Objective To summarize the timing, procedure and early and late outcomes of Surgical treatment of traumatic tricuspid insufficiency. Methods From May 1984 through September 2004, eight patients with traumatic tricuspid insufficiency were treated surgically. All were male, and the ages ranged from 7 to 67 years (median 38 years). Seven patients were blunt chest trauma (including traffic accidents in three). The median duration between trauma and operation was 19 months (range 1 month to 20 years). At operation, the heart functions of patients were in class II to IV (NYHA). Diagnoses were conformed by echocardiogram. The anterior leaflet was prolapsed because of the rupture of chord or anterior papillary muscle in all the patients, combined with chordal rupture of septal leaflet in one. In all the patients, right ventricular was enlarged in various degrees, as well as tricuspid annulus. In three patients, the tricuspid valve was repaired. Five cases received valve replacement, after repair failed. Results All the patients were recovered well without complication after operation. Only one of the three patients after tricuspid valve repair was detected mild tricuspid regurgitation by echocardiogram. The mean postoperative hospital stay was (16.6?6.5) days (7 to 24 days). The median follow-up period was 39 months (range 7 to 129 months). The heart functions were improved to class I (NYHA) in all patients. Conclusion The outcome of surgical treatment of traumatic tricuspid valve insufficiency is good. Surgical intervention should be done as early as possible once diagnosis was made to increase the feasibility of tricuspid valve repair. Tricuspid valve repair is the procedure of choice, while tricuspid valve replacement is also acceptable according to the long-term result of this report.

Objective To evaluate the outcome of valvular surgery in the elderly. Methods Between 1993 and 2004, 4546 patients underwent cardiac valve operation at our hospital. 252 patients (5.5%)(147 males, 105 females) were 65 or older [mean age (67.9?2.9) years]. Rheumatic valvular disease presented in 201(79.8%) patients and non-rheumatic valvular disease in 51 (20.2%). 56.0% of patients were in New York Heart Association (NYHA) functional class Ⅲ-Ⅳ.63 (25%) patients had aortic valve replacement (AYR), 93 (36.9%) had mitral valve replacement (MVR), 42 (16.7%) had mitral valve repair (MVP), 47 (18.7%) had AVR + MVR/MVP, and 7 (2.8%) had isolated tricuspid repair or replacement.34 (13.5 % ) had concomitant coronary artery bypass grafting (CABG) . Results Results The operative mortality was 9.1%, and the tendency of decline was observed in recent 3 years. As compared with the patients aged 16 to 64 years, the duration of mechanical ventilation, stay in ICU and in hospital postoperatively was longer [(30.6?42.8)h vs. (24.1?45.0) h,P = 0.02, (60.1?101.2) h vs. (43.0?70.6) h, P = 0.00, (25.7?41.3) days vs. (19.6?14.4) days,P=0.00]. In this group, the morbidity of postoperative complications was significant higher than that of the patients aged 16 to 64 years (10.6% vs.6.4% , P = 0.01). Preoperative NYHA function class was an important factor for postoperative mortality. Multivariate logistic regression showed that concomitant coronary artery bypass grafting (CABG) , AVR+ MVR/MVP, and prolonged cardiopulmonary bypass time, prolonged aortic cross-clamping time, postoperative acute renal failure demanding dialysis were significant independent predictors of operative mortality. Conclusion The mortality of cardiac valvular surgery in the elderly is acceptable. It is characterized by higher morbidity of postoperative complications and prolonged duration of stay in hospital. Concomitant CABG, AVR + MVR/MVP, prolonged cardiopulmonary bypass time, prolonged aortic crossclamping time and postoperative acute renal failure were significant independent predictors of operative mortality.

Objective To evaluate the efficacy and safety of helmet delivered continuous positive airway pressure (Helmet-CPAP)for hypoxemia in airway extubated patients after cardiac surgery.Methods 120 adult patients in ICU from March 2014 to July 2015,who were after cardiac surgery,were enrolled.These patients who suffered hypoxemia within 48 hours after extubation,defined as that PaO2/FiO2 with oxygen mask could not reach 200,were divided into two groups.In the control group high concentration oxygen therapy with mask was delivered,while helmet-CPAP was delivered in the experimental group.Treatment duration was 6 hours.Results Helmet-CPAP significantly improved PaO2/FiO2 (144.35 ± 24.43 vs.201.35 ± 52.97,P ＜ 0.05) and left ventricular ejection fractions(0.5383 ± 0.0844 vs.0.5540 ± 0.0844,P ＜ 0.05).Breathing rate (22.60±5.08 vs.18.53 ±4.13,P＜0.05),heart rate(102.72±17.9 vs.95.15 ±13.79,P＜0.05)and shock index (0.85 ± 0.35 vs.0.75 ± 0.15,P ＜ 0.05) were significantly lower.The rate of using mechanical ventilation (6.67％ vs.28.33％,P ＜ 0.05) and length of ICU stay[41.0(25.0,67.5) hours vs.49.5 (32.5,90.8) hours,P ＜ 0.05] was significantly less than control group.Conclusion Helmet delivered continuous positive airway pressure is an effective and safe treatment for hypoxemia in airway extubated patients after cardiac surgery.

Objective The incidence of post-operative hyperbilimbinemia, which is associated with poor outcomes in patients, was reported to be increased in recent years though it has been a rare complication for cardiac operations. Post-opera-tive impairment of liver function is highlighted. We evaluated the incidence and prognosis of post-operative hyperbiliruhinemia in adult patients who underwent cardiotomy with extracorporeal membrane oxygenation (ECMO) support. Methods Sixty-five adult patients who had received ECMO support after cardiac surgery from 2004 to 2008 were enrolled and evaluated retrospec-tively. Post-oporative hypethilirubinemia was defined as the serum level of the total bilirubin more than 51.3 μmol/L during postoperative period. Demographic and clinical data included gender, age, types of surgery, perioperative hemodynamic param-eters, biochemical variables, duration of the ventilation support, ICU stay and outcomes. Results The mean age of the pa-tients was (50.1 ± 13.9) years, forty-six patients(70.8%) were male. The main cardiac procedures were heart transplanta-tion for 9 patients, coronary artery bypass grafting and/or valve operations for 47 patients, congenital heart disease correction for 4 patients and other operations for 5 patients. Among all patients, fifty-one patients(78.5%) were weaned from ECMO succeas-fully and thirty-thrce patients were discharged from hospital. The overall mortality rate was 49.2%. Overall incidence of post-operative hyperbilirubinemia was 55.4%. In patients with postoperative hyperbilirubinemia, the mean peak value for serum to-tal bilirubin was 104.8 (68.5-156.7) μmol/l. The hospital mortality in the hyperbilirubinemia group was significantly higher than that in the non-hyperbilirubinemia group(66.7% vs. 27.6%, P <0.01). Moreover, postoperative hypethilirubinemia (adds ratio = 3. 895, 95% confidence interval, 1.088 - 13.947 ; P = 0.037) and SOFA score (odds ratio = 1.214, 95% confidence interval, 0.987 - 1.494, P = 0.047) and APACHE Ⅲ score (odds ratio = 1.096, 95% confidence interval, 1.028 - 1.169 ; P = 0.004) were associated with hospital mortality after adjusting for preoperative levels of the total bilirubin, direct bilirubin, gender and age. Conclusion Postoperative hyperbilirubinemia is one of the complications in adult patients who undergo cardiotomy with ECMO support, and is associated with increased hospital mortality.

Objective Extracorporeal membrane oxygenation (ECMO) provides a treatment for patients with acute heart-lung failure. However, as an invasive procedure, it associated with high incidence of complications. It is important to a-vert and reduce the complications for improving the success rate in critically ill patients. We investigate the complications associated with ECMO after cardiac surgery and their management. Methods Clinical data from 117 postoperative patients[32 male, mean age (48.7 ± 16.5) years]supported with ECMO in the cardiovascular intensive care unit( ICU) from March 2005 to June 2008 were analyzed retrospectively. The cardiac operations they had undergone included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle(n =9), coronary artery bypass grafting and valvular operation(n =5), repair of ventricular septal perforation following acute myocardial infarction(n =2), valvular operation( n = 46), heart/lung transplantation (n = 20/1), correction of congenital heart defects ( n = 10), and aortic operations ( n = 4). Venoarterial bypass was established in 110 patients by cannulation of the right atrium and femoral artery, and that of the right atrium and ascending aorta in 5 cases. Left atrial drainage to ECMO was added in 2 cases. Venovenous bypass was established in 2 patients with hypoxemia following cardiac surgery. Heparin was infused for maintaining the activated coagulation time (ACT) at 160 to 200 seconds for centrifugal pump(114 cases),and 200 to 250 seconds for roller pump(3 cases) to avoid thrombotic events until decannulation was achieved. Results The mean ECMO duration was 61 hours (range 3 to 225 hours). 48(41.0% ) patients died, 18 of them died of complications after weaning from circulatory assistant successfully. Complications occurred in 74 (63.2% ) patients included reoperation for hemostasis (n = 24), renal failure requiring renal replacement therapy (n =29), nosocomial infections ( n = 32) , ischemia in the extremities(n = 5), plasma leakage of oxygenators ( n = 29), gastroenteral hemorrhage ( n = 14), hemolysis ( n = 7 ), neurological complications ( n = 4) and centrifugal pump failure (n =1). Conclusion Bleeding is an early complication associated with ECMO support. The risk of nosocomial infection, renal failure and plasma leakage of oxygenators increases with the duration of ECMO support.

Objective To explore risk factors of influencing operating efficiency of endoscopic submucosal dissection (ESD) for gastric mucosal lesions. Methods The data of 304 cases with gastric mucosal lesion undergoing ESD in Xijing Hospital of Digestive Disease from April 2009 to February 2017 were retrospectively analyzed. The procedure time and complete resection rate ( R0 resection rate ) were regarded as indicators of ESD efficiency. Risk factors influencing procedure time and R0 resection rate were analyzed using Chi-square test and logistic regression. Results Using median procedure time of 45 min as the cutoff value, Chi-square test showed that specimen size ( P=0. 000) , lesion location ( P=0. 001) , and pathological type ( P=0. 003) affected the operation time. Further logistic regression analysis indicated that specimen size (≥40 mm/<40 mm, P<0. 001, OR=3. 748, 95％CI: 2. 247-6. 254) and lesion location (upper or middle 1/3 of stomach/lower 1/3 of stomach, P=0. 001, OR=2. 180, 95％CI: 1. 318-3. 606) were independent risk factors of procedure time. Using R0 resection as outcome measure, neither single nor multiple parameter analysis was statistically significant. Conclusion Specimen size and lesion location are independent risk factors influencing efficiency of gastric mucosal ESD, and could be possibly used to estimate the procedure time of ESD.

Micronutrient (MN) deficiency is common in many acute and chronic diseases and should be monitored and managed. In February 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) released the MN guidelines. This guideline aimed to inform the evaluation, monitoring and treatment principles in MN management as part of daily clinical nutrition practice with standardized terminology to avoid confusion. Extensive literature review was conducted covering multiple databases including Medline, PubMed, Cochrane, Google Scholar, and CINAHL databases. For each kind of MN, information was summarized concerning main functions, optimal detection methods, susceptibility to inflammation, potential toxicity and recommended dose for supplementation via enteral or parenteral nutrition. Practical recommendations on MN supplementation and monitoring were provided to manage MN deficiency in high-risk diseases. This review was based on the contents in the guidelines with an emphasis on interpreting the critical issues.

The nursing students of Grade 2009 to Grade 2016 were selected.Their skills,midterm,usual and final performances as well as comprehensive scores of normal human morphology course were analyzed by one-way ANOVA in combination with different stages of curriculum integration in order to compare the teaching effect between traditional teaching mode + evaluation system and mixed teaching mode + formative evaluation in the course of normal human morphology.Statistical analysis by SPSS 17.0 showed that the average score of formation stage (traditional teaching mode) was 67.55 ± 12.72,the average score of integration stage (mixed teaching mode) was 72.79 ± 10.93 and the average score of development stage (formative evaluation +mixed teaching mode) was 83.94 ± 9.58.After making comparisons,the P values of ANOVA of the course of normal human body morphology in all stages were all less than 0.001,having statistical significance.The results showed that the overall development of the curriculum is becoming mature and the new teaching model can help students who usually do not like to review.

Objective:To assess the usage of the robot-assisted core-needle biopsy for the bone tumors, moreover to compare its outcomes with the manual technique.Methods:A retrospective study was conducted from February 2019 to February 2021, the medical records of the patients with bone lesions that had received core-needle biopsy were collected. There were 57 males and 45 females, the age was 45.9 (10~79) years. Eight patients received robot-assisted biopsy, whereas 94 patients underwent C-arm/ CT guided biopsy, the recorded data included operational duration, aspirational direction adjustment, etc. The pathological diagnosis reports of the biopsy specimens and the operational specimens were compared.Results:The diagnosis outcomes included metastases (33 cases), osteosarcoma (12 cases), chondrosarcoma (12 cases), giant cell tumor of bone (12 cases), fibrous dysplasia (7 cases), chronic osteomyelitis (7 cases), lymphoma (4 cases), multiple myeloma (4 cases), chronic fracture (3 cases), chondroblastoma (2 cases), pleomorphic undifferentiated sarcoma (2 cases), leiomyosarcoma (1 case), and Langerhans cell histiocytosis (1 case). Eighty-seven cases (85.29 %) lesions were found in the limbs, whereas 15 cases (14.71%) were in the axial locations. Compared with the manual group, the robot-assisted group had more axial locations: 7/8 vs. 11.70%(11/94), P<0.01; fewer aspirational direction adjustment: (0.4 ± 0.1) times vs. (3.1 ± 1.5) times, P<0.01 ; longer operational duration: (48.8 ± 8.8) min vs. (29.6 ± 6.0) min, P<0.01. There were no statistical differences between the two groups regarding the sex, age, pathological fracture, diagnostic accuracy, open biopsy rate and complications ( P>0.05). Conclusions:The robot-assisted core-needle biopsy is a reliable technique, it helps decrease the operational difficulty. The usage of this technique is recommendable for the bone lesions with great difficulty for biopsy, such as the minimal bone tumors and the lesions in the spine and the pelvis.

Objective To explore the learning curve of the Tianji orthopedic robot in assisting percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods A retrospective study was conducted of the consecutive 44 OVCF patients (71 fractured vertebrae) who had been treated with PKP assisted by the Tianji orthopedic robot from May 2018 to March 2019 at Department of Ortbopedics,The First Hospital of China Medical University.They were 2 men and 42 women,aged from 55 to 89 years (average,68.6 years).Their operations were performed by the same surgical team.The patients were divided into 4 even groups (n =11) according to the date of operation.The accuracy of robot-assisted puncture,total operation time,robot operation time,PKP operation time and complications were statistically analyzed and compared between the 4 groups.Natural logarithm regression analysis of total operation time,robot operation time and PKP operation time was conducted to determine the association between operation time and operation number [y =aln(x) + b,x indicating operation number and y operation time].Results The 4 groups were comparable due to insignificant differences in age,gender or operative segment between them (P ＞ 0.05).The total rate of accurate puncture was 95.8％ (68/71).The rates of accurate puncture were 92.9％ (13/14),94.4％ (17/18),94.7％ (18/19) and 100％ (20/20) for groups 1,2,3,and4,respectively,with no significant differences between groups (P ＞ 0.05).The total operation time for the 4 groups was respectively 56.6 ± 6.6 min,46.4 ± 8.5 min,40.2 ± 4.7 min and 40.4 ± 5.7 min and the robot operation time for the 4 groups was respectively 32.1 ±4.9 min,23.8 ±5.1 min,18.9 ±2.7 min and 19.6 ± 5.3 min,showing significant differences between the 4 groups (P ＞ 0.05) and a significant difference between groups 1 and 2 versus groups 3 and 4 (P ＞ 0.05) but no significant difference between group 3 and 4 (P ＞ 0.05).The natural logarithm regression analysis showed that the total operation time [y =-7.2861n(x) + 66.616,R2 =0.4889,P ＜ 0.001] and robot operation time [y =-5.6621n(x) +39.763,R2 =0.5196,P ＜ 0.001] decreased significantly with the increase of operation number but became stable in groups 3 and 4.There was no significant difference in PKP operation time among the 4 groups (P ＞ 0.05).The main intraoperative complication was leakage of bone cement in the anterior vertebral space and intervertebral space,with a total incidence of 8.5％ (6/71),showing no significant difference among the 4 groups (P ＞ 0.05).Conclusions The puncture accuracy of the Tianji orthopedic robot in assisting PKP for OVCF may not change with the increased operation number.The total operation time and robotic operation time decrease with the increased operation number.The learning curve of the Tianji orthopedic robot becomes stable very fast,indicating the surgical technique is easy to learn.