Objective To analyze the clinical research literature of in vitro fertilization and embryo transfer(IVF-ET)failure,and summarize the traditional Chinese medicine(TCM)syndromes and syndrome elements,so as to provide theoretical basis for TCM syndrome differentiation and treatment of IVF-ET failure.Methods Using"in vitro fertilization and embryo transfer""IVF-ET"and"embryo transfer failure"as search terms,the literature related to TCM that had appeared in CNKI and Wanfang Data Knowledge Service Platform were searched since these database was constructed.After excluding irrelevant literature,statistical analysis was performed on the frequency and frequency of symptoms and signs.Results Kidney Yang deficiency,kidney deficiency,blood stasis,kidney Yin deficiency and liver qi stagnation were the common syndroms of failure.The disease location with high frequency of syndrome elements was kidney,and the disease was blood stasis.Conclusion Kidney-Yang deficiency syndrome is the most common type of failure,and TCM disease location syndrome is the most common in kidney.The disease deficiency is mostly Yang deficiency,and the excess is mostly blood stasis.

Objective To analyze the clinical research literature of in vitro fertilization and embryo transfer(IVF-ET)failure,and summarize the traditional Chinese medicine(TCM)syndromes and syndrome elements,so as to provide theoretical basis for TCM syndrome differentiation and treatment of IVF-ET failure.Methods Using"in vitro fertilization and embryo transfer""IVF-ET"and"embryo transfer failure"as search terms,the literature related to TCM that had appeared in CNKI and Wanfang Data Knowledge Service Platform were searched since these database was constructed.After excluding irrelevant literature,statistical analysis was performed on the frequency and frequency of symptoms and signs.Results Kidney Yang deficiency,kidney deficiency,blood stasis,kidney Yin deficiency and liver qi stagnation were the common syndroms of failure.The disease location with high frequency of syndrome elements was kidney,and the disease was blood stasis.Conclusion Kidney-Yang deficiency syndrome is the most common type of failure,and TCM disease location syndrome is the most common in kidney.The disease deficiency is mostly Yang deficiency,and the excess is mostly blood stasis.

Objective:To identify the risk factors for and outcomes of preoperative hepatic dysfunction (HD) in patients who underwent surgery for the treatment of acute DeBakey type I aortic dissection (ADIAD).Methods:A retrospective study including 810 consecutive patients between January 2014 and December 2019 in Nanjing Drum Tower Hospital was performed with emergency surgical repair. All patients were divided into non-HD and HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery and their clinical parameters and clinical outcomes were collected and compared. To determine independent predictors of preoperative HD, multivariate logistic regression analyses were performed using variables with P<0.5 in the univariate analyses. Kaplan-Meier survival analyses were conducted to analyze the association between preoperative HD and postoperative long-term survival. Results:The mean age of the patients was (52.4±12.5) years. 215 patients (26.5%) were identified as the preoperative HD group. In univariate analysis, significant difference was found with respect to the postoperative complications (98.6% vs. 94.5%, P=0.011) and 30-day mortality (20.0% vs. 8.4%, P<0.001) between the two groups. Multivariate logistic analysis showed that elevated serum troponin T levels upon admission( OR=1.921, P<0.001) and preoperative cardiac tamponade ( OR=2.158, P=0.002) were independent risk factors for preoperative HD. The long-term mortality rate was not significantly affected by preoperative HD. Conclusion:Early HD before surgery was commonly observed in patients with ADIAD and was associated with increased postoperative complications and 30-Day mortality. Elevated serum troponin T levels upon admission and preoperative cardiac tamponade were identified as risk factors for preoperative HD.

Objective:To summarize acute type A aortic dissection(ATAAD) is relatively uncommon in dialysis patients, and repair outcomes are not fully understood.Methods:Between January 2014 and March 2020, 20 patients with ATAAD required dialysis for preoperative end-stage renal disease(ESRD) were treated by our group. There were 11 male and 9 female patients at mean age of(47.8±11.3) years. The mean duration of dialysis therapy in the total 20 patients before the onset of ATAAD was(4.5±3.9 )years, with 90%(18 cases) of these patients undergoing hemodialysis(rather than peritoneal dialysis). 17 patients were treated emergency surgically, surgical operation were performed under deep hypothermic circulatory arrest and perfused the cerebral selective cerebral perfusion, 5 cases with ascending aorta + arch fenestrated stent, 5 cases with ascending aorta+ hemi-arch replacement(2 cases with stent elephant trunk), 4 cases with ascending aorta+ arch replacement+ stent elephant trunk(1 case with coronary artery bypass grafting for left anterior descending coronary artery), 2 cases with aortic valvuloplasty + ascending aorta+ hemi-arch replacement, 1 case with Bentall+ arch fenestrated stent.Results:2 patients were died from aortic ruptured before operation, 1 patient treated medically was alive three months after admission. Cross-clamp, cardiopulmonary bypass, and circulatory arrest times of all the surgical patients were(233.8±84.4) min, (155.5±63.6)min and(28.2±10.8)min, respectively. The following complications occurred postoperative: 3 cases died in the hospital, 1 case of tracheotomy, 2 cases of cerebral infarction, 1 case of cerebral hemorrhage, 1 case of transient paraplegia, and 1 case of surgical site infection. After a mean follow-up of(11.6±14.5) months(rang, 3-61 months). the overall survival rate at 1 year and 5 years was 53% and 27% respectively.Conclusion:Dialysis patients with ATAAD should be operated on urgently and medical treatment carries high risks of aortic rupture, although in-hospital mortality is acceptable, long-term mortality is poor.

Objective:To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods:From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit), all adult patients hospitalized for 7 days before open-heart surgery were included. They were randomly divided into pulmonary rehabilitation group(198 cases) and control group(234 cases). To compare and analyze the clinical effects, the main observations were observed including overall outcome indicators(such as early extubation rate, ICU stay, hospitalization costs, advanced oxygen therapy support after extubation) and lung outcome related indicators(such as the occurrence of pulmonary complications, chest drainage, secondary intubation, tracheotomy, lung infection and chest tube drainage).Results:There was no statistical difference between groups in basic conditions and surgical conditions. The lung rehabilitation group significantly increased the rate of early extubation, reduced the number of advanced oxygen therapy after weaning, shortened the length of ICU stay, saved hospitalization cost, significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function( P<0.05). Conclusion:During cardiac perioperation, pulmonary rehabilitation significantly can increase the rate of early extubation , shorten the length of mechanical ventilation, reduce the occurrence of secondary tracheal intubation and pulmonary complications. And it can also effectively promote the recovery of lung function and the overall recovery.

Objective This study was to investigate the characteristics of posterior corneal astigmatism (PCA) and aberration in cataract patients with high myopia.Methods A retrospective study was designed.Two hundred and eighty-two eligible eyes of 190 cataract patients were enrolled in Eye and ENT Hospital of Fudan University from September to December,2014.The eyes were classified into two groups according to axial length (AL):high myopia group with 139 eyes (AL≥26 mm) and control group with 143 eyes (AL was 20 to 25 mm).The mean keratometric mid-radius of curvature (Km),corneal central thickness (CCT),astigmatism and aberrations were measured by the rotating Scheimpflug System (Pentacam),and the AL were measured by the partial coherence interferometry (IOL Master).This study followed the Helsinki declaration,and was approved by the Ethic Committee of Eye and ENT Hospital,Fudan University.Informed consent was signed from each patient.Results In high myopia group,the mean PCA was 0.3 D (range 0 ～ 0.9 D) and 92.8％ eyes had PCA values ＜0.5 D.The steep corneal meridian was aligned vertically (60°～ 120°) in 87.1％ eyes for the posterior corneal surface.There was no significant difference in PCA between the high myopia group and the control group (P =0.797).Significant positive linear correlations was found between PCA and anterior corneal astigmatism (ACA),PCA and anterior corneal root mean square (RMS),PCA and anterior lower-order RMS,PCA and posterior corneal RMS,PCA and posterior high-order RMS,PCA and posterior lower-order RMS (r =0.235,P =0.005;r =0.217,P =0.010;r =0.229,P =0.007;r =0.395,P =0.000;r =0.243,P =0.004;r =0.384,P =0.000).Compared with total corneal astigmatism (TCA),anterior corneal measurements overestimated with-the-rule astigmatism (WTR) by a mean of (0.27 ± 0.18) D in 65.67％ eyes,underestimated against-the-rule astigmatism (ATR) by (0.27 ± 0.18) D in 88.10％ eyes and underestimated oblique astigmatism (Obl) by (0.22 ± 0.10) D in 63.33％ eyes.Compared with total corneal aberrations,anterior corneal aberrations measurements overestimated by (0.275 ±0.176) μm in 87.05 ％ eyes,and the anterior corneal astigmatism types had no effect on the result.Conclusions In high myopia group,92.8％ eyes had PCA values ＜0.5 D and the main astigmatism type in posterior corneal surface was ATR.The posterior corneal astigmatism and aberration were needed to consider in choosing intraocular lens (IOL) before cataract surgery.

Objective To summarize the surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion.Methods From January 2010 to November 2015,307 patients of acute Stanford A aortic dissection underwent operation were included.The mean age was (51.3 ± 13.0) years,ranged from 22 to 83.The BMI was (25.4 ± 3.7) kg/m2 and 239 (77.9％) were men.There were 210 (71.2％) with hypertension,9 (2.9％) with Marian syndrome,and 44 (14.3％) with cardiac tamponade.Coronary malperfusion was confirmed in 43(14.0％) patients with 34 in right coronary artery,5 in left coronary artery,and 4 in both.There were 26 type A,8 type B,9 type C in Neri system.We performed coronary ostia repair in 12 patients,Bentall in 16,coronary artery bypass grafting(CABG) in 9,and Bentall plus CABG in 6.CABG was also performed in 1 Bentall,1 aortic valve repair,and 5 ascending aorta replacement in 264 patients without coronary malperfusion.Results The rate of CABG,cardiopulmonary bypass(CPB) time,aorta cross-clamp time were significantly higher in patients with coronary malperfusion(P ＜0.01).The in-hospital mortality was 32.6％ in patients with coronary malperfusion and 14.4％ in patients without coronary malperfusion.Thus,coronary malperfusion significantly increased in-hospital mortality(P ＜0.01).The mean follow-up time was(19.2 ± 18.0) months with a 95％ follow-up rate.The total follow-up survival rate is 97.5％ and the rate of patients with coronary malperfusion is 100％.Multivariate logistic regression analysis shows that cardiac tamponade(OR =4.8,P ＜0.01) and CPB time(OR =1.0,P ＜0.01) was the independent risk factor of post-operation inhospital mortality of acute Stanford A aortic dissection.Conclusion Acute Stanford A aortic dissection with coronary malperfusion has a significantly high in-hospital mortality with the indeed need of revascularization of coronary arteries rapidly.The treatment strategy depends on the specific clinical condition.

The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.

Objective To analyze early-and mid-term outcomes of aortic valve repair(AVr) for patients with aortic re gurgitation(AR).Methods From April 2010 to December2013,94 patients underwent elective aortic valve repair(AVr) for aortic regurgitation(AR).There were 36 male and 58 female,and the mean age was(51.3 ± 18.0) (6-75)years.There were 2 patients(2.1％) with severe AR,88 patients (93.6 ％) with moderate AR,and 4 patients (4.3％) with mild AR.The total number of the aortic valve lesions were 110,including 31 for annnlar dilatation,1 for leaflets fenestrations,1 for leaflets vcgctation,61 for leaflets prolapses,11 for leaflets calcification or thickness,and 4 for commissure fusion.We performed the annuloplasty for 32 patients including commissure plicature for 20 patiengs,subcommissural annuloplasty for 11 patients,valve-sparing aortic root replacement for 1 patient,and the valvuloplasty for 78 patients,including leaflets plicature for 2 patients,commissure suspension for 59 patients,leaflets shaving for 11 patients,commissure resection for 4 patients,leaflet patch repair for 1 patient,and leaflets vegetation msection for 1 patient.The concomitant procedures include coronary artery bypass grafting for 18 patients,mitral valve replacement/repair for 72,tricuspid valve replacement/repair for 75,congenital heart disease correction for 27,and ascending aorta plasty for 9.Results There was no case with aorta re-erossclamp,or aortic valve replacement due to AVr failure.In-hospital mortality was 4.25％ (4/94).Postoperative echocardiography showed 75 patients (79.8％)with none AR,13 (13.8％) with mild regurgitation,and 6 (6.4％) with moderate regurgitation.There was no severe AR post operative.AR gradient reduced in 94.7 ％ (89/94) of patients.The mean follow-up period was (30.6 ± 10.4) months,and the overall survival and the freedom of re operation for aortic valve were 100％.Conclusion There was good early-and mid-term outcomes of aortic valve repair for patients with aortic regurgitation.

Objective To evaluate the optimal management of cardiac surgery during pregnancy,in the second or third trimester,and the maternal and fetal outcomes in pregnant patients after surgery.Methods Six pregnant women with heart diseases were identified,who underwent cardiac surgery with cardiopulmonary bypass.Surgery was performed using cardiopulmonary bypass at mild hypothermia/normothermia,with pulsatile perfusion.Natural progesterone(20 mg)was added in priming solution,monitoring uterine contractions and heart rate changes.The mode of surgeries included mitral valve replacement+tricuspid valve plastic in three cases,aortic and mitral valve replacement+tricuspid valve plastic in one,left ventricular myxomatomy in one,left ventricular septal myectomy+artificial aortic valvular vegetations dissection+tricuspid valve plastic in one.Results The cardiopulmonary bypass and cross clamp time averaged 169 minutes(range,96~419 minutes)and 113 minutes(range,56~296 minutes),respectively.Five patients were alive.One maternal and fetal death occurred 6 h after surgery caused by heart failure and pulmonary edema.The other 5 patients terminated pregnancies after heart surgeries,one underwent with cesarean section 3 d after surgery in second trimester,two of whom with induction of labor,and two full-term labor(one with cesarean section,one with normal delivery).Two newborns were alive with no malformation.Conclusion Cardiopulmonary bypass can be used safely with satisfactory maternal and fetal outcomes in pregnant patients with heart disease undergoing cardiac surgery.