Résumé
Objective To explore the effect of mitral valve morphology on short-term and long-term outcomes in elderly patients with rheumatic mitral stenosis(MS)undergoing percutaneous balloon mitral valvuloplasty(PBMV).Methods In the prospective study,elderly patients with rheumatic mitral stenosis undergoing PBMV between February 1996 and June 2007 were followed up for 10 years.One hundred and twenty-four patients with full follow-up data were included in the study.According to echocardiography Wilkins score,83 cases of patients (Wilkins score ≤ 8)were selected as Wilkins score ≤ 8 group,and 41 cases were selected as Wilkins score＞ 8 group.The pressure gradient in mitral valve(MV△P),mitral valve area(MVA),left atrial diameter(LAD),left ventricular end-systolic diameter(LVESd),left ventricular end-diastolic diameter(LVEDd),pulmonary artery systolic blood pressure(sPAP),ejection fraction(EF)and mitral regurgitation were measured before and after the operation.Results In both Wilkins score ≤ 8 group and Wilkins score＞ 8 groups,MVA and EF were increased immediately after PBMV operation versus before PBMV operation,and MV△P,LAD,LVEDd,LVEDs and PAPs were decreased immediately after PBMV operation versus before PBMV operation(all P ＜0.05).Severe mitral regurgitation was not found in both two groups.The clinical effects of the Wilkins score≤8 group were stable after 10 years,which had no significant difference in the indexes compared with those in the Wilkins score≤ 8 group immediately after PBMV(P＞0.05).MVA and EF in the Wilkins score＞8 group were decreased,and MV△P,LAD,LVEDd,LVEDs and PAPS were increased after 10 years as compared with those immediately after PBMV(P＜0.05).The incidence of NYHA functional class Ⅲ or Ⅳ was lower in the Wilkins score ≤8 group than in the Wilkins score＞8 group(26.5％ or 22/83 vs.46.3％ or 19/41,x2 =4.879,P=0.027).And the incidence of mitral restenosis was lower in the ≤8 group than in the Wilkins score＞8 group(34.9％ or 29/83 vs.61.0％ or 25/41,x2 =7.567,P=0.006).There was no significant difference in the incidence of moderate or severe mitral regurgitation between the two groups(10.8％ or 9/83 vs.12.3％ or 5/41,x2=1.278,P=0.258).Conclusions The short-term and long-term outcomes are good in elderly individuals with rheumatic mitral stenosis undergoing PBMV operation,and the curative effect of PBMV operation is better in patients with Wilkins score ≤8 than in patients with Wilkins score ＞8.
Résumé
Objective@#To analyze on the identification cases of pneumoconiosis in coal enterprises in Occupational disease identification institution from 2010 to 2017. Discussion on the characteristics of pneumoconiosis identification in Coal enterprises, analyze the existing problems and put forward the countermeasures.@*Methods@#The data of 235 pneumoconiosis cases were analyzed by the descriptive epidemiological method.@*Results@#A total of 235 cases during this period, the mean age of onset was (51.08 ±7.17) years. The mean service length was (20.65±7.96) years. 131 cases were coal miners, accounting for 55.74%, and 132 cases were exposed to coal dust, accounting for 56.17%. The number of Identification cases was the lowest in 2011 (13 cases) , and gradually increased in the following years, with the highest number of Identification cases in 2016 (47 cases) . 96 cases came from western Chongqing, accounting for 41.20%, and 88 cases came from northeastern Chongqing, accounting for 37.77%. Pneumoconiosis stage one have accounted to 58.29%. The results of 74 cases were not consistent with those of diagnosis, and the difference rate was 31.76%. The difference rate of observation object identification results was 60.53%, and the difference rate of nonpneumoconiosisin identification results was 40.00%.@*Conclusion@#The main types of work are coal miners, and the dust exposed to them is coal dust. The regional distribution is mainly in the western part of Chongqing and the northeast part of Chongqing. The largest difference rate Pneumoconiosis Identification is observation object and nonpneumoconiosisin.