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Objective:To evaluate the efficacy and safety of total aortic arch replacement in elderly patients with Stanford type A aortic dissection(TAAD).Methods:In this retrospective study, a total of 481 TAAD patients treated with total arch replacement in our hospital from January 2016 to January 2020 were divided into three groups: aged≤59 years, 60-69 years and ≥70 years.The differences between three groups in surgical method, extracorporeal circulation time, blocking time, circulatory time, stopping time, surgical time, ventilator use time, ICU time, hospitalization time, treatment rate of continued renal replacement, fatality rate, and cause of death were statistically analyzed and compared.Results:There were statistically significant differences in the stopping time between any two groups of the three groups(all P<0.05). The older the age, the shorter the circulatory arrest time.The difference of ventilator time and ICU time between ≤59 and 60-69 years was statistically significant( P<0.01). Patients with continuous renal replacement(CRRT)were 19.0%(71/373)in ≤59 years, 23.1%(18/78)in 60~69 years, and 26.7%(8/30)over 70 years.In-hospital mortality was 35/373(9.4%)in the group of ≤59 years old, 11/78(14.1%)in the group of 60~69 years old, and 5/30(16.7%)in the group of ≥70 years old.There was no death in patients undergoing type Ⅱ hybrid surgery. Conclusions:Age is one of the important death factors after total aortic arch replacement in TAAD patients.Total aortic arch replacement is an acceptable surgical method for elderly patients with TAAD.Hybridization may reduce hospitalization death in elderly patients.
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@#Objective To summarize the clinical feature and treatment experience of patients with acute type A aortic dissection involving coronary arteries. Methods The clinical data of 107 patients with acute type A aortic dissection involving coronary arteries, who received operation between June 5, 2012 and December 31, 2019 in our hospital, were analyzed retrospectively. There were 80 males and 27 females at age of 24-83 (49.8±11.2) years. Results The right coronary artery was involved in 65 patients, the left in 17 patients, and both coronary arteries in 25 patients. There were 48 (44.9%) patients undergoing coronary artery bypass grafting, 49 (45.8%) patients undergoing coronary artery plasty. Fifteen patients died 30 d after the operation, with a mortality rate of 14.0%. Patients with preoperative cardiogenic shock and postoperative acute renal failure had increased risk of death (P<0.05). Eighty-two (88.2%) patients were followed up for 2 to 71 months, and 1 patient had sudden cardiac death during the follow-up period. Conclusion Acute type A aortic dissection with coronary involvement is associated with high misdiagnosis rate and mortality rate. Taking proper strategies for surgical treatment of involved coronary arteries based on precise diagnosis may improve the prognosis of patients.
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At present, the prevalence rate of diabetes presents a rising tendency. The cardiovascular disease is a major complication of diabetes mellitus and acute coronary syndrome (ACS) is a severe form of coronary heart disease. Compared with non-diabetic patients, the disease situation in diabetic ACS patients is more serious with more contradictory problems and difficulty in treatment. Although percutaneous coronary intervention (PCI) plays a certain role in re-canalization of coronary artery, after PCI the problems the patients with diabetic ACS will face are still serious. traditional Chinese medicine (TCM) recognizes that the etiology and pathogenesis of diabetic ACS are deficiency in Qi and Yin, and accumulation of blood stasis and toxin inside the body. Through clinical observation and retrospective analysis, it is found that using "supplementing Qi and nourishing Yin, activating blood circulation and detoxifying"can interfere with the patients' diabetic ACS and simplify the therapeutic regimen, which is an integrated regulatory treatment with multiple links, multiple pathways and multiple targets, and is a sufficient realization of unique superiority of traditional Chinese medicine by using holistic concept, syndrome differentiation and multiple-link interference for comprehensive prevention and treatment of diabetic ACS.
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At present, the prevalence rate of diabetes presents a rising tendency. The cardiovascular disease is a major complication of diabetes mellitus and acute coronary syndrome (ACS) is a severe form of coronary heart disease. Compared with non-diabetic patients, the disease situation in diabetic ACS patients is more serious with more contradictory problems and difficulty in treatment. Although percutaneous coronary intervention (PCI) plays a certain role in re-canalization of coronary artery, after PCI the problems the patients with diabetic ACS will face are still serious. traditional Chinese medicine (TCM) recognizes that the etiology and pathogenesis of diabetic ACS are deficiency in Qi and Yin, and accumulation of blood stasis and toxin inside the body. Through clinical observation and retrospective analysis, it is found that using "supplementing Qi and nourishing Yin, activating blood circulation and detoxifying"can interfere with the patients' diabetic ACS and simplify the therapeutic regimen, which is an integrated regulatory treatment with multiple links, multiple pathways and multiple targets, and is a sufficient realization of unique superiority of traditional Chinese medicine by using holistic concept, syndrome differentiation and multiple-link interference for comprehensive prevention and treatment of diabetic ACS.
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Objective To investigate clinical effects of early postoperative oral enteral nutrition on immune function for colorectal cancer patients,to provide a reference for clinical treatment.Methods We selected 90 colorec-tal cancer surgery patients from January 2012 to April 2015,and they were divided into two groups by random number method.50 cases in the study group were given early oral enteral nutrition,and 40 patients in the control group were given postoperative parenteral nutrition.Before and after treatment,the quality of life,complications,immunology indi-cators,nutrition indicators were compared in two groups.Results In the observation group,the postoperative fever, exhaust time,hospital stay,hospital costs,quality of life scores were (54.29 ±5.76)h,(57.89 ±5.95)h,(10.48 ± 1.63)d,(41 432.85 ±2 165.46)RMB,(79.23 ±5.17)points,which were significantly lower than those in the con-trol group,the differences were statistically significant (t =8.69,P =0.00;t =8.61,P =0.00;t =9.49,P =0.00;t =5.54,P =0.00;t =4.16,P =0.01);7d after the treatment,the IgA,IgG,IgM,CD +4 ,CD +4 /CD +8 in observation group were (1.92 ±0.49)g/L,(11.31 ±2.24)g/L,(0.99 ±0.21)g/L,(41.21 ±5.51)%,(1.72 ±0.32),which were better than those in the control group,the differences were statistically significant (t =2.05,P =0.04;t =2.11, P =0.04;t =2.12,P =0.04;t =3.64,P =0.01;t =2.23,P =0.03).In observation group,postoperative 7d Hb, TRF,ALB,PAB were (113.28 ±13.36)g/L,(3.02 ±0.39)mg/L,(38.97 ±3.15)g/L,(333.15 ±18.35)mg/L, which were better than those in the control group,the differences were statistically significant (t =3.45,P =0.01;t =2.18,P =0.03;t =2.32,P =0.04;t =3.21,P =0.01).7d after operation,the CRP level of observation group was(7.29 ±2.05)mg/L,which was significantly lower than that of the control group,the difference was statistically sig-nificant (t =4.22,P =0.01 ).The incidence rate of postoperative complications in the observation group was 26.00%,that of the control group was 40.00%,the difference was statistically significant (χ2 =4.52,P =0.01). Conclusion Early oral enteral nutrition in patients with colorectal cancer will help to improve immune function, nutritional support,reduce the inflammatory response,which will help postoperative recovery.
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Objective To summarize clinical outcomes of interventional therapy on children with common congenital heart diseases(CHD).Methods A retrospective study was conducted.One hundred and fourteen patients with CHD were selected as our subjects,who underwent catheter interventional therapy in the Second Affiliated Hospital of Zhengzhou University from Jan.2004 and Dec.2012.The size of occluder was chose according to intraoperative echocardiography or cardiac imaging measurements,and occluder was released under assisted monitoring by subtraction angiography or cardiac ultrasound.Results There are all together 112 patients got the therapy successfully,2 cases failed(occluder detachment),and the success rate of operation was 98.2％.After the success of interventional,echocardiography examination showed that 11 cases were with star point across shunt,but the function of the around valve was not affected.One months after operation,echocardiography examination showed star point across shunt of 11 cases were disappeared,and no occluder was shifted as well as no thrombosis formed.Three months after operation,chest radiograph showed pulmonary congestion decreases and heart shadow was shrink.Thirty-eight cases were with three tricuspid regurgitation before operation and 32 cases were without reflux at 3 months after operation,and 6 cases relieved significantly.The patients were followed up for 6 months or 3 years,activity endurance was significantly improved than that before operation.No occluder was shiftand hemolysis and arrhythmia occurred.Meanwhile,No thrombosis or embolism occurred.Conclusion Interventional treatment for children with congenital heart disease is proved as a safe,effective methods and it have broad prospects in clinical application.
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ObjectiveTo explore the efficacy of the technique of reticular basket through cystic duct stone removal during laparoscopic common bile duct exploration.MethodsFrom January 2008 to February 2011,185 patients received laparoscopic bile duct exploration in our hospital.These patients underwent intraoperative cholangiography (IOC) through the cystic duct with a reticular basket.With the help of a choledochoscope,a reticular basket was used to take out stones for patients who were shadow-positive.Re-cholangiography was then performed to ascertain that no stone was retained in the biliary tract.ResultsOf the 185 patients,60 were found to be positive on IOC.Stones were successfully removed by using a reticular basket through the cystic duct in 45 patients,and through the cystic duct and common bile duct after a micro-incision was made under choledochoscopic assistance in 10 patients.After laparoscopic common bile duct exploration re-cholangiography found no residual stones in these patients. In 5 patients,stones were removed after conversion to open surgery. Conclusions During laparoscopic common bile duct exploration,using reticular baskets via the cystic duct for intraoperative cholangiography (IOC) and removing stones is of great value.
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Objective To study the effects of arsenic trioxide ( As2 O3 ) on inhibiting the proliferation of pancreatic carcinoma cell lines. Methods The inhibiting rate of As2O3 and Fluorouracin(5-Fu) ,Gemcitabine(GEM) on pancreatic carcinoma cell lines PC-3 were detected by using CCK-8 assay. Results As compared with 5-Fu、GEM,the inhibiting rate of As2O3 was the highest one( P ＜ 0.01 or P ＜ 0.05). Conclusion As2O3 can inhibit pancreatic carcinoma cell lines PC-3 effectively in vitro. The effects of As2O3 on inhibiting the proliferation of pancreatic carcinoma cell lines was stronger than 5-Fu and GEM. This is possibly due to the extensive and unique anticancer mechanism of As2O3.