Objective To analyze the total cost and clinical effectiveness of internal fixation and hemiar-throplasty in the treatment of femoral neck fracture for the elderly. Methods From October 2013 to May 2015,85 patients above 60-year old who were diagnosed as displaced femoral neck fracture and received operation in our hospital. All the patients were divided into internal fixation(IF)group and hemiarthroplasty(HA)group respec-tively. There were 40 cases in the IF group and 45 cases in the HA group. The total cost associated with fracture in a year was collected by medical record ,telephone interview and standard methods. At the last follow-up ,we ap-plied Harris scores to evaluate the clinical outcome for each group. Results All the patients completed the operation successfully. During 1 year follow-up the total cost in the IF group was less than that in the HA group including higher primary hospitalization cost and less post-discharge cost. The total cost was 44,556.1 Yuan in the IF group and 72,198.0 Yuan in the HA group respectively. The data showed that the total cost of HA was 1.6 times higher than that of IF. At the last follow-up the mean Harris scores was 71.1 ± 12.1 in the IF group and 74.3 ± 10.3 in the HA group while the EQ-5D index was 0.74 ± 0.15 and 0.76 ± 0.13 respectively which showed no significant differ-ence(P > 0.05). Conclusions Both internal fixation and hemiarthroplasty have effective treatment for elderly pa-tients with femoral neck fracture. Compared to hemiarthroplasty IF can provide similar clinical effectiveness with less total cost. Therefore IF may contribute to decrease the economic burden for elderly patients in China.

Objective:To evaluate the preventive effect of Danshen Shuizi Capsule on vascular restenosis after stent implantation.Methods:48 patients with endovascular stent implantation were randomly assigned to control group(n=25) (treated with western medicines)and treatment group(n=23)(treated with Danshen Shuizi Capsule)after endovascular stenting implantation.The intraluminal diameter of stenting segment was measured by QCA at 6 months after stent implantation.Results: The diameter of reference vessel in two groups was not significantly different.The intraluminal diameter of stent segment in the treatment group was not larger than that in the control group(2.22?0.21)mm vs(2.18?0.25)mm.The index number of vessel diameter reduction in treatment group was not less than that in the control group(0.50?0.16)mm vs(0.51?0.11)mm.The rate of restenosis(18.4%)and reintervention(13.1%)in treatment group were not lower than those in the control(20%,12%).However,the complication in treatment group was significantly lower than that in control group.Conclusion:These findings indicated that endovascular was useful for the prevention of endovascular restenosis after stent implantation with fewer complications

ObjectiveTo assess the prognostic efficiency of three different risk socres in patients underwent redo-coronary artery bypass grafting (redo-CABG).MethodsFrom January 1997 to July 2011,57 patients underwent redo-CABG in Fu Wai Hospital.All patients were prospectively scored for operative mortality using EuroScore,STS Score and Sinoscore.The overall expected mortality were compared with the observed mortality.Discrimination was evaluated by receiver operating characteristic (ROC) cures and area under a ROC curve (AUC).ResultsFour patients died in the whole group,the observed mortality was 7％.The overall predicted mortality of EuroScore,STS Score and SinoScore were 5.6％,2.2％ and 1.5％,all lower than the observed mortality.The AUC of the three kinds of score were respectively 0.495,0.557 and 0.535,which indicated that the discrimination of the three kinds of score are poor.ConclusionThe predictive value of EuroScore,STS Score and SinoScore for early postoperative mortality in patients undergoing redo-CABG is poor.Surgical technology is an important predictor for early postoperative mortality.

OBJECTIVETo identify the clinical predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).

METHODS322 consecutive patients who had undergone isolated CABG were reviewed. Preoperative, intraoperative and postoperative data were collected. Patients were grouped according to whether AF appeared postoperatively.

RESULTSAF occurred in 75 patients (23.3%). Most cases of AF (85.6%) appeared on or before the third postoperative day. The mean age for patients with AF was 62.5 years compared with 56.7 years for patients without AF (P < 0.05). The mean aortic crossclamp time for patients with AF was 67 min compared with 60.3 min for patients without AF (P < 0.05). The mean duration of cardiopulmonary bypass for patients with AF was 109.6 min compared with 97.3 min for patients without AF (P < 0.05). The mean duration of mechanical ventilation for patients with AF was 19.1 h compared with 15.7 h for patients without AF (P < 0.05). Multivariate logistic regression analysis was used to identify the following independent predictors of postoperative AF (P < 0.05): age > or = 65 years (OR 2.7; 95% CI 1.5 to 5.1), lesions in the right coronary artery (OR 2.5; 95% CI 1.4 to 4.5), and early postoperative withdrawal of beta blocker (OR 3.9; 95% CI 2.1 to 7.7).

CONCLUSIONSAF remains the most common complication after CABG. Age and lesions in the right coronary artery can influence the incidence of AF, and beta blocker and magnesium may be the most economical and effective prevention for AF early after CABG.

Adult ; Age Factors ; Aged ; Atrial Fibrillation ; diagnosis ; etiology ; Coronary Artery Bypass ; adverse effects ; Coronary Vessels ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications ; Prognosis

Objective:To explore the application effects of modified laparoscopic total extraperitoneal hernia repair (TEP) and laparoscopic transabdominal preperitoneal hernia repair (TAPP) in inguinal hernia.Methods:One hundred and twenty-five patients with inguinal hernia in Yiwu Central Hospital from February 2017 to December 2019 were selected for retrospective study. They were divided into modified TEP group (63 cases) and TAPP group (62 cases). The modified TEP group was treated with modified TEP, and the TAPP group was treated with TAPP. The perioperative operation related indexes, serum oxidative stress indexes, 1-year recurrence rate and semen quality indexes were compared between the two groups.Results:The scores of visual analogue scale after operation for 24 h in the modified TEP group was lower than that in the TAPP group: (1.68 ± 0.39) scores vs. (1.97 ± 0.46) scores, P<0.05. After operation for 3 d, the levels of serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) in the modified TEP group were higher than those in the TAPP group: (92.79 ± 8.82) μmol/L vs. (84.40 ± 7.36) μmol/L, (81.52 ± 9.37) U/L vs. (75.75 ± 8.50) U/L; and the level of malondialdehyde (MDA) in the modified TEP group was lower than that in the TAPP group: (23.42 ± 3.3) μmol/L vs. (26.71 ± 3.92) μmol/L; the differences were statistically significant ( P<0.05). There was no significant difference in 1-year recurrence rate between the two groups ( P>0.05). One year after operation, the levels of acid phosphatase (ACP), fructose (FRU) and α- glucosidase (α- Glu) in the modified TEP group were higher than those in the TAPP group: (180.87 ± 20.15) kU/L vs. (159.85 ± 14.50) kU/L, (3.37 ± 0.84) g/L vs.(2.53 ± 0.67) g/L, (62.94 ± 6.25) kU/L vs. (43.96 ± 5.31) kU/L, the differences were statistically significant ( P<0.05). Conclusions:Both modified TEP and TAPP are effective methods for the treatment of inguinal hernia, but the former can reduce surgical trauma, recover quickly, and protect normal reproductive function.

Objective: To summarize the peri-operative management experience of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A total of 56 CTEPH patients received PEA in our hospital from 2015-01 to 2016-11 were retrospectively analyzed. Our study was focused on the medication in respiratory and circulatory system during ICU stay, peri-operative application of vasoactive drug and target drug to pulmonary hypertension (HP), usage of ventilators, mechanical assisted devices and other management experiences. Results: No peri-operative death occurred. There were 2/56 (3.6%) patients with lung reperfusion, 2 (3.6%) with PH crisis. Compared with pre-operation, the post-operative pulmonary artery hemodynamics parameters were improved as right heart catheter measured pulmonary artery systolic pressure (PASP) decreased from (85.05±22.40) mmHg to (36.83 ±17.21) mmHg and pulmonary vascular resistance decreased from (773.84±342.95) dyn·s·cm-5 to (293.59±214.95) dyn·s·cm-5. Post-operative oxygen saturation was maintained at (95-100) % in all patients. Echocardiography found that PASP from pre-operation (85.03±25.78) mmHg decreased to (39.44±19.24) mmHg at follow-up period, P<0.01.Conclusion: A comprehensive peri-operative management of PEA was helpful to improve pulmonary hemodynamics in CTEPH patients; meanwhile, effective prevention and treatment of severe complication could obviously reduce peri-operative mortality.

Objective    To summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion. Methods    We retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation. Results    The mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism. Conclusion    CTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.

BACKGROUNDCoronary artery bypass graft (CABG) has been developed over many years. Recently, an increasing number of patients need a second surgery for relapse of symptoms. In consideration of the high surgical risk, accurate preoperative evaluation is needed. The aim of the study was to assess the predictive value of three different risk scoring system for early postoperative mortality rate in patients with redo-CABG.

METHODSSeventy-seven patients who underwent redo-CABG in Fu Wai Hospital from January 1997 to June 2013 were enrolled. All patients were retrospectively scored for early postoperative mortality rate using EuroSCORE, STS score and SinoSCORE. Overall expected mortality rates were compared with observed mortality rates. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).

RESULTSFour patients died after a redo-CABG 5%. The mortality rates predicted by EuroSCORE, STS score and SinoSCORE were 5.0%, 2.2% and 1.4%, respectively. The AUC of the three kinds of score were 0.465, 0.543 and 0.528, respectively, indicating a poor correlation between the observed and predicted mortality rates.

CONCLUSIONThe predictive value of EuroSCORE, STS score and SinoSCORE is poor for early postoperative mortality rate in patients with redo-CABG.

Adult ; Aged ; Coronary Artery Bypass ; mortality ; Female ; Humans ; Male ; Middle Aged ; Postoperative Period ; Predictive Value of Tests ; ROC Curve ; Reoperation ; mortality ; Retrospective Studies

Objective    To describe the effect of sequential pulmonary balloon angioplasty for patients with chronic thromboembolic pulmonary hypertension, who was accompanied with progressed pulmonary hypertension after pulmonary endarterectomy surgeries. Methods    From 2014 to December 2017, 7 patients were treated with a combination therapy of pulmonary endarterectomy and sequential pulmonary balloon angioplasty. There were 1 male and 6 females at age of 58 (43–59) years. A follow-up period of more than 1 year was accomplished. The result of right sided heart catheterization and ultrasonic cardiogram between and after the pulmonary endarterectomy or balloon angioplasty was collected. Results    Seven patients were treated with a combination of pulmonary endarterectomy and sequential pulmonary balloon angioplasty, which included 1 patient of single pulmonary balloon angioplasty and 6 patients of multiple pulmonary balloon angioplasties. The balloon dilation times was 2 (2–6), and the number of segments during each single balloon dilatation was 3–5, compared with the first clinical results before  the first balloon dilation, systolic pulmonary artery pressure [53 (47–75) mm Hg vs. 45 (40–54) mm Hg, P=0.042), mean pulmonaryartery pressure [38 (29–47) mm Hg vs. 29 (25–39) mm Hg, P=0.043], N terminal-B type natriuretic peptide [1 872 (1 598–2 898) pg/ml vs. 164 (72–334) pg/ml, P=0.018] improved significantly after the last balloon angioplasty. Heart function classification (NYHA) of all the 7 patients were recovered to Ⅰ-Ⅱclasses (P<0.05). Conclusion    Sequential pulmonary balloon angioplasty after pulmonary endarterectomy can further reduce the patient's right heart after load, improve the heart function for patients with progressed pulmonary hypertension after pulmonary endarterectomy surgeries.