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<p><b>BACKGROUND</b>In patients with nonvalvular atrial fibrillation (NVAF), embolic stroke is thought to be associated with left atrial appendage (LAA) thrombi. The WATCHMAN LAA Occlusion Device has been shown to be noninferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with NVAF. This study aimed to evaluate the procedural feasibility, safety and 12-month outcomes of the WATCHMAN LAA Occlusion Device in NVAF patients with high risk for stroke in China.</p><p><b>METHODS</b>The clinical data of 106 NVAF patients, who were consecutively underwent LAA closure with the WATCHMAN Device between April 2014 and May 2015, were collected. Patients were followed up at 1, 3, 6, and 12 months after discharge. A transesophageal echocardiograph was performed at 45 days after implantation and repeated in case of an unexpected event during the follow-up period.</p><p><b>RESULTS</b>This study included 106 NVAF patients with a mean age of 64.2 ± 8.6 years (ranging from 50 to 88 years), and the mean CHA2DS2-VASc score of all patients was 3.6 ± 1.6 (ranging from 2 to 9). Among those 106 NVAF patients, 100 (94.3%) patients were implanted with the device successfully. The procedural success rate was 94.3% (100/106), and the occlusion rate was 100.0% (100/100). There were one tamponade, one ischemic stroke, and eight minor pericardial effusions during hospitalization. During 12-month follow-up period, two patients developed a thrombus layer on the device that resolved with additional anticoagulation: one with visible device-thrombus experienced transient ischemic stroke, and one had a hemorrhagic stroke. There were no deaths in this study. The overall survival rate was 100.0%, and nonmajor adverse event rate was 95.0% (95/100). In this study, the expected annual rate of ischemic stroke risk in these patients according to the CHA2DS2-VASc score was 4.0%, while the observed ischemic stroke rate was 2.0% per year.</p><p><b>CONCLUSIONS</b>LAA closure with the WATCHMAN Device was feasible, efficient, and safe for NVAF to prevent the accidence of stroke in Chinese patients. During the 12-month follow-up period, the observed ischemic stroke rate (2.0% per year) in our study was lower than the predicted annual stroke risk (4.0%) using the CHA2DS2-VASc score.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Atrial Appendage , General Surgery , Atrial Fibrillation , Cardiac Surgical Procedures , Methods , China , Prospective Studies , Prosthesis Implantation , Methods , StrokeABSTRACT
Objective To determine the expression of signal transducers and activators of transcription 3 (STAT3) in intrahepatic cholangiocarcinoma (ICC) and to evaluate its influence on the outcome and prognosis of patients. Methods The expression of STAT3 was examined in intrahepatic cholangiocarcinoma (ICC) by immunohistochemistry assays. The correlation between STAT3 expression and clinicopathological parameters was analyzed by Pearson χ2 test and Fisher’s exact test Kaplan-Meier (KM) method was used to estimate and draw the survival curves, and the log-rank test was employed to compare the survival curves between groups. The effects of clinicopathological parameters and STAT3 expression on survival rate of patients were analyzed by Cox regression model. Results The expression of STAT3 in ICC tumor tissues was higher than that in peritumoral tissues, and was closely correlated with the tumor size, pathological satellite, microvascular invasion, undifferentiated-type histology and lymph node metastasis. Patients with high STAT3 expression had a poor prognosis with respect to overall survival (OS) and disease-free survival (DFS). The Cox multivariate survival analysis indicated that STAT3 was an independent prognostic factor for OS. Conclusion High STAT3 expression in ICC is correlated with worse surgical outcomes and t is an independent factor of prognosis, and may also serve as a potential target for treatment of ICC.
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<p><b>BACKGROUND</b>Reflux cholangitis has been the most common complication after Roux-en-Y choledochojejunostomy. In this study we intended to evaluate the perioperative and long-term efficacy of a new anastomosis method for choledochojejunostomy.</p><p><b>METHODS</b>Clinical data of 143 eligible patients who underwent choledochojejunostomy in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University, China between January 2007 and December 2010 were retrospectively analyzed. Among the patients, 38 consecutive cases underwent this new anastomosis method for choledochojejunostomy (improved group, IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group, CG). Changes in the incidence of cholangitis, the time of beginning to eat liquid meals, post-operative delayed gastric emptying and liver function between the two groups were compared.</p><p><b>RESULTS</b>There was no statistical difference in the levels of alanine transaminase, alkaline phosphomonoesterase and gamma-glutamy transferase between the two groups. The time of beginning to eat liquid meals was significantly shorter in IG than CG (P < 0.05). The incidence of delayed gastric emptying was lower in IG than CG, with statistical tendency between the two groups (P = 0.052). Among nine patients with different degrees of acute cholangitis in the two groups, one patient (2.6%) in IG and eight (7.6%) in CG suffered from acute cholangitis within six months of follow-up after discharge, but with no statistical difference between the two groups (P > 0.05). Of the nine patients with acute cholangitis, none in IG and four in CG were hospitalized for further treatment (P > 0.05).</p><p><b>CONCLUSIONS</b>Patients in IG had satisfactory perioperative and long-term prognosis with shorter time of beginning to eat liquid meals and lower incidence of delayed gastric emptying. This new procedure of choledochojejunostomy by the way behind antrue pyloricum was easy and safe to perform with no mortality and low complication rates.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anastomosis, Roux-en-Y , Methods , Anastomosis, Surgical , Methods , Cholangitis , General Surgery , Choledochostomy , Methods , Prognosis , Retrospective StudiesABSTRACT
<p><b>BACKGROUND</b>Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify prognostic factors affecting the survival.</p><p><b>METHODS</b>Between January 2005 and June 2008, 13 patients with synchronous hepatic metastases underwent simultaneous combined resection. The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed. Patient, tumor (primary and metastatic carcinoma), and operative parameters were analyzed for their influence on survival.</p><p><b>RESULTS</b>No patient died and two patients (15.4%) developed complications during peri-operative course. The actuarial 6-month, 1-year, and 2-year survival rates after hepatic resection were 76.9%, 38.5%, and 30.8%, respectively, and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up. In univariate analysis, hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival. Factors associated with the primary lesion were not significant prognostic factors.</p><p><b>CONCLUSIONS</b>Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients. The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Hepatectomy , Mortality , Liver Neoplasms , Mortality , General Surgery , Stomach NeoplasmsABSTRACT
Objective To investigate the indications and feasibility of resecting liver metastases from ocular melanoma. Methods and Results From Jan. 2005 to Dec. 2010, 5 patients with liver metastases from ocular melanoma were admitted to our hospital and received abdominal exploration. The clinicopathologic features and the surgical results of the 5 patients were retrospectively analyzed together with the latest literatures home and abroad. All the 5 patients received aggressive surgical managements, and simultaneous intra-arterial hepatic chemoembolization (TACE) was done in three cases. One patient received liver biopsies only after discovery of multiple visceral metastases; the other 4 with multiple liver metastases underwent palliative liver resection. All the 5 patients had poor prognoses, with a median overall postoperative survival rate of 9.6 (3-26) months. Conclusion Liver metastases from ocular melanoma are impossible to detect in an early stage. With unclear surgical indications and poor prognosis, it remains hard to handle in clinical practice.
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Objective To disclose the epidemiological status of type 2 diabetes mellitus and its related risk factors in adults in Beijing.Methods Logistic model was applied to analyze the relationship between the risk factors and type 2 diabetes mellitus.Results A total of 22301 people were studied,of whom 9836 were males,12465 females,and 2658 of them aged over 60(accounting for 11.92%).The risk factors,which might cause diabetes,would include being male(OR=1.453),with genetic history(OR=2.751),people older than 40(OR=1.584),with hypertension(OR=1.338),with larger waist circumference(OR=1.741),overweight or obesity(OR=1.098),low consumption of fruits(OR=1.430),hypertriglyceridemia(OR=1.767)and hypercholesterolemia (OR=1.315).Conclusion It is of great importance to carry out prevention and controI of type 2 diabetes mellitus programs to eliminate the risk factors among adults in Beijing,with contents as:keeping the blood pressure and weight within the normal range,increasing fruit intake,decreasing the triglyceride and cholesterol levels.
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Objective: To investigate the surgical procedure for mitral valve prolapse complicated by infective endocarditis. Methods: From June 2000 to December 2007,40 patients with mitral valve prolapse complicated by infective endocarditis received operation in our hospital. The patients included 30 males and 10 females,with a mean age of 39.2 years (ranging 13-63 years). The positive blood culture rate was 42.5% before operation. Combination of echocardiogram with post-operative pathology was the main method for diagnosis. The grades of cardiac function of the patients were in NYHA II (15 cases), III (21 cases)and N (4 cases). Mitral valve repair was performed in 5 patients and mitral valve replacement was done in 35 cases, all with artificial mechanical heart valves. Results: One patient died of renal failure early after operation. One patient had complete AV block and received pacemaker implantation. All the patients had normal body temperature on discharge. During follow-up (mean 2.7 years, ranging 6 months to 8 years), 39 patients survived without later mortality, recurrence of endocarditis and paravalvular leakage. Conclusion: Surgical treatment for patients with mitral valve prolapse complicated by progressive moderate or severe mitral regurgitation and infective endocarditis should be performed as early as possible. Radical debridement of the infected tissues and application of sensitive and high dose of antibiotics are the keys for preventing postoperative endocarditis recurrence. Replacement or annuloplasty should be chosen according to the quality of the valve during surgery. The results of mechanical prosthetic valve are excellent.
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Objective: To evaluate the surgical efficacy of valve replacement for severe paravalvular leakage (PVL) by echocardiogram. Methods: From June 2000 to December 2007, 26 patients with severe PVL were admittted to our hospital. The patients included 19 males and 7 females, with a mean age of 48 years (ranging 33 to 68 years). Severe PVL was reported in 11 cases after aortic valve replacement and 15 mitral valve replacement. The grades of cardiac function was in NYHA III (16 cases) and IV (10 cases). Preoperation echocardiogram combined with intraoperation findings was the main diagnosis approach. Nineteen patients (73.1%) underwent a second valve replacement (RO group) and 7 (26.9%) were managed conservatively (MC group). Results: One patient died of MODS early after operation in the RO group. During 2 months to 8 years follow-up (mean 2.7 years), one patient had recurrence of paravalvular leakage 2 months later and died of heart failure 5 months later after refusing a second operation. In MC group, one patient died of multiple organ failure in hospital; the rest died within 6 months after operation. Conclusion: Surgical treatment for patients with echocardiogram-diagnosed severe PVL should be performed as early as possible. The mortality and morbidity of conservative therapy are extremely high. Re-operation can greatly improve the long-term survival of the patient and the heart function.
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<p><b>OBJECTIVE</b>To study the Kv1.3 channel expression changes after CD4(+) and subsets CD28(null)/CD28(+)T cells activation in peripheral blood of patients with acute coronary syndrome (ACS).</p><p><b>METHODS</b>CD4(+)T cell in 27 ACS patients and CD4(+)CD28(null)/CD4(+)CD28(+)T cells in 12 out of these 27 ACS patients were isolated from peripheral blood with magnetic cell sorting. The whole-cell Kv1.3 currents for three T cells were recorded with patch-clamp technique before and 72 hours after activation by purified anti-human CD3 Interferon gamma, tumor necrosis factor alpha (TNF-alpha), granzyme B mRNA expression were determined by reverse transcription-PCR before and 72 hours after activation by purified anti-human CD3 in the presence or absence of recombinant Margatoxin (rMgTX, 0.1, 1, 10 nmol/L), a specific Kv1.3 channel blocker.</p><p><b>RESULTS</b>Peak Kv1.3 channel currents of CD4(+), CD4(+)CD28(null), CD4(+)CD28(+)T cells were significantly increased and the mean Kv1.3 channel numbers per cell of these cells were increased by about 90%, 60%, 80% (402 +/- 88 vs. 752 +/- 275, 553 +/- 328 vs. 874 +/- 400, 392 +/- 133 vs. 716 +/- 251, all P < 0.05) after activation compared to baseline values. Baseline CD4(+)CD28(null)T cell numbers were about 40% more than those of CD4(+)CD28(+)T cell (P < 0.05) and were similar after activation (P = 0.102). The mRNA expression of interferon gamma, TNF-alpha and granzyme B were dose-dependently down-regulated by rMgTX.</p><p><b>CONCLUSIONS</b>Kv1.3 channels of peripheral CD4(+)T cell and CD28(null)/CD28(+)T cells from ACS patients significantly increased after activation and Kv1.3-specific channel blocker rMgTX could effectively abolish this effect suggesting a potential role of Kv1.3 channel blocker on plaque stabilization in ACS patients.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Acute Coronary Syndrome , Blood , Metabolism , CD28 Antigens , Metabolism , CD4-Positive T-Lymphocytes , Metabolism , Metabolism , Lymphocyte Activation , Patch-Clamp Techniques , T-Lymphocyte Subsets , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To assess the occupational stress and its influential factors in nurses.</p><p><b>METHODS</b>A test of occupational stress, its influential factors, work ability were carried out for 248 nurses and 319 controls with revised occupational stress inventory (OSI-R) and work ability index (WAI).</p><p><b>RESULTS</b>The scores of personal cope resource (131.266 +/- 17.176) and work ability index (32.581 +/- 3.158) in nurse group were significantly higher than those in control group (126.931 +/- 19.108, 31.840 +/- 4.069) (P < 0.05). The main occupational stressors scores (role insufficiency, role clash, and responsibility) in nurses were higher than those in controls (P < 0.05). The stress response of interpersonal relationship in nurses was also higher. The items of personal cope resource, such as recreation, self-care and social support of nurses were superior to those of controls (P < 0.05). Stress response was positively correlated with occupational role (r = 0.512, P < 0.01), and negatively correlated with the personal cope resource (r = -0.475, P < 0.01). The primary influential factors of personal stress were recreation, social support, rational conduct, role insufficiency, role clash, responsibility, and poor work environment.</p><p><b>CONCLUSION</b>To strengthen social support, to improve work condition for nurses, so as to reduce the occupational stress and to enhance the work ability of nurses are important task in occupational health field.</p>
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Humans , Multivariate Analysis , Nurses , Psychology , Occupational Health , Risk Factors , Social Support , Stress, Psychological , Psychology , Surveys and Questionnaires , Workload , PsychologyABSTRACT
0.05),but the latter was superior to the former in extinction of exanthem.4.B_(19)-DNA clearance of hormone group was 25.0%,that of gamma globulin group was 81.82%,and there was significant difference between 2 groups(P
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Objective To explore the changes of S - 100? protein in cerebrospinal fluid and serum of children with viral encephalitis and its clinical significance. Methods The levels of S - 100? protein of cerebrospinal fluid and serum of 36 children with viral encephalitis and 20 lumbar anesthesia children without central nervous system diseases were measured by enzyme - linked immunosor bent assay. Differences in the levels of cerebrospinal fluid and serum S-100? protein between children with and without coma, with and without convulsion, with and without sequelae in the case group were compared. Results S-100? protein levels of cerebrospinal fluid in the case group and control group were (0.641?0.390) and (0.037 ? 0.014) ?g/L( P