of debranching hybrid repair was (445±85) min, and the intraoperative blood loss was (955±599) mL. There were 2 cases of complications in the early 30 days after surgery, without paraplegia, and 1 case died. The 30-day complication rate was 18.2%, and the 30-day mortality was 9.1%. The operation time of the patients with open repair was (560±245) min, and the intraoperative blood loss was (6 100±4 536) mL. Twelve patients had complications in the early 30 days after surgery, including 1 paraplegia and 4 deaths within 30 days. The 30-day complication rate was 66.7%, and the 30-day mortality was 22.2%. The bleeding volume in hybrid repair was significantly reduced compared with open repair (P < 0.001). Besides, the incidence of 30-day complications in hybrid surgery was significantly reduced (P=0.011). During the follow-up period, there were 4 reinterventions and 3 deaths in hybrid repair group. The 1-year, 5-year, and 10-year all-cause survival rates were 72%, 54%, and 29%, respectively. In open repair group, reintervention was performed in 1 case and 5 cases died, and the 1-year, 5-year, and 10-year all-cause survival rates were 81%, 71%, and 35%, respectively. There was no significant difference between hybrid repair and open repair in all-cause survival and aneurysm-specific survival.@*CONCLUSION@#Hybrid approach utilizing visceral debranching with endovascular aneurysm repair is a safe and effective surgical method for high-risk patients with thoracoabdominal aortic aneurysms. The incidence of early postoperative complications and mortality is significantly reduced compared with traditional surgery, but the efficacy in the medium and long term still needs to be improved.

Path analysis of the relationships among health knowledge of chronic diseases, lifestyle and utilization of workplace health services of teachers in a district of Beijing / 中华疾病控制杂志

Objective To understand the influence path of occupational health knowledge, behavior and lifestyle, and utilization of workplace health service on chronic diseases of teachers in a district of Beijing. Method A self-designed questionnaire was used among teachers in a district of Beijing through path analysis. Results The prevalence rate of chronic diseases in occupational population was 51.5%. The top three diseases were lumbar or spinal diseases (19.0%), hypertension (12.5%) and gastroenteritis (11.1%). The rate of overweight and obesity increased with age, and male teachers were higher than that of female teachers which was statistically significant ( 2=119.313，P<0.001).Overweight-obesity, health related knowledge and utilization of workplace services made direct effects on chronic diseases. Healthy behaviors and lifestyles made indirect effects on chronic diseases by overweight-obesity. Conclusions The teachers’ health in this district was not bad. It is recommended that we should pay attention to the population of teachers, especially the male so that to prevent and control the incidence of overweight and obesity, improve their health knowledge level and develop healthy habits, and increase the input of health resources in the workplace.

Study on the correlation of Ureaplasma urealyticum and Chlamydia trachomatis infection with tubal infertility / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the relationship of Ureaplasma urealyticum(UU)and Chlamydia trachomatis(CT)infections with reproductive tract microenvironment changes and clinical infertility.METHODS: From July 2018 to May2019,85 cases of tubal infertility were collected as the infertility group from the Outpatient Department of Reproductive Medicine Center,the Seventh Affiliated Hospital of Sun Yat-sen University.The ultrasonography and hysterosalpingography(HSG)showed normal size and shape of uterine cavity,and complete or incomplete obstruction of one or both fallopian tubes;infertility caused by other factors was excluded. The control group consisted of 45 normal women during the same period who had no previous pregnancy history and HSG showed no obvious abnormal fallopian tube. Vaginal and cervical secretions were collected to detect vaginal cleanliness and UU and CT infection.RESULTS: The vaginal cleanliness（Ⅲ-Ⅳ）of infertility group(18.82%)was more than that of control group(4.4%)(P<0.05).CT(18.82%),U(38.82%),CT+UU(15.29%)and total infection rates(72.94%)in infertility group were higher than those in control group(4.44%,8.89%,2.22% and 15.56%). The difference was statistically significant(P<0.01). Multivariate logistic regression analysis showed that tubal infertility was closely related to CT,UU and CT+UU infection(CT:P=0.046,OR=3.291;UU:P=0.025,OR=2.789;CT+UU:P=0.017,OR=7.528).CONCLUSION: CT and UU infections are strongly associated with tubal infertility. It is necessary to screen all women at childbearing age,especially infertile women,in order to clarify the relationship between these pathogens and impaired fertility and adverse pregnancy outcomes.

Spinal cord stimulation for non-reconstructable chronic ritical limb ischemiae: a case report / 北京大学学报(医学版)

Peripheral arterial disease is one part of systematic atherosclerosis, becoming a heavy burden of human health. Patients in end stage of peripheral arterial disease manifest critical limb ischemia with severe rest pain and refractory ulcer. Surgical revascularization is the optimal option for patients with critical limb ischemia to avoid major amputation and improve quality of life. However, some of them contraindicate surgical revascularizations owing to coexisting morbidities. Spinal cord stimulation is reported to be effective and minimally invasive in pain relief and limb salvage for patients with limb ischemia. Here, we reported one case with chronic critical limb ischemia and gangrene of foot who underwent spinal cord stimulation, which was, as we knew, the first case in China. He was diagnosed with Burger disease and accompanied with history of stroke, chronic obstructive pulmonary disease and Castleman's disease. It showed totally occlusive lesions of external iliac and femoropopliteal artery and no outflows below the knee in the computed tomography angiography. Given the complexity of lesions and weakness of the patient, spinal cord stimulation was indicated for control of rest pain and limb salvage. As specified, we implanted the temporary neurostimulator as the first step. After 2 weeks from temporary neurostimulator implantation, the patient achieved significant relief in intensity of pain, and acquired 20% improvement of transcutaneous oxygen pressure. The satisfactory results indicated probable effectiveness of spinal cord stimulation, thus we performed the permanent neurostimulator implantation 1 month later. During 2 months of follow-up, the patients stabilized at Fountain III with pain relief with one kind of nonsteroidal anti-inflammatory drug. In our case, we confirmed the significant validity of spinal cord stimulation for pain control and consequent improvement of quality of life in non-reconstructable chronic critical limb ischemia. Furthermore, we reviewed that a number of published studies suggested that spinal cord stimulation be a reasonable option for patients with critical rest pain, especially who contraindicated surgical revascularization. The application of spinal cord stimulation in pain relief for non-reconstructable chronic critical limb ischemia was approved by related guidelines released by European Society of Cardiology and Trans-Atlantic Inter-Society Consensus. Further investigations are required for assessing the long-term outcome in limb salvage.

Effectiveness of self-management behavior intervention on type 2 diabetes based on self-determination theory / 北京大学学报(医学版)

OBJECTIVE@#To provide autonomy support from three dimensions based on self-determination theory (SDT), i.e. professional support, peer support, family support, and to investigate whether this intervention can improve diabetes self-management behavior and glycemic control of diabetic patients, and to analyze the influencing factors of the effect.@*METHODS@#Using convenient sampling method, three communities were selected respectively in Beijing. Each community selected health service stations with similar conditions as different intervention groups. The diabetic patients managed by the station who were eligible for inclusion were recruited into this intervention group. The community stations were divided into three groups. The routine intervention group only issued knowledge manuals and conducted health management according to the requirements of basic public health services. Peer support groups were divided into small groups and carried out doctor-led group activities. Based on doctor-led peer support activities, the doctors and peers were trained to provide autonomy support based on self-determination theory, and their family members were trained in the form of manuals to provide autonomy support, forming a concerted support of the three dimensions. Activity processes and materials were also designed based on SDT. The intervention duration was 3 months, and the main evaluation indexes were HbA1c and patients' self-management behaviors, skills, knowledge, and self-efficacy scores.@*RESULTS@#Before and after the intervention, the HbA1c of routine intervention group were 7.40%±1.37%, 7.30%±1.18%. The HbA1c of peer support group before and after the intervention were 7.33%±1.15% and 7.13%±1.27%. The HbA1c of autonomy support group before and after the intervention were 7.42%±1.22% and 6.78%±0.80%. Before and after the intervention, the self-management score in routine intervention group was 10.54±2.28 and 10.80±2.15, the score in peer support group was 11.09±1.89 and 11.40±1.78, the score in autonomy support group was 10.34±1.99 and 11.10±1.65, respectively. The HbA1c and self-management score increased higher in autonomy support group than in the other two groups. After intervention, the control rate in autonomy support group was higher than in the other two groups. According to the multi-factor analysis, the value of HbA1c after intervention was positively related to the baseline HbA1c, and negatively related to self-management behavior. The value in autonomy support group was higher than in routine intervention group. Baseline self-management behavior, self-efficacy, knowledge, skill, family support, autonomy support, peer support and age were positively correlated with the change of behavior.@*CONCLUSION@#self-management behavior intervention based on self-determination theory can effectively promote self-management behavior and glycemic control of diabetic patients, and the effect is better than single peer support activities.

Enhance malaria screening to blood donors / 中华检验医学杂志

Since haemoplasmodium is not detected for screening in blood donor,morbidity of transfusion-associated malaria increased rapidly in China recently and became an important problem of public health.It is necessary to emphasize donor screening for malaria.Hematology analyzer with MAPSS is recommended to screen malaria.Flow cytometry and immunochromatography test(ICT)can also screen malaria effectively.For the suspicious samples with haemoplasmodium,it is necessary to be reexamined by standard microscopic examination or polymerase chain reaction(PCR).