Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results / 中国胸心血管外科临床杂志

@#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.

Assessment of the internal mammary artery using ultrasound in patients with coronary artery disease before coronary artery bypass grafting / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA. Methods    From July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed. Results    A total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05). Conclusion    Preoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.

Clinical efficacy of reduction ascending aortoplasty with wedge resection in adult patients undergoing aortic valve replacement: A single-center retrospective study / 中国胸心血管外科临床杂志

@#Objective    To assess mid-term outcomes of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospecctively analyzed clinical data of 30 adult patients with aortic valve diseases and ascending aortic dilatation in Fuwai Hospital from 2010 to 2019. There were 20 males and 10 females with an age of 38-72 (55.73±9.95) years. All patients received AVR+RAA using the wedge resection technique. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative and postoperative AAD in all patients were 48.23±3.69 mm and 37.60±5.02 mm, respectively. And the mean AAD of follow-up was 40.53±4.65 mm. There was a statistical difference in AAD between preoperation and postoperation, postoperation and final follow-up, preoperation and final follow-up. The median follow-up time was 28.50 (12-114) months. The median rate of increase in AAD postoperatively was 0.76 mm per year. And the rate of increase was ≥3 mm per year in 5 patients, while ≥5 mm per year in 4 patients with indications for reoperation. Conclusion    Mid-term outcomes of RAA in adult patients undergoing aortic valve replacement using the wedge resection technique are satisfying and encouraging. However, some patients still need surgical re-intervention.

NAFLD fibrosis score is associated with high-risk coronary plaque in patients with NAFLD / 中华健康管理学杂志

Objective:To investigate the possible role of non-invasive fibrosis scoring systems for detecting high-risk plaque among patients with non-alcoholic fatty liver disease (NAFLD).Methods:A total of 477 consecutive asymptomatic subjects underwent a health checkup including coronary computed tomography angiography (CTA) and abdominal ultrasonography. Fatty liver was evaluated using ultrasonography, and the NAFLD fibrosis score (NFS) was calculated. Coronary stenosis and plaque were evaluated using coronary CTA.Results:Of the study population, 223 had NAFLD. Among the NAFLD patients, high-risk coronary plaque was more frequent in patients with high or intermediate NFS than those with low NFS (62.5% versus 24.0%, P<0.001). The adjusted odds ratio with 95% confidence interval of high-risk plaque was 3.24 (1.11-9.40) for the highest versus lowest quartile of NFS ( P=0.016). Among those without NAFLD, NFS was not associated with high-risk coronary plaque (C-statistic with NFS versus without NFS, 0.766 versus 0.764, P=0.715). Adding NFS to the traditional cardiovascular disease (CVD) risk model increased the C-statistics by 0.679 to 0.739 ( P=0.031). Conclusions:There was an independent association of NFS with high-risk coronary plaque in patients with NAFLD, suggesting its potential use to optimize management of patients with NAFLD.

Research progress on fat aging and the occurrence and development of metabolic syndrome / 中华老年医学杂志

Obesity has become a major public health problem that threatens human health.Abdominal obesity, especially the increase in visceral adipose tissue(VAT), can in some cases lead to insulin resistance and other metabolism-related diseases such as diabetes, cardiovascular disease, thrombosis, and pro-inflammatory metabolic abnormalities.Metabolic syndrome is a group of clinical syndromes characterized by the co-occurrence of various metabolic diseases, including insulin resistance and inflammatory response.In a large extent, the occurrence and development of the metabolic syndrome are related to fat aging and visceral obesity related.Visceral obesity is an independent risk factor for cardiovascular events, and can be changed, so by setting realistic goals, by insisting on reasonable exercise and diet control can achieve control of visceral fat, prevention and control of the metabolic syndrome.This review reviews the concept and pathophysiology of metabolic syndrome and the relationship between visceral obesity and metabolic syndrome.

Clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery / 中华消化内镜杂志

Objective@#To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis.@*Methods@#A retrospective study was performed on data of 15 patients with cholecystolithiasis, who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data, including situation of operation, operative time, intraoperative hemorrhage, and postoperative complications were recorded.@*Results@#The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain, and 7 patients felt slight pain in umbilical a week after surgery. No fever, incision infection, umbilical hemia, peritonitis, and ascites were reported. The clear-liquid diet was recommended for one day after operation, and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day, and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months.@*Conclusion@#Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis, provides excellent cosmetic outcomes, and can be appropriately carried out under the strict control of surgical indications.

Clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery / 中华消化内镜杂志

Objective To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis. Methods A retrospective study was performed on data of 15 patients with cholecystolithiasis,who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data,including situation of operation,operative time,intraoperative hemorrhage,and postoperative complications were recorded. Results The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain,and 7 patients felt slight pain in umbilical a week after surgery. No fever,incision infection,umbilical hemia,peritonitis,and ascites were reported. The clear-liquid diet was recommended for one day after operation,and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day,and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months. Conclusion Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis,provides excellent cosmetic outcomes,and can be appropriately carried out under the strict control of surgical indications.

Meta-analysis of Effectiveness and Safety of Xingpi Yang ’er Granules Combined wit h Clostridium butyricum Live Powder in the Treatment of Pediatric Dyspeptic Diarrhea / 中国药房

OBJECTIVE： To systematically evaluate the effectiveness and safety of Xingpi yang’er granules（XYG） combined with Clostridium butyricum live powder （CBLP） in the treatment of pediatric dyspeptic diarrhea， and provide evidence-based reference for clinical medication. METHODS： Retrieved from Cochrane Library， PubMed， Embase， CBM， CNKI， VIP and Wanfang database， randomized controlled trials （RCTs） about XYG combined with CBLP（trial group）vs. CBLP alone（control group）in the treatment of pediatric dyspeptic diarrhea were collected. After literature screening， data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0 bias risk evaluation tool， Meta-analysis was performed by using Rev Man 5.3 software. TSA 0.9 software was used for trail sequential analysis. RESULTS： A total of 8 RCTs with 857 participants were included. Total response rate of trial group [RR＝1.20，95％CI（1.13，1.28），P＜0.000 01] was significantly higher than that of control group. Abdominal pain relief time [MD＝－1.18，95％CI（－1.42，－0.94），P＜0.000 01]， abdominal distension relief time [MD＝－1.32， 95％CI（－1.94，－0.70），P＜0.000 1]， diarrhea relief time [MD＝－2.07， 95％CI（－2.38，－1.76），P＜0.000 01]， the time of stool traits returned to normal[MD＝－2.16，95％CI（－2.43，－1.88）， P＜0.000 01] in trial group were significantly shorter than control group. The stool frequency [MD＝－1.72，95％CI（－2.18，－1.24）， P＜0.000 01] in trial group were significantly less than control group. The incidence of ADR in trial group was significantly lower than control group （P＜0.05）， or there was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）， or no significant ADR was founded in 2 groups. Trial sequential analysis showed that the evidence of total response rate of XYG combined with CBLP in the treatment of pediatric dyspeptic diarrhea was accurate. CONCLUSIONS： XYG combined with CBLP is effective and safe for pediatric dyspeptic diarrhea.

Effects of Berberine Hydrochloride on the Pharmacokinetics of Tacrolimus in Rats / 中国药房

OBJECTIVE： To study the effects of berberine hydrochloride on the pharmacokinetics of tacrolimus in rats after single or multiple administration， and to provide reference for clinical combination therapy. METHODS： 30 rats were randomly divided into 5 groups， with 6 rats in each group： group one was treated with single administration of tacrolimus； group two was treated with tacrolimus intragastrically， twice a day， for consecutive 1 week； group three was treated with single administration of berberine hydrochloride， 5 min later given single administration of tacrolimus； group four was treated with tacrolimus intragastrically， twice a day， for consecutive 1 week， and then given tacrolimus intragastrically once 5 min after intragastric administration of berberine hydrochloride on the 8th day； group five was treated with berberine hydrochloride intragastrically， twice a day， and given tacrolimus intragastrically every 5 min， for consecutive 8 d. The doses of berberine hydrochloride and tacrolimus were 200 mg/kg and 0.945 mg/kg. The blood samples 0.3 mL were collected from posterior orbital venous plexus of rats 0， 5， 15， 30 min and 1， 2， 3， 4， 6， 8， 12 h after last intragastric administration of tacrolimus. The concentration of tacrolimus in rat whole blood was determined by LC-MS/MS. DAS 2.0 software was used for pharmacokinetic study. RESULTS： Compared with group one， the pharmacokinetic parameters AUC0-12 h， AUC0-∞ and MRT0-12 h of tacrolimus in rats were decreased significantly in group three （P＜0.05），while there was no statistical significance in all pharmacokinetic parameters of tacrolimus in group four （P＞0.05）. Compared with group two， AUC0-12 h of tacrolimus was decreased significantly while CLz was increased significantly in group four （P＜0.05）； there was no statistical significance in all pharmacokinetic parameters of tacrolimus in group five （P＞0.05）. CONCLUSIONS： Single and multiple intragastric administration of berberine hydrochloride has a certain effect on the pharmacokinetics of tacrolimus in rats， it shows that there is a downward trend in blood drug concentration and needs to be used with caution.

Analysis of Common Postoperative Complications after Cranioplasty / 中国康复理论与实践

@# Objective To explore the related factors of common postoperative complications after cranioplasty. Methods From November, 2009 to June, 2013, a total of 211 patients after cranioplasty were reviewed. The conventional two-dimensional titanium alloy was used. The incidence of scalp effusion, seizure and spontaneous intracerebral hemorrhage were recorded, and the related factors including gender, age, primary disease, skull defect site, attack time, concomitant hydrocephalus and intraoperative dural damage were analyzed. Results The incidence of these complications was 4.7% (10/211) in total. There were four cases with scalp effusion, five cases with seizures and one case with spontaneous intracerebral hemorrhage. The scalp effusion was related to hydrocephalus (χ2=4.804, P=0.028) and intraoperative dural damage (χ2=7.510, P=0.006). Seizure and spontaneous intracerebral hemorrhage were not related with any factors above (P>0.05). Conclusion The occurrence of postoperative scalp effusion can be reduced by repairing intraoperative dural damage, and dealing with extreme hydrocephalus timely.

Necessity of Bone Wax Stanching Bleeding at Sternal Edge in Patients With Cardiac Surgery by Median Sternotomy / 中国循环杂志

Objective: To explore the necessity for application of bone wax stanching bleeding at sternal edge in cardiac surgery by median sternotomy. Methods: A total of 445 patients who receive cardiac surgery by the same surgeon performing median sternotomy in our hospital from 2011-01 to 2014-12 were studied. According to application of bone wax stanching bleeding, the patients were divided into 2 groups: Bone wax group,n=210 and Non-bone wax group,n=235. Re-thoracotomy for hemostasis, 12 h, 24 h and total draining volume after the operation and time of closing incision were compared between 2 groups. Results: There were 2 patients and 1 patient received re-thoracotomy for hemostasis in Bone wax group and Non-bone wax group respectively, which was not related to bone marrow cavity bleeding. In Bone wax group and Non-bone wax group, the draining volume at 12 h post-operation were (451 ± 240) ml vs (483 ± 238) ml, at 24 h post-operation were (615 ± 304) ml vs (639 ± 285) ml and the total volume were (842 ± 467) ml vs (842 ± 364) ml, allP>0.05; the time of closing incision were (68.0 ± 23.0 ) min vs (66.0 ± 19.0 ) min,P>0.05; the total transfusion rates were 21% vs 19%,P>0.05. Conclusion: Application of bone wax at sternum edge could neither affecting the drainage nor the speed of closing incision in cardiac surgery and therefore, it might be given up.

Ethical Analysis on Design and Signature of 2265 Clinical Trial Informed Consent Forms / 中国医学伦理学

Items of design and signature from clinical trial drugs were made , the occurrence ratio of every item in 2265 informed consent form ( ICF) from 63 clinical trial drugs in Beijing Youan Hospital affiliated to Capital U-niversity of Medical Sciences were analyzed , and items with lower occurrence ratio were explored .Generally , the design and signature of ICF met the requirement of GCP .However , there were some defects of ICF and antonym of signature .Based on the analysis on the problems , some measures were put forward:formulate relevant standard op-erating procedures , strengthening the management of informed consent , and strengthen the system construction and education training , promote the hospital ethics construction , to protect the rights and interests of the subjects .

Factors Related with Infection and Local Epidural Hematoma after Cranioplasty:A Retrospective Analysis / 中国康复理论与实践

Objective To explore the factors associated with the complications of cranioplasty, infection and local epidural hematoma, such as age, sex, primary disease, skull defect and concomitant hydrocephalus. Methods 211 patients after cranioplasty were reviewed. Re-sults 8 cases (3.8%) complicated one of them, in which 6 cases with local epidural hematoma and 2 cases with infection. The infection was more likely related with the areas of skull defect (P=0.003). No factor was found related with the local epidural hematoma. Conclusion It is necessary to focus the size of the frontal sinus when repairing the the frontal bone, to avoid the screw into the frontal sinus caused infection.

Incidence of sudden cardiac death of urban residents in Beijing / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the incidence of sudden cardiac death (SCD) of urban residents in Beijing.</p><p><b>METHODS</b>A community based epidemiology survey was performed on the residents of 4 communities in the Xicheng and Haidian districts in Beijing from October 2008 to September 2009. Data on the total population, age, gender and vital status were monitored, and incidence of SCD as well as related information were collected from the household administrative workers, the family members of the deceased, the hospital personnel and the witnesses.</p><p><b>RESULTS</b>479 521 subjects (244 000 men and 235 521 women) were monitored, a total of 1 285 (642 men and 643 women) all cause death occurred during the study period and 184 (86 men and 98 women) deaths were identified as SCD. The incidence of SCD was 35.2 (95%CI 27.8-42.7) per 100 000 per year for men and 41.6 (95%CI 33.4-49.8) per 100 000 per year for women. SCD accounted for 13.4% mortality in men and 15.2% mortality in women. There were 171 (91.0%) SCD cases in residents over 55 years of age. The incidence of SCD for the age group 0-24, 25-34, 35-44, 45-54, 55-64, 65-74 and 75 years and over was 5.6, 4.6, 3.0, 9.8, 78.4, 88.4, and 272.8 per 100 000 per year for men, and 1.6, 0, 3.2, 0, 21.1, 84.2 and 470.0 per 100 000 per year for women, respectively. The proportion of the cases that have at least one cardiovascular disease history was 57.0% (49/86) for men and 60.2% (59/98) for women. The cases that occurred at home, on the way to hospital, in the hospital emergency room, in the hospital ward and other places account for 53.3% (98 cases), 12.2% (22 cases), 9.2% (17 cases), 12.5% (23 cases) and 13.0% (24 cases) of the 184 SCD cases, respectively.</p><p><b>CONCLUSION</b>SCD is a great threat to the urban residents in Beijing. Most SCD cases occurred at home on residents over 55 years of age. More than half SCD residents have at least one cardiovascular disease. It is important to take preventive measures in the urban residents over 55 years old and with history of cardiovascular disease.</p>

Related Factors and Prevention for Infection post Ventricle-peritoneal Shunt / 中国康复理论与实践

Objective To investigate the related factors of infection post ventricle-peritoneal shunt and explore some preventive mea-sures. Methods 85 cases after ventricle-peritoneal shunt for normal pressure cranial hydrocephalus were analysed retrospectively. The effect of intensive prevention was observed. Results The overall infection rate was 7%after ventricle-peritoneal shunt. There was significant dif-ference between the patients with or without infection post-operation in some factors, such as preoperative infection (pneumonia, urinary tract infection, intracranial infection, biliary infection);the operator;activities of daily living. It was 9.8%(6/61) under routine aseptic opera-tion, and was 0 (0/24) under intensive management. Conclusion Infection after ventricle-peritoneal shunt is associated with many factors, es-pecially the susceptibility and contact to infection. Intensive management can significantly prevent the infection.

A Susceptible Diagnostic Criteria in Secondary Normal Pressure Hydrocephalus / 中国康复理论与实践

@# Objective To investigate the diagnostic and predictive value of spasticity in shunting patients with normal pressure hydrocephalus (NPH).Methods Twenty-three secondary NPH patients who received ventriculo-peritoneal shunt were retrospected. Increased muscular tension were quantified pre and post-shunting by modified Ashworth scale. The dilatated ventricle was measured by Evans' index.Results Four weeks after shunting, spasticity was relieved to some extent on all the identical limbs side of the primary impairment cerebral and 78% cases was improved to zero scale. on the contralateral side limbs, the relieved rate was 86% and 46% cases improved to normal scale. Evans' index improved 35%.Conclusion Increased muscle tonus could be measurement quantified and is readily available and sensitive as a diagnostic criteria in secondary NPH.

颅脑损伤急性期的救治 / 中国康复理论与实践

@#在地震中,颅脑外伤极为常见,其救治过程特点为:发生突然、时间急、伤员多、伤情复杂、抢救难度大。治疗细节决定救治的成败。在早期治疗中,主要是维持生命体征,为原发性脑损伤提供恢复条件,避免继发性脑损伤。尽早转运到后方专科医院治疗,减少死亡及伤残率。

颅脑损伤急性期的救治 / 中国康复理论与实践

@#在地震中,颅脑外伤极为常见,其救治过程特点为:发生突然、时间急、伤员多、伤情复杂、抢救难度大。治疗细节决定救治的成败。在早期治疗中,主要是维持生命体征,为原发性脑损伤提供恢复条件,避免继发性脑损伤。尽早转运到后方专科医院治疗,减少死亡及伤残率。

1-year Survey of Outpatient Consultation in Clinical Pharmaceutical Care Practice / 药物流行病学杂志

Objective:To understand the rules and features of consultation service of outpatients by examining the outpatient consultation in clinical pharmaceutical-care practice.Method:The 1-year clinical charts for outpatient consulta- tion were monitored.The population and disease characteristics of outpatients,consulted problems and resolutions were re- viewed,Result:The counseling patient's median age was 32.And 56.7% of the patients were females.The disease charac- teristics were influenced by the distribution of beth regional diseases and hospital departments.Neither history of adverse drug reactions nor drug quantity of each prescription had any significant influence on the patient consultation behavior.The major problem(72%)concerned about was how to use drugs properly.Conclusion:The general disease information about different ages,genders,periods are indispensable for consultant pharmacists to acquire.More considerate and initiative service for drug uses should be provided for the outpatient counseling.

Treatment of Closed Abdominal Trauma with Craniocerebral Trauma:34 Cases Report / 中国康复理论与实践

@#Objective To summarize the clinical feature and treatment of 34 cases with closed abdominal trauma and craniocerebral trauma. Methods 34 patients with closed abdominal trauma and craniocerebral trauma were analyzed retrospectively. Results 4 cases died in hospital. Conclusion For the patients with closed abdominal trauma and craniocerebral trauma, shock and acute intracranial hypertension should be dealt with in time. Early diagnosis and operation is important to avoid secondary brain injury and to reduce the death rate.