Objiective To evaluate the effect of pearventricular device closure of non-muscular ventricular defercts(VSDs) in infants.Methods From April 2007 to February 2008,39 patients with non-muscular VSDs were received off pump surgical treatment,perventricular device closure were for all the patients.There were 16 males and 23 females with mean age of(14.5±7.8) months(12 to 36 months and mean weight of(12.4±2.3)kg(8.5 to 18.0 kg).There were 34 perimembranous and 5 subateria VSD.The diameter of defects were 3.0 to 11 mm[mean(6.1±2.0)mm].Results Thirty-seven(94.9%)VSDs ere successfully closed,while two were repaired under cardiopulmonary bypass(CPB)instead of device closure because of the complication of moderat aortic reurgitation.The diameter of occluders were 4 to 12mm[mean(8.2±2.0)mm].The tricuspid regurgitations decareasded after operation in 3 patients with perimenmbranous VSDs,while the closure caused new mild or trace tricuspid regurgitations in 8 patients.Six patients with perimembranours VSDs acquired the incomplete right bundle branch blocks affter device closure.The length of hospital stay was 3 to 5 days[mean(3.4±0.4)]after operation and no petient had blood transfusion.Conclustion Perventricular device closure is probably an effective and safe treatment for non-muscular VSDs in unfants.

Objective To evaluate the application of inguinal incision in retroperitoneal laparoscopic nephroureterectomy(LNU)in the treatment of upper urinary urothelial carcinoma(UUUC).Methods From Mar.2007 to Jan.2012,186 retroperitoneal LNU procedures on 115 males and 71 females for the treatment of UUUC were performed in our institute.All cases were grouped as inguinal incision group(n =112)and lumbar incision group(n =74)according to specimen retrieval incision.Operative time,estimated blood loss,postoperative analgesia,hospital stay,incision complications,cosmetic satisfaction and tumor recurrence were compared between the 2 groups.Results All the 186 cases of operation were successfully accomplished.There were no differences in tumor stage,tumor grade,mean operative time,blood loss between the 2 groups.In inguinal incision group,the incidence of incision fat liquefaction,incision hernia,incision bulging,lumboabdominal unsymmetry and postoperative analgesia was less than that of lumbar incision group.In inguinal incision group,the mean hospital stay was shorter,cosmetic satisfaction(Ⅰ/Ⅱ/Ⅲ)was better(7/24/81 versus 22/18/34,P ＜ 0.01).Recurrence rate of UUUC in middle and inferior segment of ureter was fewer than that of lumbar incision group(5.3％ versus 35.0％,P ＜0.01).Conclusion Retroperitoneal LNU for UUUC combined with inguinal incision offers advantage of less trauma,less complications,higher cosmetic satisfaction and lower tumor recurrence.

Objective To evaluate the clinical efficacy of retroperitoneal laparoscopic nephroureterectomy (RLNU) combined with transurethral electric coagulation on upper urinary tract urothelial carcinoma (UUTUC).Methods Sixty UUTUC patients were enrolled from Jun.2012 to Apr.2013.The prospective clinical controlled analysis method was adopted in this study.All patients were divided into test group and control group according to the order of admission.Thirty cases (test group) underwent RLNU combined with electric coagulation,and 30 cases (control group) underwent RLNU combined with electric resection.The differences in operation time,blood loss,hospital stay and tumor recurrence rate between the 2 groups were compared.Results All the 60 operations for UUTUC were successful without conversion to open surgery.No intraoperative complications such as great vessels or surrounding organs damage occurred.There were 2 cases loss to follow-up in test group and 3 cases in control group.There were no significant differences in operation time,blood loss,follow-up time,tumor stage and tumor grade between the 2 groups.The hospital stay in the test group was shorter (5.5±2.0 d versus 7.1±2.2 d),the tumor recurrence rate was lower [4％ (1/28) versus 30％ (8/27)],and the differences were significant (P＜0.05).Conclusion Compared with RLNU combined with transurethral electric resection,RLNU combined with electric coagulation has advantages of shorter hospital stay and lower tumor recurrence rate.

Objective To investigate the effect of short-term inhalation of glucocorticoid (GC) on nasal symptoms and signs,EOS count and adrenocortical function in patients with eosinophilic sinusitis and nasal polyps.Methods Totally 80 patients with eosinophilic chronic sinusitis and nasal polyps were randomly divided into control group treated with glucocorticoid by nasal spray and observation group treated with glucocorticoid by inhalation.Short-term efficacy,the VAS score of nasal symptoms,the Lund-Kennedy score by endoscope,the level of EOS count and serum cortisol concentration before and after treatment and the recurrence rate were compared.Results The excellent rate and total effective rate of observation group were significantly higher than control group (P ＜ 0.05).The VAS score of nasal symptom and Lund-Kennedy score by endoscope in observation group after treatment were significantly lower than control group and before treatment (P ＜ 0.05).The recurrence rate at 3,6 months of follow-up in observation group were significantly lower than control group (P ＜0.05).The levels of EOS count of observation group after treatment were significantly lower than control group and before treatment (P ＜ 0.05).There was no significant difference in the level of serum cortisol concentration before and after treatment between two groups (P ＞ 0.05).Conclusion Short-term inhalation of glucocorticoid is effective in the treatment of patients with eosinophilic chronic sinusitis and nasal polyps,which can efficiently relieve nasal symptoms,inhibit the aggregation of eosinophils,reduce the long-term recurrence risk and has no significant effect on the adrenocortical function.

Objective To investigate the effect of short-term inhalation of glucocorticoid (GC) on nasal symptoms and signs,EOS count and adrenocortical function in patients with eosinophilic sinusitis and nasal polyps.Methods Totally 80 patients with eosinophilic chronic sinusitis and nasal polyps were randomly divided into control group treated with glucocorticoid by nasal spray and observation group treated with glucocorticoid by inhalation.Short-term efficacy,the VAS score of nasal symptoms,the Lund-Kennedy score by endoscope,the level of EOS count and serum cortisol concentration before and after treatment and the recurrence rate were compared.Results The excellent rate and total effective rate of observation group were significantly higher than control group (P ＜ 0.05).The VAS score of nasal symptom and Lund-Kennedy score by endoscope in observation group after treatment were significantly lower than control group and before treatment (P ＜ 0.05).The recurrence rate at 3,6 months of follow-up in observation group were significantly lower than control group (P ＜0.05).The levels of EOS count of observation group after treatment were significantly lower than control group and before treatment (P ＜ 0.05).There was no significant difference in the level of serum cortisol concentration before and after treatment between two groups (P ＞ 0.05).Conclusion Short-term inhalation of glucocorticoid is effective in the treatment of patients with eosinophilic chronic sinusitis and nasal polyps,which can efficiently relieve nasal symptoms,inhibit the aggregation of eosinophils,reduce the long-term recurrence risk and has no significant effect on the adrenocortical function.

Objective To explore the effects of family dynamics on lymphedema postoperative rehabilitation , positivity and the quality of life ( QOL) in breast cancer patients after surgery .Methods A total of 130 breast cancer patients who received rehabilitation therapy were investigated by family dynamics questionnaire , positive and negative affect scales , and QOL questionnaire .The patients are followed up for 8 weeks, and the clinical features of patients with different family dynamics , the difference in the positive rate of rehabilitation patients , the improvement degree of obstructive lymphedema after treatment and their QOL were compared.The effects of family dynamics on lymphedema rehabilitation and QOL in breast cancer patients after surgery was explored on the basis of logistic regression and multivariate linear regression methods . Results After rehabilitation, the improvement degree of lymphedema in patients with high family dynamics was apparently higher than those patients with low dynamics (P<0.05).Multiariable logistic regression analysis showed that:high family dynamics , the positivity before rehabilitation treatment , divorced or widowed , high-grade pathology and elder were independent factors of improving the lymphedema .Multiple linear regressions analysis showed that: high family dynamics, age, marital status, positivity before rehabilitation and family annual income were independent factors of QOL .There was a positive correlation between the family dynamics score and the improvement degree of positivity of rehabilitation ( r=0.241, P<0.01) as well as QOL ( r=0.358, P<0.01).Conclusions The positivity of breast cancer patients in lymphedema rehabilitation is low . The family dynamics still need to be improved and family dynamics is an influencing factor of positivity in rehabilitation .Family dynamics provides a new way for improving the positivity of rehabilitation .

Objective To observe the efficacy and safety of ultrasound-guided musculocutaneous nerve(MCN)block anesthesia in alleviating operative pain during percutaneous transluminal angioplasty(PTA)for hemodialysis internal fistula.Methods A total of 112 patients undergoing internal fistula PTA in the hemodi-alysis center of the nephrologic department of the Second Affiliated Hospital of Army Military Medical Uni-versity from February 2022 to February 2023 were selected.Among them,47 patients applied the ultrasound-guided MCN block anesthesia(MCN block group)and other 65 patients adopted perivascular local infiltration anesthesia in the injured blood vessel section(local anesthesia group).Anesthesia was independently operated by the vascular access doctor.The VAS score,analgesic satisfaction investigation and motor block evaluation were compared between the two groups,and the efficacy and safety of MCN block anesthesia were under-stood.Results The proportion of the patients with motor block score grade 1 in the MCN block group was the highest(93.6％),and there were no patients with the grade ≥3.The proportion of the patients with the VAS score(4-6)points in the local anesthesia group was the highest(52.3％),while the proportion of the patients with the VAS score(1-3)points in the MCN block group was the highest(76.6％);the proportions of(1-3)points,(4-6)points,(7-10)points and the patients with additional anesthesia had statistical differences between the MCN block group and local anesthesia group(P＜0.05).The satisfaction degree of postoperative analgesia in the local anesthesia group was 55.4％,which was lower than 85.1％in the MCN block group,and the difference was statistically significant(P＜0.05).Conclusion The upper arm MCN block anesthesia could effectively relief the operative pain in arteriovenous internal fistula PTA,and is an effective anesthesia method suitable for the independent operation of hemodialysis channel surgeons.

Objective    To investigate the reliability and safety of the technique of percutaneous left ventricular transapical access guided by cardiac three dimensional CT angiography (3D-CTA) combined with echocardiography applied in structural heart defects. Methods    The clinical data of 9 patients (7 males and 2 females with a median age of 50 years ranging from 43 to 64 years) with paravalvular leaks closed by percutaneous left ventricular transapical access in West China Hospital, from April 2015 to August 2018, were retrospectively analyzed. We applied preoperative cardiac 3D-CTA to define the puncture site and trace, which was established by combining with real-time guidance of transesophageal echocardiography (TEE/3D-TEE), and an occluder was deployed at the apical access point for hemostasis with real-time guidance of transthoracic echocardiography (TTE). Results    The puncture needles were successfully introduced into the left ventricular cavity at one time in all patients without injury of lung tissue, coronary artery or papillary muscle. There was no occluder displacement or apex bleeding. One patient developed pleural effusion caused by intercostal artery injury. Conclusion    That cardiac 3D-CTA is used to define puncture sites and trace with advantages of simplicity and repeatability. A safe access and secure exit of left ventricle can be achieved by combining with real-time guidance of echocardiography. There are acceptable technology-related complications.

Adolescent ; Adult ; Beijing/epidemiology* ; Contact Tracing ; Female ; Humans ; Male ; Prevalence ; Tuberculosis/transmission* ; Universities ; Young Adult

Objective    To explore the mechanism of volume-related mitral regurgitation (MR) from the anatomy of mitral valve. Methods    A total of 32 patients with ventricular septal defect (VSD) combined MR meeting inclusion criteria in West China Hospital from September 2018 to November 2019 were enrolled in this study. The direction relative to the cardiac axis: the deviation of the MR bundle along the left atrial wall was eccentric, otherwises it was central. There were 23 patients of VSD and eccentric MR (EMR, a VSD-EMR group), including 10 males and 13 females aged 21 (10, 56) months, and 9 patients of VSD and central MR (CMR, a VSD-CMR group), including 4 males and 5 females aged 26 (12, 87) months. Besides, 9 healthy children were enrolled in a control group, including 4 males and 5 females aged 49 (15, 72) months. All patients underwent transthoracic echocardiography (TTE) examination at 2 weeks before surgery and 6 months after surgery, respectively, The MR degree, end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), antero-posterior diameter (AP), annulus circumference (AC), commissural diameter (CD) were assessed. Results    Before operation, EDV, ESV, SV, AP, AC and CD in the VSD-EMR and VSD-CMR groups were significantly larger or longer than those in the control group (P<0.05); after operation, EDV, ESV, SV, AP and CD decreased compared with those before operation (P<0.05), but there was no significant difference compared with the control group (P>0.05). Compared with the control group, AC was slightly decreased (P<0.05). There was no significant difference in EF between and within groups before and after operation (P>0.05). The improvement rate of MR was 78.9%(15/19) in the VSD-EMR group and 100.0% (9/9) in the VSD-CMR group. Conclusion    After unloading of volume, the valve structure is back to normal except AC. The improvement rate of MR in the VSD-EMR group is lower than that in the VSD-CMR group, which may indicate that the mechanism of VSD-EMR is more complicated.