Prognostic value of different health-related indicators in elderly patients with diabetes mellitus and coronary heart disease / 公共卫生与预防医学

Objective To analyze the influence of different health-related indicators on the prognosis of elderly patients with diabetes mellitus complicated with coronary heart disease, and to provide theoretical basis for the diagnosis and treatment of diabetes mellitus complicated with coronary heart disease. Methods Among of 456 elderly patients with diabetes mellitus complicated with coronary heart disease admitted to our hospital from December 2018 to December 2020 were selected. According to the occurrence of Major adverse cardiovascular events (MACE) within 1 year after discharge, patients were divided into the control group (no MACE) and the observation group (MACE). The Clinical data of patients including age, gender, BMI, smoking, alcohol consumption, diabetes course, degree of coronary artery stenosis and number of lesions, were collected from the medical record system. Univariate analysis and logistic regression were used to analyze the influence of health indicators such as systolic blood pressure, LEVF, HbA1c, LDL-C, LDH and ALP on the occurrence of MACE in patients with diabetes and coronary heart disease. Spearman correlation analysis was used to analyze the correlation between different health-related indicators and the occurrence of MACE in elderly patients with diabetes mellitus and coronary heart disease. Results A total of 456 elderly patients with diabetes mellitus and coronary heart disease, 122 cases (26.75%) developed MACE. There were no differences in age, male proportion, BMI, smoking and drinking of diabetes course between the two groups (P>0.05). The degree and number of coronary artery stenosis in the observation group were significantly higher than those in the control group (P7.0% (OR=2.617), LDL-C>2.6 mmol/L (OR=2.976) and BUA >420μmol/L (OR=2.341) were independent risk factors for MACE in elderly patients with diabetes mellitus and coronary heart disease (P7.0%, LDL-C >2.6 mmol/L and BUA >420 μmol/L, active treatment should be conducted to improve the prognosis of patients.

Pregnancy combined with acute Stanford type A aortic dissection: single center experience and literature review / 中华胸心血管外科杂志

Objective:To summarize the clinical characteristics and surgical treatment experience of pregnant women with acute Stanford type A aortic dissection.Methods:From January 2005 to December 2018, a total of 12 patients with acute Stanford type A aortic dissection were treated in Zhongshan Hospital affiliated to Fudan University. Two patients died of sudden aortic dissection rupture during emergency CTA examination. The other 10 patients underwent surgical treatment, the age was 22-40 years[mean(30.7±5.8) years], the pregnancy was 15-39 weeks[mean(28.8±6.5) weeks], two cases in the second trimester of pregnancy, seven cases in the third trimester of pregnancy and one case in puerperium. Among them, seven cases were Marfan syndrome, one case was bicuspid aortic valve malformation, two cases were complicated with pregnancy hypertension.Results:One case died during perioperative period and died of rupture of abdominal aortic dissection in twelfth day after operation. One fetus was diagnosed as stillborn before operation. Before December 2013, six patients underwent surgeries, the mean cardiopulmonary bypass time was(96.8±16.5)min, aortic occlusion time was(70.8±19.3)min, intensive care unit time was(3.4±2.3) days, ventilator-assisted mechanical ventilation time was(21.6±15.6)h. After January 2014, four patients underwent surgeries, the mean cardiopulmonary bypass time was(202.3±6.4)min, the aortic cross-blocking time was(137.5±10.3)min, circulatory arrest time was(27.3±8.8)min, intensive care unit time was(12.0±5.7) days, and the ventilator-assisted mechanical ventilation time was(40.3±24.4)h. The postoperative complications included tracheotomy in two cases, hemodialysis in one case, poor wound healing in one case. One patient who had been treated with Bentall was followed up to sixth year and died of progressive rupture of descending arch dissection. One patient was followed up to seventh year after Bentall surgery, redo Bentall and Sun’s procedure were performed because of artificial valve infection, and was discharged uneventful. No adverse cardiovascular events occurred in other patients.Conclusion:Surgical treatment should be actively considered in pregnancy complicated with acute Stanford type A aortic dissection. Multi-disciplinary team cooperation can effectively improve the safety and effect of operation.

Effects of Extracorporeal Shock Wave Therapy on Tendon Adhesion in Late Period after Hand Tendon Repair / 中国康复理论与实践

Objective:To observe the effect of extracorporeal shock wave therapy on tendon adhesion in late period after hand tendon repair. Methods:From July, 2017 to December, 2018, 40 patients with tendon adhesion after hand tendon repair more than three months were collected. They were randomly divided into control group (n = 20) and experimental group (n = 20). Two groups received routine therapy, and the experimental group added extracorporeal shock wave therapy. Before and two months after treatment, the total active movement (TAM) of the fingers and the grip strength were messured. Results:There was no significant difference in TAM of the fingers and the grip strength before treatment (P > 0.05). After treatment, TAM of the fingers and the grip strength significantly increased (|t| > 10.284,P < 0.001), and were higher in the experimental group than in the control group (t > 0.386,P < 0.001). Conclusion:Extracorporeal shock wave therapy could facilitate to improve the tendon slippage and hand function in patients with tendon adhesion after hand tendon repair.

Advantages and suggestions for medical MOOC education in the information age / 中华医学教育探索杂志

Massive open online courses (MOOC) is an emerging teaching mode based on website, which has been developed rapidly in China since 2013. Contemporary medical education, assisted by MOOC, diverges greatly with various modes. In this paper, the current situation and advantages of MOOC on medical education in the information age were analyzed, and suggestions for improvement of MOOC on modern medical education were proposed in combination with foreign case study, which is conducive to the reform and innovation of medical education model.

The effects of tetrandrine on activity of collagenase derived from human hypertrophic scar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe the effect of tetrandrine on activity of collagenase derived from human hypertrophic scar for the sake of clarifying the mechanism as tetrandrine acting on scar.</p><p><b>METHODS</b>The experimental concentration was controlled below that of cell proliferation inhibited, SDS-PAGE electrophoresis was adopted to separate collagenase from extracellular matrix, and then activated by trypsin analyzed the activity of collagenase with density scanning apparatus. At the same time quantity of extracellular collagen was measured using improved chloraseptine T oxidizing assay, moreover analyzed correlation between activity of collagenase and quantity of extracellular collagen.</p><p><b>RESULTS</b>In the concentration below the lever of inhibiting fibroblast proliferation, the total activity of collagenase could be significantly increased by tetrandrine with dosage-dependence associated with quantity of extracellular collagen reduced, which was much greater than that of triamcinolone.</p><p><b>CONCLUSION</b>Increasing activity of collagenase on degradation of collagen even in a lower concentration was one of the mechanisms of tetrandrine treating hypertrophic scar.</p>

Expression and significance of alpha5beta1 integrin in abnormal scars / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the expression of alpha5beta1 integrin in the abnormal scars and its role and significance in the formation and development of abnormal scars.</p><p><b>METHODS</b>The expression of alpha5beta1 integrin was observed in hypertrophic scar (15 samples), keloid (15 samples) and normal skin (10 samples) with SP immunohistochemical method and colloidal gold immuno-electron microscopic technique. The data were semi-quantitatively analyzed.</p><p><b>RESULTS</b>The expression levels of alpha5beta1 integrin in the fibroblasts of keloids and hypertrophic scars were higher than normal skin; the expression of alpha5beta1 integrin in the fibroblasts of keloids was higher than hypertrophic scars (P < 0.01).</p><p><b>CONCLUSION</b>The alpha5beta1 integrin appears to have close relation to the formation and development of abnormal scars. To find a way to decrease the expression level of alpha5beta1 integrin in fibroblasts may be a new approach to inhibit scar hypertrophy.</p>