Pulmonary arterial hypertension is a severe complication in pregnant women and poses a significant risk to mother and fetus.We post an introduction in the diagnosis and clinical classification of PAH,risk assessment of pregnancy,gestation and postpartum management of common classification.Standardized assessment and treatment in the corresponding medical institutions helps to improve the prognosis of mothers and infants in pregnancy with pulmonary hypertension.

OBJECTIVE: To systematically review the clinical efficacy of total ankle arthroplasty (TAA) and ankle arthrodesis (AA) in the treatment of end-stage ankle arthritis. METHODS: The PubMed, EMBASE and Cochrane Library databases were searched for articles published in the treatment of end-stage ankle arthritis with AA or TAA from the establishment of the database to June 2021. Bias risk tool was used to evaluate the quality of the literature. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS), visual analog scale (VAS), ankle osteoarthritis scale(AOS), gait analysis (pace, frequency, stride), range of motion (ROM), satisfaction, complications and reoperation rate were analyzed by meta-analysis between AA and TAA groups by RevMan 5.3 software. RESULTS: A total of 12 articles were included, including 1 050 patients in the AA group and 3 760 patients in the TAA group, totaling 4 810 patients. Meta-analysis showed that the total score of AOFAS[MD=-3.12, 95%CI(-9.02, 2.96), P=0.31], pain score [MD=1.60, 95%CI(-1.35, 4.54), P=0.29], alignmentl score[MD=-0.04, 95%CI(-0.52, 0.44), P=0.88], VAS[MD=0.10, 95%CI(-0.49, 0.68), P=0.74], and AOS total score [MD=-4.01, 95%CI(-8.28, 0.25), P=0.06], the difference was not statistically significant (P>0.05). The score of AOFAS functional in TAA group was significantly higher than that in TAA group[MD=44.22, 95%CI(-8.01, -0.43), P=0.03]. There was no significant difference in gait analysis between the two groups (P>0.05). Postoperative ROM [MD=-4.93, 95%CI(-6.35, -3.52), P<0.000 01] and change in ROM from preoperative to follow-up[MD=-5.74, 95%CI(-8.88, -2.61), P=0.0003] between two groups, the difference was statistically significant. There was no significant difference in satisfaction between the two groups [OR=1.011, 95%CI(0.46, 2.23), P=0.98]. Complications [OR=1.61, 95%CI(1.26, 2.06), P=0.0002] and non-revision reoperation [OR=1.61, 95%CI(1.17, 2.21), P=0.003] were significantly lower in the TAA group than in the AA group. There was no significant difference in the rate of revision and reoperation(P>0.05) between the two groups [OR=1.02, 95%CI(0.37, 2.78), P=0.97]. CONCLUSION The clinical efficacy of AA is similar to that of TAA, but the non revision reoperation rate and main surgical complications of TAA are significantly reduced. Therefore, further high-quality methodological research and long-term follow-up are needed to confirm this conclusion.
Humans ; Ankle/surgery* ; Ankle Joint/surgery* ; Arthroplasty, Replacement, Ankle ; Treatment Outcome ; Osteoarthritis/surgery* ; Arthrodesis ; Retrospective Studies

Minimal hepatic encephalopathy (MHE) refers to a state of neuropsychological or neurophysiological abnormality and normal cognitive function in patients with liver cirrhosis, which is commonly seen in patients with liver cirrhosis. Early diagnosis and treatment of MHE can improve the quality of life of patients and reduce accidental deaths. At present, Psychometric Hepatic Encephalopathy Score is mainly used for the diagnosis of MHE, but its operation is complicated and time-consuming and is affected by age and educational level, with unsatisfactory reliability in clinical diagnosis. Serum biomarkers are objective reference indicators with simple and convenient measurement and can easily be promoted in clinical practice. Potential serum biomarkers such as S100β, 3-nitrotyrosine, and arterial blood ammonia have their own advantages and disadvantages in specificity, sensitivity, and diagnostic value. This article reviews the above-mentioned serum biomarkers.

Objective: To assess the efficacy and long-term outcome of percutaneous balloon aortic valvuloplasty (PBAV) for children with congenital aortic stenosis (CAS) and to explore risk factors for significant aortic regurgitation (AR) and reintervention after PBAV during follow up. Methods: This was a retrospective study. Children (≤18 years old) with CAS, who underwent PBAV in Guangdong Provincial Hospital from January 2004 to December 2018, were included in this study. Demographic, preoperative transthoracic echocardiography (TTE) and surgical data were collected. Postoperative complications were closely observed, and the patients were followed up at 1, 6, 12 months after the operation, and then at one year interval thereafter. Endpoint events included significant AR and reintervention. Reintervention was defined as any intervention that needed to be performed on the valve for various reasons, including re-PBAV, surgical valvuloplasty and valve replacement. Significant AR was defined as AR grade≥3 by TTE criteria. The results of the last TTE examination before the end of the study were collected. The Kaplan-Meier curve for long-term AR-free and intervention-free survival was plotted. Cox regression model was used to further analyze the risk factors for significant AR and reintervention after PBAV in CAS patients. Results: A total of 55 patients were enrolled in this study, and the age was 4.6(1.6, 6.5) years, with 37(67.3%) males. The peak systolic valve gradient fell from (80.3±30.6)mmHg to (38.5±18.5)mmHg(P<0.001, 1 mmHg=0.133 kPa). Surgical success rate was 89% (49/55). Acute post-PBAV AR occurred in 18 patients, including 3 patients with RA≥3 grade. In-hospital complications occurred in 6 patients (2 deaths, 2 cases of transient arrhythmia, and 2 cases of femoral artery embolization). Fifty patients accomplished the follow-up and the follow-up time was 6.2(3.4, 8.5) years. Significant AR was found in 20 patients. Significant AR-free survival rate was 53% at 5 years and 19% at 10 years. Reintervention was performed in 11 patients (4 with valvuloplasty and 7 with valve replacement), and the 5-year and 10-year intervention-free survival rates were 87% and 62%, respectively. Multivariate Cox regression analysis showed that acute post-PBAV AR was a risk factor for long-term significant AR (HR=2.398, 95%CI 1.007-5.712, P=0.048). Post-PBAV residual pressure gradient ≥ 35 mmHg (HR=4.747, 95%CI 1.116-19.329, P=0.030)and acute post-PBAV AR (HR=5.104, 95%CI 1.083-24.065, P=0.039)were risk factors for re-intervention. Conclusions: PBAV is safe and effective in the treatment of CAS in children, but attention should be paid on significant AR post procedure. Acute post-PBAV AR is a risk factor for re-intervention and significant AR post PBAV, and high post-PBAV residual pressure gradient is a risk factor for re-intervention.
Aorta ; Aortic Valve Insufficiency ; Aortic Valve Stenosis/surgery* ; Cardiac Surgical Procedures ; Child ; Humans ; Male ; Retrospective Studies

OBJECTIVE: To establish the clinical pathway of chronic mild occupational cadmium poisoning,and to promote the application of clinical pathway in the treatment of occupational diseases. METHODS: Chronic mild occupational cadmium poisoning was selected as a disease for a pilot study based on GBZ 17-2015 Diagnosis of Occupational Cadmium Poisoning. The diagnosis and treatment scheme and the clinical pathway were developed based on the theory of evidencebased medicine and expert consultation. It was then used and evaluated in clinical practice in several hospitals. RESULTS: The content of clinical pathway of chronic mild occupational cadmium poisoning included the standard in-hospital treatment process protocol,the clinical pathway forms and the consent document for patients. The clinical application of the pathway significantly improved the outcome of treatment,shortened hospital stays and effectively control hospitalization expenses.CONCLUSION: The clinical pathway for chronic mild occupational cadmium poisoning is rational and feasible. The result confirms that the clinical pathway may have good application prospect for the treatment of occupational diseases.

OBJECTIVE: To analyze the usage of glucocorticoid in patients who were treated with occupational medicamentose-like dermatitis due to trichloroethylene( OMDT),in order to provide a reference for regulating the glucocorticoid treatment of the disease. METHODS: Using a retrospective survey method,144 OMDT cases of patients who were diagnosed and cured by Guangdong Province Hospital for Occupational Disease Prevention and Treatment from 2001 to2013 were selected. The general information,clinical data and the use of glucocorticoid were collected and analyzed.RESULTS: i) The usage of glucocorticoid. The median and the 0th to 100 th percentile [M( P_0-P_(100)) ] of first dose of methylprednisolone was 100. 00( 40. 00-1 000. 00) mg / d; 58 patients( 40. 3%) using the first dose of treatment were ineffective. The dosage of glucocorticoid was increased one week after admission,the M( P_0-P_(100)) to an initial dose of120. 00( 40. 00-1 000. 00) mg / d; The M( P_0-P_(100)) of maintenance time of initial dose was 5. 5( 1. 0-14. 0) days. After treating effectively,should the decrement to stop using gradually the first glucocorticoid. The dose was gradually cut down to 20-50 mg every 1 to 3 days if the glucocorticoid dose was more than 100 mg / d; it was cut down to 10 mg every 2 to 3days if the glucocorticoid dose was less than 100 mg / d. The M( P_0-P_(100)) of glucocorticoid using time was 66. 0( 22. 0-229. 0) days. The M( P_0-P_(100)) of total amount of glucocorticoid was 3 510. 0( 420. 0 ~ 27 336. 3) mg. ii) The first dose of glucocorticoid in patients of erythema multiforme group were less than those of exfoliative dermatitis group and bullous epidermal necrolysis group( P < 0. 05),the initial dose and total amount of glucocorticoid were less than the other 3 types of rash( P < 0. 05). iii) Compared with the patients with severe impaired liver function,the first dose,the initial dose and the total amount of glucocorticoid were significantly higher than those in mild impaired liver function( P < 0. 05),and the time of using glucocorticoid was longer than that in mild impaired liver function( P < 0. 05). iv) The first dose and the initial dose of glucocorticoid in patients were positively correlated with the total amount of glucocorticoid [Spearmen correlation coefficient( r_S) were 0. 73 and 0. 78 respectively,P < 0. 01). The maintenance time of the initial dose of glucocorticoid was not correlation with the time of patients who were out of contact with trichloroethylene or the urinary level of trichloroacetic acid at admission( r_Swere- 0. 14 and 0. 10 respectively,P > 0. 05). v) Binary Logistic regression analysis showed that,if the patients who had no erythema multiforme,the more severe the degree of liver dysfunction or the white blood cell count higher than 9. 5 × 10~9/ L,the first dose of glucocorticoid used should be more than 120 mg / d( P <0. 05). CONCLUSION: Liver function and type of rash are important factors that affect the usage of glucocorticoid in patients with OMDT. Glucocorticoid therapy should be prescribed in reference to the liver function and skin lesion of patients with OMDT.

At present, the methods for verifying the attenuation of hearing protective devices(HPDs) mainly include real-ear attenuation at threshold(REAT), microphone in real ear(MIRE), and acoustical test fixture(ATF). Among them, the REAT is the gold standard, but its testing requirements are strict and there is a physiological noise masking effect. The test results of MIRE need to be modified by transfer function of the open ear, which has the advantage of convenient operation without being affected by subjective feelings. The ATF method is mainly used to verify the shape and quality of customized HPDs since its artificial ear design cannot truly reflect the real-ear test situation. The HPD fit testing has been well developed and widely applied abroad, which has been proved to be able to accurately verify and effectively improve the attenuation of workers wearing HPDs. However, relevant research and applications have only been carried out in China in recent years. At present, the main problems in the verification of the protective effect of HPDs in China are as follows: firstly, the measurement is only limited in attenuation and fail to comprehensively consider the applicability and comfort of the HPDs; secondly, a-weighted sound pressure level is mostly used in noise monitoring in China, while the choice of HPDs is based on C-weighted-sound pressure level. The transition between these two has not been established. Future research should be devoted to solve the above problems and help the use of HPDs in preventing the hearing loss of noise-exposed workers.

OBJECTIVE: To analyze the correlation between four vessel regulate factors and vibration-induced white finger( VWF) evaluating in workers exposed to hand-arm vibration,and discuss the value of regulate factors for VWF screening.METHODS: Using typical sampling method,77 male workers exposed to hand-arm vibration with more than 1 year of polish work from a metalwork factory were selected as the study subjects. Based on the workers' self-report,they were divided into VWF group( 43 workers) and non-VWF group( 34 workers). The venous blood from center elbow was collected and plasma was separated. The plasma level of endothelin( ET) was detected by radioimmunoassay. The plasma levels of transforming growth factor beta( TGF-β),soluble intercellular adhesion molecule-1( s ICAM-1) and 5-hydroxytryptamine( 5-HT) were detected by enzyme-linked immunosorbent assay. The regulate factors for evaluating VWF were screened and the new multivariable model index ^y was built by logistic regression. The related factors were analyzed according to the receiver operating characteristic( ROC) curve. RESULTS: Compared with the non-VWF group,the plasma level of ET in VWF group was decreased( P < 0. 01),and the plasma level of TGF-β was increased( P < 0. 01). Both the levels of s ICAM-1 and 5-HT between the two groups showed no significant difference( P > 0. 05). The logistic regression analysis results showed that after adjusting the confounding factors of age,smoking,alcohol and symptoms in hands,there was a negative correlation found between the ET plasma level and VWF( P < 0. 01) and a positive correlation between the TGF-βplasma level and VWF( P < 0. 01). The VWF incidence was not correlated with plasma levels of s ICAM-1 and 5-HT( P >0. 05). According to ROC curve analysis,the area under the curve( AZ) value of the plasma levels of ET and TGF-β were0. 787 and 0. 691,respectively( P < 0. 01); the sensitivity were 70. 60% and 53. 49%,and the specificity were 79. 10%and 85. 29% respectively. The multivariable model index ^y built with ET and TGF-β by logistic regression was used to judge the AZvalue of VWF to be 0. 821( P < 0. 01),with the 72. 09% of sensitivity and 76. 47% of specificity. The AZ values among ET and TGF-β,^y and ET showed no statistical significance( P > 0. 05). The AZvalue of ^y was larger than that of TGF-β( P < 0. 05). CONCLUSION: The plasma levels of ET and TGF-β are correlation with VWF in hand-arm vibration exposure workers,which can be used in the reseach of screening VWF. The correlation between VWF and SICAM as well as 5-HT needs to be further research.

OBJECTIVE: To evaluate the efficacy and safety of sodium dimercaptopropane sulfonate( DMPS) in the treatment of patients with increased urinary mercury. METHODS: By random sampling method,68 patients with elevated urinary mercury were chosen as study subjects. Among them,61 cases were observation subjects working with mercury and 7 cases were chronic occupational mild mercury poisoning. DMPS was used to eliminate mercury by intramuscular injection. The changes of urinary mercury level were observed before and after treatment,and the curative effect was analyzed. RESULTS: The median( the 25 th and 75 th percentiles) of natural voiding urinary mercury was 36. 6( 28. 4,55. 6) μmol / mol creatinine and 24 hours total urine mercury amount was 1 074. 7( 608. 0,1 646. 3) μg / d in the first course of treatment.After 1 to 8 courses of mercury expulsion,the 24 hours total urine mercury amount in 68 patients were lower than the normal reference level( 45. 0 μg / d). The median( the 25 th and 75 th percentiles) of one-time morning urinary mercury level before hospital discharge was 2. 7( 1. 8,4. 0) μmol / mol creatinin,which was lower than the level of natural voiding urinary mercury( P < 0. 05). The first and second course of treatment resulted in the highest decline in urinary mercury,followed by a gradually decreased in urinary mercury in later courses. The number of treatment courses in observation subjects working with mercury was less than that in patients with chronic mild mercury poisoning [( 4. 0 ± 1. 3) vs( 5. 6 ±1. 1) times,P < 0. 05]. There was a positive correlation between the number of treatment courses and the level of natural voiding urinary mercury or 24 hours total urine mercury amount in the first course of treatment( P < 0. 01). The number of courses of mercury expulsion was not related to gender,length of service and age( P > 0. 05). One patient had dizziness and pale after intramuscular injection of DMPS,the symptom was disappeared with symptomatic treatment; 68 patients after treatment have no other adverse reactions. CONCLUSION: Using DMPS as mercury displacement treatment was effective and relatively safe. The change of urinary mercury after DMPS treatment can be used as a basis for establishing clinical standard for patients with increased urinary mercury.