OBJECTIVETo assess the predict value of European system for cardiac operative risk evaluation (EuroSCORE) II on early death in patients with severe coronary artery disease undergoing active treatment.

METHODSConsecutive 2 240 patients with three-vessel disease ( with or without left main disease) diagnosed by elevtive coronary angiogram between July 2011 and September 2012 were screened for this study, data from 1 892 patients who underwent active treatments (percutaneous coronary intervention or coronary artery bypass grafting) were analyzed retrospectivly. The predicted 30 days operative mortality calculated with EuroSCORE II was compared with the actual one. The calibration and discrimination of EuroSCORE II were tested with Hosmer-Lemeshow χ2 test and area under receiver operating characteristic (ROC) curve respectively.

RESULTSAge was 61.0 (54.0-68.0) years old and 75.8% (1,435/1,892) were male in this cohort, 58.0% (1,097/1,892) patients received percutaneous coronary intervention and 42.0% (795/1,892) patients received coronary artery bypass grafting. The overall 30 days operative mortality was 0.53% (10/1,892), 30 days operative mortality predicted by EuroSCORE II was 0.85% (95% CI:0. 44%-1.26%). The calibration (χ2 = 3.47 and P > 0.10) and discrimination (area under ROC curve was 0.75) of EuroSCORE II were satisfactory.

CONCLUSIONEuroSCORE II could precisely predict 30 days operative mortality for three-vessel disease patients with or without left main disease undergoing active treatments.

Aged ; Coronary Artery Bypass ; Coronary Artery Disease ; mortality ; Female ; Heart ; Humans ; Male ; Middle Aged ; ROC Curve ; Risk Assessment

Objective To explore the clinical efficacy and the dynamic changes of serum vascular endothelial growth factor(VEGF),connective tissue growth factor(CTGF),hypoxia inducible factor 1α(HIF-1α)and osteopontin(OPN)levels after transcatheter arterial chemoembolization(TACE)combined with sorafenib in the treatment of advanced hepatocarcinoma(HCC)patients.Methods A total of 113 HCC patients in Cancer Hospital of Taizhou,from September 2013 to December 2014 were elected and were randomly divided into control group(n=56)and experiment group(n=57)according to random number.Control group were treated with sorafenib and experiment group were treated with TACE combined with sorafenib.The serum VEGF,CTGF,HIF-1α and OPN levels were tested and compared using indirect ELISA method preoperative and postoperative 1,3,7 days and which were carried out Spearman correlation analysis.The long-term clinical efficacy and adverse reaction in two groups were statisticed.Results The serum VEGF,CTGF,HIF-1α and OPN levels of two groups postoperative 1 day increased than preoperative(P<0.05).From postoperative one to seven days,the serum VEGF,CTGF,HIF-1α and OPN levels of two groups present downward trend(P<0.05 or P<0.01),and there was significant difference between two groups(P<0.01).The level of HIF-1α significantly positive correlated with the levels of VEGF,CTGF and OPN(r=0.951,0.954,0.929,P<0.05).Compared with control group,the median survival time and 1-year-survival rate of experiment group increased significantly(P<0.01).The incidence of hand-foot reaction,alopecia and diarrhea in experiment group were higher than those in control group(P<0.05),while the others had no significant difference between two groups(P>0.05).Conclusion The levels of VEGF,CTGF,HIF-1α and OPN of HCC patients after treated with TACE combined with sorafenib are lower than that treated with TACE alone,Simultaneously,the survival is prolonged and adverse reactions don't increase.

Objective To study the clinical and pathological features of periodic paralysis.Methods The clinical and pathological data of 9 patients with periodic paralysis were analyzed.Results The clinical manifestation of 9 patients were consistent with the general manifestation of periodic paralysis.The typical tubular aggregates in many fibers were observed in 4 cases of 7 patients with skeletal muscle biopsy.A few degenerating fibers were observed,while necrotic fibers and regenerating fibers were not found.Electromicroscope showed Honeycomb appearance in tubular aggregates of cross section,which was filled with glycogen granule.Conclusions According to the clinical manifestation and the laboratory examination,periodic paralysis can be clinical diagnosis.The tubular aggregates in many fibers are important pathological characteristic of periodic paralysis.In electromicroscope analysis,tubular aggregates may be compose of transverse tubular system or sarcoplasmic reticulum expansion.

Parkinson's disease (PD) is a commonly encountered central neurodegenerative disease in elderly people. According to theories of traditional Chinese medicine (TCM), PD is characterized by deficiency in the root and excess in the branch. Deficiency was referred to qi-blood deficiency of the liver and kidney. Excess was referred as the wind, fire, phlegm and stasis. Deficiency was the root and excess was the branch. Good efficacies have been obtained by treatment based on syndrome differentiation, treatment with specific prescriptions, acupuncture and moxibustion and comprehensive treatment. Some experiments had been conducted to elucidate its mechanisms. However, no uni-fied standard for therapeutic evaluation, poor control of medicinal quality, inferior quality of designed clinical trials, and unclear treatment mechanism in the clinical study on therapeutic effect of PD treatment with TCM require fur-ther studied.

Aim To investigate the influence of Tanshinone ⅡA on cytokine secreted by kuppfer cells via LPS stimulation,and explore its mechanism of therapying chronic hepatic disease. Methods The liver cell and kupffer cells were isolated and the model of liver cell injuries was made induced by LPS and D-GlaN, and the effects of TanshinoneⅡA was observed on the injuries of liver cell induced by lipopoly-saccharide(LPS) and D-Galactosamine(D-GlaN). Cytokine were released secreted by kupffer cells through LPS stimulation and the contents of TNF-?,IL-6,IL-8 were determined by radio-immunoassay. The hepatocyte morphological character was observed by HE stain,the expressions of TNF-?、CD14、iNOS、eNOS in kupffer cell were explored by immunohistochemical, double-decker chamber was used for observing the damage of hepatocyte caused by cytokine secreted by kupffer via LPS stimulation. Results Tanshinone ⅡA could restore the injury of liver cell induced by D-GlaN and LPS, the levels of ALT、MAO、LDH-L、GSH-S and contents of MDA were significantly reduce.It could inhibit TNF-? IL-8 secreted by kupffer cells through LPS stimulation ,and the expressions of TNF-?、CD14 Inos、eNOS in kupffer cell through LPS stimulation were inhibited. Blocking injuries of the inflammatory cytokine release excessive on liver cell, it hadn′t the protect action on liver cell damage suffer from inflammatory cytokine.Conclusion The mechanism of Tanshinon ⅡA of blocking liver cell injuries induced by D-GlaN and LPS may be correlation with inhibiting the excessive cytokine by kupffer cells

Objective: To investigate the quality of life and its influencing factors among patients with gestational diabetes mellitus (GDM), so as to provide insights into the improvements in the quality of life among patients with GDM. Methods: GDM patients admitted to Department of Obstetrics and Gynecology, Hangzhou First People's Hospital Affiliated to Zhejiang University Medical School from June 2021 to June 2022 were recruited. Participants' demographics, diagnosis and treatment, sleep quality, depression and social support level were collected. Patients' quality of life was evaluated using the Quality of Life Scale for Pregnant Women with Gestational Diabetes Mellitus, and the factors affecting the quality of life were identified among patients with GDM using a multivariable linear regression model. Results: A total of 300 questionnaires were allocated, and 284 valid questionnaires were recovered, with an effective recovery rate of 94.67%. The respondents had a mean age of (32.81±4.93) years, and the mean scores for the quality of life was (92.63±14.10) points. Multivariable linear regression analysis identified depression (β'=-0.293), sleep disorder (β'=-0.177), insulin therapy (β'=-0.316), regular exercise (β'=0.272) and social support level (medium: β'=0.153; high: β'=0.381) as factor affecting the quality of life among GDM patients. Conclusions GDM patients have a low quality of life. Depression, sleep disorders, insulin therapy, and lack of exercises may cause a decline in the quality of life among GDM patients, and strong social support facilitates the improvements in the quality of life among GDM patients.

OBJECTIVETo explore the clinical effects of Dynesys system combined with posterior lumbar interbody fusion (PLIF) in treating multiple lumbar degenerative disease.

METHODSThe clinical data of 46 patients with multiple lumbar degenerative diseases treated by Dynesys system combined with PLIF from September 2010 to May 2013 were retrospectively analyzed. There were 17 males and 29 females, aged from 38 to 68 years old with an average of (56.38±11.63) years. Operation section was in L2-L5 of 16 patients (6 with fusion of L4,5 and 10 with fusion of L4,5,L5S1) and in L3-S1 of 30 patients (11 with fusion of L5S1 and 19 with fusion of L4,5,L5S1). Patients were followed up for three times: postoperative 3 months, 1 year and final follow-up. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess clinical symptoms preoperatively and postoperatively. All patients underwent flexion/extension radiographs examinations before surgery and at final follow-up. Range of motion (ROM) and disc height index (DHI) were recorded.

RESULTSAll patients were followed up from 16 to 48 months with the mean of (23.23±7.34) months. At third follow-up after operation, ODI and VAS of lumbago and leg pain were significant improved than that of preoperative (P<0.01). DHI of fusion segment was significantly increased than that of preoperative (P<0.05). There was no significant difference in adjacent non-fusion segment between preoperative and postoperative (P>0.05). Postoperative ROM of fusion and non-fusion segments were obviously decreased than that of preoperative. There was no significant difference in ROM of upper adjacent non-fusion segment between 3 months and 1 year after operation (P>0.05), but at final follow-up, the ROM was increased (P<0.05).

CONCLUSIONThe preliminary clinical results of the Dynesys system combined with PLIF in the treatment of multiple lumbar degenerative diseases are satisfactory. It can be determined in fusion or non-fusion according to the individual needs and can reserve the some intervertebral motion, prevent the early degeneration of adjacent segments. However, its long-term clinical efficacy should be verified with long time.

Humans ; Lumbar Vertebrae ; surgery ; Range of Motion, Articular ; Retrospective Studies ; Spinal Diseases ; physiopathology ; surgery ; Spinal Fusion ; methods ; Visual Analog Scale

ObjectiveTo investigate the clinical value of right lateral position with real-time monitor for capsule endoscopy.MethodsA total of 80 patients were randomly divided into two groups.The observation group assumed the right lateral position,while the control group was in upright,standing or sitting position.The capsule endoscope was monitored real time.The patients were allowed to move after the capsule endoscope passed pylorus.Gastric transit time,small bowel transit time,small bowel examination completion rate and positive detection rate were compared between the two groups.ResultsThe mean gastric transit time of the observation group was (31.7 ± 29.8)min,which was significantly shorter than that in the control group (62.6 ± 55.9) min ( U =559.000,P =0.020).The mean transit time of small bowel was (221.3 ±78.8) min in the observation group,which was not significantly different from that of the control group ( t =0.511,P =0.611 ).The examination completion rate of whole small bowel was 95.0％ (38/40)in the observation group,which was significantly higher than that of the control group (x2 =5.165,P =0.023).The positive detection rates were 75.0％ (30/40) and 65.0％ (26/40),respectively,which were not significantly different (x2 =0.952,P =0.329).ConclusionThe right lateral position with real-time monitor during capsule endoscopy is of better clinical value.

Objective To improve short-and mid-term surgical outcomes ofter the tricuspid ring annuloplasty,and to provide theoretic basis for strategy making among patients with tricuspid regurgitation secondary to left-sided heart diseases.Methods Tricuspid regurgitation secondary to left-sided heart diseases ( including mitral valve diseases and aortic valve diseases) were treated by using tricuspid ring annuloplasty techniques.Patients'age averaged (47.3 ± 12.0) years old,there were a total of 84 female patients(53.2％ ).The average systolic pulmonary pressure was (53.4 ± 19.8) mm Hg.From August 2002 to December 2007,a total of 158 consecutive patients underwent tricuspid ring annuloplasty in Fuwai Cardiovascular disease Hospital.Among this group of patients,there were 66 mild tricuspid regurgitation(41.8％ ),54 moderate(34.2％ ),and 38 severe tricuspid regurgitation(24.0％ ).The average age was (47.3 ± 12.0) years old and female accounted for 53.2％ of the whole cohort.The indications for the tricuspid ring annuloplasty included:moderate to severe tricuspid regurgitation or moderate to severe pulmonary hypertension ( systolic pulmonary hypertension ＞40 mm Hg).In the current study,the ring annuloplasty techniques were modified in the following aspects:selection of undersized ring and partial fixation of tricuspid septal segment.In all the patients,we chose Cosgrove-Edwards ring for tricuspid annuloplasty.The surgical outcomes were evaluated through multivariate regression and Cox analysis.Results Compared with moderate and severe tricuspid regurgitation groups,mild regurgitation group had the smallest ring diameter,mild group ( 38.2 ± 4.9 ) mm,moderate group(47.0 ± 11.6 ) mm,severe group(44.5 ± 8.9) mm,P ＜0.001.No significant differences were noted in terms of ejection fraction among three groups (0.59 ± 0.08,0.59 ± 0.06 and 0.58 ± 0.09,P =0.73 ).Compared with mild and moderate tricuspid regurgitation groups,severe regurgitation group had the highest systolic pulmonary pressure.The diameter reduction was most significant in severe regurgitation group,diameter reduction in mild,moderate and severe regurgitation groups were ( 12.4 ±5.6) mm,(20.8 ± 11.5 ) mm,( 18.6 ± 8.3 ) mm,respectively,P ＜ 0.00 1.An in-hospital death occurred in moderate regurgitation group.157 patients discharged alive.The median follow-up time was 49.1 months.During follow up,three moderate to severe regurgitation occurred,among which one was in moderate regurgitation group,two in severe regurgitation group ( P =0.06).There were three deaths in mild regurgitation group,two in moderate regurgitation group,and four in severe regurgitation group.No significant differences were found in terms of mid-term morality,P =0.10.Conclusion For patients with tricuspid regurgitation secondary to left-sided heart diseases,the mid-term outcomes of modified Cosgrove-Edwards ring annuloplasty were satisfactory.The taking home messages include:positive recommendation for patients with pulmonary hypertension to accept tricuspid annuloplasty,use of undersized ring,and partial fixation of septal segment.

Objective To evaluate the efficacy and safety of dorsal root entry zone (DREZ) incision for pain induced by brachial plexus injury. Methods A cohort study was performed in 41 consecutive patients with pain induced by brachial plexus injury treated with DREZ incision from July 2005 to December 2007. Of all, 19 patients were amputated and had phantom limb sensation. Oral pain relief (0%-100%) and complications were followed up by one professional doctor. Oral pain relief rate ≥50% was considered satisfactory outcome. Results The proportion of patients with satisfactory pain relief was 90% (37/41), 81% (30/37), 77% (24/31) and 70% (16/23) at 2 weeks, 3 months, 6 months and last follow-up (over one year) after surgery. At last follow-up, 15 out of 16 patients with over 10 years of pain duration got satisfactory pain relief; while only 16 out of 25 patients with less than 10 years of pain duration got satisfactory pain relief (x2 =4.682, P =0.030). In 16 amputees who were followed up for more than three months, seven patients with alteration of phantom limb sensation got satisfactory pain relief, while only four out of nine patients without alteration of phantom limb sensation got satisfactory pain relief. Among 37 patients followed up for more than three months, severe neurological defects were found in three patients including one with mild motor disturbance in the ipsilateral lower limb and two with severe sensory disturbance in the ipsilateral lower limb. Conclusions DREZ incisions are effective and safe neurosurgical procedure for relieving pain induced by brachial plexus injury. The possible predictive factors of better outcome are the long preoperative pain duration and postoperative phantom limb sensation among amputees.