Objective To evaluate the long-term effect after mechanical valve replacement in adult patients with small aortic root,and guide clinical practice.Methods From July 2003 to February 2005,36adult patients with small amtic root(diameter≤ 19 mm)received mechanical valve replacement,23 mm CarboMedics valve were implanted in 14 patients by using of Manougnian annulus enlargiW; technique(CM group),19 mm CarboMedics Top Hat Supra-Annular Aortic valve were implanted in 22 patients(CMSA group).All of the patients were examined for cardiac functions(CF),left ventricular end-diastolic diameter (LVDD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),pressure gradients across aortic valve(PGav),and left ventricular fractional shortening(LVFS),calculating left ventricular ejection fraction(LVEF)before operation and 6 years after operation.Twenty healthy adults were as control group.Results Compared to the preoperation,there was no statistical difference in CMSA group in IVST[(10.37 ± 2.06)mm vs.(11.03 ± 2.45)mm]and LVPWT[(10.53 ± 2.18)mm vs.(11.24 ±degrees(P＜ 0.01 or ＜ 0.05).PGav in CM group was lower significantly than that in CMSA group after 6 years [(9.24 ±5.93)mm Hg(1 mm Hg =0.133 kPa)vs.(24.30 ± 12.50)mm Hg],the difference was statistically significant(P ＜ 0.05).The indicators in CM group were not statistically significant compared to control group,while CMSA group in IVST,LVPWT,PGav was significant difference(P ＜0.05).Conclusions The long-term effect after mechanical valve replacement is satisfied in adult patients with small aortic root,especially in left ventricular function.Line valve ring augmentation larger diameter valves implanted will help reverse the left vehicular morphology.

Objective Investigation of the significance for applying the percentage of neutrophils, neutrophil to lymphocyte ratio combined with contrast enhanced ultrasonography in the diagnose of coronary artery disease through examining the percentage of neutrophils, neutrophil to lymphocyte ratio on peripheral blood. Methods 130 patients with acute coronary syndrome (ACS group) , 90 patients with stable angina (SAP group) and 50 nonCAD patients (control group were observed. The neutrophils counts of all the patients were detected and Neut％, NLR were calculated; all the patients were asked to examine enhanced carotid contrast echocardiography. The plaque enhancement (DE) , and luminal enhancement ratio (Ratio) were recorded. The differences in neut％, NLR and CEUS were compared among the three groups. The Pearson correlation analysis was used to analyze the correlation between Ratio and Neut％, NLR. Multivariate logistic regression analysis was used to evaluate the predictive value of Neut％, NLR and CEUS for ACS. Results (1) The value of Neut％, NLR of the peripheral blood, DE, and Ratio in both ACS group and SAP group were higher than those in control group, and the value of ACS group was higher than that in SAP group (P < 0.05 or P < 0.01); (2) The analysis of Linear correlation showed that the ratio of CEUS in ACS patients was positively correlated with Neut％ (r = 0.422, P = 0.001) and NLR (r = 0.407, P = 0.001). (3) The ROC results showed that circulating Neut％, NLR and DE, Ratio play a significant role in the diagnose of unstable plague in CAD patients; (4) Multivariate logistic regression analysis showed that Neut％, NLR, DE, Ratio were independent indicators of the ACS patients (P< 0.05 or P < 0.01).Conclusions Contrast enhanced carotid examination combined with leukocyte analysis on peripheral blood were useful to detect plaque instability and inflammatory response in CAD patients, and it also provide lots of objective evidence for predicting and intervening unstable plaque in CAD patients.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.