Analysis on occupational noise deafness in a provincial occupational disease diagnosis institution from 2016 to 2020 / 中国职业医学

@#Objective - （ ） To analyze the epidemiological characteristics of occupational noise induced deafness ONID （ ） diagnosed by Guangdong Province Hospital of Occupational Disease Prevention and Control GDHOD from 2016 to 2020 and - Methods the reasons non ONID diagnosis. The data of ONID patients diagnosed in GDHOD from 2016 to 2020 were collected “ from the Occupational Disease Report Card in the Occupational Disease and Occupational Health Information Monitoring ” “ ” - System subsystem of the China Disease Prevention and Control Information System . The data of non ONID subjects were ， collected from the occupational disease diagnosis archives in the same hospital and the relevant data were analyzed Results ， ， （ ） retrospectively. Of the 1 432 subjects 824 subjects were diagnosed as ONID patients mainly of mild ONID 86.0% . （M） ， M Male patients accounted for 88.0%. The median of diagnosis age was 45.0 years old and of length of employment of ， ， ， diagnosis was 8.3 years. ONID patients were mainly found in Zhongshan Dongguan Zhuhai Jiangmen and Guangzhou City in ， ， （ ） the Pearl River Delta accounting for 67.6%. The cases distributed in 519 enterprises mainly on manufacturing 90.2% . ， - ， ； Among the 139 enterprises each enterprise had 2 11 patients worked within five years accounting for 53.9% 91.1% of the -， - - - ONID patients were distributed in large medium and small enterprises. ONID patients mainly worked in non public enterprises that accounted for 91.3%. There were 606 subjects could not be diagnosed as ONID. The main reasons for not being （ ）， diagnosed were that the weighted value of better ear hearing threshold was less than 26 dB 34.8% the working history of （ ）， occupational noise exposure was less than three years 31.5% the weighted value of better ear hearing threshold was less thanConclusion 26 dB and the average hearing threshold of binaural high frequency was less than 40 dB 16.2% . The ONID ， ， -， - patients have the characteristics of group aggregation. The Pearl River Delta manufacturing industry large medium and - - ： small non public enterprises are the key points of ONID prevention. The main reasons for not being diagnosed as ONID were ， the working history of occupational noise exposure was less than three years the weighted value of better ear hearing threshold ， - was less than 26 dB and the average high frequency hearing threshold of both ears was less than 40 dB.

Procedure optimization and realistic option——To evaluate the improvement of efficiency in the new Administration Measures for the Diagnosis and Verification of Occupational Disease / 中国职业医学

@#Improving the efficiency of occupational disease diagnosis and verification is conducive to protecting the rights and interests of workers, better realizing the legislative value pursuit of the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases, and truly demonstrating the spirit of legal fairness and justice. In 2021, the Administration Measures for the Diagnosis and Verification of Occupational Disease was revised and implemented. The working procedures of occupational disease diagnosis are adjusted and optimized, and the efficiency of diagnosis of occupational disease is greatly improved. They include items such as new provisions specifying working time limits; optimize the working mode; the diagnosis of occupational disease attribution applies to presumptive causality is emphasized and the logical thinking of inversion of burden of proof is carried out. However, the work efficiency of occupational disease diagnosis does not make a great breakthrough in quality, mainly manifests in three aspects: difficult to confirm labor relationships, raising the threshold of occupational disease diagnosis, the administrative field investigation is empty and the diagnosis of occupational disease is complicated. There are many pre-procedures in occupational disease diagnosis, which restrict the efficiency of diagnosis. In the future, attention needs to be paid to promote the independent work of occupational disease diagnosis institutions, and through the revision of the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. Occupational disease diagnosis institutions should be empowered to confirm labor relationship, so as to lower the threshold of diagnosis of occupational disease and maximize the protection of the rights and interests of workers.

Distribution of pathogenic bacteria and analysis of drug sensitivity in acute dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the pathogenic bacteria and drug resistance of acute dacryocystitis, and to provide a guide for rational clinical medication.<p>METHODS: Lacrimal sac pus samples from 80 acute dacryocystitis cases were collected for bacterial culture and drug sensitivity test in Hebei Provincial Eye Hospital from January 2014 to October 2019. The change of detection rate of pathogenic bacteria in different years, the species of pathogenic bacteria of acute dacryocystitis, the main pathogenic bacteria, drug sensitivity and drug resistance of acute dacryocystitis, and the average detection rate of pathogenic bacteria in acute dacryocystitis were analyze.<p>RESULTS:Totally 56 samples were positive for pathogenic bacteria, including 55 cases of bacteria and 1 case of fungi. The average detection rate was 70%. The detection rate of pathogenic bacteria strains was gradually decreasing year by year, and there were various types of pathogenic bacteria strains detected from samples. In addition, Gram-positive cocci was the main pathogenic bacteria of acute dacryocystitis, accounting for 68%(38 cases), of which, staphylococcus aureus accounted for 38%(21 cases). What's more, most Gram-positive cocci were sensitive to rifampin, levofloxacin, and chloramphenicol, and Gram-negative bacilli were more sensitive to tobramycin, levofloxacin, ciprofloxacin, and gentamicin. Fifty-five cases of bacterial samples were obviously resistant to the first and second generation cephalosporins.<p>CONCLUSION: Gram-positive cocci constitute the main pathogenic bacteria of acute dacryocystitis, and levofloxacin can be used as the first choice of topical antibiotics for the treatment of acute dacryocystitis.

Analysis of matching degree between drug consumption in Wuhan Huoshenshan Hospital and medicine prepared by medical team / 医学研究生学报

Based on the rapid development of COVID-19 epidemic, China has built Huoshenshan Hospital in Wuhan. This paper analyzes the matching degree between drug consumption in Huoshenshan Hospital and medicine prepared by the medical team in the early stage and the use of medicine in the first week after receiving the patients in Huoshenshan Hospital, and compares it with medicine carried by the medical team. With the novel coronavirus infection developing rapidly, the superior group has a tight schedule and a heavy task, and the preparation time before setting out is only 3 days, the matching degree of pharmaceutical supply can reach 60% within a short period of time, which can already meet the general clinical treatment needs. This paper analyzes the situation of preparing medicine in medical teams in the early stage, and provides experience for future medical teams to carry out the law again.

DNA methyltransferase 3A regulates the expressions of collagens during the activation of cardiac fibroblasts / 医学研究生学报

Objective The mechanisms of methylation acting on myocardial fibrosis are not yet clear at present. The aim of this study was to investigate the role of DNA methyltransferase 3A (DNMT3A) in regulating the expressions of collagens during the activation of cardiac fibroblasts.Methods Cardiac fibroblasts were obtained from 50 neonatal mice and divided into three groups: blank control, DNMT3A overexpression plasmid (mDNMT3A-pEGFP-C3) and small interference DNMT3A siRNA. The contents of collagens in the cell supernatant were detected by ELISA. The mRNA and protein expressions of type I collagen (Col Ⅰ), type Ⅲ collagen (Col Ⅲ) and DNMT3A in the cardiac fibroblasts were determined by real-time quantitative PCR and Western blot respectively and the proliferative activity of the cardiac fibroblasts measured by CCK8 assay.Results The contents of Col I and Col Ⅲ in the cell supernatant were significantly increased in the DNMT3A overexpression plasmid group but decreased in the DNMT3A siRNA group as compared with those in the blank control (P<0.05). The expressions of Col Ⅰ, Col Ⅲ and DNMT3A were remarkably higher in the DNMT3A overexpression plasmid group but lower in the DNMT3A siRNA group than in the blank control (P<0.05). The cell activity was markedly higher in the DNMT3A overexpression plasmid group than in the empty vector plasmid and control groups (2.087±0.317 vs 1.063±0.223 and 1.082±0.207, P<0.05) but lower in the DNMT3A siRNA group (0.463±0.087) than in the latter two (P<0.05).Conclusion DNMT3A can increase the proliferation and activation of cardiac fibroblasts, upregulate the expressions of collagens and thus promote myocardial fibrosis.

Medicinal materials support scheme for multi-module medicine vehicle / 医疗卫生装备

Objective To explore medicinal materials support scheme for the multi-module medicine vehicle to enhance the efficiency of the medicine support module.Methods Mission-oriented exercises were executed according to modularity principle so as to solve the problems in the missions.Results The scheme for the multi-module medicine vehicle adapted itself to variable support environments and requirements.Conclusion The scheme facilitates rapid and mobile medicine support.

Maxillary first premolar with 3 root on both sides of a subjet:case report / 实用口腔医学杂志

The maxillary first premolar is a transitional tooth between incisors and molars. Most maxillary first premolars have 2 root canals. However, the bilateral maxillary first premolar with 3 roots and 3 canals has not been described. This article reports a rare case:The bilateral maxillary first premolar with 3 roots and 3 canals.

Clinical features of 30 patients with cryoglobulinemia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the clinical features of cryoglobulinemia.</p><p><b>METHOD</b>We retrospectively analyzed the clinical data of 30 patients admitted to Peking Union Medical College Hospital from January 2003 to March 2013 due to cryoglobulinemia.</p><p><b>RESULTS</b>The average age was(53.8±11.9)years in these 30 patients(12 men and 18 women),among whom 22 patient(73.3%)developed infectious diseases including hepatitis B(n=11)and hepatitis C(n=11);in addition,3 hepatitis B patients and 1 hepatitis C patient also had malignancies. Four patients(13.3%)were accompanied with malignant lymphocytic proliferation diseases,and three(10.0%)with connective tissue diseases. The cause of disease was unclear in 5 patients(16.7%). The clinical manifestations varied due to the primary diseases;notably,20 patients(66.7%)had an onset of purpura rash,22(73.3%)and 19(63.3%)were accompanied with hypertension and chronic renal insufficiency,respectively. The severity of renal involvement was relevant with the increase of C reactive protein,erythrocytes,sedimentation rate,and IgM and the decrease of complements. Treatment should be directed at the primary diseases. Glucocorticoid and immunosuppressants were good choices for relieving renal involvement. Elderly, type 1 cryoglobulinemia,and poor renal function were associated with the poor prognosis.</p><p><b>CONCLUSIONS</b>Cryoglobulinemia is mainly seen in middle and elderly patients. It can often affect multiple systems,in particular the kidney. Inflammatory markers,IgM,and complements is related with the disease severity. Age,primary disease,and renal function are related with prognosis.</p>

Application of intravenous anesthesia in combination with oropharyngeal airway ventilation in hysteroscopy / 中国基层医药

Objective To observe the safety and efficiency of two different ways of intravenous anesthesia combined with oropharyngeal airway ventilation in hysteroscope operation.Methods 40 ASA Ⅰ ～ Ⅱ patients undergoing hysteroscopy were randomly assigned into two groups,20 cases in each group.Patients in the group A,B,were administered respectively with sufentanil 0.1 μg/kg or dexmedetomidine 0.5μg/kg by micro-pump in at least 10 minutes before operation.The perioperative hemodynamic index was recorded.The different outcomes including total dose of propofol,hemodynamic changes,recovery time,postoperative uterine contraction pain and episodes of adverse actions were observed and compared.Results Compared with group A,heart rate (HR) and systolic blood pressure (SBP) were higher in group B (P ＜ 0.05).The recovery time in group A was longer than that in group B (P ＜0.05).But there were no statistical differences of the total dosage of propofol,the incidence of respiratory depression,and the incidence rate of drowsiness after operation betwween group A and group B (P ＞ 0.05).Conclusion There was safe and effective of two different ways of intravenous anesthesia combined with oropharyngeal airway ventilation in hysteroscope operation,but the dynamic index was more stable,and the recovery time was shorter in patients with lowdose dexmedetomidine.

A systematic review regarding the effects of different kinds of selenium supplementations on Kaschin-Beck disease / 中华流行病学杂志

Objective To systematically assess the efficacy of different programs regarding the selenium supplementation formulae used for prevention and treatment of Kaschin-Beck disease (KBD) in children.Methods PubMed,EMBASE,Cochrane Library,SCI expanded,CNKI (Chinese National Knowledge Infrastructure),VIP (Chinese Science and Technique Journals Database),CBM (The Chinese Biomedical Database),Wanfang Database,CSCD (Chinese Science Citation Database)had been electronically searched.All the searching processes were up-dated to Dec 2012 to identify randomized trials (RCTs) and non-RCTs to compare the selenium supplementation formulae with placebo or with no intervention.Two reviewers assessed the methodological quality of the study design,including RCTs or non-RCTs according to Cochrane Handbook for Systematic Reviews of Interventions 5.1 or a checklist described by Deeks J J,et al,respectively.Data was extracted independently.Results There were 14 RCTs and 12 non-RCTs papers included,but showing low methodological quality.Data from Meta analysis showed that selenium supplementation had caused the following progresses:radiologic improvement (RR=3.28,95％CI:2.06-5.22),higher hair selenium (SMD=2.05,95％ CI:1.00-3.11) lower new radiologic lesions (OR=0.18,95％ CI:0.09-0.36) than in the placebo or with no treatment groups.Both selenium and vitamin C supplementation did not show differences in radiologic improvement of metaphysis (RR=1.01,95％CI:0.84-1.22).Combination of selenium and vitamin E supplementation showed higher radiologic improvement than the placebo group.Combination of selenium and vitamin C supplementation had no influence on the difference in radiologic improvement or hair selenium than selenium supplementation.Selenium-enriched yeast showed higher radiologic improvement than sodium selenite (70.83％ vs.48.84％,P＜0.05).Selenium fertilization showed higher radiologic improvement than the nontreatment group (RR=3.98,95％ CI:2.25-7.05).Comprehensive intervention program and ‘grain drying approach' also showed certain effects.Conclusion Selenium supplementation could lead to better radiologic improvement and hair selenium,with lower new radiologic lesions.Current evidence supported its benefits on prevention and treatment of KBD.Large sample sized and well-designed trials together with the reporting on adverse outcome remained necessary.

Transitional cell carcinoma associated with aristolochic acid nephropathy: most common cancer in chronic hemodialysis patients in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The research of cancer in patients on hemodialysis (HD) in China has not been reported. The aim of this study was to investigate the clinical and histological features and outcomes of cancer in Chinese HD patients.</p><p><b>METHODS</b>The study subjects were 49 cancer patients (1.4%) out of 3448 end stage renal disease (ESRD) patients maintained on HD at China-Japan Friendship Hospital from October 1997 to July 2011.</p><p><b>RESULTS</b>Urinary tract cancer (74%) was the most common followed by gastrointestinal tract cancer (12%), breast cancer (6%), lung cancer (4%), thyroid cancer (2%), and hematologic cancer (2%). Thirty-three patients (67%) had urinary tract transitional cell carcinoma (TCC) and 29 of them had aristolochic acid nephropathy (AAN) as underlying disease. Death occurred in eight patients out of 49, and the survival rate of HD patients with cancer was similar to those without cancer (P = 0.120).</p><p><b>CONCLUSION</b>The urinary tract TCC is the most common cancer in HD patients with AAN in one of the centers of northern China.</p>

Systematic review of randomized controlled trials of acupuncture for glaucoma / 中国针灸

<p><b>OBJECTIVE</b>To assess the efficacy of acupuncture for glaucoma.</p><p><b>METHODS</b>The search was conducted through database to identify randomized controlled trials of acupuncture for glaucoma until September 2010. The quality assessment, data extraction and Meta-analysis were performed by Cochrane Handbook for Systematic Re views of Interventions.</p><p><b>RESULTS</b>Eight articles were included. Meta-analysis showed that acupuncture did not decrease intraocular pressure compared with eye drops [SMD = -0.1 66, 95% CI (-1.45, 0.13)]. However, acupuncture increased the effectiveness rate of treatment for glaucoma [OR = 4.45, 95% CI (1.96,10.09)]. Compared with placebo, acupuncture did not decrease intraocular pressure 20 min after acupuncture (P = 0.13) and 24 hours after acupuncture (P = 0.21). Nonetheless, acupuncture increased the effectiveness rate of treatment for glaucoma [OR = 45.00, 95% CI (9.73, 208.08)]. Compared with acupuncture, quantitative acupuncture manipulation increased the effectiveness rates of treatment for glaucoma [OR = 2.23, 95% CI (1.14, 4.36)].</p><p><b>CONCLUSION</b>Acupuncture therapy has potential to increase effectiveness rates of treatment for glaucoma. It lacks reliable evidence to prove that acupuncture decreases intraocular pressure. More trials with high quality are needed to estimate adverse effects and cost effectiveness of acupuncture therapy.</p>

Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in patients with coexistent carotid and coronary artery diseases.</p><p><b>METHODS</b>Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out.</p><p><b>RESULTS</b>A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was (25.5 +/- 7.0) minutes. The mean number of distal grafts per patient was 3.30 +/- 0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was (11.3 +/- 5.4) hours, (2.1 +/- 0.9) days, and (12.5 +/- 6.1) days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients (92.16%) with a mean follow-up of (39.5 +/- 12.5) months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred.</p><p><b>CONCLUSION</b>Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.</p>

Is the use of cardiopulmonary bypass for isolated coronary artery bypass an independent predictor of mortality and morbidity in patients with severe left ventricular dysfunction? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients presenting with severe left ventricular dysfunction (SLVD) undergoing conventional coronary artery bypass grafting (CCABG) are at an increased risk of perioperative mortality and morbidity. The aim of this study was to assess the risk factors responsible for mortality and morbidity among patients with SLVD by comparing CCABG and off-pump coronary artery bypass surgery (OPCAB).</p><p><b>METHODS</b>We retrospectively evaluated 186 consecutive patients with SLVD who underwent coronary artery bypass grafting (CABG), including 102 by CCABG and 84 by OPCAB. Registry database, medical notes, and charts were studied for preoperative and postoperative data of the patients. Different variables and risk factors (preoperative, intraoperative, and postoperative) were evaluated and compared. The morbidity and mortality outcomes were compared in the two groups. The follow-up results and quality of life were assessed after surgery.</p><p><b>RESULTS</b>The two groups had similar percentage of patients with preoperative high-risk profiles and no significant differences were found between groups in baseline variables such as age or comorbidities. There was a significant difference in the number of grafts used between the two groups. CCABG patients received (3.6 +/- 0.5) grafts per patient, while OPCAB patients had (2.7 +/- 0.6) grafts (P < 0.05). Completeness of revascularization was also significantly different between the two groups (CCABG 91.1% vs OPCAB 73.8%, P < 0.05). The hospital mortality was similar in the two groups (4.8% in OPCAB vs 5.9% in CCABG). The risk-adjusted mortality, according to the calculated propensity score, did not reach statistical significance in the two groups. In this study, OPCAB seemed to have a beneficial effect on reducing reoperation for bleeding, blood transfusion requirement, and the length of stay at ICU. But the incidence of perioperative myocardial infarction was more common in the off-pump group (P < 0.05). The degree of improvement in angina and quality of life did not differ significantly between the two groups.</p><p><b>CONCLUSIONS</b>Using cardiopulmonary bypass is not an independent predictor of mortality and morbidity in patients with SLVD. Isolated CABG can be safely performed in SLVD patients with acceptable postoperative morbidity and mortality in addition to encouraging home discharge rates and higher quality of life. Therefore, CCABG remains a viable option in selected patients with SLVD.</p>

Surgical treatment of obstructive hypertrophic cardiomyopathy with ventricular septal myectomy concomitant mitral valve replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experiences and results of ventricular septal myectomy concomitant mitral valve replacement (MVR) for obstructive hypertrophic cardiomyopathy (OHCM).</p><p><b>METHODS</b>From January 2000 to June 2007, 22 patients of OHCM with moderate or severe mitral regurgitation underwent concomitant ventricular septal myectomy concomitant MVR. There were 20 male and 2 female patients. The age ranged from 28 to 51 years old with a mean of (36 + or - 5) years old. The left ventricular out tract gradient pressure (LVOTGP) was 55 to 120 mm Hg (1 mm Hg = 0.133 kPa), with a mean of (88.0 + or - 15.8) mm Hg. The manifestation of pre-operative UCG, intra-operative transesophageal echocardiography (TEE) and post-operative UCG in 10 d, 6 months and 1 year were compared and analyzed.</p><p><b>RESULTS</b>One patient died in hospital due to serious ventricular arrhythmias. The intra-operative TEE showed that the phenomenon of systolic anterior motion (SAM) of mitral valve disappeared in all patients. Twenty-one cases were followed-up. The intra-operative TEE and post-operative UCG in every period of all 21 cases survived indicated that the mean LVOTGP and interventricular septal thickness (IVST) decreased obviously (P < 0.01).</p><p><b>CONCLUSION</b>Concomitant ventricular septal myectomy concomitant MVR is an effective and safe treatment for OHCM with moderate or severe mitral regurgitation, the short and mid-term outcome is excellent.</p>

Impact of preoperative clopidogrel in coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze and assess the impact of clopidogrel given preoperatively in coronary artery bypass grafting (CABG) surgery.</p><p><b>METHODS</b>From January 2005 to January 2007, 440 consecutive patients undergoing CABG surgery were divided into two groups: the clopidogrel group (with clopidogrel exposure in 5 days prior to surgery, n = 90) and the control group (without clopidogrel exposure > 5 days prior to surgery, n = 350). Patients undergoing emergency surgery because of failed percutaneous transluminal coronary angioplasty and cardiogenic shock, associated valvular surgery, redo-CABG were excluded. Patients who received aspirin and/or heparin treatment before surgery were included.</p><p><b>RESULTS</b>There was no significant difference in two groups regarding age, gender,diabetes mellitus and hypertension. Compared to the control group, patients in clopidogrel group had a higher prevalence of angina class III or IV (66.7% vs. 40.0%, P < 0.01), received more often revascularization within 48 h (41.1% vs. 14.3%, P = 0.02), and had received more frequently stenting (56.7% vs. 13.4%, P < 0.01). Chest tube drainage was significantly increased during the first 24 h following CABG in the clopidogrel group (800 ml vs. 350 ml, P < 0.01). Patients of the clopidogrel group also required more transfusion of packed red blood cells and fresh frozen plasma. Overall re-exploration rate because of bleeding was remarkably higher in the clopidogrel group (4.4% vs. 1.1%, P < 0.01).</p><p><b>CONCLUSIONS</b>Clopidogrel exposure in 5 days or less prior to CABG surgery significantly increases the risk of postoperative bleeding, the need for perioperative transfusion and the incidence of re-exploration. For the elective CABG patient, we suggest that the surgery should to be performed 5 days or more after clopidogrel exposure.</p>

Diversity Investigation of Actinomycetes Isolated from Radiation-polluted Soil / 微生物学通报

One hundred and fifty two actinomycetes were isolated from forty two radiation-polluted soil samples,using six different isolation media. Sixty cultures were chosen for 16S rRNA gene sequence and systematic analysis,which based on their morphology and ARDRA. Results of 16S rRNA gene sequences blasting showed that the strains were assigned to 12 recognized genera of actinomycetes,most of them fall within Streptomyces genus and a great deal of strains belonged to rare actinomycetes,which indicated a rich diversity of actinomycetes in the radiation-polluted soil.

Coronary endarterectomy and bypass grafting without cardiopulmonary bypass for patients with diffused coronary artery disease / 中华外科杂志

<p><b>OBJECTIVE</b>To review and summarize the early outcomes and clinical experience of coronary endarterectomy (CE) and bypass grafting without cardiopulmonary bypass for patients with diffused coronary artery disease.</p><p><b>METHODS</b>From May 2003 to May 2005, 53 patients with diffused coronary artery disease underwent CE and bypass grafting without cardiopulmonary bypass. There were 41 males and 12 females aged from 55 to 79 (mean 64 +/- 7) years old. 72% patients (38/53) were in Canadian Cardiac Society (CCS) angina class III and IV. 49% (26/53) had history of myocardial infarction. Coronary angiogram revealed that 3 cases had double vessels disease and, other 50 cases had triple vessels disease with 9 left main stem disease. The left ventricular ejection fraction (LVEF) ranged from 0.26 to 0.65 (0.52 +/- 0.17). Seventy endarterectomies were performed in 53 patients totally which included 38 in left anterior descending artery (LAD), 8 in circumflex artery and 24 in right coronary artery. Five cases received on-lay venous patch after CE in LAD and then grafted by internal mammary artery (IMA) on the patch. There were 53 left IMAs, 2 radial arteries, others were great saphenous veins, the mean number of grafts was 3.8 +/- 1.1 with index of completeness of revascularization (ICR) 1.03 +/- 0.07.</p><p><b>RESULTS</b>Intra-operative graft flow-meter was used to check the flow in the grafts before chest closure. There is no death in the group. Sixty-three (90%) out of 70 grafts after CE showed a satisfactory grafts flow intra-operatively. Two patients had peri-operative myocardial infarctions but neither had hemodynamic changes. All patients discharged uneventfully with mean hospital stay 9 days postoperatively. Forty-four patients had 6 to 29 months follow-up with no angina re-occurrence. Six patients had coronary angiogram 3 to 27 months postoperatively with all patent grafts to the CE coronaries.</p><p><b>CONCLUSION</b>CE and bypass grafting without cardiopulmonary bypass is technically feasible and can be performed safely in patients with diffused coronary artery disease with increased completeness of myocardial revascularization.</p>

Application of Adjustable Interatrial Fistulization in Operation of Congenital Heart Disease Accompany with Severe Pulmonary Arterial Hypertension / 实用儿科临床杂志

Objective To investigate the method and value of adjustable interatrial fistulization in the operation of congenital heart disease(CHD) accompany with severe pulmonary arterial hypertension(PH).Methods Twenty-seven patients(19 male,8 females) accompany with severe PH were entered the study,age ranged from 4 to 14 years old,weight from 13.7 to 42.0 kilogram.The enrolled diseases included 11 cases of atrial septal defect(ASD),10 cases of ventricular septal defect(VSD),4 cases of patent ductus arteriosus(PDA),and 2 cases of Ebstein syndrome accompany with severe tricuspid insufficiency.All patients were diagnosed as CHD accompany with severe PH(bidirectional shunt)which was the contraindications for routine operation before operation through chest X-ray,electrocardiography,ultrasonic cardiography,cardiac catheteri-zation and cardiac angiography.Results With adjustable interatrial fistulization and treatment to the abnormalities,14 fistulaes were closed immediately after operation,7 fistulaes were closed 2 days after operation,3 fistulaes were closed 3 days and 1 fistulae was closed 4 days after operation and accompanied with empyema discharged initiatively.One fistula was never closed,1 case died from low cardiac output symptom.The effective rate was 92.6%,closed to that of routine operations.Conclusion Adjustable interatrial fistulization is an easy procedure,and it can decrease the danger of PH post-operation effectively and provide operation opportunity for those patients with CHD approaching terminal stage.