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@#Objective To evaluate the safety and efficacy of transapical mitral valve repair with moderate-to-severe or severe mitral regurgitation (MR) by using LifeClip system. Methods We retrospectively analyzed the clinical data of 7 symptomatic patients with moderate-to-severe or severe MR who received transapical mitral valve repair by using the LifeClip system in our hospital from July to November 2021. There were 5 males and 2 females with an average age of 76.0±7.5 years. Results There were 2 patients with degenerative MR and 5 patients with functional MR. All of the procedures were successful and 6 patients received 1 LifeClip while the other one patient received 2. The operation time was 135.7±46.9 min, the mechanical ventilation time was 12 (3, 14) h, and the hospital stay time was 18.1±4.1 d. No serious complications or death occurred during the perioperative or follow-up period. MR reduction by ≥ grades was achieved in all the patients at the one-month follow-up. The classification of cardiac function was improved in varying degrees. Conclusion Transapical mitral valve repair using the LifeClip system shows good safety and efficacy for severe MR patients, and MR degree is significantly improved at early follow-up. However, the benefit of LifeClip should be validated in a larger sample size of Chinese population and through long-term follow-up.
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Objective To explore the multiple disciplinary model of emergent extracorporeal membrane oxygenation (ECMO) for cardiac arrest (CA) patients.Methods A retrospective investigation was done to analyze the general material,multiple disciplinary corporations,the complication and its treatment of patients who underwent emergent ECMO for non-surgery CA from January 2016 to August 2017.Results Three patients were all men with mean age 45.3 ± 20.3 years.Their mean cardiopulmonary resuscitation duration was 34 ± 10 min,and 2 patients returned to spontaneous circulation,yet hemodynamics instability.2 patients discharged with cerebral performance category 1-2,however the third died.3 cannulation of femoral artery and venous were all operated by cardiac surgery using surgical exposure via open cutdown.Mean duration of CA to ECMO pump-on was 132 ±93 min,while the mean duration of ECMO was 3 858 ± 1 092min.The implementation and maintenance of ECMO needed collaboration of emergent physicians,cardiovascular medicine and surgeon,anesthetists,nurses and so on.At the same time,incision site oozing blood,platelet counting decreasing,coagulopathy and other complications would occur,which needed interventional vascular surgeon and blood bank to participate in.Conclusions Emergent ECMO for CA patients need corporations of prehospital emergent medical system,emergent physicians,cardiovascular physicians and surgeons,anesthetists,perfusionists,blood bank and so on.Establishing coordination and cooperation model of multiple disciplinary quick response team with emergency department as the guide is the important guarantee for emergent department developing emergent extracorporeal resuscitation.
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Objective To investigate the effects of posterior focus on the voice quality of hearing-impaired children.Methods A total of 15 cases of 3~6 years old hearing-impaired children with posterior focus and 20 cases of 3~6 years old without oral resonance disorders were included in this study.Fundamental frequency (F0), frequency standard deviation (F0SD), fundamental frequency perturbation (jitter), amplitude perturbation (shimmer) and normalized noise energy (NNE) on each group of children of /(ae)/ were extracted and analyzed by Dr.Voice.Results Hearing-impaired children with posterior focus problems mainly showed the voice disorder of the hyperthyroidism type.The abnormal rate of shimmer values was the highest of hearing-impaired children with posterior focus, followed by F0, jitter and F0SD,and the minimum was NNE.The average value of the voice parameters was greater than hearing-impaired children without oral resonance disorders.The jitter and shimmer of children with posterior focus showed significant differences (P<0.05) compared to the hearing-impaired children without oral resonance disorders.Conclusion Children with posterior focus have a high rate of voice disorders and mainly change the voice jitter and shimmer.
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Objective To explore the situation and question of standardized training of residents/graduate students in cardiac surgery by questionnaire survey. Methods From September 2010 to May 2012, 61 resident physicians/graduate students were chosen as research objects in Department of Cardiac Surgery, Peking University Third Hospital. A total of 61 questionnaires were sent out, with a recovery rate of 100%,and an effective rate of 95.1%.The contents of investigation included standardized training content design, standardized training management, the time and"environment" pressure, compliance training effect analysis,student opinion and others,a total of 14 options.EpiData 2.1a software was used to sort and record the data. SPSS 17.0 software was used for statistical analysis. The enumeration data were compared by chi square test.Results During the period of training,the most expected teaching method was"small lecture", accounting for 63.8%; The most difficult part of the process of cardiac surgery training was "postoperative care", accounting for 69%; 100% of the trainees thought that it would be helpful for future work through cardiac training;8.3% of the trainees thought the teachers of cardiac surgery teaching consciousness was not strong; resident weekend "in the hospital" was higher than the proportion of graduate students, and most graduate students chose weekend "in the experiment and research work", the difference was statistically significant (P<0.05). Conclusion Appropriate standardized training program should be combined with the students' background; Teaching team construction and clinical reasonable and effective clinical skills train-ing system is an important link to ensure the quality of teaching.The combination of residents' standardized training and postgraduate education of professional degree remains to be tracked and evaluated in a long time.The feedback from all aspects of the training should be paid more attention to,and the training details should be improved.
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Objective To compare the oral resonance differences between normal children and children with spastic cerebral palsy,and to explore the oral resonance characteristics of children with spastic cerebral palsy.Meth-ods A total of 15 cases of preschool children with spastic cerebral palsy and 25 cases of normal preschool children were included in this study.The first and second formants on each group of children of Chinese vowels/a/,/i/,/u/core,were extracted and analyzed by Dr speech software.Results There were no significant difference of/a/F1,/a/F2,/u/F1 between two groups (P>0.05);/i/F1 and/u/F2 had a significant difference (P<0.05);/i/F2 had a high degree of statistical significance (P<0.01).Conclusion Children with spastic cerebral palsy are prone to oral resonance while most oral resonance disorder of children with cerebral palsy is post focusing and mixed oral res-onance disorder;/i/F2 and/u/F2 can provide a meaningful reference for speech and oral resonance disorders evalua-tion of children with cerebral palsy.
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Objective To discuss the value of percutaneous dilatational tracheotomy(PDT) for cardiosurgery in intensive care unit by comparing its outcomes with that of open tracheotomy(OT).MethodsA prospective study was conducted on 40 severe patients undergoing cardiosurgery.The patients were divided into PDT(treated from January 2002 to July 2003) and OT groups(treated from August 2003 to February 2008) with 20 cases in each.The operation time,length and heal time of the incision,blood loss,vital signs,and postoperative complications were compared between the two groups.ResultsThe operation time,length and heal time of the incision in the PDT group were significantly different from that in the OT group [(8.8?2.2) min vs(21.5?5.3) min,t=-9.897;(1.3?0.2) cm vs(3.4?0.5) cm,t=-17.440;and(3.9?0.9) d vs(5.9?1.2) d,t=-5.963;P=0.000].One patient in the PDT group(5%) had Ⅱ degree blood loss during the operation that was significantly less than those in the OT group(13 patients,65%,?2=15.824,P=0.000).The level of the vital signs change in the PDT group was significantly milder than those in the OT group [MAP: 1-5 mm Hg(median 2) vs 1-20 mm Hg(median 3.5),Z=-2.959,P=0.003;heart rate: 3-12 beats/min(median 5.5) vs 7-70 beats/min(median 10),Z=-3.956,P=0.000;SpO2: 0-4%(median 2%) vs 0-31%(median 3.5%),Z=-3.548,P=0.000].Furthermore,the rate of incisional leakage of sputum and overall rate of complications in the PDT group were significantly lower than those in the OT group.[1(5%) vs 8(40%),?2=5.161,P=0.023;and 1(5%) vs 12(60%),?2=13.789,P=0.000].ConclusionsPDT is a safe and minimally invasive technique with a high rate of success and low rate of complications.The method is easy to operate,and thus could be a good choice for severe patients after cardiovascular surgeries.