Objective To investigate the knowledge level of the caregivers about pressure ulcer in patients with high risk of pressure ulcer in rural community,and to provide the scientific basis for the prevention and treatment of pressure ulcer.Methods 216 caregivers for patients with high risk of pressure ulcer in rural community were chosen from Mar.2012 to May 2013.The investigation on the awareness of pressure ulcer was performed by using questionnaire survey.Results The awareness rate of pressure ulcer in caregivers was 41.5 ％.The caregivers had gender difference (174females and 42 males).Most of the caregivers were 41 to 50 years old (124 cases,57.4％).Most caregivers had 1 ～ 2 years work experience (94 cases,43.5％).Most of them had low level of education (170 cases,78.7％) and non-professional training (178 cases,82.4％).The questionnaire score was higher in young caregivers than in the olders(F=2.483,P＜0.05).The questionnaire score was higher in caregivers having a long working lifetime(F=3.624,P＜0.05),higher educationalbackground (F=5.139,P＜ 0.01) and discipline training (t=7.346,P＜ 0.01) than in caregivers not having them.Conclusions The awareness rate of the knowledge about pressure ulcer is low in caregivers for patient with high risk of pressure ulcer in rural community.It is necessary to strengthen the guidance and training in caregivers to reduce the incidence of pressure ulcers and the medical cost,and improve the quality of life in patients with high risk of pressure ulcer in rural community.

Objective To evaluate the combination use of transcatheter arterial chemoembolization (TACE), portal vein embolization (PVE) and high intensity focused ultrasound (HIFU) in treating portal vein tumor thrombus(PVTT). Methods A total of 85 patients with primary hepatocellular carcinoma complicated by PVTT, who were encountered during the period from Jan. 2011 to Feb. 2012 at authors’ hospital, were enrolled in this study. The patients were divided into the study group (n=47) and the control group (n=38). TACE, PVE and HIFU were performed in the patients of the study group, while only TACE and PVE were carried out in the patients of the control group. The therapeutic process was as follows: PVE was carried out 2 weeks after TACE was performed, and for the patients of the study group additional HIFU was conducted about 10 days after PVE procedure. Results The short-term effective rate in the study group and the control group was 89.4% (42/47) and 39.5% (15/38) respectively, and the difference between the two groups was statistically significant (P< 0.05). The 6-month, one-year, and two-year survival rate in the study group were 87.2%(41/47), 66.0%(31/47) and 27.7%(13/47) respectively; the median survival time was 15.4 months. In the control group, the 6-month, one-year, and two-year survival rate were 55.3% (21/38), 39.5% (15/38) and 10.5%(4/38) respectively;the median survival time was 10.3 months. The differences between the two groups were statistically significant (P< 0.05). Conclusion For the treatment of primary hepatocellular carcinoma associated with portal vein tumor thrombus, transcatheter arterial chemoembolization, portal vein embolization together with high intensity focused ultrasound is an safe and effective therapy as it can significantly improve the therapeutic effect and prolong the survival time.

ObjectiveTo investigate the pathologic characteristics of the sural nerve in amyotrophic lateral sclerosis. MethodsClinical, electrophysiologic, laboratory data and sural nerve biopsy of 11 patients were reviewed. The clinical and laboratory data were compatible with the diagnosis of ALS. The sural nerve was removed and immediately fixed in 10% formalin and phosphate-buffered 2.5% glutaraldehyde and processed according to the procedure used in our laboratory for light and ultrastructural examination.Results4 groups were distinguished based on pathologic changes: normal; with mild axon degeneration and demyelination; with mild loss of the myelinated nerve, axon degeneration and demyelination; with severe loss of the myelinated nerve, axon degeneration and demyelination.ConclusionPredominantly axonal neuropathies are common and occur early in ALS. Axon degeneration of the nerve fibers is predominant, and demyelination also can be performed in patients with ALS.

OBJECTIVETo study the transdermal absorbability of gentiopicroside, naringin and protosappanin B contained in Xuanbi gel plaster.

METHODThe Franz diffusing cells method was adopted for the in vitro model of rat belly skins. Three indexes, gentiopicroside, naringin and protosappanin B, residued in the accept liquid, skins and plaster were determined by HPLC.

RESULTThe penetration rates of gentiopicroside, naringin and protosappanin B were respectively 3.47, 1.59, 2.13 microg x cm(-2) x h(-1). After 24 h, their penetration rates were 25.42%, 11.73%, 17.78%, respectively. The residual quantities of gentiopieroside, naringin and protosappanin B in skin were 0.231, 0.593, 0.568 microg x cm(-2), ith the retention rates of 0.027%, 0.227%, 0.475%, respectively. The amount of residue of gentiopicroside, naringin and protosappanin B in plaster were 2179, 674, 278 microg, with the retention rates of 81.36%, 81.92%, 73.83%, respectively.

CONCLUSIONThe in vitro transdermal behavior of Xuanbi gel plaster is close to a zero-order process. The residual quantity the retention rate in skins is much lower than the penetration rate and the residual rate in plaster.

Administration, Cutaneous ; Animals ; Flavanones ; metabolism ; Gels ; chemistry ; Iridoid Glucosides ; metabolism ; Male ; Phenols ; metabolism ; Rats ; Rats, Sprague-Dawley ; Skin Absorption

Objective To analyze abnormal characteristics of mitral valve (MV) caused by rheumatic and degenerative mitral valvedisease in virtue of the real-time three-dimensional transesophageal echocardiography(RT3DTEE) and quantitative analysis software.Methods Sixty patients underwent RT3DTEE study:21 patients with rheumatic valvular disease(RHD) studied intraoperatively(9 severe mitral stenosis,6 severe mitral regurgitation,6 severe mitral stenosis couple with regurgitation ) and 20 patients with normal MV who were used as controlsubjects(NS).TomTec-Arena 1.0-4D MV-Assessment 2.3 software was used to measure parameters of annular dimensions and geometry,[eafletsurface area and so on.Results Compared with NS,the diameter between anterior and posterior(AP) of RIID increased,however,the commissural width (CW)didn't change.Parameters of AP,CW,annulus circumference(AC) and annulus area(AA) of degenerative mitral valve disease(DMVD) increased obviously,the spherical index instead didn't change,the original "saddle" shapebecame flat.The impact on mitral valve leaflets is difference between RHD and DMVD.The anterior instead of posterior leaflet arena and length became larger of the group MS and MS&MI.However,the group of DMVD has increased leaflet area of anterior as well as posterior.Posterior leaflet angle is significantly increased in the group of MS&MI.The angle,between the DAP and plane of aortic valve annular (Angle AAo-AP),were magnified in both RHD and DMVD.From the automatic dynamic analysis,the parameters of annular displacement(max),annulus area fraction(2D)decreased considerably in RHD group.Conclusion RHD has relatively mild impact on annular of MV,but the lesions of mitral valve leaflet and chordae tendineae limit the movement of bicuspid valve an nular.The dilated and flattened annular of DMVD still has the "saddle" shape.

Objective To explore the clinic results of our new designed transcatheter valve in valve for the mitral biopro-thesis deterioration.Methods Mitral bioprothesis deterioration patients with high risk for the routine bypass surgery got con-sent.After general anesthesia in the hybrid operation the left ventricle apical puncture was performed with guidance of 3D echo and X-ray.The retro-preset J Valve system was guided into the left atrium and the mitral bioprothesis with the beating heart . Results There were total 9 cases between Jan 2019 to Mar 2019 which had STS score above 6-8.The mitral bioprothesis in-cluded Hancock valve 3 cases, Perimount valve 3 cases, Epic valve 2 cases, Baxiter valve 1 case.The mitral bioprosthesis size included 27 for 6 cases and 25 for 3 cases.The successful implant rate was 100％, mortality rate 0, and all the patients recov-ered well without any main complications.The mean tran-valular pressure was only(8 ±2) mmHg (1 mmHg=0.133 kPa). Conclusion This innovative mitral valve in valve technique with retro-preset J Valve system got very good clinic results and worthy of deep research.

Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.

Objective:To investigate the safety and efficacy of J-valve transapical catheter aortic Valve replacement(TA-TAVI) in the early treatment of aortic stenosis with low coronary ostium.Methods:From January 2020 to April 2022, 20 patients with aortic stenosis with coronary opening height ≤10 mm who underwent TA-TAVI treatment in the Valve Surgery Center of Beijing Anzhen Hospital Affiliated to Capital Medical University were enrolled retrospectively. All patients underwent preoperative imaging screening, and 5 patients underwent preoperative coronary artery protection: The height of coronary artery opening was less than 5 mm in 3 cases. 2 cases had stent stenosis & LT after coronary artery stenting 50%, and the position of the coronary artery opening was less than 8mm. The postoperative complications, mortality and cardiac function prognosis of TA-TAVI were analyzed.Results:There were 5 males and 15 females. The average age of the whole group was(73.00±6.20) years. Transthoracic echocardiography showed that all patients had severe aortic valve stenosis, and 85% of the patients had NYHA grade Ⅲ-Ⅳ, and 80% of the patients had aortic valve stenosis with insufficiency. The mean height of left coronary artery opening was(9.07±3.70) mm. RCA(11.39±3.00) mm; The opening height of coronary artery was ≤5 mm in 3 cases(left 7.5%), 5-8 mm in 5 cases(12.5%), and 8-10mm in 16 cases(40.0%). Mean aortic sinus(valsalva) diameter: Left(30.06±5.90) mm; Right(28.50±5.68) mm; Non(29.96±6.15) mm. J-valve Valve was successfully implanted through apical catheter in all patients, most of whom were size 23. CPB was performed in 2 patients at the same time, permanent pacemaker was inserted in 2 patients, and moderate or above perivalvular leakage was found in 0 patients. All patients had TNI( P=0.12) and MYO( P=0.03) before and 24 hours after operation. None of the 5 patients underwent coronary artery stenting. None of the 5 patients died within 30 days after the operation. Ta-tavi is effective 30 days after operation, with low complication rate and good prognosis of cardiac function. Conclusion:J-valve transapical catheter aortic Valve replacement is safe and effective in the treatment of aortic stenosis with low coronary ostium.

Objective To analyze the characteristics of platelet changes and their influencing factors during postoperative hospitalization in patients who underwent transcatheter aortic valve implantation (TAVI). Methods The patients who underwent TAVI at Beijing Anzhen Hospital Valve Surgery Center between March 2017 and October 2021 were retrospectively selected. The patients were divided into a self-limiting group and a non-self-limiting group according to the characteristics of postoperative platelet decline. In addition, the general preoperative data, preoperative and postoperative ultrasound data, intraoperative data, and the use of anticoagulant drugs during the postoperative stay in the hospital were compared between the two groups. Results A total of 249 patients were enrolled in this study. There were 175 (70.3%) patients in the self-limiting group, including 100 males and 75 females, and there were 74 (29.7%) patients in the non-self-limiting group, including 43 males and 31 females, with no statistical difference between the two groups (P=0.863). The mean age of patients was 73.11±8.88 years in the self-limiting group and 71.54±10.39 years in the non-self-limiting group (P=0.231). The decline of platelets in the self-limiting group generally occurred on the postoperative day 2 and reached the lowest count on the postoperative day 4, and returned to the baseline level on the postoperative day 5-7, while the platelets in the non-self-limiting group changed by simple rise, fall or irregular fluctuation. Patients in the self-limiting group had severer preoperative aortic stenosis (P<0.001) and used more extracorporeal circulation assistance during surgery (P<0.001). Postoperatively, patients in the self-limiting group were more likely to have periaortic valve leakage than those in the non-self-limiting group (P=0.013). Conclusion Platelet changes in most patients after TAVI show a self-limiting decline, which may be related to the severity of patients’ preoperative aortic stenosis, intraoperative extracorporeal circulation device use, and postoperative perivalvular leakage.

Objective    To summarize and analyze the risk factors and management of artificial valve slippage in transcatheter aortic valve implantation (TAVI). Methods    We retrospectively analyzed the clinical data of 131 patients undergoing TAVI surgery in our center from September 2017 to May 2019, including 62 patients through transapical approach and 69 patients through transfemoral artery approach. Results    A total of 131 patients received TAVI surgery, among whom 4 patients had slipped during the operation, 2 patients via transfemoral artery approach, and another 2 patients via transapical. The average age was 77±9 years with one female (25%). Preoperative evaluation, higher position and poor coaxial were main risk factors for valve slip in TAVI. Conclusion    Valve slippage is also a serious complication in TAVI surgery. Reasonable and effective treatment can avoid thoracotomy.