Objective To analyze the causes for the failures after posterior pedicle screw instrumentation for thoracolumbar fractures.Methods From June 2003 to December 2014,182 patients with thoracolumbar fracture were treated by fixation through the posterior approach using pedicle screws and fully followed up in our institute.We analyzed the cases of postoperative infection,recovery of neural symptoms,breakage and loosening of pedicle screws and connecting rod,non-union of the fractured vertebra,and correction loss of kyphosis in associations with the AO classification and Loading Sharing Classification of Spine Fracture (LSCSF) system,osteoporosis,intervertebral disc injury and methods of internal fixation.Results In this series,altogether 27 cases failed(14.8％).The rate of postoperative infection was 1.1％ (2/182).The rate of breakage of pedicle screw or connecting rod was 7.7％ (14/182).The implant breakage rates for fractures of AO types A1,A2 and A3.1 were significantly lower than for other types (P ＜ 0.05).The implant breakage rate for the patients with ≤6 LSCSF points was significantly lower than for those with ≥7 LSCSF points (P ＜ 0.05).The implant breakage occurred in 3 cases of those who underwent fixation of one normal vertebra respectively below and above the two contiguous segments but not in those who underwent additional fixation of the injured vertebrae.The rate of screw loosening was 2.2％ (4/182).The non-union rate of the injured vertebra was 2.7％ (5/182).The rate of kyphosis recurrence was 1.1％ (2/182).Conclusions To prevent the failure of posterior pedicle screw fixation,surgeons should pay more attention to the following key points before operation:the type and evaluation of spinal fractures,a proper approach and method of internal fixation,and the weight bearing capability of the anterior column.

Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute decompensation of chronic liver disease associating with multiple organ failures and high short- term mortality. Patients with ACLF are highly susceptible to infection due to the pathophysiology features including immune function disorder (overlap of excessive inflammatory reaction and immune dysfunction), gut bacterial overgrowth/dysbiosis and translocation of gut microbiota/products. Appropriate empirical antibiotics plays a pivotal role in the management of ACLF with infection.

Objective: To explore the changes of peripheral leukocyte’s telomere length (LTL) in patients of premature coronary artery disease (PCAD) with inlfuencing factors. Methods: Our research was conducted in 2 sets of groups, by coronary artery condition: PCAD group,n=128 including 88 patients with ACS, 40 with SCAD and Non-CAD group,n=128 subjects; by age status: the age≤30 years, 31-40 years, 41-50 years, 51-60 years had 2, 14, 65, 47 patients in each group respectively. Peripheral LTL was detected by lfuorescent quantitative analysis, the relationship between LTL and PCAD with inlfuencing factors were studied by Spearman correlation analysis. Results: In PCAD group, compared with SCAD patients, ACS patients had more male gender, higher Gensini score, lower T/S ratio and shorter LTL, allP<0.05. Compared with Non-CAD group, PCAD group had decreased T/S ratio (0.88 ± 0.86) vs (1.10 ± 0.57),P<0.05. T/S ratio was negatively related to age in both PCAD group (r=-0.275,P=0.002) and Non-CAD group (r=-0.316,P=0.000). Spearman correlation study presented that in PCAD group, LTL was negatively related to hyperlipidemia (r=-0.415,P=0.049) and diabetes (r=-0.472,P=0.036); multi linear regression analysis indicated that in PCAD group, LTL was negatively related to age (B=-0.023,P=0.038) and in Non-CAD group, LTL was negatively related to age (B=-0.027,P=0.000), smoking (B=-0.278,P=0.012), HDL-C (B=-0.297,P=0.046). Conclusion: PCAD had more male ACS patients with shorter LTL and severer coronary lesions; LTL was negatively related to hyperlipidemia and diabetes, age was an important inlfuencing factor for LTL shortening.

Objective To evaluate the effects of drug-eluting stents (DES) versus bare-metal stents (BMS) on clinical outcomes in patients with acute ST-segment elevation myocardial infarction (ASTEMI) receiving primary percutaneous coronary intervention (PPCI). Methods The 217patients with ASTEMI receiving PPCI from Jan. 2005 to Dec. 2007 were enrolled in this study. And they were divided into two groups: DES group (n=92) and BMS group (n=125). The baseline characteristics including age, gender, angiographic characteristics, stents characteristics, Killip classification, cardiac troponin I(CTnI)levels, left ventricular ejection fraction(LVEF), hemoglobin levels, hypertension, diabetes, hyperlipidemia, obesity and smoking of the two groups were collected.Clinical follow-up end point were major adverse cardiac event(MACE)including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was(16.8±11.3) months (6-38 months). Results The average age (years), rate of Killip classification (class 2, 3, 4), average diameter (mm) of stent were significantly higher in BMS group than in DES group(64.6±11.9 vs. 61.2±11.8, t=2.09, P=0.037;25.9% vs. 12.2%, χ2=5.53, P=0.019;3.07±0.38 vs. 2.91±0. 40, t=2.78, P=0.006). And the average LVEF (%) was significantly lower in BMS group than in DES group (55.4±11.9 vs. 60.3±12.8, t= -2.57, P=0.011). The average length (mm) of stent, rate of stent post dilatation and diabetes were significantly higher in DES group than inBMSgroup (32.8±16.2 vs. 26.2±11.2, t=-3.54, P=0.001;45.7% vs. 21.6%, χ2=13.85, P=0. 000;28.2% vs. 16.0%, χ2=4.77, P=0.030). MACE occurred in 36 patients during clinical follow-up, 6 in DES group and 30 in BMS group. Incidence of MACE was significantly lower in DES group than in BMS group(6.5% vs. 24.0%, χ2=11.70, P＜0.01). Conclusions Using DES in ASTEMI patients is safe and may improve clinical outcomes by reducing incidence of MACE compared with BMS.

Acute-on-chronic liver failure (ACLF) is a clinical disease significantly different from acute liver failure and acute decompensation of simple liver cirrhosis, and it may have acute progression to liver failure and failure of other organs. ACLF has a high short-term mortality rate and has become a disease burden worldwide. In recent years, several international associations for the study of the liver have proposed different diagnostic criteria for ACLF and published their respective consensus or review on the diagnosis and treatment of ACLF, and there are still great differences in the comprehension of chronic liver diseases, acute injury, and organ failure. At present, there are still limited data for the key links of ACLF management in China, such as liver transplantation, intensive care unit, and palliative care, and in the context of no consensus on the diagnosis of ACLF around the world, it is necessary to further strengthen the application of existing international criteria and evidence and the accumulation of evidence-based data in China.

Objectives We sought to determine the factors that predicted in-hospital heart failure(HF)in patients undergoing successful primary percutaneous coronary intervention(PCI)for ST-segment elevation myocardial infarction(STEMI). Methods The clinical and angiographic data were retrospectively reviewed in patients undergoing successful primary PCI for their ifrst STEMI. According to the occurrence of in-hospital HF, patients were divided into HF group and non-HF group. The incidence and predictors of in-hospital HF and its impact on prognosis were determined. Results A total of 834 patients were included, among them 94 patients (11.3%) were in the HF group and 740 patients(88.7%) were in the non-HF group. The mean age was (62.9±12.9) years and 662 patients (79.4%) were male. All-cause mortality at 30 days was signiifcantly higher in the HF group than in the non-HF group (24.5%vs. 1.5%, P<0.001). In Cox regression analysis, left anterior descending artery (LAD) as the culprit vessel (HR 2.173, 95% CI 1.12~4.212, P=0.022), ln 24 h NT-proBNP (HR 1.904, 95%CI 1.479~2.452, P<0.001), 24 h hsCRP≥11.0 mg/L (median) (HR 2.901, 95%CI 1.309~6.430, P=0.009) and baseline serum glucose (HR 1.022, 95%CI 1.000 ~ 1.044, P=0.046) were independent predictors of in-hospital HF. Receiver operator characteristic analysis identiifed 24 h NT-proBNP ≥ 1171 pg/ml (c=0.883, P < 0.001) and 24 h hsCRP ≥ 13.5 mg/L (c=0.829, P < 0.001) were the best cut-off values in discriminating in-hospital HF with a sensitivity and speciifcity of 92.5%and 76.8%for 24 h NT-proBNP, 86.0%and 77.0%for 24 h hsCRP, respectively. Even among patients with LAD as the culprit vessel, the incidence of in-hospital HF was only 0.4%in patients whose 24 h NT-proBNP was<1171 pg/ml and 24 h hsCRP was<13.5 mg/L;while the incidence of in-hospital HF was up to 60.9%in patients whose 24 h NT-proBNP≥1171 pg/ml and 24 h hsCRP≥13.5 mg/L (P<0.001). Conclusions The incidence of in-hospital HF was still high in STEMI patients even after successful primary PCI. Patients with in-hospital HF had poor prognosis. LAD as the culprit vessel, hsCRP, NT-proBNP and baseline serum glucose were independent predictors of in-hospital HF. Assessment and combined use of different serum biomarkers were effective methods to estimate the risk of in-hospital HF in STEMI patients undergoing primary PCI.

Background:Complete colonoscopy is key to the diagnosis and treatment of colorectal disease,its role in reducing the morbidity and mortality of colorectal cancer is well known.Nonetheless,there are numerous factors,not just from the endoscopist's perspective but also from the patient's,that can potentially increase the difficulty of completing a colonoscopy.Aims:To identify patient-related factors that influenced the difficulty of a colonoscopy.Methods:Through two rounds of expert consultation,the factors that might affect the difficulty of colonoscopy were selected.A total of 1621 consecutive painless colonoscopies from Jan.2021 to Jan.2022 at the endoscopy center of The Affiliated Wuxi People's Hospital of Nanjing Medical University were evaluated in a retrospective manner.Factors including demographic data,cecal insertion time,adenoma detection rate and so on were recorded.These factors were analyzed to determine their association with difficulty by using Logistic regression model.Results:A total of 29 patient-related factors affecting the difficulty of colonoscopy were selected.Through retrospective analysis,the mean age of 1621 cases was(47.45±13.27)years,of which 45.8%were male and the mean body mass index was(23.32±3.11)kg/m2.Logistic regression analysis revealed that age≥60 years(OR=2.890,95%CI:1.957-4.269,P<0.001),female gender(OR=0.324,95%CI:0.217-0.484,P<0.001),history of gynecological surgery(OR=14.895,95%CI:9.741-22.776,P<0.001),constipation for 20-30 years(OR= 1.412,95%CI:0.925-2.156,P=0.010)were independent risk factors for difficult colonoscopy.Conclusions:This retrospective study identified several patient-related factors that influence the technical difficulty of colonoscopy.These findings had implications for practice and teaching of colonoscopy.

OBJECTIVES: To investigate the relationship between the fatty acid-binding protein 4 (FABP4) and colorectal cancer (CRC). METHODS: Using an enzyme-linked immunosorbent assay (ELISA), we measured the expression of FABP4 in plasma of 50 patients who underwent surgery for CRC from October 2017 to May 2018 and 50 healthy controls. The content of the visceral fat area (VFA) as seen with abdominal computed tomography (CT) scanning was measured by ImageJ software. The expression levels of FABP4, E-cadherin, and Snail proteins in CRC and adjacent tissues were determined by immunohistochemistry. RESULTS: The mean concentration of plasma FABP4 of CRC patients was higher than that of the control group (22.46 vs. 9.82 ng/mL; CONCLUSIONS High LPA and VFA were risk factors for increased plasma FABP4 in CRC patients. FABP4 protein was highly expressed in CRC tissues and associated with TNM stage, differentiation, and lymph node metastasis of CRC. The level of FABP4 in CRC tissue was correlated with E-cadherin and Snail expression, suggesting that FABP4 may promote CRC progression related to epithelial-mesenchymal transition (EMT).

OBJECTIVETo investigate the activated clotting time (ACT) level after administration of guideline-recommended dose of unfractionated heparin (UFH) and to confirm the importance of ACT monitoring in percutaneous coronary intervention (PCI).

METHODSWe performed a retrospective study on 1 062 patients undergoing elective PCI in Peking Union Medical College Hospital from May 1, 2011 to December 31, 2012. All patients were administrated weight-adjusted UFH (70-100 U/kg) based on PCI guideline of ACCF/AHA/SCAI. Patients were divided into 3 groups: ACT < 300 s (598 cases), ACT 300-350 s (183 cases) and ACT > 350 s (281 cases). ACT level and factors that may affect UFH anticoagulation were analyzed.

RESULTS(1) The mean age was (63.0 ± 10.6) years and 751 (70.7%) patients were men. The mean weight was (70.5 ± 11.7) kg, and the mean UFH dose used was (100.7 ± 9.1) U/kg. (2) The median ACT was 285 (240-352) s after the UFH use. Pre-defined ACT target (300-350 s) was achieved only in 17.2% (183/1 062) patients. (3) Age, gender, height, weight, UFH/weight and the risk factors of coronary heart disease were similar among 3 groups (all P > 0.05). Multifactor linear correlation analysis showed that UFH/weight was related to ACT level (r = 0.07, P < 0.01), but other factors were not related to ACT level (all P > 0.05). (4) Among 598 patients with ACT < 300 s, 444 (74.2%) patients received additional UFH. No major bleeding events were observed in 1 062 patients. The incidence of minor bleeding and ischemic complications within 48 h after procedure were similar among 4 groups of ACT < 300 s with additional UFH, ACT < 300 s without additional UFH, ACT 300-350 s and ACT > 350 s (all P > 0.05).

CONCLUSIONSIn this single-center study, only a small proportion of patients reached the ACT target after administration of weight-adjusted UFH. Our results supported the recommendation of ACT monitoring in current PCI guideline to improve efficacy and safety of UFH anticoagulation therapy.

Aged ; Anticoagulants ; therapeutic use ; Coronary Disease ; Female ; Hemorrhage ; epidemiology ; Heparin ; therapeutic use ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Whole Blood Coagulation Time

OBJECTIVETo investigate the impact of gender on early outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI) as their reperfusion strategy.

METHODSThe present study included consecutive patients with STEMI treated with primary PCI in our hospital from November 2003 to December 2012. Gender difference and predictors of 30 day all-cause death were examined among 957 patients, 197 of whom were women (20.6%). The impact of gender on 30 all-cause death was further evaluated by a propensity-matched analysis to adjust the differences in baseline characteristics between men and women.

RESULTSCompared with men, women were older ((69.4±10.2) years old vs. (60.6±12.6) years old, P<0.001), more likely to have hypertension (72.1% (142/197) vs. 54.6% (415/760), P<0.001) and diabetes (45.2% (89/197) vs. 32.4% (246/760), P = 0.001), but less likely to be treated with β-blockers (85.3% (168/197) vs. 92.0% (699/760), P = 0.006) and angiotensin converting-enzyme inhibitors/angiotensin-receptor blockers (82.2% (162/197) vs. 88.4% (672/760), P = 0.024). Symptom-to-balloon time was longer in women than in men (330 (240, 600) minutes vs. 270 (180, 450) minutes, P < 0.001). Multivariate linear regression analysis of log-transformed symptom-to-balloon time revealed that female gender was an independent predictor of longer symptom-to-balloon time (β = 0.141, 95% confidence interval (CI) 0.053-0.228, P = 0.002). Women with STEMI had higher unadjusted 30 day all-cause death (12.6% vs. 4.2%, P < 0.001) than men. Female gender independently predicted 30 day all-cause mortality both with (hazard ratio (HR) = 3.497, 95% CI 1.485-8.234, P = 0.004) and without (HR = 2.495, 95% CI 1.170-5.323, P = 0.018) the adjustment for baseline characteristics by propensity-matched analysis.

CONCLUSIONSEven with primary PCI as their reperfusion strategy, women with STEMI had higher 30 day all-cause death than men. Aggressive control of cardiovascular risk factors, adequate medical treatment and shortening of delay in reperfusion therapy might further improve the outcomes of female STEMI patients undergoing primary PCI.

Acute Disease ; Aged ; Aged, 80 and over ; Cause of Death ; Female ; Humans ; Hypertension ; Male ; Multivariate Analysis ; Myocardial Infarction ; therapy ; Percutaneous Coronary Intervention ; Proportional Hazards Models ; Risk Factors ; Sex Factors ; Time Factors