Objective: To investigate the possible pathogenesis and report the postoperative results of the late tricuspid regurgitation (TR) after left cardiac valve replacement. Methods: 56 patients developed severe TR after left cardiac valve replacement, including 10 patients with normal prosthesis valve function (group A) and 46 patients with prosthesis valve dysfunction (group B). Four patients underwent mitral valve replacement (MVR) and 6 patients underwent mitral and aortic valve replacement (DVR) in group A. In group B, 36 patients received MVR, 4 aortic valve replacement (AVR) and 6 DVR. Ten patients underwent tricuspid De Vega annuloplasty and 46 patients' tricuspid valves were normal during the initial operation. The surgical treatment of tricuspid valve included tricuspid valve replacement (TVR) in 9 and tricuspid valve plasty (TVP) in 47 at the second operation. Results: Two patients died postoperatively with hospital mortality of 3.6%. The 54 survivors were followed up from 6 to 132 months, mean 79.4 months. The heart function improved significantly in 8 after TVR and 40 after TVP. However, echocardiography showed moderate TR in 5 and severe TR in 1 patient after TVP and medical treatment was needed. Conclusion: The sustained pulmonary hypertension, irreversible right heart impairment, resumption of left ventricular function and sustained atrial fibrillation may be responsible for the development of late TR after left cardiac valve replacement. TVR may achieve a reliable result for severe functional TR and rheumatic tricuspid valve lesion. In some patients with TVP during the follow up, the TR might become more serious.

It's difficult to diagnose precancerous lesion and early cancer for a long time, because both of them haven't typical morphological characteristics. As a novel diagnostic modality, fluorescence endoscopy can accurately reflect minimal changes in human's tissue, thus making a meaningful progress for cancer diagnosing. 200 patients were examined by fluorescence endoscopy to evaluate the diagnostic value. The overall accuracy, sensitivity and specificity for detecting malignant gastrointestinal tumor was 94.0%, 94.6% and 93.5%, respectively. Thus, fluorescence endoscopy can be used to diagnose malignant gastrointestinal tumors with high validity and reliability, and is advantageous over conventional white light endoscopy especially in detecting the atypical and suspicious lesions. Furthermore, fluorescence endoscopy can also guide target biopsy, is significant to improve the early cancer detection rate, has a broad development prospect.
Endoscopy ; instrumentation ; Fluorescence ; Gastrointestinal Neoplasms ; diagnosis ; Humans ; Sensitivity and Specificity

Objective To summarize the experience of radical treatment of tetralogy of fallot in adults.Method Between Nov. 1985 and May 2005,115 patients over 18 years of age with tetralogy of fallot underwent total surgical correction.Longitudinal or oblique right ventriculotomy was used to ensure complete release right ventricular outflow obstruction and complete ventricular septal defect closure.Transannular patches were used in 74 patients,right ventricular outflow tract(RVOT) patches in 37 cases,primary closure of right ventricle in 5 cases,respectively.One patient had separate pulmonary main artery and RVOT enlargement.Results Seven patients had residual septal defect and 3 cases suffered from residual RVOT obstruction.Severe cardiac output syndrome occurred in 10 patients and 6 patients died early postoperatively with the mortality rate of 5.22%.Conclusion By careful surgical management,the treatment of total correction in adult patients may result in good effectiveness.

Objective:To investigate the clinical application of noninvasive high frequency oscillatory ventilation(nHFOV)and heated humidified high flow nasal cannula(HHHFNC)in sequential ventilator evacuation of preterm infants with very low birth weight with respiratory distress syndrome(RDS).Methods:A total of 88 preterm infants of very low birth weight with RDS were enrolled in the study, who had received endotracheal intubation invasive ventilation and were ready to be replaced by non-invasive ventilation at neonatal intensive care unit(NICU)of Xuzhou Central Hospital from May 2017 to January 2020.All premature infants were routinely treated with caffeine citrate.They were divided into two groups through random number table: nHFOV/HHHFNC group(45 cases)and continuous positive airway pressure(nCPAP)/oxygen hood group(43 cases). nHFOV was given after invasive ventilator removal and HHHFNC transition was followed after nHFOV withdrawal in the nHFOV/HHHFNC group, while nCPAP was given after invasive ventilator removal and oxygen hood was followed after nCPAP withdrawal in the nCPAP/oxygen hood group.The main observation consequences were compared with arterial blood gas indexes after invasive ventilator evacuation, weaning effect and the incidence of related complications.Results:(1)There were no statistically differences between the two groups in terms of gender, gestational age, birth weight, Apgar score at 1 min and 5 min after birth, the number of glucocorticoid usage in 24 h before delivery, the number of pulmonary surfactant usage, invasive ventilation time and RDS grading( P>0.05). (2)The PaO 2, PaCO 2and oxygenation index(OI=100×MAP×FiO 2/PaO 2)of the nHFOV/HHHFNC group at 1 h and 24 h after invasive ventilator removal showed significant difference compared with the nCPAP/oxygen hood group( P<0.05). The differences as the following listed were statistically significant( P<0.05)between the two groups, including the failure rate of invasive ventilation weaning during 72 h [9%(4/45)vs.26%(11/43)], the incidence of frequent apnea [7%(3/45)vs.23%(10/43)], the failure rate of nHFOV and nCPAP noninvasive ventilation weaning [4%(2/45)vs.21%(9/43)], the oxygen-used time [12.02(9.08~12.31)d vs.14.44(11.32~13.26)d] and the incidence of nasal injury [4%(2/45)vs.26%(11/43)]. (3)The time of the first noninvasive ventilation of nHFOV and nCPAP, the incidences of lung air leakage, neonatal necrotizing enterocolitis, grade Ⅲ to Ⅳ intraventricular hemorrhage, above stageⅡretinopathy, bronchopulmonary dysplasia and the mortality rate between the two groups showed no statistical significance( P>0.05). Conclusion:nHFOV and HHHFNC used in the sequential ventilator evacuation of RDS in preterm infants with very low birth weight could improve oxygenation, reduce CO 2retention, improve the success rate of machine weaning and reduce the occurrence of apnea and nasal injury.

To explore the optimized dispatch of the rescue resources based on the mastered resources informa-tion. The objective function was set as the shortest rescue time, and 0-1 programming models were established and solved for the conditions that the number of medical rescue units was more or less than needed by the missions. In the two conditions, the model's calculated results were both optimal, and could be used to obtain the optimal dispatch solutions while the medical rescue time was the shortest. The 0-1 programming model can be effectively used to optimize dispatch strategy for medical rescue team.

Objective: To evaluate the mitral, aortic and tricuspid valve replacement for rheumatic heart disease. Methods: From June 1990 to June 2001, 941 patients underwent valve replacement. Among them, 24 patients underwent simultaneously mitral, aortic and tricuspid valve replacement. There were 17 females and 7 males, with mean age of 36 years (ranged from 18 to 59 years). Eight patients had previous closed mitral valvotomy. Eleven patients complicated with left atrium thrombus, 16 with hapotomeglia, and 8 with ascites. The X ray results showed that the C/T ratio was 0.66 to 0.91. The heart function (NYHA) was class III in 9, and class IV in 15. All patients had combined mitral, aortic valve lesions associated with severe tricuspid valve regurgitation. Results: One patient died postoperatively with an operative mortality of 4.2%. 23 patients followed up from 20 to 36 months (mean, 26.4 months). There was no thrombolism and anticoagulant related hemorrhage. The echocardiography demonstrated the diameter of left atrium right ventricle, and LVDd significantly decreased after operation. The heart function was also significantly improved. Conclusion: The combination of mitral, aortic and tricuspid valve replacement could achieve a satisfactory result with low mortality and better recovery of heart function.

Objective To explore the status quo of pain assessment by the nurses in intensive care units (ICU) of Class Ⅲ hospitals, to analyze the factors influencing the implementation of pain assessment by ICU nurses, and to provide evidence for improving the practice of pain assessment by ICU nurses. Methods Totally 410 ICU nurses from 11 ClassⅢ hospitals in Hu'nan, Guangdong, Beijing and Hebei were selected by convenient sampling and investigated with the self-designed pain assessment questionnaire between April and July 2017. SPSS 21.0 was used to conduct the statistical analysis of the data. Results The implementation rate of pain assessment by ICU nurses was 77.6%. The application of subjective pain assessment tools was consistent mainly with the Numeric Rating Scale (NRS) (74.2%), while objective assessment tools were less used, including the Critical Care Pain Observation Tool (CPOT) (40.6%) and Behavioral Pain Scale (BPS) (29.9%). The standard rate of the use of pain assessment tools in ICU was 81.8%. The type of ICU and the frequency of continuing education in pain among ICU nurses were the factors that affected pain assessment by ICU nurses. Conclusions ICU nurses have not standardized their pain assessment, applied less objective pain assessment tools, and lacked norms for pain assessment in ICU. It is suggested that hospitals and departments should formulate relevant pain management rules and regulations, strengthen the continuous professional education for ICU nurses, and standardize and promote the clinical pain assessment of ICU nurses so as to improve the quality of pain care in ICU.

The mechanism and principles of autofluorescence imaging based on autofluorescence technique are reported. The threshold value of fluorescence spectrum ratio applied can be quantitative and objective and the reliable measurement method that may provide intuitive method of autofluorescence imaging in the gut mucosa. The suspected lesion may be found rapidly according to the imaging color difference, therefore the results of clinical study of the digestive tract cancer diagnosis indicated that the sensitivity, specificity, and diagnostic accuracy were 94%, 95.5% and 94.8% respectively, and it has very high value in clinical application.
Digestive System Neoplasms ; diagnosis ; Early Detection of Cancer ; instrumentation ; methods ; Endoscopy, Digestive System ; instrumentation ; Fluorescence ; Humans ; Photofluorography ; Sensitivity and Specificity

Objective To analyze the current situation and latent profiles of nurses'voice behavior in nurses,and explore the influencing factors of different types.Methods Through convenience sampling,812 nurses who worked in tertiary hospitals from 5 cities in Guangdong Province during April 2022 to June 2022 were recruited.The demographic questionnaire,the Voice Behavior Scale,the Humble Leadership Scale,and the Team Psychological Safety Climate Scale were used for investigation.Latent profile analysis was used to explore the latent profiles of nurses'voice behavior.The influencing factors of latent profiles were identified by multivariate Logistic regression.Results The total score of the voice behavior in 812 nurses is(37.04±5.88).Voice behaviors in nurses is divided into 3 latent classes,namely"conservation group"(27.83％),"balanced-risky group"(61.95％),and"the challenge group"(10.22％).The influencing factors include recruitment type,whether to assist in department management,humble leadership,team psychological safety climate(all P＜0.05).Conclusion The level of nurses'voice behavior is upper medium with heterogeneity,which can be divided into 3 latent profiles.Nurses managers should focus on nurses with conservation group and balanced-risky group and conduct early targeted prevention and care according to characteristics and influencing factors of different latent profile.

It’s difficult to diagnose precancerous lesion and early cancer for a long time, because both of them haven’t typical morphological characteristics. As a novel diagnostic modality, fluorescence endoscopy can accurately reflect minimal changes in human’s tissue, thus making a meaningful progress for cancer diagnosing. 200 patients were examined by fluorescence endoscopy to evaluate the diagnostic value. The overal accuracy, sensitivity and specificity for detecting malignant gastrointestinal tumor was 94.0%, 94.6%and 93.5%, respectively. Thus, fluorescence endoscopy can be used to diagnose malignant gastrointestinal tumors with high validity and reliability, and is advantageous over conventional white light endoscopy especial y in detecting the atypical and suspicious lesions. Furthermore, fluorescence endoscopy can also guide target biopsy, is significant to improve the early cancer detection rate, has a broad development prospect.