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Objective:To study on the association between vasoactive-inotropic score(VIS) and mortality of total arch replacement in Stanford type A aortic dissection(TAAD) patients.Methods:Data of TAAD patients admitted from January 2018 to November 2018 were analyzed retrospectively. According to the inclusion and exclusion criteria, 187 patients were finally included in the analysis. 30-day mortality was calculated and the patients were divided into death group(18 cases) and non-death group(169 cases). The VIS at each time point and perioperative indexes of the two groups were compared. The value of VIS in predicting mortality was analyzed.Results:The 30-day mortality was 9.63%(18/187). The operation time, cardiopulmonary bypass time, ventilator assistance time, the incidence of tracheotomy and major postoperative complications in the death group were significantly higher than those in the non-death group( P<0.05). VIS of death group was significantly higher than that of non-death group( P<0.05). At each time point, the area under ROC curve(AUC) of VIS was greater than 0.500( P<0.05), among which AUC of ICU 48 h VIS was the largest(0.817), and the best cut-off point of ICU 48 h VIS was determined to be 9, sensitivity 61.1%, specificity 92.3%. Logistic regression analysis showed that ICU 48 h VIS was an independent risk factor for predicting the death of total arch replacement in TAAD patients( OR=1.465, 95% CI: 1.194-1.796, P<0.001). Conclusion:When ICU 48 h VIS≥9, the risk of death was increased in patients with total arch replacement of TAAD. VIS may be a useful reference index for predicting the mortality of total arch replacement in TAAD patients in the early postoperative period.
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Objective To verify and compare the TI-RADS developed by Kwak et al .( Kwak TI-RADS ) ,2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer ( ATA Guideline Classification) ,2017 TI-RADS released by the American College of Radiology (ACR TI-RADS) and TI-RADS developed by Zhou et al .(Zhou TI-RADS) in the evaluation of thyroid nodules . Methods The ultrasound images of 339 thyroid nodules in 273 patients were analyzed by retrospective study . The thyroid nodules were categorized into aforementioned four stratified systems . Based on the pathological findings considered the "gold standard",the receiver operating characteristic( ROC ) curve was created to compare the clinical application value of aforementioned four stratified systems . Results The percentage of nodules that could not be categorized were 1 .2％ ,17 .5％ ,0 and 1 .2％ for the Kwak TI-RADS ,ATA guidelines ,ACR TI-RADS ,and Zhou TI-RADS ,respectively and the area under the ROC curve ( AUC) was 0 .899 ,0 .879 ,0 .876 ,and 0 .918 ,respectively . The sensitivity of Kwak TI-RADS ,ATA guidelines classification ,and ACR TI-RADS were higher than that of Zhou TI-RADS (all P < 0 .05) ,whereas the specificity of Zhou TI-RADS was the highest (all P < 0 .05) . As for the accuracy ,no statistically significant differences were observed between any two of Kwak TI-RADS ,ATA guidelines ,ACR TI-RADS ,and Zhou TI-RADS systems ( all P > 0 .05) . Conclusions Four thyroid risk stratification systems provide effective risk assessment for thyroid nodules ,Zhou TI-RADS has relatively lower sensitivity ,but its specificity and AUC value are the highest among the four evaluated systems . In addition ,ACR TI-RADS can classify the most nodules ,while the number of nodules that can′t be categorized by ATA guideline is maximum .
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Objective To observe the protective effect of growth differentiation factor 11(GDF11) on myocardial injury and the changes of myocardial apoptosis in type 2 diabetic C57BL/6J mice.Methods Sixty male C57BL/6J mice weighing 20-25 g were randomly divided into three groups: control group (control), type 2 diabetes mellitus group (DM) and GDF11 intervention group (DM + GDF11).To establish mouse model of type 2 diabetes, the mice were fed with high fat and high sugar diet for 4 weeks, and i.p.injected consecutively three times of streptozotocin (STZ) in a dose of 60 mg/kg.After the continuous high-fat and high-sugar diet for 4 weeks, the cardiac function was detected by small animal ultrasound, TUNEL staining was used to detect the apoptosis in myocardium, and the expressions of cleaved-caspase-3, Bcl-2, Bax were measured.Results Diabetic injury significantly reduced the left ventricular ejection fraction and left ventricular short axis shortening rate, and increased myocardial apoptosis.Recombinant GDF11 protein significantly improved cardiac function and reduced myocardial apoptosis.Conclusions Exogenous GDF11 can significantly reduce myocardial apoptosis and improve heart function after diabetic injury.
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[Objective]Primarily discuss cases selection and operation skill of hip joint superficial substitution.[Method]From Oct.2004 to Feb.2007,10 hip joints of 8 cases were made superficial substitution,paying attention on cases selection and operation skill.[Result]All cases had no such complications as femur neck fracture,infection,joint dislocation,vessel or nerve injury,deep vein embolism or ectopic ossification in early stage.The patients' score increased to 93~99 and average 95 from 35~56 and 45 before operation,the unequal limbs were corrected for DDH cases.On X-ray measurement:40?~50?for acetabula abduction angle,44?in average;134?~143?,139?for short-handle eversion angle of femur lateral;average off-set rate was 0.20 for femur neck;no loose prosthesis or narrow femur neck,no bright zone around short-handle.[Conclusion]Hip joint superficial substitution is very fit for young people with much sports,but we should pay attention to case selection and operation skill.