Cardiac toxicity is found in frequently used chemotherapeutic agents.There are many factors related to the cardiac toxicity caused by chemotherapeutic agents.The common cardiovascular complications include heart failure,ischemia,hypertension,hypotension,edema,QT prolongation,pleural effusion,pericardial effusion,bradyarrhythmia and thromboembolism.It is necessary to monitor the left ventricular function before and after chemotherapy and take effective measures to protect myocardium.

Adult ; Aged ; Autoimmune Diseases ; diagnosis ; metabolism ; Female ; Humans ; Insulins ; metabolism ; Male ; Middle Aged

Objective:To analyze the risk factors for postoperative delirium in cardiac surgery through an observational cohort study.Methods:Data of postoperative cardiac surgery patients (1 562 cases)who underwent median open-heart extracorporeal circulation between January 2020 and April 2021 at Fuwai Hospital were prospectively included, and patients were divided into delirium group(503 cases, 32.2%) and non-delirium group(1 059 cases, 67.8%) according to whether delirium occurred after surgery, and clinical indicators of the two groups were compared preoperatively, intraoperatively and postoperatively to determine the risk factors for postoperative delirium.Results:The first 48 h after surgery was the high incidence of delirium, accounting for 87.2% of the total incidence of delirium. The incidence of postoperative delirium varied widely among patients with different types of cardiac surgery. The percentage of unemployment and joblessness was higher in delirium group (7.3% vs. 4.8%, P<0.05), and the percentage of hypertension and carotid stenosis were higher than those in non-delirium group( P<0.05). Statistical differences existed between the type of surgery, intraoperative extracorporeal circulation time and block time, and intraoperative hypotensive events (MAP<40 mmHg, 1 mmHg=0.133 kPa), P<0.05. The first postoperative blood glucose was higher in delirium group , and the first blood gas partial pressure of oxygen and the first postoperative ultrasound left ventricular ejection fraction were lower than those in non-delirium group( P<0.05). There was no statistical difference in the duration of postoperative mechanical ventilation between the two groups( P>0.05), but the mean ICU stay was higher in delirium group ( P<0.05). The in-hospital mortality rate , the incidence of postoperative respiratory complications, and the mean hospitalization cost were also higher in delirium group than those in non-delirium group ( P<0.05). Multifactorial logistic regression analysis showed that carotid stenosis, preoperative hypertension, intraoperative block time >120 min and first postoperative blood glucose were independent risk factors for postoperative cardiac delirium. Conclusion:Carotid stenosis, preoperative hypertension, intraoperative block time >120 min and first postoperative blood glucose were independent risk factors for postoperative cardiac delirium.

Purpose: To evaluate the use of signal intensity index (SII) of skull-base invasion in nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI), select a best cut-off SII value to predict the outcome of NPC. Materials and Methods: One hundred and twenty-two NPC patients (92 men, 30 women) with skull-base invasion were included. All patients underwent MRI, signal intensities on T1-weighted imaging (T1WI) were measured for each invaded site and its contralateral normal counterpart. The SIIs were calculated, receiver operating characteristic curves were constructed. The optimal cut-off values were extracted. The overall survival (OS) rates of 5-year follow-up were performed. Results: Sensitivities for differentiating skull-base invasion from normal contralateral anatomy were 98.9%, 88.5% and 70.0%, and specificities were 98.9%, 96.0% and 74.4%, respectively. There were three cut-off values for differentiating invasion from normal anatomy of skull-base, 49%, 98%, and 60%. Significant difference in OS rates (84.2% vs. 57.1%, p=0.007) was seen for SII threshold values > 60% and those ≤ 60%. Conclusions: The SII might be a useful means of differentiating invasion from normal tissue at the skull-base in NPC. The cut-off value of quantitative SII at the skull-base may aid in monitoring the response to treatment of NPC patients.

Aortopulmonary Septal Defect ; diagnostic imaging ; surgery ; Female ; Humans ; Infant ; Tomography, X-Ray Computed ; methods

Computer Graphics ; Computer-Assisted Instruction ; Forensic Pathology ; Humans ; Imaging, Three-Dimensional ; Pathology ; education ; Pathology, Clinical ; Specimen Handling ; methods

Objective: To make long-term comparison of drug-eluting stent (DES) implantation betweenleft internal mammary artery (LIMA) graft and native vessel in patients with previous coronary artery bypass grafting (CABG).
Methods: A total of 151 patients with anterior wall ischemia because of previous CABG induced LIMA graft lesion who received percutaneous coronary intervention (PCI) in our hospital from 2004-07 to 2012-12 were retrospectively studied. The clinical, coronaryangiography (CAG) and follow-up conditions for DES implantation were analyzed;according to the target vessel, the patients were divided into 2 groups:LIMA group, n=40 and Native vessel (NV) group, which meant all segments of left main to left anterior descending arteries, n=111. Primary end points included target lesion revascularization (TLR), target lesion failure (TLF) as cardiac death, target vessel related non-fatal MI with the composition of TLR and major adverse cardiovascular events (MACE).
Results:The median follow-up time was 30 (10-100) months. The rates of TLR and TLF were similar between 2 groups:(15.0%vs 11.7%, log-rank P=0.65) and (17.5%vs 13.5%, log-rank P=0.63). MACE occurrence in LIMA group was higher than NV group (35.0%vs 18.0%, log-rank P=0.043) which was mainly presented by new non-target vessel revascularization as right coronary artery, left circumlfex and saphenous vein graft(17.5%vs 4.5%, log-rank P=0.014). Cox multivariate analysis indicated that target lesion stent length was the only independent predictor for both TLR (HR=1.03, 95%CI1.00-1.06, P=0.01) and TLF (HR=1.03, 95%CI1.00-1.05, P=0.02);whereas, LIMA-PCI was the only independent predictor for MACE occurrence (HR=3.09, 95%CI1.28-7.60, P=0.012).
Conclusion: The chances of TLR and TLF were similar inpatients with previous CABG by either LIMA or NV, while MACE occurrence was higher in LIMA patients which should be further investigated.

Objective To analyze the related risk factors of postoperative delirium(POD)in patients with Stanford type A aortic dissection, and to guide clinical practices. Methods The clinical data of 118 cases [81 males and 37 females, average age (55.0 ± 10.3) years] with Stanford type A aortic dissection in Tianjin Chest Hospital from January 2016 to December 2017 were analysed in this study. According to whether developed delirium after surgery, the patients were divided into POD group(n=56)and Non-POD group(n=62).The preoperative,perioperative,and postoperative clinical data were collected.The univariate and multivariate Logistic regression analysis was used to investigate the risk factors of POD in patients with the Stanford type A aortic dissection. Results Single factor analysis showed that the proportions of drinking and cerebrovascular history significantly increased,the proportions of early electrolyte disorder and hypoxemia significantly increased, the levels of granulocytes / lymphocytes, circulatory time and blood volume during operation increased significantly, and the duration from onset to operation was decreased, but fibrinogen level decreased significantly in POD group than those of Non-POD group (P < 0.05). Multivariate Logistic analysis indicated that the more intraoperative consumption of blood (OR=1.733, 95% CI:1.409-2.129) and early postoperative electrolyte disorder (OR=10.500, 95% CI:2.930-37.622)were independent risk factors of POD,while the higher level of preoperative fibrinogen(OR=0.157,95% CI:0.050-0.635) and longer time from onset to surgery (OR=0.871, 95% CI:0.808-0.943) were protective factors of POD in patients with Stanford type A aortic dissection.Conclusion The early identification of risk factors of POD,and the active intervention of POD have a positive significance to reduce the occurrence of POD.

Objective To analyze the spatial point pattern distribution characteristics of hemorrhagic fever with renal syndrome (HFRS) in Jingzhou city, Hubei province during the two seasons spring- summer and autumn-winter of 2017, to discuss its high incidence area and reason, and to provide basis for the resource allocation of public health. Methods The analytical data was collected from Infectious Disease Reporting Information System in China, and the spring-summer season was from March to August of 2017, while the autumn-winter was from the September of 2017 to the February of 2018. The Ripley's K-function and kernel density estimation were applied to analyze the spatial point pattern distribution and compare the distribution characteristics of spatial point pattern between the two seasons. Results In 2017, 133 cases of HFRS were reported in Jingzhou city, including the spring- summer and autumn-winter two pick incidences. The strongest aggregation distance was 17.77km in spring-summer season, and 14.40 km in autumn-winter season. The spatial gathering center was located in the north of Jianli County in spring-summer, and it moved to the south of Jiangling County and Shashi District in autumn-winter. Conclusions The key areas for the prevention and control of HFRS in Jingzhou City are Jiangling County, the southern part of Shashi District and the northern part of jianli county. The key groups are the residents of the urban-rural junction in the southern part of Shashi City, residents along the route of large-scale projects, and farmers engaged in agricultural planting or crayfish breeding in the gathering areas.

Purpose: Some patients with respiratory failure fail initial weaning attempts and need prolonged mechanical ventilation (MV). Prolonged MV is associated with many complications and consumption of heathcare resources. Objective weaning indices help staffs to identify high-potential patients for weaning from the MV. Traditional weaning indices are not reliable in clinical practice. Transitional percentage of minute volume (TMV%) is a new index of the work of breathing. This study aimed to investigate the utility of TMV% in the prediction of weaning potential. Methods: This study was prospectively performed including all patients with prolonged MV. Researchers recorded their demographics, TMV%, respiratory parameters, Acute Physiology and Chronic Health Evaluation II score, and laboratory data upon arrival at the respiratory care center. The factors associated with successful weaning were analyzed. Results: Out of the 120 patients included, 84 (70.0%) were successfully weaned from MV. Traditional weaning indices such as rapid shallow breathing index could not predict the weaning outcome. TMV% was a valuable parameter as patients with a lower TMV%, higher tidal volume, higher hemoglobin, lower blood urea nitrogen, and lower Acute Physiology and Chronic Health Evaluation II scores had a higher rate of successful weaning. TMV%, tidal volume, and HCO3- levels were independent predictors of successful weaning, and the area under the curve was .79 in the logistic regression model. Conclusion TMV% is a novel and effective predictor of successful weaning. Patients with lower TMV% had a higher MV weaning outcome. Once patients with a high potential for successful weaning are identified, they should be aggressively weaned from MV as soon as possible.