Objective To discuss the role of assistance of intraoperative uitrasonography in ret-roperitoneal laparoscopic nephron-sparing surgery for renal tumors. Methods The intraoperative laparoscopic ultrasonography was applied in retroperitoneal nephron-sparing surgery for 20 patients, of whom 11 were men and 9 were women. The average age was 53(range 33 to 73) years. There were 12 patients with renal cell carcinoma and the mean tumor size was 2.9(range 1.4 to 4.6)cm in diame-ter. All of them were staged as T1 N0 M0. Seven patients had angiomyolipoma and the mean tumor size was 4.5(range 1.8 to 8.0)cm in diameter and 1 patient had a 3.1 cm oncocytoma in diameter. The ul-trasonography was used to locate the tumor, observe the bloodstream and detect whether there were small satellite tumors. The surgical time, time of renal artery occlusion and operative effect were ob-served. Results Laparoscopic surgery was successful in all cases without conversion to open surger-y. Mean operative time was 115 (range 85 to 270) min, mean time of renal artery occlusion was 28 (range 22 to 50) min. During the mean followup of 16(range 4 to 30) months, no patients with renal cell carcinoma had local or port site recurrence or metastatic disease. Conclusion In retroperitoneal laparoscopic nephron-sparing surgery, the intraoperative uhrasonography is helpful to locate the tumor in the surgery, to estimate whether the renal artery is occluded completely and to excise the tumor pre-cisely.

Keshan disease is an endemic cardiomyopathy of unclear cause.The major clinical manifestations are cardiac dysfunction and arrhythmia.Based on time course of onset and cardiac function of a suffering patient,Keshan disease is generally classified into four types:acute,sub-acute,chronic and latent types.This article elaborates on the pharmacological mechanisms and dosages of drug treatment for heart failure:diuretics,neurohormonal antagonists,ivabradine,positive inotropic drugs,vasodilators,etc,in order to provide basis for clinical treatment of chronic Keshan disease.

Objective:To investigate the clinical characteristics and causes of death of chronic Keshan disease cases.Methods:A retrospective analysis was conducted on the last clinical data of 39 death cases of chronic Keshan disease who were repeatedly hospitalized in Jingchuan County People's Hospital from March 2016 to August 2020 before their death, including gender, age, course of disease, clinical symptoms and signs, chest X-ray, electrocardiogram, cardiac echocardiography, causes of death, etc., and analysis was made on the clinical characteristics related to the death of chronic Keshan disease cases.Results:Among the 39 death cases of chronic Keshan disease, 27 cases (69.2%) were male and 12 cases (30.8%) were female. The age was (62.64 ± 8.63) years old, and the median course of disease was 5 years. Dyspnea [37 cases (94.9%)] and edema [33 cases (84.6%)] were the main clinical symptoms. All cases had varying degrees of cardiac enlargement, pulmonary congestion signs, and abnormal changes in electrocardiogram. Among the causes of death, 18 cases (46.2%) were sudden cardiac death, 11 cases (28.2%) were heart failure, 5 cases (12.8%) were cardiogenic shock, and 3 cases (7.7%) were heart failure combined with cardiogenic shock, and 2 cases (5.1%) had other causes.Conclusion:Dyspnea and edema are the main clinical characteristics of death cases of chronic Keshan disease, sudden cardiac death, heart failure and cardiogenic shock are the three common causes of death.

Keshan disease (KD) is a unique endemic cardiomyopathy of unknown origin in China.According to the state of heart function and the pathogenesis,KD is divided into four types:acute,sub-acute,chronic and latent.Chronic KD comes on slowly,and the clinical manifestation is chronic cardiac insufficiency.Chronic patients often have poor treatment outcomes,with high mortality and disability.This article summarizes the nonpharmacological treatment of heart failure in chronic KD in order to provide a basis for clinical treatment.

Objective:To evaluate the quality of life of patients with chronic Keshan disease, and to explore related influencing factors, in order to provide a theoretical basis for improving the quality of life of patients with chronic Keshan disease.Methods:According to the standard of "Diagnosis of Keshan Disease" (WS/T 210-2011), 110 patients with chronic Keshan disease treated in the Jingchuan People's Hospital, Pingliang City, Gansu Province were selected as the research subjects, and demographic and disease data of the patients were collected by questionnaire survey; the quality of life of patients was assessed by the Minnesota living with heart failure questionnaire (MLHFQ); and correlation analysis was used to analyze and explore the influencing factors of patients' MLHFQ score.Results:Among the 110 patients with chronic Keshan disease, 66 were males and 44 were females, aged (60.93 ± 8.22) years; the education level was mainly junior high school or below, accounting for 92.73% (102/110); average annual family income was 20 700 yuan; the cardio-thoracic ratio of the patient was 0.64 ± 0.09; the ejection fraction (EF) was (36.71 ± 7.55)%; the labor ability classification was mainly based on simple activities, accounting for 60.91% (67/110); and the cardiac function classification was mainly Grade Ⅲ, accounting for 67.27% (74/110). The total MLHFQ scores of chronic Keshan patients were (69.17 ± 16.14) points, and the scores of physical, emotional and other fields were (26.32 ± 6.70), (15.86 ± 4.96) and (26.94 ± 6.10) points, respectively. The total MLHFQ scores had statistically significant differences among patients with different education level, cardio-thoracic ratio, EF, labor ability classification, cardiac function classification and annual family income ( F=7.121, 6.236, 4.515, 3.427, 5.418, Z=2.346 , P < 0.05). The results of correlation analysis showed that educational level and labor ability classification were negatively correlated with scores in physical field and other fields ( r=- 0.302, - 0.206, - 0.343, - 0.285, P < 0.01), and annual family income was negatively correlated with scores in emotional field ( r=- 0.263, P < 0.01). The cardiac function classification was positively correlated with scores in physical and other fields ( r=0.233, 0.210, P < 0.05). Conclusions:The quality of life of patients with chronic Keshan disease is poor. The quality of life of patients is affected by their educational level, annual family income, labor ability classification, cardiac function classification, etc.

Objective:To evaluate the reliability and validity of the Chinese version of concise health status questionnaire (SF-36 scale) in evaluating the quality of life of patients with chronic Keshan disease, and to provide a scientific basis for studying the quality of life and the evaluation of treatment and rehabilitation of this population.Methods:In the August 2017, using cluster random sampling method, 175 patients with chronic Keshan disease treated by self-management of family beds in Pingliang City, Gansu Province in 2017 were selected as survey subjects, and demographic and disease data were collected. The Chinese version of SF-36 scale was used to investigate the quality of life. Split-half reliability and Cronbach's α coefficient were used to evaluate the reliability of the SF-36 scale; the factor analysis, correlation and differences between groups were used to evaluate the validity of the SF-36 scale.Results:The split-half reliability value of SF-36 scale was 0.916, and the Cronbach's α coefficient was 0.869. Factor analysis extracted 3 common factors from 8 dimensions of SF-36 scale, and the cumulative contribution rate of the 3 common factors to the total variance was 72.08%. In addition to the correlation coefficient ( r) between Role-Emotional and Bodily Pain dimension, the r value between total score and the scores of each dimension, and the scores of each dimension of SF-36 scale were 0.140 - 0.769. Except for the Bodily Pain dimension, there were statistically significant differences in the scores of Physiological Functioning, Role-Physical, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health dimension of the quality of life of patients with different grades of cardiac function ( F = 4.66, 10.73, 6.77, 14.61, 5.58, 9.57, 7.10, P < 0.05). Conclusion:The Chinese version of SF-36 scale has good reliability and validity in evaluating the quality of life of patients with chronic Keshan disease, and can be used to evaluate the quality of life of the patients.

Objective:By investigating the cognitive level and influencing factors of heart failure knowledge in patients with chronic Keshan disease, so as to provide reference for improving the cognitive level of disease-related knowledge of the patients with Keshan disease in the targeted manner.Methods:In 2019, 100 patients with chronic Keshan disease were selected in Jingchuan County, Gansu Province. A questionnaire survey was conducted using the heart failure knowledge questionnaire to conduct correlation and regression analysis on the cognitive level of patients' heart failure knowledge and influencing factors.Results:Patients' average score of the heart failure knowledge level was (6.18 ± 2.72) points, and the scoring accuracy rate was 41.20%. The Spearman correlation analysis indicated that heart failure knowledge level was associated with annual family income ( r = 0.363, P < 0.01), the hospitalization times due to heart failure ( r = 0.304, P < 0.01), and the number of family members ( r = 0.240, P < 0.05). The results of multiple linear regression showed that the cognitive level of heart failure knowledge in male patients was higher than that in female patients ( P < 0.05). The more hospitalization times ( P < 0.05) and the more family members ( P < 0.05) were, the higher the cognitive level of heart failure knowledge was. Conclusions:The cognitive level of heart failure knowledge of patients with chronic Keshan disease is generally low. Medical staff should actively make use of the patient's hospitalization time for health education, and pay attention to the health education of family members of the patients.

Objective:To evaluate the reliability and validity of Chinese version of Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale among patients with chronic Keshan disease.Methods:The patients with chronic Keshan disease diagnosed in Keshan disease area of Gansu Province from August 2018 to April 2020 were selected as the survey subjects to analyze the reliability and validity of the Chinese version of MLHFQ scale in evaluating the quality of life of patients with chronic Keshan disease. To evaluate the reliability of MLHFQ scale, the Cronbach's α coefficient was used, and when the Cronbach's α coefficient > 0.8 indicated that the consistency reliability of the scale was good. Kaider-Meyer-Olkin(KMO) statistic and Barlett's sphericity test were used to evaluate whether the scale was suitable for factor analysis (applicable when KMO > 0.6 and Barlett's sphericity test P < 0.05). The principal component analysis and maximum variance method of exploratory factor analysis were used to extract common factors, and the structural validity of the scale was evaluated. The discrimination validity of the scale was evaluated by New York Heart Association (NYHA) cardiac function classification and analysis of variance. Pearson correlation analysis was used to evaluate the content validity of the scale. Results:A total of 333 questionnaires were collected, of which 329 were valid. There were 180 males and 149 females, aged (59.52 ± 9.26) years. The Cronbach's α coefficient of the Chinese version of MLHFQ scale was 0.95 ( > 0.8). Among them, the Cronbach's α coefficients in the physical domain, emotional domain and other domains were 0.93, 0.91 and 0.86, respectively ( > 0.8). The KMO value of the Chinese version of MLHFQ scale was 0.95 ( > 0.6), and Barlett's sphericity test rejected the hypothesis (χ 2 = 5 222.01, P < 0.05). Principal component analysis and maximum variance method were used to extract 3 common factors, which were named kinetic energy of life, physical condition and emotional condition, respectively. The cumulative contribution rate of principal components was 66.22% ( > 50%). Compared with patients with NYHA cardiac function grade Ⅱ and patients with grade Ⅲ and Ⅳ, there were significant differences in the physical domain, other domain and total score ( P < 0.001). The Pearson correlation coefficients between the physical, emotional, and other domains and their respective items ranged from 0.74 to 0.88, 0.78 to 0.90, and 0.56 to 0.80, respectively, and the correlation coefficients between each item and its domain were all > 0.5 ( P < 0.001). Conclusion:The Chinese version of MLHFQ scale has good reliability and validity in patients with chronic Keshan disease in Gansu Province, and can be used to evaluate the quality of life of patients with chronic Keshan disease.