Objective:To explore the predictive value of lipoproteins on the progression of critically ill patients to chronic critical illness (CCI).Methods:A retrospective cohort study was conducted to analyze clinical data of patients admitted to the intensive care unit (ICU) of Nanjing Drum Tower Hospital from January 1, 2020, to December 31, 2022. The levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL) and apolipoproteins (ApoA-Ⅰ, ApoB) at 1, 3, 7, 14 and 21 days after admission to ICU were collected. The progression to CCI was recorded. CCI was defined as the length of ICU stay ≥14 days with sustained organ dysfunction [sequential organ failure assessment (SOFA) score ≥2]. Differences in lipoprotein levels between the patients with and without CCI were compared. Multivariate Logistic regression was used to analyze risk factors for critically ill patients progressing to CCI. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of lipoproteins on critically ill patients progressing to CCI.Results:A total of 200 patients were enrolled in the final analysis. 137 patients (68.5%) progressed to CCI, and 63 patients (31.5%) did not. The lipoprotein indicators in the CCI group showed a decrease after the acute phase, while the lipoprotein indicators in the non-CCI group showed an increase. The levels of HDL, LDL, ApoA-Ⅰ, and ApoB at various time points in the CCI group were significantly lower than those in the non-CCI group. HDL at 7 days in the CCI group was significantly lower than that in the non-CCI group [mmol/L: 0.44 (0.31, 0.61) vs. 0.67 (0.49, 0.75), P < 0.01]. Multivariate Logistic regression analysis showed that 7-day HDL was an independent risk factor for critically ill patients progressing to CCI [odds ratio ( OR) = 0.033, 95% confidence interval (95% CI) was 0.004-0.282, P = 0.002]. ROC curve analysis showed that the area under the ROC curve (AUC) of 7-day HDL for predicting critically ill patients progressing to CCI was 0.702, with a 95% CI of 0.625-0.779, P < 0.001. When the optimal cut-off value was 0.59 mmol/L, the sensitivity was 69.8%, and the specificity was 72.4%. Conclusions:The low level of lipoproteins is closely related to the progression of critically ill patients, and 7-day HDL has a certain predictive value for critically ill patients progressing to CCI. Continuously observation of the change trend of lipoprotein level is helpful to judge the progression of CCI in critically ill patients.

Objective:To investigate the application of side branch protection technique in interventional treatment of intracranial arteriosclerosis stenosis.Methods:We reviewed the patients who underwent interventional treatment of intracranial arteriosclerosis stenosis from November 2018 to May 2021 in Affiliated Drum Tower Hospital of Nanjing University Medical School, and analyzed the role of side branch protection technique in the prevention and treatment of complications. Relevant evaluation indicators including: (1) imaging: patency of blood flow in target vessels and branch vessels; (2) clinical presentation: ischemic stroke or transient ischemic attack (TIA) events within 72 hours and one month follow-up results.Results:A total of 9 patients underwent side branch protection during interventional treatment for intracranial arteriosclerosis stenosis, the blood flow of target vessels was improved obviously after operation, and the blood flow of the affected branches was not affected; no stroke or TIA events occurred in 72 hours after operation and one month follow up.Conclusions:Proper application of side branch protection technique can reduce the perioperative complications effectively during the interventional treatment for intracranial arteriosclerosis stenosis.

Objective:To explore the effect of action research in first aid skills training for nurses in Pediatric Clinic.Methods:This study was a own control study. From March to August 2020, convenience sampling was used to select 28 nurses from the Pediatric Clinic of the West China Second University Hospital, Sichuan University as the research subject. The first aid skills training for nurses was optimized through the spiral cycle process of "plan-action-observation-reflection" using action research. Before the training, after the first cycle, and after the second cycle, the self-designed First Aid Skills Assessment and Training Satisfaction Evaluation Scale was used, combined with the results of semi-structured interviews, to evaluate the first aid skills and training satisfaction of nurses in Pediatric Clinic before and after the program improvement.Results:Before training, in the first cycle, and in the second cycle, the nurses' first aid theory (except resuscitation balloon usage dimension) , first aid operation scores and satisfaction scores were compared, and the differences were statistically significant ( P<0.05) . Conclusions:The systematic training of first aid knowledge and operation for nurses in Pediatric Clinic by action research can effectively improve nurses' first aid skills and training satisfaction.

Modern vehicle safety design and safety regulations are mostly based on 50th percentile populations. However, with the increase of obese populations, it is very important to investigate the injury mechanism and protection of obese occupant. Methods such as traffic accidents statistics, cadaver experiments, multi-body modeling and finite element modeling, are currently used to study the injury mechanism of obese occupants. Different hypotheses including cushion effect, body geometrical effect and mass increasing effect have been put forward to explain the effect of obesity on occupant injury mechanism, which means that its mechanism is still uncertain. The impact injury mechanisms of obese occupant were comprehensively summarized. Furthermore, the problems confronted by the research of current obese occupant impact injury and future investigations were proposed in this study.

OBJECTIVETo compare mid-term results of surgical treatment with aortoiliac stenting (AIS) in patients with chronic aortoiliac occlusion.

METHODSA retrospective review of 68 patients treated between January 2005 and December 2010 was performed. Thirty-three patients underwent surgical revascularization (surgical group) and 35 patients underwent AIS (AIS group). Preoperative clinical factors and outcome data including complications, ankle-brachial index and mortality were collected. Kaplan-Meier estimates for survival, limb salvage and patency were analyzed.

RESULTSPreoperative risk factors were similar between the two groups. Surgical group were younger than AIS group ((56±11) years vs. (65±10) years, t=-2.789, P=0.008) with more patients manifesting rest pain (23/33 vs.15/35, χ2=4.963, P=0.026) and relative higher perioperative mortality (3/33 vs. 0/35, P=0.109). Mean ankle-brachial index increased significantly in both groups after operation (Surgical group 0.90±0.15 vs. 0.43±0.20, t=-7.849, P=0.000; AIS group 0.85±0.20 vs. 0.41±0.25, t=-5.379, P=0.000). Postoperative complications occurred, with statistically higher rates of respiratory failure, transient renal dysfunction and multiple organ dysfunction syndrome in surgical group (χ2=6.98, P=0.010; χ2=9.62, P=0.000; P=0.023). The 5-year primary patency in surgical group was 90.2%, compared with 64.2% in AIS group (χ2=3.717, P=0.054). No difference was observed in survival rate, limb salvage and secondary patency between the two groups.

CONCLUSIONSFive-year primary patency of endovascular reconstruction for chronic aortoiliac occlusion is lower than that for traditional open surgery. Open surgery is still the first choice for the patients who can endure the surgery. Endovascular treatment is an option for patients with high risk. However, additional interventional treatment is needed in some cases.

Adult ; Aged ; Arterial Occlusive Diseases ; surgery ; Humans ; Limb Salvage ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stents ; Survival Rate ; Treatment Outcome ; Vascular Patency ; Vascular Surgical Procedures

Objective To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients.Methods A total of 60 patients with HCM and left ventri cular outflow tract gradient (LVOTG) ＜ 50 mm Hg (1 mm Hg =0.133 kPa) at rest were enrolled consecutively,and LVOTG at rest and exercise were measured by echocardiography.Of 51 patients with gradients ＜ 30 mm Hg at rest,26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg,25 were non LVOTO with exercise peak value LVOTG ＜ 30 mm Hg,and 9 were resting obstruction with LVOTG 30-49 mm Hg.The morphological characteristics of different types of obstruction were analyzed.Results Patients with latent LVOTO were more likely to have SAM(73.1％ vs 8.0％),narrow of LVOT(46.2％ vs 4.0％),higher resting gradients [(16.9 ±7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values ＜ 0.05).The distribution of septal hypertrophy were different in the two groups (P ＜ 0.05).Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431,95 ％ CI 2.323-291.112,P =0.002) at rest and distribution of septal hypertrophy (OR 0.011,95％ CI 0.001-0.179,P =0.008).Conclusions Approximately half of patients with nonobstructive HCM at rest have latent LVOTO.SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.

Objective To assess the treatment of splenic artery aneurysms (SAA) and prognosis.Methods Clinical data of 18 SAA patients treated in our hospital from 1999 to 2011 were retrospectively analyzed. Results There were 18 patients diagnosed as SAA,including 7 males and 11 females.The average age was 53.8 ± 7.3 years.8 patients were asymptomatic found by routine physical examination,7 patients complained upper left abdominal pain,3 cases suffered from aneurysm rupture. Diagnosis was established by three-dimensional computed tomography angiography (3DCTA) in 14,Digital subtraction angiography (DSA) in 3 and magnetic resonance angiography (MRA) in 1 patient.Three patients with ruptured splenic artery aneurysm underwent emergent operations,11 patients underwent elective surgery or interventional therapy.Surgical procedures included aneurysmectomy and splenectomy in 4 patients,distal pancreatectomy in 5 cases; aneurysmectomy and splenic artery ligation in one patient; and aneurysmectomy with splenectomy and colon resection in 1 case.Interventional embolization by coils of the splenic aneurysm in 3 patients.The remaining 4 being asymptomatic and with tumor diameter less than 2 cm were put on a close follow-up.There was no perioperative mortality.Two were lost to follow-up.16 cases were followed-up for averaging 3.2 years. 1 patient died of cerebral hemorrhage after four years. Conclusions Splenic artery aneurysms was a rare disease and with usually occult symptoms,but rupture can leads to abdominal apoplexy.Open surgery and minimally invasive endovascular treatment is effective and offers a good prognosis.

Objective To evaluate surgical therapies in patients with popliteal aneurysms (PA).Method The clinical data of 25 PA patients admitted from January 1988 to January 2012 were retrospectively analyzed.There were 21 men and 4 women,the mean age was (56 ± 16)years.There were 27 PA in these 25 patients,with bilateral PA in 2 cases.The main symptoms were pulsatile mass in the popliteal fossa,limb pain,acute or chronic distal limb ischemia and limb edema.Result In this series 23out of 25 PA cases recieved operations,17 of them were treated with aneurysmectomy and saphenous vein interposition or bypass grafting,4 of them were treated with aneurysmectomy and prosthetic grafts interposition,1 was treated with aneurism ligation and 1 underwent end-to-end anastomosis after aneurysm resection.There was no perioperative mortality.One patient recieved amputation for distal anastomotic thrombosis and severe limb ischemia.The mean follow-up time is (6.5 ± 0.5) years.After 4 years,a right subclavian artery aneurysm was found in a bilateral PA case and treated surgically.Conclusions Early elective surgical treatment is recommended for patients with PA because PA may go rupture or induce dital limb ischemia and these patients may have good outcome after surgical treatment.Long-term follow-up is warranted to detect the new aneurysm formation.

Objectives To compare endovascular aortic repair (EVR) and medical therapy for acute type B aortic dissection (AD) in terms of treatment results.Methods From January 2004 to October 2010 116 cases were collected and were divided into two groups,with treatment of EVR (n =60)and medical therapy (n ＝ 56).Treatment outcomes were assessed.Results Clinical manifestations of AD are complex and variable,with the most common symptom being pain on chest and back (74.1％).CTA is the most valuable method in confirming the diagnosis of aortic dissection.In conservative group of 56 patients admitted to hospital,30-day mortality rate was 16.1％.In EVR group of 60 patients with grafts successfully released,the 30-day mortality was 1.7％.There is significant difference between the two groups on mortality rate during 30-day(P ＜0.05).Follow-up rate in conservative group and the EVR group was 71.4％ and 86.7％,with average follow-up time of (38 ± 16) months and (35 ± 14) months.The 5-year survival rates were 87.5％ and 88.5％ respectively in conservative group and EVR group (P ＞ 0.05).Conclusions EVR is considered to be the first choice for acute Stanford type B dissection.EVR can improve patients' 30-day survival,though long term result is comparable with that of conservative treatment.

Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism,and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 eases misdiagnosed aorta disease,including clinical manifestation,misdiagnosis,improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first.Three cases were treated with emergent thrombectomy using Fogarty catheter.The correct diagnosis Was achieved by 3-dimensional CT angiography (3DCTA) after operation,and the eitiology of other 6 cases were also pmved as aortic disease by 3DCTA before operation.Among 5 cases of acute aorta dissection with iliac-femoral artery involved,2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged.The other 3 cases were treated with endovascular therapy successfully.One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection.The other 3 caBes of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass.The limbs ischemia were improved in all cases without perioperative death.Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia,mimicking limb artery thrombo-embolism.Preoperative imaging especially 3 DCTA helps to establish correct preoperative diagnosis for a successful treatment.