Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

Objective:To analyse the effect of preoperative renal function classification on early outcomes for patients with acute type A aortic dissection(AAAD) and to estimate the risk factors of postoperative major adverse events.Methods:From January 2012 to December 2019, 226 patients with AAAD who underwent total arch replacement at our institution were retrospectively analysed, including 146 males and 80 females, aged(54.4±12.5) years old. Stages of preoperative renal function were defined as follows: Normal[estimated glomerular ltration rate(eGFR)≥90 ml·min -1·1.73 m -2, 68 cases], Mild(eGFR 60-89 ml·min -1·1.73 m -2, 73 cases); Moderate(eGFR 30-59 ml·min -1·1.73 m -2, 57 cases), Severe(eGFR<30 ml·min -1·1.73 m -2, 28 cases). The independent risk factors for postoperative death were analyzed by logistic regression analysis. The area under the receiver operating characteristic curve was used to assess the efficiency of eGFR for predicting the postoperative hemodialysis. Results:In-hospital death occurred in 24(10.6%) cases. Major complications included postoperative hemodialysis in 49(21.7%) cases, stroke in 19(8.4%) cases and tracheotomy in 15(6.6%) cases. The best cut-off value of the eGFR for predicting postoperative hemodialysis was 36.5 ml·min -1·1.73 m -2(area under the receiver operating characteristic curve was 0.793). The following variables were found to be risk factors of in-hospital mortality in multivariate logistic regression analysis: serum creatinine, eGFR<30 ml·min -1·1.73 m -2, neural malperfusion, bowel malperfusion, postoperative stroke and hemodialysis. Conclusion:Total arch replacement can be safely performed in patients with AAAD and mild renal dysfunction. Preoperative renal dysfunction is a risk factor for postoperative hemodialysis, and eGFR is useful for predicting the requirement for hemodialysis after total arch replacement. The severity of preoperative renal dysfunction could greatly influence the outcomes after total arch replacement for AAAD. More importance should be attached to the assessment of preoperative renal function during clinical risk assessment.

To scientifically evaluate the intervention effect of Chinese medicine preventive administration(combined use of Huo-xiang Zhengqi Oral Liquid and Jinhao Jiere Granules) on community population in the case of coronavirus disease 2019(COVID-19), a large cohort, prospective, randomized, and parallel-controlled clinical study was conducted. Total 22 065 subjects were included and randomly divided into 2 groups. The non-intervention group was given health guidance only, while the traditional Chinese medicine(TCM) intervention group was given two coordinated TCM in addition to health guidance. The medical instructions were as follows. Huoxiang Zhengqi Oral Liquid: oral before meals, 10 mL/time, 2 times/day, a course of 5 days. Jinhao Jiere Granules: dissolve in boiling water and take after meals, 8 g/time, 2 times/day, a course of 5 days, followed up for 14 days, respectively. The study found that with the intake of medication, the incidence rate of TCM intervention group was basically maintained at a low and continuous stable level(0.01%-0.02%), while the non-intervention group showed an overall trend of continuous growth(0.02%-0.18%) from 3 to 14 days. No suspected or confirmed COVID-19 case occurred in either group. There were 2 cases of colds in the TCM intervention group and 26 cases in the non-intervention group. The incidence of colds in the TCM intervention group was significantly lower(P<0.05) than that in the non-intervention group. In the population of 16-60 years old, the incidence rate of non-intervention and intervention groups were 0.01% and 0.25%, respectively. The difference of colds incidence between the two groups was statistically significant(P<0.05). In the population older than 60 years old, they were 0.04% and 0.21%, respectively. The incidence of colds in the non-intervention group was higher than that in the intervention group, but not reaching statistical difference. The protection rate of TCM for the whole population was 91.8%, especially for the population of age 16-60(95.0%). It was suggested that TCM intervention(combined use of Huoxiang Zhengqi Oral Liquid and Jinhao Jiere Granules) could effectively protect community residents against respiratory diseases, such as colds, which was worthy of promotion in the community. In addition, in terms of safety, the incidence of adverse events and adverse reactions in the TCM intervention group was relatively low, which was basically consistent with the drug instructions.
Adolescent ; Adult ; Betacoronavirus ; Coronavirus Infections ; drug therapy ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Middle Aged ; Pandemics ; Pneumonia, Viral ; drug therapy ; Prospective Studies ; Young Adult

Objective To investigate the imaging features of primary Rosa-i Dorfman disease (RDD)in the central nervous system and to increase the understanding of the disease.Methods The MRI findings of 5 cases with primary RDD of the central nervous system were analyzed retrospectively,and the related literatures were reviewed.Results Four cases located in the cranium,1 case located in the spinal cord,and 5 tumors were attached to the brain (ridge)membrane.The tumor was equal and low signal on T1 WI,and equal or slightly high signal on T2 WI.Obvious enhancement could be seen on enhance study,and obvious enhancementwas visible in adjacent brain (ridge)membrane,in which 1 case involved the skull,with thickening and strengthening of the skull.Tumors were attached to the meninges in a wide range,the local meninges of 3 cases were penetrated by tumor.Conclusion If young and middle-aged males have no obvious specific clinical manifestations,the images of MRI are single or multiple lesions that are closely related to the brain (ridge)membrane in larger extent and easily penetrate the brain (ridge)membrane,the possibility of RDD should be considered.

This study was performed to evaluate the oncological and reproductive outcomes of childbearing-age women treated with fertility-sparing surgery (FSS) for non-epithelial ovarian tumors in China. One hundred and forty eight non-epithelial ovarian tumor women treated with FSS between January 1, 2000 and August 31, 2015 from two medical centers in China were identified. Progression-free survival (PFS) was 88.5%, whereas overall survival (OS) was 93.9%. Univariate analysis suggested that delivery after treatment is related to PFS (P = 0.023), whereas histology significantly influenced OS. Cox regression analysis suggested that only histology was associated with PFS and OS (P < 0.05). Among the 129 women who completed adjuvant chemotherapy (ACT), none developed amenorrhea. Among the 44 women who desired pregnancy, 35 (79.5%) successfully had 51 gestations including 35 live births without birth defects. Non-epithelial ovarian tumors can achieve fulfilling prognosis after FSS and chemotherapy. Histology might be the only independent prognostic factor for PFS and OS. FSS followed by ACT appeared to have little or no effect on fertility. Meanwhile, postoperative pregnancy did not increase the PFS or OS. Use of gonadotropin-releasing hormone agonist was not beneficial for fertility.
Adolescent ; Adult ; Chemotherapy, Adjuvant ; adverse effects ; Child ; China ; Female ; Humans ; Infertility, Female ; etiology ; prevention & control ; Neoplasm Staging ; Organ Sparing Treatments ; Ovarian Neoplasms ; drug therapy ; surgery ; Pregnancy ; Pregnancy Rate ; Prognosis ; Retrospective Studies ; Survival Analysis ; Young Adult

Objective To assess the diagnostic value of apparent diffusion coefficient (ADC) in the classification of solid nodules of brain parenchymal tuberculosis and response evaluation of patients.Methods Brain parenchymal lesions of 128 patients,with clinically and (or) pathologically confirmed brain parenchymal tuberculosis were analyzed retrospectively.Results Significant differences were observed in the average ADC values between enhanced areas and edematous areas of homogeneously enhancing and ring-enhancing lesions in all 128 patients before treatment(P<0.05).In 52 patients, the average ADC values of enhanced areas and edema areas in homogeneously enhancing and ring-enhancing lesions were significantly different before and after the treatment(P<0.05).Conclusion The ADC values in different areas of solid nodules of brain parenchymal tuberculosis are different, so can be used as a supplement to magnetic resonance imaging diagnosis and classification.After anti-tuberculosis treatment, the ADC values can be used as an observational indicator in follow-up.

Objective To explore the value of time-invariant CTA in assessing collateral circulation of patients with acute ischemic stroke and assisting clinicians in predicting clinical outcomes.Methods The score of collateral circulation was compared between single-phase and time-invariant CTA.NIHSS score was calculated at admission and two weeks after admission.A 50% or greater decrease in NIHSS score over two weeks was considered as major neurologic improvement,which showed good clinical outcome;otherwise,it indicated bad outcome.The predictive ability of time-invariant CTA for clinical outcomes was assessed based on ROC curves.Results Compared with single-phase CTA,more collateral vessels could be viewed on time-invariant CTA.The average score of collateral circulation on time-invariant and single-phase CTA was 1.50±0.69 and 1.15±0.49 respectively (P=0.006<0.05 ).Time-invariant CTA had the moderate predictive ability for clinical outcomes in patients with acute ischemic stroke (AUC=0.810;P=0.032<0.05). Conclusion The time-invariant CTA showed potential value in assessing collateral circulation of patients with acute ischemic stroke and assisting clinicians in predicting clinical outcomes.

Objective To evaluate the accuracy of presurgically resting-state fMRI(rs-fMRI) with subject order-independent group independent component analysis(ICA), compared to electric cortical stimulations. Methods Twenty-three patients with the lesion in motor area, which were recorded by our hospital from Jan, 2014 to Dec, 2015, were collected as the study sample. The data of 9 patients were excluded because of excessive head motion. As a result, 14 patients were included in this study. Rs-fMRI data before the surgery and the results of electric cortical stimulations were collected. Results All of this 14 patients were preoperatively located by rs-fMRI with SOI-GICA, including all the SMA and the ipsilesional primary motor area. On the side with lesion, the number of functional location of motor area was decreased compared with healthy side. Evaluate the accuracy of ICA by comparing the coincidence rate of these two techniques, based on the standardized electrical cortical stimulation in operation. The completely concordance between rs-fMRI with the SOI-GICA and electrical cortical stimulation in operation was 11 (11/14). Meanwhile the basically concordance of corresponded case was 3(3/14). Conclusions Rs-fMRI with the ICA has a relatively high accuracy rate in localizing motor area. Rs-fMRI has a remarkably referential contribution to the presurgically function assessment and surgical planning in implementation.

Objective To compare the outcomes of off-pump versus on-pump CABG.Methods From 2002 to 2008,CABG was performed in 105 patients aged 80 years and over,including 45 without cardiopulmonary bypass (CPB) or off-pump (OP) CABG (OPCAB) and 60 with CPB (onpump CABG).The outcomes were compared between two groups.Results The mean ICU stay was (37.1±30.3) h in OPCAB group and (60.6±58.2) h in on-pump CABG group (P＜0.01).Average ventilator-assisted time was (10.8±9.7) h for OPCAB group versus (22.3±35.7) h for onpump CABG group (P＜0.01).Postoperative atrial fibrillation occurred in 31.1％ of OPCABG patients and 41.7 ％ of on-pump CABG patients (P＜0.01).The mortality rate was 5.0％ in OPCABG group versus 8.3％ in on-pump CABG group (P＜0.05).Conclusions OPCABG is a safe and efficient method of myocardial revascularization in the elderly patients with lower morbidity and complications.