Aged ; Aortic Valve Insufficiency ; diagnostic imaging ; Echocardiography ; Humans ; Male

Accidents, Occupational ; Construction Industry ; Humans ; Occupational Health

Objective To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation.Methods A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December,among them,719(21.90％) patients with previous abdominopelvic surgery history (study Group),2 564 (78.10％) patients have no history of abdominopelvic surgery (control group).Study group 719 patients,previous operation times:one time in 525 cases,194 cases were multiple; previous operation:185 cases of gynecological surgery,305 cases of obstetric surgery,108 cases of general surgery,and 121 complex surgery (include at least two kinds of surgery) ;previous operative approach:650 cases laparotomy and 69 cases laparoscopy.Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation,analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesionon and gynecological laparoscopic operation.Results The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2％ (368/719),which was significantly higher than that of 8.2％ (211/2 564) in patients without previous abdominopelvic surgery (P＜0.01).But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7％ (183/368),moderate 36.1％ (133/368),severe 14.1％ (52/368)] compared with the control group score (median 2) and degree [mild 55.0％(116/211),moderate 25.6％(54/211),and severe 19.4％(41/211)] were no statistical difference (P=0.930,P=0.684).Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1％,166/719) was significantly higher than that in the control group (3.3％,85/2 564; P＜0.01).And the rate of conversion to laparotomy was 0.6％ (4/719)significantly more than the control groups(0.l％,2/2 564; P=0.023).Compared with other groups,patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P＜0.01).The rate of super-umbilical primary trocar site,hospitalization time,operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P＜0.05) ; the rate of blood transfusion,postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P＞0.05).Conclusion The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations,but the conversion rate increases,for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operatio

Objective To assess the reliability and validity of the Tree-Drawing Test in medical college students.Methods The study randomly selected 312 aged 19 to 23-year-old medical students to take part in TreeDrawing Test.In addition,a total of 275 college students were selected to receive re-test,30 days late and Pearson correlation coefficient of two tests were calculated.The three raters were invited to assess 30 trees painting score,analyzing the Kendall coefficient of concordance between the scores to verify raters' reliability; parts of students also participated in the 16PF test,SAS,SDS test,analyzing the correlation coefficient between the various test results,in order to assess the effectiveness of the Tree-Drawing Test.Results The re-test reliability in different time was 0.570-0.733 and 0.341-0.713 (P＜0.05),the raters' reliability was 0.491 ～ 0.626(P＜0.05),there are some correlations between Tree-Drawing Test and 16PF,SAS,SDS.Conclusion The Tree-Drawing Test has good reliability and validity; it can be applied to the detection of college students' psychological assessment and psychological problems.

BACKGROUND:The patients receiving total knee arthroplasty are high in average age, and often accompanied with hypertension, diabetes and other basic diseases. Due to the poor physical conditions of the patients,
perioperative hemorrhage becomes the important factor that affecting the safety of replacement.
OBJECTIVE:To analyze perioperative hidden hemorrhage of primary total knee arthroplasty, and to explore the method of evaluating perioperative blood loss by osteoarthritis severity before total knee arthroplasty.
METHODS:A retrospective analysis of 126 knee osteoarthritis patients undergoing total knee arthroplasty was conducted. Al the patients were divided into two groups according to Kel gren and Lawrecne imaging classification:stage Ⅲ group and stage Ⅳ group. The hidden hemorrhage of the patients in two groups was calculated.
RESULTS AND CONCLUSION:The average total blood loss of the patients was 1 560 mL, included hidden hemorrhage 865 mL (55%). The mean blood loss of stage Ⅲ group was 1 290 mL with the mean hidden
hemorrhage of 684 mL (53%). The mean blood loss of stage Ⅳ group was 1 644 mL with the mean hidden
hemorrhage of 921 mL (56%). Statistical analysis showed there were significant differences of total blood loss and hidden hemorrhage between two groups (P<0.05), but there was no significant difference in the percentage of
hidden hemorrhage. The results indicate that higher grade of osteoarthritis imaging classification, the more of total blood loss and hidden hemorrhage, while the change of the percentage of hidden hemorrhage is not significant. Preoperative evaluation of patients’ blood loss by osteoarthritis severity has great significance for blood
management and surgical safety of patients.

OBJECTIVETo explore evaluation strategies for middle ear dysfunction in cleft palate patients, to optimize the diagnosis and treatment of this dysfunction, and ultimately to improve the comprehensive treatment of cleft palate.

METHODSThe relationship among abnormal tympanic types (B, C, and Anomaly), effusion rate, tympanic pressure, and hearing loss were analyzed. We collected relevant information on 469 ears of cleft palate patients and traced one-year longitudinal changes in the tympana of 124 ears from 62 patients with both cleft lip and cleft palate.

RESULTSThe effusion rates of cleft palate patients with type B, type C, and type Anomaly were 50.3% (97/193), 34.8% (8/23), and 20.9% (53/253), respectively. The tympanic pressure of the ears with and without effusion showed no significant difference (P>0.05). The hearing loss in type B cleft palate patients with middle ear effusion was worse than that in patients without effusion (P=0.001). However, the hearing loss in type Anomaly showed no difference (P>0.05). The constituent ratio of each tympanic type remained constant during the period between cheiloplasty and palatoplasty for cleft lip and palate patients (P>0.05).

CONCLUSIONCleft palate patients of all tympanic types may all suffer from middle ear effusion at different rates. Examination by centesis is suggested for ears with abnormal tympanic types. Early aggressive therapy is essential for type B cleft palate patients with middle ear effusion to avoid hearing loss. However, catheterization may be not necessary for type Anomaly patients, and conservative observation should be performed instead. Myringotomy with grommet insertion during palatoplasty does not delay treatment timing for patients with both cleft lip and cleft palateg.

Objective: To analyze the long-term prognosis of re-operation in patients with functional tricuspid regurgitation (FTR) after left sided valve replacement (LSVR) and hence evaluate the optimal timing of mentioned re-operation. Methods: A total of 59 FTR patients who had re-operation after their prior LSVR in our hospital from 1999-01 to 2013-01 were analyzed. The clinical information and post-operative follow-up results were recorded in all patients. Results: There were 5/59 (8.5%) patients died in peri-operative period and the overall post-operative mortality was 11.9% (7/59). The follow-up data of 54 survivors were available for the mean time of 51.1 (21-188) months. There were 19/54 (35.2%) patients suffered from MACE and 30 (55.6%) were beneifted by improved cardiac function. Uni-variable analysis indicated that pre-operative NYHA class IV (P=0.008), pre-operative right ventricular (RV) dysfunction (P=0.037), concomitant left-sided redo-operation (P=0.017) and TVR operation (P=0.002) were associated with all cause mortality of tricuspid re-operation. Multi-variable Cox regression analysis showed that pre-operative RV dysfunction was the only independent risk factor of long term MACE-free accumulating survival rate (HR=3.0, 95% CI 1.11-8.2,P=0.031); while TVR operation (HR=12.8, 95% CI 1.53-107.02,P=0.019) and pre-operative NYHA class IV (HR=5.3, 95% CI 1.20-24.51,P=0.032) were the independent risk factors for long-term mortality in patients after tricuspid re-operation. Conclusion: Patients with compensatory RV function showed better long term prognosis after secondary tricuspid operation. Aggressive re-operation before the occurrence of right ventricular dysfunction could be beneficial for relevant patients.

Objective To investigate the safety and clinical effect of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatocellular carcinoma (HCC) with cirrhosis.Methods The retrospective cohort study was adopted.The clinical data of 5 patients with primary HCC with cirrhosis who underwent ALPPS at the First Bethune Hospital of Jilin University between October 2014 and August 2015 were collected.The surgical plan was determined according to preoperative liver function and liver functional reserve.The patients underwent portal vein (PV) ligation and liver partition in the first staged surgery.The second staged surgery was performed when growing future live remnant (FLR) came up to the standard of safe section by rescan of computed tomography (CT) at 10,14,18 days after the first staged surgery,and hemihepatectomy and hepatic segmentectomy were applied to patients.(1) The intraoperative situations were observed,including the severity of liver cirrhosis,first staged surgery time,volume of intraoperative blood loss and FLR in the first staged surgery,interval time of surgery,growth rate of liver volume,ratio of FLR and standard liver volume (SLV),time and volume of intraoperative blood loss in the second staged surgery.(2) Pre-and postoperative biochemical indicators in the first and second staged surgeries were detected,including total bilirubin (TBil) and alanine phosphatase (ALT).(3) Postoperative situations were observed,including occurrence of complications,results of pathological examination and duration of hospital stay.(4) The follow-up using telephone reservation and outpatient examination was performed to detect tumors recurrence and metastasis and survival of patients by imaging examination and tumor marker test up to November 2015.Count data were represented as mean (range).Results (1) Intraoperative situations:of 5 patients,there were 1 patient with F3 of liver cirrhosis and 4 with F4 of liver cirrhosis.One patient was complicated with lots of peritoneal effusion,followed by acute renal failure,and didn't receive the second staged surgery.Four patients underwent successful ALPPS.The first staged surgery of 5 patients:average operation time,volume of intraoperative blood loss,FLR,interval time of surgery,growth rate of liver volume,ratio of FLR and SLV were 282 minutes (range,240-320 minutes),500 mL (range,300-700 mL),457 em3(range,338-697 cm3),15 days (range,14-18 days),58％ (range,46％-67％) and 42％ (range,32％-44％),respectively.Average operation time and volume of intraoperative blood loss in second staged surgery were 220 minutes (range,200-260 minutes) and 412 mL (range,300-600 mL).(2) Pre-and post-operative biochemical indicators:levels of TBil and ALT of 5 patients from pre-operation to postoperative day 12 in the first staged surgery were from 4.9-30.4 μmol/L to 9.8-56.1 μmol/L and from 12.9-156.1 U/L to 46.3-207.3 U/L,respectively.Levels of TBil and ALT of 4 patients from pre-operation to postoperative day 10 in the second staged surgery were from 10.1-21.2μmol/L to 6.9-38.0 μmol/L and from 30.8-55.5 U/L to 19.8-72.8 U/L,respectively.(3) Postoperative situations:there were no perioperative death and postoperative complications of liver failure and intraperitoneal infection.One patient complicated with bile leakage was cured by non-operative treatment for 30 days.Results of pathological examination:5 patients were confirmed as Ⅱ-Ⅲ stage HCC,and 4 tumors had vascular tumor thrombi and negative resection margin with tumor size of 8-13 cm.Duration of hospital stay of 5 patients was 36 days (range,28-48 days).(4) Results of follow-up:4 patients undergoing successful ALPPS were followed up for 4-12 months.One patient was emerged with a new lesion of 2 cm in left half liver at postoperative month 7,level of AFP of which was 512 μg/L before the first staged surgery reduced to normal level at postoperative month 2,and then the patient received transcatheter arterial chemoembolization (TACE) and radio frequency ablation (RFA) treatments without tumor recurrence up to postoperative month 12.No tumor recurrence and new lesions in liver were detected in other 3 patients by abdominal enhanced scan of CT,with a normal level of AFP.Conclusion ALPPS is safe and feasible for HCC with cirrhosis,with a satisfactory short-term outcome.

Objective To compare 99Tcm-MIBI MPI with delayed enhancement MRI (DE-MRI) in patients with idiopathic dilated cardiomyopathy (IDCM). Methods Forty patients with IDCM were included. They underwent both rest 99Tcm-MIBI myocardial perfusion imaging and DE-MRI within 7 days. 99Tcm-MIBI MPI was performed to identify diffuse or segmental abnormal perfusion patterns including reduced or defect perfusion segments. DE-MRI images were divided into 4 categories: no delayed enhancement, septal, subendocardial and transmural delayed enhancement, x2 test was used for data analysis. Results Diffuse and segmental perfusion abnormality on 99Tcm-MIBI MPI were found in 19 (47.5%) and 21 (52.5%)patients respectively, while DE-MRI enhancement was simultaneously found in 5 patients of the former (5/19, 26.3%) and 18 (18/21, 85.7%) of the latter (x2 =14.401, P＜0. 001). For those (n=18) with both segmental perfusion abnormality and DE-MRI enhancement, the number of segments of the 4 DE-MRI respectively. A significant difference was found in the DE-MRI enhancement categories between normal and defect perfusion segments (x2 = 29. 183, P ＜0.001 ) and between reduced and defect perfusion segments as well (x2 =25. 110, P＜0. 001). Conclusions Both diffuse and segmental perfusion abnormalities on 99Tcm-MIBI MPI can be found in patients with IDCM. DE-MRI enhancement is more frequently found in patients with segmental perfusion abnormality.

The intestinal absorption of berberine (Ber) and its structural modified compound 8-hydroxy dihydroberberine (Hdber) was compared, and their effects on the intestinal absorption of sugar by perfusion experiment were investigated in order to reveal the mechanism of low dose and high activity of Hdber in the treatment of hyperglycemia. The absorption of Hdber and Ber in rat small intestine was measured by in situ perfusion. High performance liquid chromatography (HPLC) was used to determine the concentrations of Hdber and Ber. In situ perfusion method was also used to study the effects of Hdber and Ber on sugar intestinal absorption. Glucose oxidase method and UV spectrophotometry were applied to examine the concentrations of glucose and sucrose in the perfusion fluid. The results showed that the absorption rate of Ber in the small intestine was lower than 10%, but that of Hdber was larger than 70%. Both Hdber and Ber inhibited the absorption of glucose and sucrose at the doses of 10 and 20 μg/mL. However, Hdber presented stronger activity than Ber (P<0.01). It is suggested that Hdber is absorbed easily in rat small intestine and that its inhibitory effect on the absorption of sugar is better than Ber.