Since the advent of coronary artery bypass grafting (CABG), it has been one of the main ways to treat coronary heart disease. However, compared with percutaneous coronary intervention (PCI), it causes more trauma, complications and pain which discourage many patients. Recently, minimally invasive CABG has gradually become one of the main choices in some medical centers with the progress of technology and the development of surgical instruments. Compared with traditional CABG, minimally invasive CABG has the advantages of less trauma, less pain, faster recovery, lower perioperative mortality and less demand for blood transfusion. In this paper, we will mainly focus on the current stage and prospect of minimally invasive CABG.
Legionella, one of the causative pathogens of atypical pneumonia, firstly outbroked during the period of American Legion’s convention in 1976, Philadelphia. Legionella infection can accompany multisystem involvement. In addition to pulmonary lesions, it also accompanies extrapulmonary manifestations, including gastrointestinal symptoms (primarily diarrhea and hepatic dysfunction), neurological symptoms (primarily headache, disorientation and confusion of consciousness), urinary symptoms (primarily hematuria, proteinuria and acute kidney injury), rhabdomyolysis, as well as electrolyte disorder mainly characterized by hyponatremia and hypophosphatemia. This article reviews the extrapulmonary manifestations and its regulatory mechanism of Legionella infection.
ObjectiveTo investigate the safety, feasibility, and efficacy of full repair strategy under small incision in the treatment of closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture.MethodsThe clinical data of 57 patients with closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture treated by full repair strategy (fracture, ligament, and cartilage repair) under small incision between January 2012 and January 2017 were retrospectively analyzed. There were 31 males and 26 females, with an average age of 41.1 years (range, 21-65 years). The causes of injury included traffic accident injury in 33 cases and falling injury in 24 cases. All of them were closed fractures, including 20 cases of medial malleolus fracture, 37 cases of complete medial malleolus but deep and shallow rupture of deltoid ligament. The average time from injury to admission was 9.6 hours (range, 3-34 hours). The quality of reduction of distal tibial articular surface (based on Ketz-Sanders standard), the reduction of tibiofibular syndesmosis (the anterior and posterior distances of distal tibiofibular syndesmosis and the lateral ankle twist angle measured by CT scan at 10 mm above the ankle joint line), and the fracture healing were evaluated. The medial clear space (MCS), tibiofibular clear space (TFCS), and distal fibular tip to lateral process of talus (DFTL) were measured on the X-ray films of ankle points. Before and after operation, the pain and functional improvement of ankle joint were evaluated by visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Association (AOFAS) score, and the activities of ankle dorsiflexion and plantar flexion were measured.ResultsThree cases with osteochondral lesions of the talus were found during operation and all were treated with microfracture techniques. Tournament paralysis occurred in 2 cases after anesthesia. The surgical incisions healed by first intention in all patients. All the 57 patients were followed up 24-84 months, with an average of 38.6 months. All patients achieved bone healing without bone nonunion and malunion at 12 months after operation. The reduction quality of distal tibial articular surface was excellent in 56 cases and good in 1 case at 3 months after operation, the excellent and good rate was 100%. There was no significant difference in the MCS, TFCS, DFTL, anterior distance of distal tibiofibular syndesmosis, posterior distance of distal tibiofibular syndesmosis, and lateral ankle twist angle between the affected and healthy sides at 12 months after operation (P>0.05). At last follow-up, the VAS score, AOFAS score, ankle dorsiflexion and plantar flexion activities of the affected side were significantly improved when compared with preoperative ones (P<0.05). Compared with the healthy side, there was no significant difference in ankle dorsiflexion and plantar flexion activities (P>0.05).ConclusionFull-repair strategy under small incisions for the treatment of Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture is effective and safe. It can not only reduce wound complications, but also improve the quality of joint reduction of the ankle joint and distal tibiofibular syndesmosis. Full repair of ligaments and cartilage can improve the internal fixation strength and joint stability of the ankle joint.
This paper introduces the background, significance, definition and types of clinical audit and describes five stages of clinical audit, including preparing for clinical audit, selecting criteria, measuring performance and sustaining improvement. This paper also introduces the international and national status quo of implementing clinical audit in nursing practice and describes the reporting guideline for articles of clinical audit. Finally, this article suggests that providing methodological training and creating a supportive environment are crucial strategies to promote the implementation of clinical audit and bridge the gaps between evidence and practice.
Valvular heart disease is a structural or functional disease of the heart due to rheumatic fever, congenital malformation, infection, or trauma, resulting in abnormal cardiac hemodynamics and ultimately heart failure. Implantation of artificial heart valves has become the main way to treat heart valvular disease. Because the structure of the artificial heart valve plays a key role in the stress distribution and hemodynamic performance of the valve and stent, the geometric configuration of the artificial heart valve is constantly updated and improved during its development from mechanical valve to biological valve, which closely mimics the geometric characteristics of the normal natural heart valve. This article sums up the design process of geometric configuration of artificial heart valves and the influence of geometric configuration on the central disc stress and durability of artificial heart valves, analyzes the important parameters of geometric modeling for artificial heart valves, and discusses the development of the corresponding modeling method, to provide reference and new ideas for the biomimetic optimization design of artificial valves.
Objective To verify the predictive value of Sino System for Coronary Operative Risk Evaluation（SinoSCORE） on quality of life in patients undergoing coronary artery bypass graft （CABG） surgery. Method A total of 234 patients in Peking University People’s Hospital undergoing CABG between November 2008 and September 2010 hadcompleted the preoperative and 6-month postoperative Short Form-36 （SF-36）. There were 172 （73.5%） male patients and63 （26.5%） female patients. The average age was 63.0±10.1 years. According to the SinoSCORE， 234 patients were dividedinto three groups：low risk （SinoSCORE score less than 1 point，n=67）， medium risk （SinoSCORE score 2-5 points，n=77） and high risk （SinoSCORE score more than 6 points，n=90） group. Clinical information of the 234 patients was collected， andthe score values of all patients were calculated according to the SinoSCORE model. Statistic methods were performed toevaluate the relationship between quality of life and SinoSCORE. Results The postoperative quality of life have improvedsignificantly， but the improvement of quality of life have no significantly different between groups. There was statisticallysignificant correlation between quality of life and SinoSCORE （P＜0.05， r value at-0.150 to 0.255）.Linear regression analysis showed that SinoSCORE was significantly collected with quality of life in multiple subgroups （P＜0.05， r 2＜0.1） .Conclusion SinoSCORE have statistically correlated with quality of life， and have certain but limited predictive value on quality of life in CABG patients.
Abstract： Objective?To summarize our experience of redo coronary artery bypass grafting（CABG） and explore appropriate redo CABG strategy for Chinese patients. Methods We retrospectively analyzed clinical data of 27 patients who underwent redo CABG in People’s Hospital of Peking University from January 2000 to January 2010. There were 15 male patients and 12 female patients with their age of 41-84 （63±8） years. The mean time between the first CABG and the redo CABG was 45 （4-168） months. Preoperatively all the patients had unstable angina pectoris. Twenty-one patients were in New York Heart Association （NYHA） functional classⅠ-Ⅱ， and 6 patients were in NYHA functional classⅢ-Ⅳ. Preoperatively， their left ventricular end-diastolic dimension （LVEDD） was 41-69 （51.0±0.7） mm， and their left ventricular ejection fraction （LVEF） was 32%-78% （58%±12%）. At the time of redo CABG for the 27 patients， there were 6 new coronary artery lesions， 7 left internal mammary artery （LIMA） lesions， 3 radial artery lesions （including 1 proximal anastomosis lesion alone） and 49 saphenous vein graft （SVG） lesions （including 3 proximal lesions alone and 3 distal lesions alone）.?Results?The surgical approach of redo CABG included median sternotomy in 18 patients， left lateral thoracotomy in 8 patients， upper midline abdomen and subxiphoid incision in 1 patient. Off-pump coronary artery bypass grafting （OPCAB） surgery was performed in 25 patients， but intra-operatively 2 patients underwent conversion to CABG under cardiopulmonary bypass. A total of 65 distal anastomoses and 41 proximal anastomoses were performed during redo CABG. A total of 10 LIMA， 3 right internal mammary artery (RIMA)， 16 left radial artery， 2 right radial artery and 17 SVG were used in redo CABG . There were 1-4 （2.4±0.8） distal anastomoses for each patients. The operation time was 170-530 （304±86）min. Postoperative transfusion was 0-10 （4.3±3.5） U packed red blood cells and 0-1 600 (685±549) ml fresh frozen plasma for each patient. Postoperative mechanical ventilation time was 6-156 （24±32） h and postoperative hospital stay was 7-35 （14±6） d . There was no in-hospital death. All the patients were discharged without any angina symptoms. A total of 26 patients were followed up and 1 patient was lost with the mean follow-up time of 80 （13-133） months. During follow-up， 16 patients were alive without angina symptoms， 4 patients died， and 6 patients had recurrent angina symptoms or heart failure. Conclusions OPCAB is an effective surgical strategy of redo CABG， but cardiopulmonary bypass should also be prepared. Arterial graft should be use as long as possible in redo CABG and the surgical strategy should be individualized.
Objective To construct adenovirus expressing NGF (Ad-NGF) and to investigate its promotive effect on the reparation and regeneration of sciatic nerve injury in rats. Methods NGF gene sequence was cloned into shuttle plasmid pCA13 of adenovirus type 5. After packed in HEK-293 cells, the recombinant adenoviruses-Ad-NGF underwent sequence identification. Thirty-two male SD rats weighing 180-200 g were randomly divided into 4 groups (n=8 rats per group). Sciatic nerve injury model was establ ished by disconnecting and direct suturing the right sciatic nerve in the rat. Theright gastrocnemius muscle of group A and C received Ad-NGF injection and adenovirus vector without NGF gene sequence injection, respectively, and 1 × 108 PFU/per time was given every other day for three times. Group B and D received NGF injection (200 U/d) and normal sal ine (100 ?L/d), respectively, for 3 weeks. The effect of various treatments on injured sciatic nerve was evaluated by performing sciatic nerve function index and nerve electrophysiology detections 31 days after operation. Meanwhile, the sciatic nerve in the anastomosis and at the site 1 cm distal to the anastomosis were obtained, and underwent RTPCR and Western blot analysis for detecting NGF mRNA and protein expression level in the injured sciatic nerve in the rats. Histology, immunohistochemistry, and transmission electron microscope observations were conducted. Results Ad-NGF carrying NGF gene sequence was constructed successfully and confirmed by sequence analysis. The sciatic nerve function index, nerve conduction velocity, evoked potential ampl itude, and latent period of group A was better than those of other groups (P lt; 0.05), and there were no significant differences among group B, C, and D (P gt; 0.05). RT-PCR and Western blot detection: the expression levels of NGF mRNA and protein in group A were greater than those of group B, C, and D (P lt; 0.05), and no significant differences were noted among group B, C, and D (P gt; 0.05). Histology and immunohistochemistry observation showed that the regeneration of the sciatic nerve in group A was obvious superior to that of other groups. Transmission electron microscopy observation suggested there was significant difference between group A and groups B, C, and D in terms of axonal diameter of sciatic nerve cross-section, myel in sheath thickness and nerve fiber number (P lt; 0.05), and there were no significant differences among group B, C, and D (P gt; 0.05). Conclusion Ad-NGF can effectively promote the repair of sciatic nerveinjury in rats, and is a new method for obtaining large amounts of NGF in the area of injured peripheral nerve.
ObjectiveTo explore the relation of preoperative red blood cell distribution width (RDW) with prognosis in esophageal cancer.MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, VIP, Wanfang, CNKI and SinoMed databases were searched to identify potential studies assessing the correlation between preoperative RDW and prognosis of esophageal cancer patients from establishment of databases to February 2019. The endpoint events included the overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). The Stata 12.0 software was applied for the meta-analysis and the hazard ratio (HR) and 95% confidence interval (CI) were calculated.ResultsA total of 10 retrospective studies involving 4 260 esophageal cancer patients from China or Japan were included. The score of Newcastle-Ottawa scale (NOS) of the included studies was more than 6 points. The results demonstrated that elevated preoperative RDW was significantly associated with poor CSS (HR=1.50, 95% CI 1.14 to 1.99, P=0.004) and DFS (HR=1.45, 95% CI 1.14 to 1.85, P=0.002), while no significant association between preoperative RDW and OS in esophageal cancer was observed (HR=1.17, 95% CI 0.95 to 1.45, P=0.143). Subgroup analysis based on the pathology revealed that preoperative RDW had high prognostic value in esophageal squamous carcinoma (ESCC) (HR=1.37, 95% CI 1.05 to 1.77, P=0.018).ConclusionPreoperative RDW may be an independent prognostic factor for Chinese and Japanese esophageal cancer patients, especially for ESCC patients. However, more prospective studies with bigger sample sizes from other countries are still needed to verify our findings.
ObjectiveTo investigate the safety and efficacy of 3D thoracoscopic surgery in uniportal lobectomy.MethodsClinical data of 248 patients with lung cancer who underwent uniportal thoracoscopic lobectomy in our hospital from September 2018 to May 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods, a 3D thoracoscopic group (76 patients, including 52 males and 24 females with an average age of 58.59±7.62 years) and a 2D thoracoscopic group (172 patients, including 102 males and 70 females with an average age of 57.75±8.59 years). Statistical analysis of clinical and pathological data, lymph node dissection, surgical complications, postoperative hospital stay, etc was performed.ResultsCompared with the 2D thoracoscopic group, the 3D thoracoscopic group had shorter operation time, more lymph nodes dissected and pleural effusion on the first day after operation (P<0.05). There was no significant difference in the postoperative chest tube duration, postoperative hospital stay, incidence of pulmonary infection, arrhythmia, bronchopleural fistula, or recurrent laryngeal nerve injury between the two groups.ConclusionCompared with the traditional 2D thoracoscopic minimally invasive surgery, uniportal lobectomy with 3D thoracoscopic surgery is safer and more efficient during operation, and lymph node dissection is more thorough, which is worth promoting.