The clinical research on the screening,diagnosis and treatment of the left subclavian artery stenosis before the coronary artery bypass grafting / 天津医药

Objective To discuss the meanings and methods of the screening, diagnosis and treatment of the left subclavian artery stenosis before the coronary artery bypass grafting (CABG). Methods A total of 612 patients intend to perform coronary artery bypass grafting in Tianjin Thoracic Hospital,and who were with severe stenosis or occlusion with left subclavian artery were screened by non invasive arteriosclerosis before operation. The diagnosis was confirmed by computerized tomography angiography(CTA),then the stenting angioplasty to the left subclavian artery was performed.The off-pump bypass surgery with the left internal thoracic artery(LITA)-left anterior descending artery (LAD) bypass was performed one week after operation.Results The CTA and digital subtraction angiography(DSA)confirmed the results of the left subclavian stenosis according to the non-invasive artery testing.All the 5 patients were performed with the stenting angioplasty to the left subclavian artery successfully,and the residual stenosis rate was<10%.The clinical symptoms were markedly improved after operations in all symptomatic patients,and the systolic pressure difference was<20 mmHg in two upper extremities.The blood flow was enough in LITA during the LITA-LAD bypass.The angina pectoris was improved after the operation. No coronary-subclavian artery steal phenomenon occurred. Neither stroke, myocardial infraction nor death occurred during perioperative period.All the patients were followed up for a time of 6-12 months,and the average time was about 10 months.No posterior circulation,upper limbs or myocardial ischemia occurred,and the systolic pressure difference was<20 mmHg in two upper extremities.Conclusion The non-invasion testing is of unique value in the screening of the left subclavian artery stenosis.

Relationship between calcified aortic stenosis and peripheral blood inflammatory cells and lipids in the elderly / 天津医药

Objective To investigate the relationship between calcific aortic valve stenosis and inflammatory cells in peripheral blood and dyslipidemia in elderly patients(age ≥65 years).Methods A total of 76 elderly patients(≥65 years old)diagnosed as calcific aortic stenosis in our hospital from June 2015 to June 2017 were selected as the case group,and 78 seniors(excluding valvular heart disease)hospitalized due to chest discomfort were selected as the control group.The white blood cell count (WBC), neutrophil ratio (N%), neutrophil count (N), lymphocyte count (L), neutrophil lymphocyte ratio (NLR),hypersensitive C-reactive protein(hs-CRP),N-terminal B-type natriuretic peptide(NT-pro BNP),total cholesterol (TC),triglyceride(TG),apo-α,high-density lipoprotein(HDL),low-density lipoprotein(LDL),very low-density lipoprotein (VLDL)and other indicators were tested on admission.All these indicators were compared between the two groups. Results The levels of WBC, N%,N,NLR, hs-CRP, NT-pro BNP,VLDL were higher in the case group than those in the control group.The levels of L and HDL were significantly lower in the case group than those of the control group(P<0.05).Multiple regression analysis showed that smoking, the increased hs-CRP and NT-pro BNP levels were independent risk factors for senile calcific aortic stenosis.Conclusion Senile calcific aortic stenosis is not a simple degenerative disease.It is closely related to systemic inflammatory response and abnormal lipid metabolism.

Progress in diagnosis and treatment of aortic dissection / 天津医药

Aortic dissection is a serious disease,and it has a high mortality and disability rates.In recent years,with the application of a variety of imaging tests,especially the development of CT imaging technology,the diagnostic rate of aortic dissection is increased significantly. The recognition and prognostic evaluation of aortic dissection also deepened with the improvement of biochemical detection. A variety of operative modes can be selected according to involved scope of aortic dissection.Especially to the therapeutic method of aortic arch department,not only traditional elephant trunk technique but also Sun's operation and triple-branched stent grafting can be selected.Mortality and complication rates have been dropped significantly after using new operative modes. The application of thoracic endovascular aortic repair (TEVAR) turns the invasive therapy to minimally invasive therapy for the treatment of aortic dissection. But TEVAR has strict imaging constraints.However TEVAR's indications are extended by debranching operation,which makes the patients with surgical contraindications to conform to the operation indication. In this article, on the basis of development of diagnosis and treatment of aortic dissection in recent years,the current early diagnosis,laboratory examination,prognostic evaluation,and the present treatment methods are summarized for reference in basic and clinical research.

Clinical efficacy of malignant obstructive jaundice treated by domestic biliary metallic stent insertion / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of implanted biliary metallic stents in the management of malignant obstructive jaundice (MOJ).</p><p><b>METHODS</b>Percutaneous transhepatic cholangiography and stent insertion were performed in 241 consecutive patients to treat malignant biliary obstruction between December 1998 and February 2009. The study end point was patient death. All patients were followed-up until death or until February 2010. The therapeutic efficacy was determined by statistical analysis of life span and pre- and post-operative laboratory indices.</p><p><b>RESULTS</b>All 241 patients were successfully stented. The level of bilirubin descended obviously within four weeks of implantation (P less than 0.05), and the early mortality rate was 4.56% (11/241). Two-hundred-and-two patients were followed-up (range: 8-193 weeks post-transplantation) and showed a median survival of 43.55 weeks. The survival rates at 13, 26, 39 and 52 weeks post-transplantation were 87%, 66%, 56%, and 41%, respectively. The stent patency rates at 13, 26, 39 and 52 weeks post-transplantation were 70%, 46%, 36% and 24%, respectively; the mean stent patency was 27.57 weeks. Cox regression analysis identified the strong predictors of improved survival as an initial bilirubin level of less than 221 mumol/L (P = 0.01) and a stent-induced bilirubin reduction of more than 50% (P = 0.002).</p><p><b>CONCLUSION</b>Transhepatic metallic biliary stenting is a safe and effective therapeutic intervention for malignant biliary obstruction. Significant periods of survival and palliation of jaundice can be achieved with this method. Hyperbilirubinemia and a stent-induced bilirubin reduction of less than 50% are independent predictive factors for the survival of MOJ patients.</p>