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@#Objective To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.
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Based on the multipole expansion theory, we show that a transverse optical torque acting on a dipolar plasmonic spherical nanoparticle can be anomalously enhanced in two plane waves with linear polarization. Compared with a homogeneous Au nanoparticle, the transverse optical torque acting on an Au-Ag core-shell nanoparticle with an ultra-thin shell thickness can be dramatically enhanced by more than two orders of magnitude. Such enhanced transverse optical torque is dominated by the interaction between the incident optical field and the electric quadrupole excited in the dipolar core-shell nanoparticle. It is thus noted that the torque expression based on the dipole approximation usually used for dipolar particles is not available even in our dipolar case. These findings deepen the physical understanding of the optical torque (OT) and may have applications in optically driven rotation of plasmonic microparticles.
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The strategy of enhanced recovery after surgery (ERAS) runs through the whole perioperative period, which requires to reduce the traumatic stress and psychological stress caused by disease, surgery and anesthesia, reduce postoperative complications, accelerate the early postoperative rehabilitation and improve the long-term prognosis. The recovery period of anesthesia is a special period with high incidence of multiple complications, and its severity may endanger the lives of patients. It is a great challenge for the medical staff in the post anesthesia recovery room to quickly and safely recover the patients from the anesthesia state to the physiological state close to the pre anesthesia state, so as to reduce the complications in the post anesthesia recovery room, shorten the residence time, and achieve safe and comfortable recovery. Therefore, this article reviews the clinical progress of ERAS strategy in postanesthesia care unit.
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Eriodictyol is a natural flavonoid which is abundant in vegetables, fruits and some Chinese medicines with many pharmacological effects such as anti-oxidation, anti-inflammatory, antitumor and neuroprotection. It has been used in the treatment of asthma, allergic rhinitis, rheumatism and other diseases frequently. With the deeper research on eriodictyol, the mechanism of its pharmacological effect has been found to be involved in nuclear factor erythroid-2-related factor 2 (Nrf2), nuclear transcription factor-κB (NF-κB), and protein kinase B (PKB/Akt) signal pathways. In this paper, we summarize the recent research progress on pharmacological effects of eriodictyol, with purpose to offer reference in further research, development and utilization.
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Objectives: The purpose of this study was to compare the 30-day clinical outcome after simultaneous hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCABG) in patients with multivessel coronary artery disease and evaluate the safety and efficiency of simultaneous hybrid coronary revascularization strategy. Methods: Simultaneous HCR was performed in 533 patients with multivessel coronary artery disease at Fuwai hospital from January 2009 to January 2017. These patients were 1:1 matched with patients underwent OPCABG using propensity score matching method. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE) over the 30-day follow-up post-surgery, and the second endpoints were in-hospital outcomes, including chest tube drainage, transfusion rate, mechanical ventilation time and length of stay in intensive care unit. Results: Chest tube drainage post-surgery (ml)(714 [523, 971] vs 965 [716, 1 220], P<0.001),Blood transfusion rate (19.7% vs 34.0%, P=0.024), mechanical ventilation time (hours) (12.6[9.3, 15.7] vs 16.0 [12.8, 18.7], P<0.001), and stay in intensive care unit (hours) (21.7[19.8, 42.4] vs 41.6[23.6, 70.0], P<0.001) were all significantly reduced in the simultaneous HCR group than in OPCABG group. Mortality, myocardial infarction, stroke, repeat revascularization rate and accumulated MACCE rate during the 30-day follow-up were similar between HCR group and OPCABG group .Conclusions: For selected patients with multivessel coronary artery disease, simultaneous HCR provided a safe and effective alternative revascularization strategy. Simultaneous HCR is associated with less blood loss, faster recovery, and fewer perioperative complications and achieved similar and favorable early outcomes as compared with OPCABG strategy.
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Objective: To compare the middle and long term clinical outcomes of one-stop hybrid coronary revascularization, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in treating the patients with multivessel coronary artery disease; to explore the optimal indication of one-stop hybrid technology. Methods: Our research included in 3 groups: Hybrid group, n=141 patients received one-stop hybrid coronary revascularization in our hospital from 2006-06 to 2010-16. Meanwhile, 5797 patients received CABG and 4254 received PCI, the major pre-operative risk factors were studied by Logistic regression analysis to calculate propensity score, adjacent matching was used to respectively select 141 subjects from CABG and PCI patients to make 1:1 match with Hybrid group as CABG group and PCI group. EuroSCORE and SYNTAX score were used to make risk stratification in all 3 groups. By EuroSCORE system: low risk ≤ 2, medium risk (3-5) and high risk ≥ 6; by SYNTAX score system: low risk ≤ 24, medium risk (25-29) and high risk ≥ 30. The incidence of major adverse cardiac/cerebral vascular events (MACCE) was compared among 3 groups at different risk stratifications. Results: The mean follow-up time was 4.5 years up to 2015-01. The overall incidence of MACCE was lower in Hybrid group (9.9％) than PCI group (27.7％), P<0.001; while it was similar between Hybrid group and CABG group (19.1％), P=0.150. By EuroSCORE stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than both CABG group (P=0.017) and PCI group (P<0.001). By SYNTAX score stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than PCI group (P<0.001), it was similar between Hybrid group and CABG group (P=0.355). Conclusion: One-stop hybrid technology had the better middle and long term outcomes for treating multivessel coronary artery disease patients with high risk stratification, which provided an alternative strategy in clinical practice.
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As a special subgroup of multiple intracranial aneurysms, mirror aneurysms are located bilaterally on the corresponding intracranial arteries. The current study sought to compare the clinical and demographic features of patients harboring mirror aneurysm, and to elucidate the corresponding risk factors. We performed a retrospective cohort study of 2641 intracranial aneurysms patients, who were admitted to our hospitals between January 2005 and June 2014. Patients were subdivided into three groups based on the inclusion criteria: (i) single (n=2250); (ii) non-mirror multiple (n=285); and (iii) mirror aneurysms (n=106). Clinical and demographic files of the three groups were collected and compared, and medical histories including stroke, hyperlipemia, hypertension, hyperglycemia, valvular heart disease were considered as potential risk factors. Potential morphological reasons for mirror cerebral aneurysms rupture, including aneurysms size, irregular walls and cerebral hemispheric dominance, were also compared. Our data showed that the male to female ratio of mirror aneurysms patients was 1:3.61, which was significantly different from that of single aneurysm (1:1.27) and multiple aneurysms (1:2.00). The prevalence of mirror aneurysms in women is higher than that in men (P<0.001). Older patients (especially 60-69 years old) also appear to be more vulnerable to mirror aneurysm than single aneurysm (P<0.001). In 84 mirror aneurysm patients the aneurysms were located on the internal carotid arteries (79.2%), most typically at the PComA or in the Cavernous ICA. Patients with medical history of hyperlipemia appear to have an increased risk of harboring mirror aneurysms. Larger aneurysm size and presence of an irregular aneurysm wall appear to be the morphological factors that predispose for mirror aneurysms rupture.
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Carotid Artery, Internal/diagnostic imaging , Intracranial Aneurysm/diagnostic imaging , Adult , Aged , China/epidemiology , Computed Tomography Angiography , Female , Humans , Hypertension , Intracranial Aneurysm/epidemiology , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Assessment , Risk Factors , Sex FactorsABSTRACT
Objective To research the effect of neoadjuvant chemotherapy with anthracycline and taxane in early or locally advanced breast cancer and its effects on ER, PR and Her-2.Methods 120 cases of early or locally advanced breast cancer patients were selected as the research objects, according to the order of admission, the patients were divided into the observation group and the control group.The control group were given conventional chemotherapy with EC regimen (epirubicin +cyclophosphamide), while the observation group were treated with anthracyclines and taxanes.The clinical efficacy and the expression of ER, PR and Her-2 receptor in the two groups after treatment were compared.Results The total effective rate of the observation group was 73.33%, which was higher than that of the control group (53.33%) (P<0.05).After treatment, the positive expression level (0~+++) of ER receptor in the observation group were 20.00%, 15.00%, 35.00%, 30.00%, respectively, the positive expression level(0~+++) of PR receptor were 26.67%, 20.00%, 23.33% and 30.00%, respectively, were significantly better than those of the control group ( ER:31.67%, 21.67%, 28.33%, 18.33%, PR:40.00%, 25.00%, 20.00%, 15.00%) (P<0.05).But there was no significant difference between the two groups in the expression of Her-2 receptor (25.00%, 11.67%, 30.00%, 33.33% and 31.67%, 21.67%, 16.67%, 30.00%, respectively).The incidence of adverse reactions in the observation group and the control group were 6.67% and 21.67%, respectively, and there was significant difference between the two groups ( P<0.05 ) .Conclusion In the treatment of early or late stage breast cancer , anthracycline combined with taxane neoadjuvant chemotherapy has a significant effect, which can effectively improve the expression of ER and PR receptors.In addition to improve the effect of clinical treatment, and reduce the incidence of adverse reactions in a certain extent,so it can be used as a new adjuvant chemotherapy in the clinical application of the best option.
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Objective:To explore the clinical features,surgical treatment and prognosis in acute myocardial infarction (AMI) patients with ventricular septal rupture (VSR) complicating cardiogenic shock (CS).Methods:A total of 77 AMI-VSR patients received surgical repair in our hospital from 2005-01 to 2015-05 were retrospectively studied.The patients were divided into 2 groups:CS group n=52 and Without CS group,n=25.Clinical features were compared between 2 groups and the outcomes in CS group were analyzed.Results:Both groups showed multiple aneurysm (73.0％ vs 68.0％);CS was more occurred in patients with posterior VSR (48.0％ vs 24.0％),P=0.044.Compared to Without CS group,CS group had the larger diameter of VSR (16.16±6.73) mm vs (11.86±4.62) mm,P=0.003;lower LVEF (45.0±8.8) ％ vs (47.9±12.3) ％,higher pre-operative application rates of IABP (34.6％ vs 0％) and vasoactive drugs (96.2％ vs 28.0％),more patients received emergent surgery (42.3％ vs 8.0％) and less patients received elective surgery (57.7％ vs 92.0％),all P＜0.05.In CS group,there were 3 in-hospital death,49 patients survived with the mean follow-up time at (4.5±3.1) years and 2 patients died during that period.Conclusion:Larger or posterior VSR were more likely to develop CS,the patients survived after surgical treatment may have good mid-term outcomes.
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Objective:To explore the clinical features,surgical treatment and prognosis in acute myocardial infarction (AMI) patients with ventricular septal rupture (VSR) complicating cardiogenic shock (CS).Methods:A total of 77 AMI-VSR patients received surgical repair in our hospital from 2005-01 to 2015-05 were retrospectively studied.The patients were divided into 2 groups:CS group n=52 and Without CS group,n=25.Clinical features were compared between 2 groups and the outcomes in CS group were analyzed.Results:Both groups showed multiple aneurysm (73.0％ vs 68.0％);CS was more occurred in patients with posterior VSR (48.0％ vs 24.0％),P=0.044.Compared to Without CS group,CS group had the larger diameter of VSR (16.16±6.73) mm vs (11.86±4.62) mm,P=0.003;lower LVEF (45.0±8.8) ％ vs (47.9±12.3) ％,higher pre-operative application rates of IABP (34.6％ vs 0％) and vasoactive drugs (96.2％ vs 28.0％),more patients received emergent surgery (42.3％ vs 8.0％) and less patients received elective surgery (57.7％ vs 92.0％),all P＜0.05.In CS group,there were 3 in-hospital death,49 patients survived with the mean follow-up time at (4.5±3.1) years and 2 patients died during that period.Conclusion:Larger or posterior VSR were more likely to develop CS,the patients survived after surgical treatment may have good mid-term outcomes.
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The introduction of MOOC to medical education in China can greatly promote the development of modern medical education.Using the content analysis method,the paper systemizes the research literatures on MOOC published in 2013-2015 in China.According to the analysis,currently,the research on MOOC in China is still in the initial stage.Therefore,it proposes the focus of domestic research on MOOC and the research development direction in medical education in the future.
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Objective To determine the content of heavy metals and harmful elements in commercially available Yuanhu Zhitong Capsule. Methods The determination of lead, cadmium, arsenic, mercury, copper and chromium by atomic absorption spectrometry and atomic fluorescence spectrometry was established.Results The recovery rate of the method was between 91.2% and 111.2%, and the precision of the experiment was less than 5%, and the range of each element was good.The stability and reproducibility of the method were good.Lead and cadmium and copper of Yuanhu zhitong capsule in different degree exceeded the standard, while the content of arsenic, mercury and chromium was in accordance with the requirements. Conclusion The method is simple and easy to operate, convenient and quick.The content of the current limit of Yuanhu zhitong capsule still need to establish the quality standard of lead and cadmium, arsenic, mercury, copper and chromium.In this paper, the establishment of the heavy metals and harmful elements determination method of Yuanhu zhitong capsule provide quality control and safety evaluation of reference.
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Objective:To investigate frequency and position characteristics of the vestibular dysfunction in vestublar neuritis patients. Method:Colaric test (CT), head impulse test (HIT), cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) were applied in 43 vestublar neuritis patients to assess their vestublar dysfunction. Superior vestublar nerve (S-VN), inferior vestibular nerve (I-VN), total vestibular nerve (T-VN) and each vestibular end organ incidence rate were calculated and statistically analyzed. Result:CT incidence rate (93.0%) was statistically higher than that of HIT (72.1%) (P<0.01). Total frequency incidence rate (72.1%) was statistically higher than that of low frequency (20.9%) (P<0.01). No high frequency only case was observed. The incidence rate of S-VN only, I-VN only and T-VN was 44.2%, 4.7% and 51.2% respectively. Among them, the incidence rate of I-VN was significantly lower than the others (P<0.01). The incidence rate of vestibular end organs was 17.4% (S-SCC), 44.2% (H-SCC), 20.9% (P-SCC), 39.5% (utricule) and 26.7% (saccule) respectively. The incidence rate of H-SCC was remarkably higher than the other semicircular canals (P<0.01). The difference between utricule and saccule was not statistically significant. Conclusion:The semicricular canal dysfunction in vestibular neuritis patients mainly involves total frequency of vestibular function, low frequency is more common than high frequency. Total vestibular nerve and single S-VN are mostly involved in vestibular neuritis.
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Objective To explore the mechanisms of Artemisia argyi burning and moxibustion photo-thermal effect.Methods N-alkanes were obtained by gradient solvent extraction and silica gel column chromatography elution from 1, 3 and 5 years’ Artemisia argyi produced in QiChun, Hubei and analyzed by gas chromatography mass spectrometry (GC-MS).Results The n-alkane contents of 1, 3 and 5 years’ Artemisia argyi were 318.65, 528.23 and 394.20μg/g, respectively. A total of seventeen kinds of n-alkanes were detected from the Artemisia argyi of three kinds of years. The 31 carbon alkane content was highest in all of them. Because N-alkanes affect the temperature and stability of Artemisia argyi burning, it may be the material basis for explaining “worrying seven years’ diseases seek 3 years’ Artemisia argyi”.
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The paper starts with a study of problems existing in current fundamental computer course assessment in Traditional Chi-nese Medicine ( TCM) colleges and universities and analyzes the competence-based procedural assessment of fundamental computer courses, points out that such an assessment, as the key factor in discipline construction and course construction, effectively guarantees the cultivation of versatile informatization professionals in the TCM field and is able to better promote the modernization of TCM.
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One case with metal crochet through external auditory meatus embedded stylomastoid foramen, preoperative found no paralysis, underwent temporal bone CT examination to assess the illness after emergency surgery to remove the foreign body, postoperative patients of peripheral facial paralysis, explore and summarize the clinical experience.
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Humans , Ear Canal , Pathology , Facial Paralysis , General Surgery , Foreign Bodies , General Surgery , Metals , Otorhinolaryngologic Surgical Procedures , Methods , Temporal BoneABSTRACT
<p><b>OBJECTIVE</b>To investigate the Th17 cell and Treg cell levels in patients with sarcoidosis, and their relation to disease activation and glucocorticoids treatment.</p><p><b>METHODS</b>Twenty-three sarcoidosis patients admitted in Yinzhou People's Hospital from January 2009 to December 2013 and 25 healthy subjects (controls) were included in this study. The blood samples and bronchoalveolar lavage fluid (BALF) samples were collected in all patients before and after glucocorticoids treatment. The serum angiotensin converting enzyme (SACE) levels were detected. The percentages of Th17 cells and Treg cells in peripheral blood and BALF were determined by flow cytometry, the concentrations of cytokines in serum and supernatants of BALF were measured by enzyme-linked immunosorbent assay (ELISA). The levels of ROR-γt and Foxp3 mRNA transcripts in peripheral blood mononuclear cells (PBMC) were determined by real-time quantitative PCR. The potential correlation between the percentages of Th17 or Treg cells and SACE levels was evaluated.</p><p><b>RESULTS</b>Compared with healthy controls, significantly higher frequencies of Th17 cells (4.34%±0.89% vs 1.60% ± 0.42%), lower frequencies of Treg cells (1.28% ± 0.37% vs 3.39% ± 0.50%) in peripheral blood were observed. Higher level of ROR-γt mRNA (21.31 ± 3.55 vs 3.63 ± 1.00) and lower level of Foxp3 mRNA (1.60 ± 0.24 vs 3.12 ± 0.76) in peripheral blood were detected in sarcoidosis patients in active stage (before glucocorticoids treatment) (all P<0.01). After the treatment of glucocorticoids, these index in peripheral blood were significantly improved (Th17 cells 2.16% ± 0.68%，Treg cells 2.21% ± 0.42%, ROR-γt mRNA 10.15 ± 1.93, Foxp3 mRNA 2.44 ± 0.38) ( all P<0.05). The changing trends of Th17 and Treg cell cytokines levels in serum were consistent with two type cells. Meanwhile, the changing trends of above index in BALF of patients treated by glucocorticoids were consistent with those in sarcoidosis patients in active stage. The increased ratios of Th17 cells to Treg cells were positively correlated with the level of serum SACE (r= 0.781).</p><p><b>CONCLUSION</b>The imbalance of Th17 cells and Treg cells in peripheral blood and airway may be involved in the pathogenesis of sarcoidosis, which was associated with the activity of disease, and the treatment of glucocorticoids may achieve a therapeutic effect by correcting the immune imbalance.</p>
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Humans , Bronchoalveolar Lavage Fluid , Case-Control Studies , Cytokines , Allergy and Immunology , Enzyme-Linked Immunosorbent Assay , Forkhead Transcription Factors , Metabolism , Leukocytes, Mononuclear , Metabolism , Nuclear Receptor Subfamily 1, Group F, Member 3 , Metabolism , Sarcoidosis , Allergy and Immunology , T-Lymphocytes, Regulatory , Allergy and Immunology , Th17 Cells , Allergy and ImmunologyABSTRACT
<p><b>OBJECTIVE</b>To study the value of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting symptomatic patent ductus arteriosus (sPDA) in preterm infants.</p><p><b>METHODS</b>Preterm infants born at a gestational age (GA) of ≤ 32 weeks and diagnosed with patent ductus arteriosus (PDA) by echocardiography within 48 hours after birth between June 2014 and April 2015 were selected as subjects. Their clinical manifestations were observed, and serum NT-proBNP levels were measured and echocardiography was performed at 3 and 5 days after birth. The infants were divided into sPDA group and asymptomatic PDA (asPDA) group based on their clinical manifestations and the results of echocardiography. The correlations between serum NT-proBNP level and echocardiographic indices were analyzed. Serum NT-proBNP levels were compared between the two groups. The receiver operator characteristic (ROC) curve was applied to determine the sensitivity and specificity of serum NT-proBNP in the prediction of sPDA.</p><p><b>RESULTS</b>A total of 69 preterm infants were enrolled in this study, with 13 infants in the sPDA group and 56 infants in the asPDA group. Serum NT-proBNP level was positively correlated with the diameter of the arterial duct (r=0.856; P<0.05)and the ratio of left atrial diameter to aortic root diameter (LA/AO) (r=0.713; P<0.05). At 3 and 5 days after birth, the serum NT-proBNP levels in the sPDA group were significantly higher than those in the asPDA group (P<0.05). The area under the ROC curve (AUC) for the prediction of sPDA by NT-proBNP levels at 3 days after birth was 0.949 (95% CI: 0.892-1.000; P<0.001), with a cut-off value of 27 035 pg/mL (sensitivity: 92.3%; specificity: 94.6%); the AUC for the prediction of sPDA by NT-proBNP levels at 5 days after birth was 0.924 (95% CI: 0.848-1.000; P<0.001), with a cut-off value of 6 411 pg/mL (sensitivity: 92.3%; specificity: 92.9%).</p><p><b>CONCLUSIONS</b>NT-proBNP may be a quantitative index for shunt volume. The measurement of serum NT-proBNP levels on 3 and 5 days after birth may be useful to predict sPDA in preterm infants.</p>
