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@#Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion In MIE, advanced-stage tumor, anesthesia-related factors,extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.
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@#Recently, in situ gel has been widely used as a local delivery system for periodontitis treatment because of its lesion injectability, local drug depot function, and drug sustained-release effect.Different therapeutic purposes can be achieved by loading different types of drugs such as antibiotics, bioactive factors, etc.In this review, different types of in situ gel with temperature-sensitive, ion-sensitive, pH-sensitive and solvent-exchanged characteristics were introduced for their applications and limitations in the delivery of drug for periodontitis;and the elimination of periodontal inflammation, periodontal tissue repair and the long-term role after loading microsphere achieved by the in situ gel system were also reviewed.
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There are still differences in the surgical treatment of children with pulmonary atresia(PA-VSD) with ventricular septal defect. The high rate of postoperative complications and reoperation intervention is still a problem that plagues surgeons. There are few reports on the understanding of the anatomy and physiological functions of MAPCAs. This article systematically reviews and analyzes domestic and foreign literature, and reviews the anatomical classification, surgical management strategies and related complications of PA-VSD patients.
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@#Objective To investigate the best anatomical classification, surgical timing, procedure and clinical outcomes of congenital vascular ring. Methods The clinical data of 58 patients who underwent congenital vascular ring surgery in Pediatric Surgery Center, Fuwai Hospital between 2014 and 2019 were retrospectively analyzed. There were 32 (55.2%) males and 26 (44.8%) females with a median age of 16.5 (2-73) months. Preoperative symptoms, imaging examinations, anatomical classifications, surgical procedures and postoperative recovery were assessed. Results There were 20 (34.5%) patients of double aortic arch, 22 (37.9%) patients of right aortic arch with left arterial duct or ligament, 15 (25.9%) patients of left aortic arch with aberrant right subclavian artery, and 1 (1.7%) patient of circumflex aorta with cervical aorta arch. The median ventilator supporting time was 6.0 (0-648) h, and the median hospital stay time was 14.5 (7-104) d. One patient with coarctation of aorta died of severe pulmonary infection during perioperative period, and the others survived without symptoms and reoperation after discharge. The median follow-up time was 7.0 (1-62) months. Conclusion For children with unexplained dyspnea and dysphagia, or with right aortic arch, preoperative imaging examinations such as computed tomography or magnetic resonance imaging are required to confirm the diagnosis of vascular ring. Surgical correction of congenital vascular ring is safe and reliable, and can effectively relieve symptoms. The mortality rate and reoperation rate are low, and the follow-up results are satisfactory.
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Objective@#To examine the association of BMI with major chronic diseases morbidity and all-cause mortality in Chinese adults.@*Methods@#This study is based on China Kadoorie Biobank. Anthropometric indexes were objectively measured at the baseline survey during 2004-2008. After excluding participants with heart disease, stroke, cancer, COPD and diabetes, 428 113 participants aged 30 to 79 years were included in the analysis. Cox regression models were used to investigate the associations of BMI and waist circumference with incidence of major chronic diseases (including cardiovascular disease, cancer, COPD, and type 2 diabetes) and all-cause mortality.@*Results@#Over an average of 10 years, 131 454 participants developed any one of major chronic diseases. A total of 26 892 all-cause deaths were reported. The risk of major chronic diseases increased with BMI. Compared with normal BMI (18.5-24.0 kg/m2), the HR (95%CI) of overweight (BMI 24.0-28.0 kg/m2) and obesity (BMI≥28.0 kg/m2) were 1.26 (95%CI: 1.24-1.27) and 1.59 (95%CI: 1.57-1.62) respectively. Underweight and obesity were both associated with risk of all-cause mortality. Waist circumference was positively associated with risk of major chronic diseases and all-cause mortality. According to recommended cut-off points of BMI and waist circumference for Chinese adults, maintaining a healthy body weight would prevent 12% incident cases of major chronic diseases.@*Conclusion@#General and central obesity were risk factors for major chronic disease among Chinese adults.
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Objective To compare the clinical efficacy and safety following the topical application of pazufloxacin mesylate eye drops with levofloxacin eye drops (LOFX) for bacterial conjunctivitis.Methods A multicenter,randomized,investigator-masked,parallel-controlled clinical trial was performed.Five hundred and twenty eyes of 520 patients with bacterial conjunctivitis were enrolled from March to October 2008 in seven ophthalmic centers in China.The patients were randomized into trial group and control group in 3 ∶ 1 ratio with the 390 eyes in the trial group and 130 eyes in the control group.Pazufloxacin mesylate eye drops was topically used 4 times per day for consecutively 7-14 days in the trial group,and levofloxacin eye drops was used in the same way in the control group.Microbiological cultures for conjunctiva sac secretions and drug sensitive test were carried out before and at the end of the administration of eye drops.The signs and symptoms were observed and scored before treatment and 0,3,7 and 14days after treatment.The adverse events following the administration of the eye drops were evaluated and compared.Results The intention to treat analysis (ITT) showed that the cure rate was 59.38％ in the trial group and 60.47％ in the control group,with the effective rate 88.80％ and 86.05％,respectively,with an insignificant difference between the two groups (x2 =0.12,P =0.72).The clinically evaluable analysis (CE) exhibited that the cure rates were 63.48％ in the trial group and 63.87％ in the control group,with the effective rate 92.46％ and 88.24％,whichwas not significantly different between them (x2 =0.54,P=0.46).The modified-ITT analysis (mITT) showed that the cure rates were 60.57％ in the trial group and 62.07％ in the control group,with the effective rate 90.32％ and 88.51％,without significant difference between the two groups (P＞0.05).Based on microbiologically evaluable analysis (ME),the clinical cure rates were 63.71％ and 63.41％ in the trial group and control group,and the effective rates were 93.44％ and 90.24％,respectively.There was no significantly difference between the both groups (P＞0.05).In the trial group and control group,the bacterial eradication rate was 89.42％ and 90.80％ based on ITT,90.11％ and 92.77％ based on CE,respectively.There was no significant difference in incidences of adverse events following the administration of the drug between the trial group and control group,including ocular tolerance,burning sensation,pricking and itching (P =0.34).Conclusions The effectiveness and adverse response were resemble between Pazufloxacin mesylate eye drops and LOFV following the topical application for bacterial conjunctivitis,which indicate that Pazufloxacin mesylate eye drops is effective and safe.
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Objective To summarize the treatment experience and strategies of patients with acute type A aortic dissection involving coronary arteries in order to improve the efficacy of such patients.Methods Between March 2013 and April 2016,we recruited 37 patients with coronary involvement caused by acute type A aortic dissection,26 men,11 women;mean age (49.7 ± 10.4) years.All procedures were done on an emergency basis within 24 hours after the patient's arrival.Results Acute type A aortic dissection with coronary involvement is a more complex operation associated with high in-hospital mortality(18.9％,7/37) and low short-term survival(64.9％,13/37).There were 9 patients underwent coronary artery bypass graft after completion of the root procedure because of ventricular wall motion abnormality(7 patients) and new ST-segment elevation (2 patients) during weaning from cardiopulmonary bypass.Four of them were survival during follow-up due to the success from rescue coronary artery bypass graft.Conclusion Acute type A aortic dissection with coronary involvement is associated with high in-hospital mortality and low short-term survival.If patients suffered abnormal ventricular wall motion or new ST-segment elevation during weaning from cardiopulmonary bypass,rescue coronary artery bypass graft is essential to salvage these critically ill patients.
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Objective To describe the characteristics of cooking and heating fuel use in participants from the China Kadoorie Biobank (CKB) study.Methods The CKB study recruited 512 891 adults from 10 areas in China during 2004-2008.Information on cooking fuel and heating fuel was collected using a questionnaire in baseline survey.The proportions of various fuels used in different areas,in different populations,and at different time points were calculated and compared.Results Overall,52.1％ participants used solid fuel for cooking or heating.Rural areas had higher prevalence of solid fuel use than urban areas.The percentage of participants using solid fuel for cooking was 36.1％ (coal 20.1％,wood/charcoal 16.0％);The percentage of participants using solid fuel for heating was 36.7％ (coal 22.7％,wood/charcoal 14.0％).The prevalence of solid fuel use and the fuel type mainly used varied widely across 10 areas.The proportion of clean fuel use was lower in less-educated and lower-income people.Household coal and wood/charcoal use showed a declining trend,which was more remarkable in urban areas.Conclusion There are still a large number of rural residents and people with low income relying on solid fuel in China,which is a serious public health concern.
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Objective To describe the characteristics of cooking and heating fuel use in participants from the China Kadoorie Biobank (CKB) study.Methods The CKB study recruited 512 891 adults from 10 areas in China during 2004-2008.Information on cooking fuel and heating fuel was collected using a questionnaire in baseline survey.The proportions of various fuels used in different areas,in different populations,and at different time points were calculated and compared.Results Overall,52.1％ participants used solid fuel for cooking or heating.Rural areas had higher prevalence of solid fuel use than urban areas.The percentage of participants using solid fuel for cooking was 36.1％ (coal 20.1％,wood/charcoal 16.0％);The percentage of participants using solid fuel for heating was 36.7％ (coal 22.7％,wood/charcoal 14.0％).The prevalence of solid fuel use and the fuel type mainly used varied widely across 10 areas.The proportion of clean fuel use was lower in less-educated and lower-income people.Household coal and wood/charcoal use showed a declining trend,which was more remarkable in urban areas.Conclusion There are still a large number of rural residents and people with low income relying on solid fuel in China,which is a serious public health concern.
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Objective To investigate gender specific differences in the association between stressful life events (SLEs) and depression in Chinese adults aged 30-79 years. Methods In the baseline survey during 2004-2008, the China Kadoorie Biobank (CKB) recruited 512891 men and women aged 30-79 years from 10 areas of China. Detailed information on SLEs, including demographic and socio-economic status, smoking, alcohol drinking and history of chronic disease, as well as depression symptoms and major depressive episodes (MDEs) in preceding 12 months, was collected by using standardized questionnaire. Multinomial logistic regression model was employed to estimate the relative risk ratio (RRR) and 95%CI of SLEs (3 categories, 10 items) on depression and the dose-response relationship between the number of SLEs experienced and depression. The interactions between gender and SLEs on depression were examined with likelihood ratio test. Results Among the 512891 participants, 35085 (6.8%) reported family-related events, 5972 (1.2%) reported finance-related events, and 4453 (0.9%) reported other stressful life events. Females had a higher occurrence of family-related events, while males had a higher occurrence of finance-related and other events (all P-value <0.001). After adjusted for potential confounders, SLEs were significantly associated with MDEs (RRR=11.99, 95%CI: 10.49-13.71 for males; RRR=14.15, 95%CI: 12.97-15.43 for females), and with depressive symptoms (RRR=7.43, 95%CI:6.94-7.95 for males;RRR=8.30, 95%CI: 7.91-8.72 for females). And the associations were stronger in females than in males (P for interaction=0.049). In the three categories of SLEs, family-related events showed stronger association in female (P for interaction<0.001), while no gender specific differences were observed for the other two categories (all P-value>0.05). Furthermore, the effect of the number of SLEs experienced increased in a dose-response manner on depressive symptoms and MDEs for both genders, but no gender specific differences were found. Conclusions The gender modifies the association between stressful life events and depression in Chinese adults, and women experienced family-related events have a greater risk of depression. The more the stressful events experienced, the more likely to have depression.
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Objective To examine the prospective associations between airflow obstruction (AFO) and risks of major chronic diseases morbidity in Chinese adults.Methods Samples of this study were from the China Kadoorie Biobank.A total of 486 996 participants aged 30 to 79 years (mean 51.5 years) at the baseline study,were included after excluding those who self-reported of having heart disease,stroke and cancer at baseline.AFO was defined under the Global Initiative on Obstructive Lung Disease (GOLD) criteria and forced expiratory volume per one second in percentage of the expected one (FEV1％P).Cox regression models were used to investigate the associations of AFO with incidence rates of ischemic heart disease,cerebrovascular disease and lung cancer after adjusted for potential confounders.Results Over a period of 7 years through the follow-up program,the incident cases of ischemic heart disease,cerebrovascular disease and lung cancer appeared as 24 644,36 336 and 3 218,respectively.Compared with people without AFO,the HR (95％CI) of GOLD-1 to GOLD-4 were 0.89 (0.78-1.01),1.05 (0.98-1.12),1.29 (1.18-1.40) and 1.65 (1.42-1.91) respectively for ischemic heart disease.The HR (95％ CI) of GOLD-1 to GOLD-4 were 0.96 (0.70-1.26),1.12 (0.96-1.31),1.38 (1.14-1.65) and 1.48 (1.05-2.02) respectively for lung cancer.No statistically significant differences in the associations between GOLD level and cerebrovascular disease morbidity were found.However,each 10％ decrease in FEV1％P was associated with 7.2％ (95％CI:6.4％-8.0％),3.6％ (95％CI:3.0％-4.3％) and 10.5％ (95％CI:8.4％-12.6％) increased the risks of ischemic heart disease,cerebrovascular disease and lung cancer respectively.The results were persistant when stratified by smoking status.Conclusion Higher degree of AFO seemed to be associated with the risks of ischemic heart disease,cerebrovascular disease and lung cancer morbidity among the Chinese adults.
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Objective To investigate gender specific differences in the association between stressful life events (SLEs) and depression in Chinese adults aged 30-79 years. Methods In the baseline survey during 2004-2008, the China Kadoorie Biobank (CKB) recruited 512891 men and women aged 30-79 years from 10 areas of China. Detailed information on SLEs, including demographic and socio-economic status, smoking, alcohol drinking and history of chronic disease, as well as depression symptoms and major depressive episodes (MDEs) in preceding 12 months, was collected by using standardized questionnaire. Multinomial logistic regression model was employed to estimate the relative risk ratio (RRR) and 95%CI of SLEs (3 categories, 10 items) on depression and the dose-response relationship between the number of SLEs experienced and depression. The interactions between gender and SLEs on depression were examined with likelihood ratio test. Results Among the 512891 participants, 35085 (6.8%) reported family-related events, 5972 (1.2%) reported finance-related events, and 4453 (0.9%) reported other stressful life events. Females had a higher occurrence of family-related events, while males had a higher occurrence of finance-related and other events (all P-value <0.001). After adjusted for potential confounders, SLEs were significantly associated with MDEs (RRR=11.99, 95%CI: 10.49-13.71 for males; RRR=14.15, 95%CI: 12.97-15.43 for females), and with depressive symptoms (RRR=7.43, 95%CI:6.94-7.95 for males;RRR=8.30, 95%CI: 7.91-8.72 for females). And the associations were stronger in females than in males (P for interaction=0.049). In the three categories of SLEs, family-related events showed stronger association in female (P for interaction<0.001), while no gender specific differences were observed for the other two categories (all P-value>0.05). Furthermore, the effect of the number of SLEs experienced increased in a dose-response manner on depressive symptoms and MDEs for both genders, but no gender specific differences were found. Conclusions The gender modifies the association between stressful life events and depression in Chinese adults, and women experienced family-related events have a greater risk of depression. The more the stressful events experienced, the more likely to have depression.
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Objective To examine the prospective associations between airflow obstruction (AFO) and risks of major chronic diseases morbidity in Chinese adults.Methods Samples of this study were from the China Kadoorie Biobank.A total of 486 996 participants aged 30 to 79 years (mean 51.5 years) at the baseline study,were included after excluding those who self-reported of having heart disease,stroke and cancer at baseline.AFO was defined under the Global Initiative on Obstructive Lung Disease (GOLD) criteria and forced expiratory volume per one second in percentage of the expected one (FEV1％P).Cox regression models were used to investigate the associations of AFO with incidence rates of ischemic heart disease,cerebrovascular disease and lung cancer after adjusted for potential confounders.Results Over a period of 7 years through the follow-up program,the incident cases of ischemic heart disease,cerebrovascular disease and lung cancer appeared as 24 644,36 336 and 3 218,respectively.Compared with people without AFO,the HR (95％CI) of GOLD-1 to GOLD-4 were 0.89 (0.78-1.01),1.05 (0.98-1.12),1.29 (1.18-1.40) and 1.65 (1.42-1.91) respectively for ischemic heart disease.The HR (95％ CI) of GOLD-1 to GOLD-4 were 0.96 (0.70-1.26),1.12 (0.96-1.31),1.38 (1.14-1.65) and 1.48 (1.05-2.02) respectively for lung cancer.No statistically significant differences in the associations between GOLD level and cerebrovascular disease morbidity were found.However,each 10％ decrease in FEV1％P was associated with 7.2％ (95％CI:6.4％-8.0％),3.6％ (95％CI:3.0％-4.3％) and 10.5％ (95％CI:8.4％-12.6％) increased the risks of ischemic heart disease,cerebrovascular disease and lung cancer respectively.The results were persistant when stratified by smoking status.Conclusion Higher degree of AFO seemed to be associated with the risks of ischemic heart disease,cerebrovascular disease and lung cancer morbidity among the Chinese adults.
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Objective] To find a rapid method for diagnosing Acanthamoeba keratitis and identifing Acanthamoeba . [Methods] 10% potassium hydroxide(KOH) wet mount preparations, Acanthamoeba culture, inverted phase contrast microscopy,and pathological examination using H.E. staining and PAS staining. [Results]Using corneal scrapings and corneal materials obtained from surgery,7 cases and 5 cases of Acanthamoeba keratitis were diagnosed by 10% KOH wet mount preparations. 6 strains of Acanthamoeba were isolated in corneal materials of 6 cases by protozoa culture method. The cysts, trophozoites and pseudopods on the trophozoites of Acanthamoeba were directly observed under the inverted phase contrast microscope. The cysts and trophozoites of Acanthamoeba were seen by H.E. staining and PAS staining with 20 h. [Conclusion] Acanthamoeba keratitis could be rapidly diagnosed by 10% KOH wet mount preparations and inverted phase contrast microscopy. Acanthamoeba organisms could be directly observed and identified under inverted phase contrast microscope.