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Objective:To explore the clinical characteristics and related risk factors of senile degenerative valvular heart disease(SDHVD), and to provide clinical basis for early prevention intervention of SDHVD.Methods:Clinical data of 1568 elderly patients ≥60 years old hospitalized in our hospital from January 2022 to June 2022 were collected to compare the clinical characteristics and analyze the risk factors of patients in the degenerative heart valve disease group and the non-degenerative heart valve disease group.Results:Age(per 10-year increase)( OR=2.107, 95% CI=1.518-2.924), blood calcium( OR=8.934, 95% CI=2.023-39.447), total cholesterol( OR=1.167, 95% CI=1.044-1.304), female( OR=2.098, 95% CI=1.305-3.374), and reduced mean platelet volume(MPV)( OR=0.818, 95% CI=0.682-0.981)were independent risk factors for the development of SDHVD( P<0.05).Post hoc two-by-two comparisons showed that different degrees of calcification were associated with age( P<0.05); apoA, UA, P, and FT3 were statistically significant in the no-calcification group compared with the control group( P<0.05); E/e′, PASP, and NT-ProBNP were statistically significant in the moderate calcification group compared with the control group( P<0.05); TC was statistically significant in the no-calcification and mild calcification groups compared with the control group There was statistical significance( P<0.05)compared with the control group. Conclusions:Age, blood calcium, total cholesterol, female, and reduced MPV are independent risk factors for SDHVD.
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Objective:To study the clinical effect of sacrospinous ligament fixation (SSLF) and traditional vaginal hysterectomy on pelvic organ prolapse (POP) .Methods:A retrospective analysis was performed on 68 patients with POP of degree II-IV admittedl from Jan. 2017 to Dec. 2019. Among them, 33 patients were treated with SSLF (observation group) and 35 patients were treated with vaginal total hysterectomy (control group). Intraoperative blood loss, operative time, postoperative indwelling catheter and average length of hospital stay were compared between the two groups. The patients were followed up for 6 months, and the scores of pelvic floor dysfunction questionnaire-20 (PFDI-20) and sexual quality questionnaire -12 (PISQ-12) were used to evaluate the subjective satisfaction degree of postoperative recovery.Results:In the observation group, the intraoperative blood loss (173.94±52.14) ml, postoperative indurating catheter time (2.72±0.45) d and average length of hospital stay (7.09±0.63) d were observed. There were statistically significant differences in intraoperative blood loss (228.86±53.40) ml, postoperative induration time (4.54±0.61) d and mean hospital stay (9.22±0.81) d in the control group ( P<0.05). There was no significant difference in the operation time between the observation group (99.57±9.50) min and the control group (101.06±8.64) min, ( P>0.05). The improvement of PFDI-20 and PISQ-12 in both groups was significant before and after treatment. The PISQ-12 score of the observation group was higher than that of the control group 6 months after surgery, and the difference was statistically significant ( P <0. 05). There was no significant difference in PFDI-20 score between the two groups ( P>0.05). There was statistical significance in the positions of pop-Q indicators in the two surgical methods ( P < 0.05) . Conclusions:SSLF with uterus preservation and total vaginal hysterectomy are both effective in treatment of moderate and severe POP. However, SSLF with uterus preservation has less intraoperative blood loss, and the postoperative recovery is significantly better than that with total vaginal hysterectomy. In addition, it satisfies patients’ desire to preserve uterus, improves the postoperative sexual life quality, which is worthy of promotion.
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Objective:To introduce Revised American Pain Society Patient Outcome Questionnaire for patients with cancer pain in China, and to test its reliability and validity.Methods:Cross-cultural adjustment was conducted on the basis of the Revised American Pain Society Patient Outcome Questionnaire of the American Pain Association published on the official website through expert review and pre-experiment. A convenience sample of 153 hospital patients with cancer pain was recruited. And the data were analyzed for reliability and validity.Results:The adjusted Revised American Pain Society Patient Outcome Questionnaire contains 18 core items, which are easy to understand and can be completed within 10 minutes. Reliability test: the Cronbach α coefficient of internal consistency for the total scale was 0.735. The Cronbach α coefficient of pain intensity dimension was 0.233, the Cronbach α coefficient of sleep interference dimension was 0.891, the Cronbach α coefficient of activity interference dimension was 0.830, the Cronbach α coefficient of emotion dimension was 0.846, the Cronbach α coefficient of pain management related side effects dimension was 0.591, and the Cronbach α coefficient of perception dimension of pain care was 0.633. Validity test: The total content validity of the scale was 0.98, and the content validity of each item ranged from 0.82 to 1.00.Conclusion:The adjusted Revised American Pain Society Patient Outcome Questionnaire has good reliability and validity, providing an effective assessment tool for medical institutions to evaluate the quality of cancer pain management.
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Objective@#To introduce Revised American Pain Society Patient Outcome Questionnaire for patients with cancer pain in China, and to test its reliability and validity.@*Methods@#Cross-cultural adjustment was conducted on the basis of the Revised American Pain Society Patient Outcome Questionnaire of the American Pain Association published on the official website through expert review and pre-experiment. A convenience sample of 153 hospital patients with cancer pain was recruited. And the data were analyzed for reliability and validity.@*Results@#The adjusted Revised American Pain Society Patient Outcome Questionnaire contains 18 core items, which are easy to understand and can be completed within 10 minutes. Reliability test: the Cronbach α coefficient of internal consistency for the total scale was 0.735. The Cronbach α coefficient of pain intensity dimension was 0.233, the Cronbach α coefficient of sleep interference dimension was 0.891, the Cronbach α coefficient of activity interference dimension was 0.830, the Cronbach α coefficient of emotion dimension was 0.846, the Cronbach α coefficient of pain management related side effects dimension was 0.591, and the Cronbach α coefficient of perception dimension of pain care was 0.633. Validity test: The total content validity of the scale was 0.98, and the content validity of each item ranged from 0.82 to 1.00.@*Conclusion@#The adjusted Revised American Pain Society Patient Outcome Questionnaire has good reliability and validity, providing an effective assessment tool for medical institutions to evaluate the quality of cancer pain management.
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Objective To evaluate the effect of partial neuromuscular blockade (NMB) on the efficacy and safety of nerve monitoring during microvascular decompression (MVD) of facial nerve.Methods Seventy American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 39-78 yr,weighing 44-84 kg,scheduled for elective MVD,were divided into 2 groups (n=35 each) using a random number table method:control group and partial NMB group.Anesthesia was induced by intravenous injection of 3-fold ED95 cisatracurium.In control group,muscle relaxants were not used after intubation.In partial NMB group,cisatracurium was continuously infused intravenously to maintain partial NMB,and the T1/Tc ratio was maintained at 20％-40％.Intraoperative neuroelectrophysiological monitoring was performed using lateral spread response (LSR).The success rates of LSR monitoring,occurrence of body movement,requirement for anesthetics and cardiovascular agents were recorded during operation,and the patients were followed up on day 7 after surgery,and the therapeutic efficacy and occurrence of neurological complications were recorded.Results Compared with control group,the incidence of intraoperative body movement was significantly decreased,the intraoperative consumption of propofol and remifentanil was decreased,and the intraoperative requirement for vasopressors was decreased in partial NMB group (P＜0.05).There was no significant difference in the success rate of LSR monitoring,therapeutic efficacy and incidence of neurological complications between two groups (P＞0.05).Conclusion Partial NMB (T1/Tc=20％-40％) can be effectively used for MVD monitored by LSR,decrease the occurrence of the body movement,and raise the perioperative safety in patients.
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Objective To observe the efficacy of Mimics finite element analysis software in the gasserian ganglion radiofrequency treatment of trigeminal neuralgia. Methods 180 cases with primary trigeminal neuralgia and VAS score ≥8 were randomly divided into 2 groups (n = 90 each): CT group (group C) and Mimics group (group M). The preoperative skull CT image of the foramen of cranial base could be analyzed in group C. The preoperative cranial CT image could be reconstructed and analyzed by Mimics finite element analysis software in group M. The puncturing success rate, complications rate and the outcomes between two groups were recorded. Results The puncturing success rates were 100% in group M and 92% in group C (P 0.05) between them. Conclusions The Mimics finite element analysis software could improve the success rate of basicranial foramen ovale puncture and reduce the occurrence rate of puncture complications. Therefore , it could be safely applied to the treatment of primary trigeminal neuralgia by gasserian ganglion radio frequency.
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Objective To evaluate the clinical effects of percutaneous micro-balloon compression (PBC) trigeminal ganglion for the treatment refractory trigeminal neuralgia. Methods Surgical results of 452 patients with trigeminal neuralgia treated by PBC from October 2009 to May 2013 were analyzed retrospectively. 125 cases aged over 80 years old and 70 cases′ pain belongs to the first branch neuralgia. Such procedures as Meckle′s cave cannulated with No.4 Forgarty catheter and the balloon inflated and compressed the gasserian ganglion monitored by X-ray were observed by PBC. Follow-up interview and curative effects were recorded. Results The average hospitalization was 6.1 days. Among them, 432(95.6%) cases had immediate relief from pain. The overall pain relief rate was 97.8% in our group without serious surgical complications. Postoperative complications include hemifacial numbness in 385 patients (85.2%), mild masseter muscle weakness in 248 patients (54.9%), diplopia in 2 patients. All symptoms relived or disappeared within 1 ~ 6 months. The average follow-up intervier period is 23.5 months. The recurrence rate is 10.2% (46 cases). Conclusion PBC is a safe and effective method with high pain relief rate in the treatment of refractory trigeminal neuralgia , especially for the treatment of the high risk patients , patients with recurrent symptoms or the patients suffered from the first branch neuralgia.
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Objective To compare clinical outcome of microvascular decompression (MVD) and percutaneous balloon compression (PBC) by using a prospective cohort study in order to provide a reliable evidence for the clinical decision-making. Methods Patients with trigeminal neuralgia hospitalized at Hangzhou First People′s Hospital in 2010 were chosen as database for cohort study. The patients were divided into MVD group (30 cases) and PBC group (30 cases). The clinical efficacy was followed by independent observers for 36 months after surgery. Chi-square test for hierarchical data, t test for quantitative data, and Kaplan-Meier plot for clinical outcomes were applied in the research. The endpoint was follow-up accomplishment or severe occurrence. Results Sixty patients were included in the research till the endpoint. The general records before surgery were almost the same with the literature records. By comparing painless period, mild and severe relapse, MVD group was superior to PBC group (P < 0.05). As for the painless survival period, MVD group was 96.7% of pain free after 1 year, 93.3% after 3 years, while PBC group was 90.0% after 1 year and 83.3% after 3 years. Regarding 3 years of follow-up, the relapse seemed occurred after 1 year in both groups. Conclusions As a curative and nondestructive procedure , MVD is more effective and has longer lasting pain free period , which should be considered as the first choice of treatment for trigeminal neuralgia in healthy people.
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Objective: To investigate the effect of Tanreqing injections combined with azithromycin in the treatment of children bronchial pneumonia. Methods:Totally 56 cases of pediatric bronchial pneumonia were selected in our hospital from September 2012 to September 2013 and randomly divided into the observation group and the control group with 28 cases in each. The control group was with azithromycin treatment, and the observation group was with Tanreqing injections additionally. The effect and adverse reactions of the two groups were studied and compared. Results:In the observation group, the effective rate was 92. 9%, which was significantly higher than that in the control group(P<0. 05). The hospitalization time and the symptoms disappearance time in the observation group were significantly shorter than those in the control group (P<0. 05). The adverse reactions showed no significant difference be-tween the two groups. Conclusion:Tanreqing injections in the treatment of children bronchial pneumonia is rapid, effective and safe.
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Objective To observe the correlation between the changes of neural cell apoptosis arid caspase-3 gene expression in brain tissues following acute severe traumatic injury to brain(TIB).Method A total of 120 adult Spraque-Dawley rats were divided into a control group(n=8)，TIB group(n=56)and TIB with administration of caspase-3 inhibitor group(n=56).TIB models of rats were made with Feeney's method.The z-DEVDfmk(5 μg)，caspase-3 inhibitor，was administered by intracerebral infusion，and the rats were sacrificed 1，6，24，48 hours and 3，7，14 days postinjury(n=8 for each interval).The specimens of the injured cerebral cortex，suhcerticai white matter，hippocampus，dentate gyrus and contrahteral corresponding brain tissues were taken for detecting apoptesis of neural cells by the terminal deoxynucleotidyl transferase mediated DUTP nick end labeling (TUNEL)methods and flow cytomeay.Caspase-3 mRNA and protein expression were detected by using RT-PCR，immunohistochemistry and western blot analysis.The caspase-3 activity was detected by using caspase-3 fluorescent assay kit.Student t-test and Spearman correlation analysis were used to analyze the data with SPSS version 10.1 software package.Results Apoptesis indexes(AI)and the apoptesis percentage(AP)of neural cells in the injured brain regions increased quickly after injury，and reached its peak 24 to 48 hours later，then decreased slowly,but it remained at higher level above that of normal till 14 days later(P＜0.01).The levels of caspase-3 mRNA,eastme-3 protein and caspase-3 activity were increased significantly post injury，and reached its peak at 24 to 48 hours，then it gradually decreased.Compared with control group，the levels ofoptical density of caspase-3 proteins in the injured hippocampus and subcortical white matter at 24 and 48 hours post injury increased 1484% and 1690%，caspase-3 mRNA expressiom increased 1043%and 1180%，and the degreas of caspase-3 activity increased 148% and 183%，respectively.The expression of caspase-3 proenzyme and its P17 subarrit increased.After trealment with caspase-3 inhibitor z-DEVD-fmk，the levels of caspase-3 mRNA，protein expression and caspase-3 activity were significantly decreased.and AI and AP were significantly decreased as well.The correlation between caspase-3 mRNA and level of neural apoptesis was positive(r=0.821，P＜0.01)，and it was likewise between caspase-3 protein and level of neural apoptosis(r=0.638.P＜0.01).Interestingly enough，a positive correlation was found between caspase-3 mRNA and easpase-3 proteins(r=0.945，P＜0.01).Conclusions The activation of caspase-3 leads to apoptosis of neural cells after acute TIB.The expression of caspase-3 are consistent with apoptosis of neural cells following TIB.The regulation of caspase-3 induced by TIB occurs at a ceriain critical link before transduction.Caspase-3 inhibitor can efficiently inhibit apoptosis of neural cells following TIB.
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Objective To investigate the expression of osteopontin(OPN) mRNA and its correlation with clinicopathologic features of glioma. Methods The expression of OPN mRNA was detected by semi-quantitive RT-PCR in 60 cases of gliomas and their correspondent normal tissues.The relationship between the relative content of OPN mRNA and clinicopathologic features of glioma was also analyzed. Results The positive rate of OPN mRNA expression was 73.3%(44/60) in our group.The OPN mRNA expression in normal brain tissue was all negative.Furthermore,the OPN mRNA expression was associated with the pathological grade of glioma.All patients were followed up for an average of 12 months.We did observed that the OPN mRNA expression positive group(44 cases) had recurrence in 36 patients and the negative group(16 cases) had only 2 case with recurrence (P
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Objective To summarize the clinical features and treatment for the patients with acute spontaneous spinal epidural hematoma.Methods We retrospectively studied the causes of hemorrhage,clinical presentation,MR images,diagnosis and therapy in 8 cases operated in recent years.Results All patients had no specific cause with semilunar space occupying mass in posterior of the spinal canal on MR imaging.All patients were decompressed as early as possible,7 of them operated within 24 hours since the onset recovered well and the another operated after 50 hours because of misdiagnosis recovered poor.Conclusions MRI is the optimal choice for the diagnosis of acute spontaneous spinal epidural hematoma.Early diagnosis and decompression of spinal cord is crucial to neurological function recovery.
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Purpose Progressive hypertensive intracerebral hemorrhage (PHICH) is often observed in clinical ward,but its prognosis is undetermined.This study is to investigate the duration and the risk factors of progressive hypertensive intracerebral hemorrhage.Methods The diagnosis of PHICH was determined by comparing the first and second CT scans.Potential risk factors including the sex,age,location of hematoma,blood pressure,coagulopathy and the duration of admission to the first CT scan were analyzed.Results In a cohort 143 patients,the PHICH were found in 41 cases(28.7%)after the second scan,and among them,32 patients(22.4%)were necessary to perform craniotomy for evacuation of hematoma,most of the PHICH occurred within 24 hours after onset.Older age,thalamus bleeding,high systolic blood pressure within 6 hours,coagulapathy and shorter duration from admission to the first CT scan were the predictors associated with PHICH.Conclusion PHICH occurs in almost 1/4 of hypertensive intracerebral hemorrhage,predominantly in elder,thalamus bleeding,coagulapathy,high systolic blood pressure within 6 hours and shorter duration between onset and the first CT scan.CT examination within 24 hours after admission is crucial to reveal the exact condition of the patient.
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Objective To summarize the clinical features and transsphenoidal microsurgical experiences of pituitary adenomas in the elderly patients over 70 years old Methods Twenty four elderly patients accepted transsphenoidal microsurgery were conductded a retrospective review,whose clinical data including clinical main presentation,histological types,surgical conditions,perioperative treatment and outcome were also analyzed Results There were 16 non functional adenomas (66 7%) and 18 giant macroadenomas(75%) respectively Visual deterioration was the commonest complain in 20 (83 3%) Despite the majority of patients having coexisting medical conditions,we had no mortality and no postoperative adjunctive morbidity with an average hospital stay of 17 8 days For an average follow up of 3 5 years,we did observe major patients(79 2%) vision had improved Conclusions Pituitary adenomas in the elderly are most frequently non functional macroadenomas that present with visual deterioration and hypopituitarism If special care is devoted to the perioperative treatment,in particular to fluid and electrolyte balances,transsphenoidal microsurgery is safe and effective in hands of an experienced team