Objective:To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR).Methods:This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results:In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ2=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ2=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts ( χ2=5.24, P=0.155). Conclusion:The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Objective:To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR).Methods:This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results:In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ2=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ2=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts ( χ2=5.24, P=0.155). Conclusion:The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Objective To observe the early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients. Methods Clinical data of 6 single kidney transplantations from cardiac death pediatric donors in adult recipients in Department of Organ Transplantation ,Guangdong Province No.2 People′s hospital were retrospectively analyzed. the transplant operations were carried out between January 2010 to may 2016.The median age of 6 pediatric donors was 9 years (5 years to 15 years). All recipients had the same blood type. The median age of 12 recipients was 38 years (21 years to 65 years),with 4 man and 8 women. All recipients received kidney transplantation for the first time,and overall reactive antibodies(PRA) were negative,with HLA mismatch between 1to 4. All recipients received single kidney transplantation in right fossa iliaca. Results 12 kidney transplantations were successful. The renal allografts recovered successfully without acute renal rejection , delayed graft function or primary nonfunction. Renal function of 5 of recipients immediately recovered in 5 days,5 recovered in 10 days,and 2 recovered slowly. 1 recipient manifested urine leak and recovered after drainage. 1 case developed delayed incision healing and recovered after dressing at stage II. All patients and renal grafts functions were wellnormal during follow?up period between 1 month to 36 months. Conclusion The early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients is good and could be a promising pathway to expand the organ donor sources.

Objective To observe the clinical efficacy of Xiezhuo Zhubi Decoction combined with Etoricoxib for the treatment of acute gout arthritis.Methods Seventy acute gout arthritis patients were randomly divided into treatment group and control group,35 cases in each group.Based on the fundamental treatment,the control group were given oral use of Etoricoxib and the treatment group was treated with Xiezhuo Zhubi Decoction combined with Etoricoxib.The treatment for both group lasted for 7 days.Before and after treatment,the changes of blood uric acid,C-reactive protein and erythrocyte sedimentation rate in both groups were observed.After treatment,the clinical efficacy was evaluated,and the toxic and adverse effects were also monitored.Results (1) In the treatment group,the total effective rate was 91.4％;in the control group,the total effective rate was 71.4％.There were significant differences between the two groups(P ＜ 0.05).(2) After treatment,blood uric acid,C-reactive protein and blood sedimentation rate were much improved in both groups (P ＜ 0.05 compared with those before treatment),and the treatment group had better effect on improving blood uric acid and C-reactive protein(P ＜ 0.05).(3) The control group had 3 cases of nausea,while no adverse reactions occurred in the treatment group.Conclusion Xiezhuo Zhubi Decoction combined with Etoricoxib is effective for the treatment of acute gout arthritis,and its effects on relieving clinical symptoms and decreasing blood uric acid and erythrocyte sedimentation rate are better than Etoricoxib alone.

Objective To investigate the effects of Epigallocatechin gallate(EGCG)on IL-1βinduced MIN6 cells apoptosis. M.Methods The experiment group was divided into control group,IL-1β group,IL-1β+ EGCG low concentration group and IL-1β+EGCG high concentration group.Cell activity was detected by CCK8.Insulin secretion was detected by ELISA.cell apoptosis was detected by flow cytometry.The mitochondrial membrane potential was detected by flow cytometry.ATP content and cell ac-tivity of ROS were detected by colorimetry and chemiluminescence method.Results Compared with normal group,IL-1β group showed much lower cell activity,insulin secretion,cell mitochondrial membrane potential and ATP content,and at the same time IL-1βgroup had significantly higher cell apoptosis and ROS activities.After given EGCG,both low concentration group and high con-centration group had higher cell activity,insulin secretion,cell mitochondrial membrane potential and ATP content,at the same time lower cell apoptosis and ROS activities was showed.And the IL-1β+EGCG high concentration group worked more powerful.Con-clusion EGCG has protective effects on IL-1βinduced MIN6 cells apoptosis.Its mechanism may be related to increasing the content of the ATP and mitochondrial membrane potential and protecting mitochondrial function as well reducing the activity of ROS.

Objective To study the characteristics of skinfold thickness of Han adults in Jiangsu province . Methods The skinfold thicknesses of facial , subscapular , suprailiac , biceps , triceps and calf on 311 urban adults ( 157 males and 154 females) and 421 rural adults ( 213 males and 208 females ) of Han were investigated in Huaian city of Jiangsu province .Results The thickness of skinfold of urban females were thicker than that of urban males .Rural adults were the same .Han adults of Jiangsu showed the most significant differences between urban areas and rural areas .The values of six skinfold thicknesses of Jiangsu urban adults have positive correlation with age .Conclusion Han adults of Jiangsu show the most significant differences between genders .

Objective To investigate the application of somatosensory evoked potential stim-ulator in cancerous pain nursing assessment of cancer patients.Methods Selected 102 cancerous pain patients from 2013 June to 2014 March in our hospital oncology,Respectively by using visual analogue scale (VAS)and somatosensory evoked potential stimulator to assess Cancerous pain,and given other routine nursing care.The results of two assessment tools and their correlation were ob-served.Results The average pain degree evaluated by somatosensory evoked potential stimulator was 1.55±0.83,the average VAS was 1.67±0.71,By correlation analysis,there was a signifi-cant positive correlation between the two (r =0.823,P <0.001).Conclusions Somatosensory e-voked potential stimulator has good correlation with VAS in cancerous pain assessment,can be used in the clinical assessment of cancer pain degree and the judgment of efficacy of treatment.

Objective To investigate the application of somatosensory evoked potential stim-ulator in cancerous pain nursing assessment of cancer patients.Methods Selected 102 cancerous pain patients from 2013 June to 2014 March in our hospital oncology,Respectively by using visual analogue scale (VAS)and somatosensory evoked potential stimulator to assess Cancerous pain,and given other routine nursing care.The results of two assessment tools and their correlation were ob-served.Results The average pain degree evaluated by somatosensory evoked potential stimulator was 1.55±0.83,the average VAS was 1.67±0.71,By correlation analysis,there was a signifi-cant positive correlation between the two (r =0.823,P <0.001).Conclusions Somatosensory e-voked potential stimulator has good correlation with VAS in cancerous pain assessment,can be used in the clinical assessment of cancer pain degree and the judgment of efficacy of treatment.

OBJECTIVETo analyze the characteristics of autopsies in medical dispute.

METHODSThe data of 202 autopsy cases in medical disputes performed by the Department of Pathology of Jiangxi Medical College from January 2001 to December 2010 were retrospectively analyzed.

RESULTSThe number of autopsy in medical disputes increased year by year. Neonatal, infant and 30 ≊ 60y were more common age groups in dispute; the gender ratio of male to female was 2:1 and more cases were from hospitals in rural areas. Most medical disputes came from in departments of pediatric, obstetrics and gynecology and general surgery. Death caused by cardiovascular diseases ranked at the first place.

CONCLUSIONAutopsy is important in medical disputes to define the cause of death and to preserve evidence.

Adolescent ; Adult ; Aged ; Autopsy ; statistics & numerical data ; Cardiovascular Diseases ; mortality ; Cause of Death ; Child ; Child, Preschool ; Dissent and Disputes ; Female ; Hospital Departments ; statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Malpractice ; Middle Aged ; Retrospective Studies ; Sex Ratio ; Young Adult

OBJECTIVETo summarize the clinical characteristics, surgical management and postoperative complications in patients with congenital bicuspid aortic valve (CBAV) over 50 years of age.

METHODSFrom January 2009 to September 2011, 73 CBAV patients aged 51-76 years (mean 61.8∓0.73 years) were treated in our center. Except for 1 patient who underwent Bentall surgery and another having Wheat surgery, all the patients received aortic valve replacement (AVR), including 7 with double (mitral and aortic) valve replacement (DVR), 6 with mitral valvular plasty, 11 with tricuspid valvular plasty, 8 with coronary artery bypass graft implantation, 1 with aortic-left ventricular tunnel repair, 1 with atrial maze ablation, and 1 with left atrial thrombosis removal.

RESULTSTwo patients died after the surgery, with a perioperative mortality rate of 2.7%. The cardiopulmonary bypass time was 78-217 min (mean 131.9 ∓6.0 min) with an aortic blocking time of 56-158 min (mean 88.2 ∓4.8 min) and total postoperative ICU time of 23.0-647.4 h (mean 97.9∓10.5 h). The postoperative complications included low heart output syndrome in 5 cases, bleeding in 4 cases, wound debridement in 4 cases, and hemodialysis due to acute renal failure in 1 case. The left ventricular end diastolic diameter reduced significantly after the surgery (52.6∓1.7 vs 43.2∓1.0, P=0.001). No significant changes were detected in the left ventricular ejection fraction (62.3∓2.5 vs 65.5∓1.3, P=0.257).

CONCLUSIONThorough preoperative examination, preoperative risk factor assessment, timely perioperative interventions, careful evaluation of patients' tolerance of surgery, and prevention of surgical complications are essential to decrease the perioperative mortality in elderly patients with CBAV.

Aged ; Aortic Valve ; abnormalities ; surgery ; Coronary Artery Bypass ; Female ; Heart Valve Diseases ; mortality ; surgery ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies