Clinical outcomes of vocal fold immobility after tracheal intubation / 北京大学学报(医学版)

OBJECTIVE@#To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.@*METHODS@#We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.@*RESULTS@#A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.@*CONCLUSION@#Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.

Establishment of Chinese Cardiovascular Surgery Registry Database / 中国循环杂志

Objective: To introduce the construction idea and function for establishing China Cardiovascular Surgery Registry (CCSR)database and to provide a reference for domestic congener databases. Methods: Using peer database as reference, taking current status of cardiovascular surgery registry and hardware in our country with the necessity of international communication, we worked on a variables selection, metadata instruction, logic rules, case report form develpment and finally established a web-based, multi-functional database that enabled cross-database and international merging of data, forming a national intelligent data-exchanging platform for cardiovascular surgery. Results:CCSR database has over 300 variables of multiple topics including basic information, risk factors, medical procedures and endpoint events. Taking clinical and association data exchange standards as reference, it may conduct cross-discipline data connection, record important peri-operative information in relevant patients and meanwhile, it has the functions of automatic logic check, data report, statistical study, data export and importing the electronic medical records. Conclusion:CCSR database is a national platform accord with current status of Chinese cardiovascular surgery and characteristics, meanwhile it gives consideration to international communication and data exchange; which may play a important role in improving medical care and clinical investigation.

Surgical Treatment in Patients With Anomalous Left Coronary Artery From Pulmonary Artery Combining Severe Left Ventricular Dysfunction / 中国循环杂志

Objective:To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery (ALCAPA) combining severe left ventricular dysfunction.Methods:A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied.The patients' mean age was 7.0 (5.0,17.8)months including 13 male;mean left ventricular ejection fraction (LVEF)＜30％ and the median pre-operative LVEF was 21.0％ (17.3％,26.5％).Results:There were 2/24 (8.3％) in-hospital death,The median cardiopulmonary bypass time was 109 (95,128) min,aorta cross-clamp time 65 (48,87) min,mechanical ventilation time 94.5 (48.3,165.5) h and ICU stay time 176.5 (101.0,305.3) h;2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation.In 22 survival patients,the median discharge LVEF was 26.0％ (20％,35％) which was similar to pre-operative condition,P＞0.05.The mean follow-up time was (15.3±14.9) months at the longest of 63 months,no re-admission,reoperation and death occurred.The patients had NYHA I and the last follow-up LVEF was 60％ (50％,69％) which was increased than discharge level,P＜0.05,4 patients had LVEF＜50％.Conclusion:Surgical treatment had satisfactory short-and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction;comprehensive effort should be emphasized in surgery,anesthesia,cardiopulmonary bypass and ICU management at peri-operative period.

Establishment of Chinese Cardiovascular Surgery Registry Database / 中国循环杂志

Objective: To introduce the construction idea and function for establishing China Cardiovascular Surgery Registry (CCSR)database and to provide a reference for domestic congener databases. Methods: Using peer database as reference, taking current status of cardiovascular surgery registry and hardware in our country with the necessity of international communication, we worked on a variables selection, metadata instruction, logic rules, case report form develpment and finally established a web-based, multi-functional database that enabled cross-database and international merging of data, forming a national intelligent data-exchanging platform for cardiovascular surgery. Results:CCSR database has over 300 variables of multiple topics including basic information, risk factors, medical procedures and endpoint events. Taking clinical and association data exchange standards as reference, it may conduct cross-discipline data connection, record important peri-operative information in relevant patients and meanwhile, it has the functions of automatic logic check, data report, statistical study, data export and importing the electronic medical records. Conclusion:CCSR database is a national platform accord with current status of Chinese cardiovascular surgery and characteristics, meanwhile it gives consideration to international communication and data exchange; which may play a important role in improving medical care and clinical investigation.

Surgical Treatment in Patients With Anomalous Left Coronary Artery From Pulmonary Artery Combining Severe Left Ventricular Dysfunction / 中国循环杂志

Objective:To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery (ALCAPA) combining severe left ventricular dysfunction.Methods:A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied.The patients' mean age was 7.0 (5.0,17.8)months including 13 male;mean left ventricular ejection fraction (LVEF)＜30％ and the median pre-operative LVEF was 21.0％ (17.3％,26.5％).Results:There were 2/24 (8.3％) in-hospital death,The median cardiopulmonary bypass time was 109 (95,128) min,aorta cross-clamp time 65 (48,87) min,mechanical ventilation time 94.5 (48.3,165.5) h and ICU stay time 176.5 (101.0,305.3) h;2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation.In 22 survival patients,the median discharge LVEF was 26.0％ (20％,35％) which was similar to pre-operative condition,P＞0.05.The mean follow-up time was (15.3±14.9) months at the longest of 63 months,no re-admission,reoperation and death occurred.The patients had NYHA I and the last follow-up LVEF was 60％ (50％,69％) which was increased than discharge level,P＜0.05,4 patients had LVEF＜50％.Conclusion:Surgical treatment had satisfactory short-and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction;comprehensive effort should be emphasized in surgery,anesthesia,cardiopulmonary bypass and ICU management at peri-operative period.

Detection of exon 7 mutations of PAH gene in classical phenylketonuria by high-resolution melting analysis / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To establish a simple, rapid, inexpensive and sensitive method for detecting hot region for mutations in exon 7 of PAH gene.</p><p><b>METHODS</b>High-resolution melting (HRM) technology was used to detect a c.728G>A mutation in exon 7 in 88 patients with classical type phenylketonuria. Suspected mutations were validated by direct DNA sequencing.</p><p><b>RESULTS</b>The results detected by HRM are in good agreement with the results obtained by direct sequencing.</p><p><b>CONCLUSION</b>HRM analysis is a simple, rapid, inexpensive and sensitive method for detecting hot mutational region in exon 7 of PAH gene.</p>

Tortuosity and kinking of cervical segment of internal carotid artery: an analysis of 7 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To outline the clinical manifestations and compare the different radiological methods of detecting malformation of cervical segment of internal carotid artery.</p><p><b>METHODS</b>A retrospective analysis of 7 cases with malformation of cervical segment of internal carotid artery between May, 2004 and April, 2011. CT angiography (CTA) and magnetic resonance angiography (MRA) were used to detect the morphology of cervical segment of internal carotid artery.</p><p><b>RESULTS</b>This disease entity provided no obvious symptoms in five cases, and such complains as pharyngeal foreign body sensation in one and odynophagia in another. Physical examination showed a bulge with pulsation on pharyngeal wall in four cases, and apparent normal pharynges in other three patients, all of which were covered with intact pharyngeal mucosa. Twelve carotid arteries were observed in seven cases, five of which were showed tortuosity and seven kinking. All of the five patients with recorded radiological materials had identified malformations of internal carotid artery, two of which were tortuosity bilaterally and two kinking bilaterally and one tortuosity and kinking respectively. CTA and MRA revealed tortuosity of cervical segment of internal carotid arteries.</p><p><b>CONCLUSIONS</b>No typical clinical symptoms were shown in the malformation of cervical segment of internal carotid artery. Pharyngeal bulge with pulsation could be encountered. CTA and MRA showed excellent ability to depict the malformation of cervical segment of internal carotid artery and its relationship with surrounding structures, which could protect carotid artery from unintended damage.</p>

Study on the mutations of phenylalanine hydroxylase gene in patients with phenylketonuria in Shanxi province / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To study the mutations in exons 3, 6, 7, 11 and 12 of the phenylalanine hydroxylase gene (PAH) in Shanxi population.</p><p><b>METHODS</b>The mutations in exons 3, 6, 7, 11 and 12 and flanking sequences of PAH gene were detected by PCR-DNA sequencing, in 59 patients with phynelketonuria(PKU) and 100 healthy children from Shanxi province.</p><p><b>RESULTS</b>By sequence analysis, three single nucleotide polymorphism (SNP) Q232Q (CAA>CAG), V245V (GTG>GTA) and L385L (CTG>CTC) were detected in both the patients and healthy children, with the frequencies of nt 696, 735 and 1155 of the PAH cDNA up to 96.2%, 76.1% and 7.6% in patients respectively, and 97.0%, 77.3% and 8.3% respectively in the healthy controls. In addition, 72 different mutations accounting for 61.0% of mutant alleles were identified in the patients only. In exon 3, R111X, H64>TfsX9 and S70 del were found accounting for 5.1%, 0.8% and 0.8%; EX6-96A>G in exon 6 was found accounting for 10.2%. In exon 7, R243Q was the highest incidence accounting for 12.7%, followed by Ivs7+2 T>A(5.1%) and T278I(2.5%); the lowest incidences were G247V, R252Q, L255S, R261Q and E280K accounting for 0.8 %, respectively. In exon 11, Y356X (5.9%) and V399V (5.1%) were found; in exon 12, R413P and A434D were found accounting for 5.9% and 2.5%. In total, 9 missense mutations, 3 splice site mutations, 2 nonsense mutations and 2 deletions were included in 16 kinds of different mutations.</p><p><b>CONCLUSION</b>The mutation characteristics and distribution in exons 3, 6, 7, 11 and 12 of the PAH gene have been identified, and it suggested that the EX6-96A>G and R243Q were the hot spots of PAH gene mutations in Shanxi PKU population.</p>

Application of health vignettes in correcting self-reported health condition / 中华流行病学杂志

To introduce the application of vignettes in the survey on health condition,we took the Hangzhou health survey as an example. We tried to find the respondents' health judgment standard by using vignettes first and discovered the population' s demographic characteristics as sex,age, years of schooling and income etc. could influence the self-reported health condition on the response category cut-points. Then the cut-points were corrected through hierarchical ordered probit model in order to reflect the respondents' self-reported health condition based on the same standard,making the result suitable for comparison. Data from our research discovered that the level of health condition of females was lower than that of males among the residents living in Hangzhou and the higher income they received, the better health condition they had. Thus, the health vignettes seemed very essential in the survey on health condition.

Clinical efficacy of rapid Rhino Stammberger sinus dressing following endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the clinical benefits of rapid Rhino Stammberger sinus dressing (RR), a new nasal packing material for functional endoscopic sinus surgery (ESS), with traditional packing materials sorbalgon plus Vaseline gauze (SV) prospectively.</p><p><b>METHODS</b>Twenty-four patients with chronic sinusitis of the similar grade were enrolled in the study. After ESS, the nasal cavities of each patient were packed with RR in the right side as observing group and SV in the left side as control group. SV in the left nasal cavity was removed in the first day after operation and RR remained in the right nasal cavity until the first endoscopic follow-up 1 week postoperatively. The same perioperative treatments such as irrigation and local steroid were given in both sides of nasal cavities. The grade of rhinalgia, nasal obstruction, discharge, bleeding and epiphora in each side of nasal cavities were assessed on a visual analogue scale (VAS) by the patients at the operation day (packing period), the first day and the second day after operation respectively. Postoperative endoscopic assessment of nasal cavities including crust, discharge, pseudomembrane, edema of mucosa, bubble and ostium obstruction were carried out by a rhinologist on VAS at 1, 2, 3, 4, 6, 8 weeks postoperatively. The follow-up continued until the complete mucosal healing.</p><p><b>RESULTS</b>Three patients were dropped from statistical analysis. One of them with severe hypertension bleeding when he awoke from anesthesia, the RR was run out from the nasal cavity. The other two were lost in the follow-up. Twenty-one patients completed the follow -up ranging between 2-20 months. The scores of rhinalgia, epiphora at the operation day and the rhinalgia at the first day after operation in RR side were lower than SV side (P<0.05). The scores of the amount of crust at the first week after operation in RR side were lower than SV side (P<0.05). Statistically, no significant deference was found between RR and SV in the length of mucosal healing period.</p><p><b>CONCLUSIONS</b>Patients felt more comfortable with the package of RR than traditional material. No pain and secondary bleeding happened. The efficacy of RR on mucosal healing was similar with SV. RR showed some advantages and could be used as packing material following ESS.</p>

Exploring the Antifungal Activity of Bacillus amyloliquefaciens NK10.BAhjaWT / 微生物学通报

Bacillus are well known antibiotic producers. In this study,dozens of Bacillus strains from different sources were screened. Among them,a strain with strong antifungal activity was found. With 16S rDNA test and Biolog assay,this strain was identified to be Bacillus amyloliquefaciens. The fermentation conditions were optimized in small conical flasks. After ammonium sulfate salting out,dialysis,freezing vacuum dehydration,the crude protein extracts were obtained. The thermal stability,pH stability,protease stability,ion stability and antifungal spectrum of this protein were studied further. Scanning electronic microscope was also used to explore the antifungal mechanism.