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@#Objective To summarize and analyze the preliminary clinical outcomes of the KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation (DMR). Methods This study was a single-arm, prospective, single-group target value clinical trial that enrolled patients who underwent the KokaclipTM transcatheter edge-to-edge repair (TEER) system for DMR in the Department of Heart Surgery of Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute from June 2022 to January 2023. Differences in the grade of mitral regurgitation (MR) during the perioperative and follow-up periods were compared, and the incidences of adverse events such as all-cause death, thoracotomy conversion, reoperation, and severe recurrence of MR during the study period were investigated. Results The enrolled patient population consisted of 14 (50.0%) females with a mean age of 70.9±5.4 years. Twenty-eight (100.0%) patients were preoperatively diagnosed with typeⅡ DMR, with a prolapse width of 12.5 (11.0, 16.1) mm, a degree of regurgitation 4+ leading to pulmonary venous reflux, and a New York Heart Association cardiac function class≥Ⅲ. All patients completed the TEER procedure successfully, with immediate postoperative improvement of MR to 0, 1+, and 2+ grade in 2 (7.1%), 21 (75.0%), and 5 (17.9%) patients, respectively. Mitral valve gradient was 2.5 (2.0, 3.0) mm Hg. Deaths, thoracotomy conversion, or device complications such as unileaflet clamping, clip dislodgement, or leaflet injury were negative. Twenty-eight (100.0%) patients completed at least 3-month postoperative follow-up with a median follow-up time of 5.9 (3.6, 6.8) months, during which patients had a mean MR grade of 1.0+ (1.0+, 2.0+) grade and a significant improvement from preoperative values (P<0.001). There was no recurrence of ≥3+ regurgitation, pulmonary venous reflux, reoperation, new-onset mitral stenosis, or major adverse cardiovascular events. Twenty-two (78.6%) patients’ cardiac function improved to classⅠorⅡ. Conclusion The domestic KokaclipTM TEER system has shown excellent preliminary clinical results in selected DMR patients with a high safety profile and significant improvement in MR. Additional large sample volume, prospective, multicenter studies, and long-term follow-up are expected to validate the effectiveness of this system in the future.
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This project starts with the teaching of clinical anatomy for eight-year medical students, selects specialists to enter the courses according to the content of clinical anatomy, and explores the deep integration of basic and clinical education. This study used the self-made questionnaire to evaluate the effect of the integrated teaching model, and Likert scale was used to score. Meanwhile, the correlation between the scores of each question and total points was analyzed with the item analysis. Moreover, we assessed the principal components through the exploratory factor analysis. The results showed that more than 95% questioned students thought the preclinical education integrated with clinical medicine teaching model is necessary and practical, which can assist medical students in the anatomical structure learning combined with clinical disease, and meanwhile cultivate students' clinical thinking. Only fewer than 10% thought it can connect the basic knowledge and clinical cases effectively, and over 35% thought there are difficulties. Additionally, more than half students (54%) hold the negative attitude which clinicians can't completely replace basic teachers in teaching. Our finding suggests that the integrated teaching model is attractive and feasible. Nonetheless, clinicians can’t replace preclinical teachers completely in the clinical anatomy education yet.
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Objective To explore the effect of individualized nutrition intervention mode based on dysphagia screening in postoperative patients with cerebellopontine angle occupying lesion. Methods By developing nurses training, selecting special screening and evaluation tools, developing screening methods and individualized nutrition intervention measures and meal spectrum, making screening and intervention flow chart, and starting to be implemented in postoperative patients with cerebellopontine angle occupying lesion in July 2017. Forty-six patients with cerebellopontine angle occupying lesion in the previous year were reviewed as the control group, who were given routine treatment and nursing; One year after implementation, Another 48 patients were set as the experimental group, and were given individualized nutritional care based on screening of dysphagia. Results The incidence rate of dominant aspiration(0), pneumonia (4.17% , 2/48) and diarrhea (2.08% ,1/48) in the experimental group was lower than 4.35% (2/46), 21.74% (10/46), 19.57% (9/46) in the control group, especially the difference of incidence rate of pneumonia and diarrhea was statistically significant (pneumonia: χ2=0.010, P=0.013; diarrhea: χ2=0.006, P=0.007). The retention rate of gastric tube in the experimental group (31.30%, 18/48) was lower than that in the control group (58.70%, 27/46), the difference was statistically significant (χ2=7.158, P=0.007). Average retention time of gastric tube in the experimental group (4.47± 1.13) d was less than that in the control group (5.11±0.70) d, the difference was statistically significant (t=2.296, P=0,027). The hospitalization time in the experimental group (8.69±1.36) d were less than those in the control group (12.57 ± 2.95) d, the difference was statistically significant (t=8.248, P=0,000). The nutritional status of 7 days after operation of the experimental group was better than that of the control group, the differenc e was statistically significant (albumin: t=4.888, P<0.01; prealbumin: t=5.188, P<0.01; hemoglobin: t=4.039, P<0.01). The knowledge and skills of swallowing of general nurses improved significantly after the work, in particular, the accuracy of screening tests for Wa Tian drinking water increased from 5/8 to 20/20. The difference was statistically significant (χ2=8.148, P=0.017). Conclusions Individualized nutrition intervention based on screening for dysphagia can improve the clinical outcome of patients, improve the comprehensive ability of nurses and achieve a win-win situation of nurse-patient.
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Objective@#To explore the effect of individualized nutrition intervention mode based on dysphagia screening in postoperative patients with cerebellopontine angle occupying lesion.@*Methods@#By developing nurses training, selecting special screening and evaluation tools, developing screening methods and individualized nutrition intervention measures and meal spectrum, making screening and intervention flow chart, and starting to be implemented in postoperative patients with cerebellopontine angle occupying lesion in July 2017. Forty-six patients with cerebellopontine angle occupying lesion in the previous year were reviewed as the control group, who were given routine treatment and nursing; One year after implementation, Another 48 patients were set as the experimental group, and were given individualized nutritional care based on screening of dysphagia.@*Results@#The incidence rate of dominant aspiration(0), pneumonia (4.17%, 2/48) and diarrhea (2.08%,1/48) in the experimental group was lower than 4.35% (2/46), 21.74% (10/46), 19.57% (9/46) in the control group, especially the difference of incidence rate of pneumonia and diarrhea was statistically significant (pneumonia: χ2=0.010, P=0.013; diarrhea: χ2=0.006, P=0.007). The retention rate of gastric tube in the experimental group (31.30%, 18/48) was lower than that in the control group (58.70%, 27/46), the difference was statistically significant (χ2=7.158, P=0.007). Average retention time of gastric tube in the experimental group (4.47±1.13) d was less than that in the control group (5.11±0.70) d, the difference was statistically significant (t=2.296, P=0,027). The hospitalization time in the experimental group (8.69±1.36) d were less than those in the control group (12.57±2.95) d, the difference was statistically significant (t=8.248, P=0,000). The nutritional status of 7 days after operation of the experimental group was better than that of the control group, the differenc e was statistically significant (albumin: t=4.888, P<0.01; prealbumin: t=5.188, P<0.01; hemoglobin: t=4.039, P<0.01). The knowledge and skills of swallowing of general nurses improved significantly after the work, in particular, the accuracy of screening tests for Wa Tian drinking water increased from 5/8 to 20/20. The difference was statistically significant (χ2=8.148, P=0.017).@*Conclusions@#Individualized nutrition intervention based on screening for dysphagia can improve the clinical outcome of patients, improve the comprehensive ability of nurses and achieve a win-win situation of nurse - patient.