Before transcatheter aortic valve replacement (TAVR), echocardiography is the first choice for preoperative screening of suitable patients, which can be used to observe the morphology of aortic valve, determine the cause of aortic stenosis, and evaluate the severity of aortic stenosis and other cardiac structure and function. During TAVR procedure, echocardiography is mainly used for real-time monitoring of complications and immediate postoperative evaluation. After TAVR, echocardiography can be used to evaluate the shape and function of the prosthesis valve and monitor long-term complications. This article reviews the research progress of echocardiography in TAVR for guiding clinical practice.
ObjectiveScreening the Database from Colorectal Cancer (DACCA) based on West China Hospial data by " Operation Date”, we purposed to analyze the population characteristics of colorectal cancer patients in regional medical center within recent Database Version.MethodsThe DACCA Version was updated in December 12th, 2018. Personal data (including sex, age, blood type, height, weight, and BMI), location data (including provinces, cities, and subordinate areas in Chengdu), occupation and education data, and main diagnosis data were included in the items. Characteristic analysis was performed on each selected data item.ResultsAccording to screening, 9 633 analytical data rows were obtained. Based on the database information, there were 24 consecutive years from 1995 to 2018 into every year. We set 2005 to 2006 as the time node for the database construction. The contribution to database before 2005 (including) was 1 358, while after 2005 (not including) were 8 275. The contribution rate (contribution numbers/years) after 2005 was higher than before 2005 ［1 358/11 vs. 8 275/13, 95% CI was (–625.337, –400.831), P<0.001］. According to gender distribution, total male data were 4 669, female were 3 340, non-checked were 1 624. According to age distribution, age were from 13 to 104 ［(59±13) years］. Linear prediction was used to predict the age distribution with the " year” as the time axis. The results showed the stable linear prediction (\begin{document}$\hat y$\end{document}=0.016 1x+26.54, R2=3.42×105, P=0.601 108). According to height, height were from 138 cm to 192 cm ［(161±7)cm］, linear prediction results showed that the linear variation with height changes by value (\begin{document}$\hat y$\end{document}=0.110 5 x–60.911, R2=0.002 6, P=0.000 272). According to weight, weight were from 27.5 kg to 80.5 kg ［(59.38±10.27) kg］, linear prediction results showed that the linear variation with height changes by value (\begin{document}$\hat y$\end{document}=0.296 5x–537.24, R2=0.010 625, P=2.37×1014). Available 6 884 data showed the difference between serving areas by West China Hospital and official definition of western region. A total of 9 209 data obtained by analyzing main diagnosis, showed that the main site of disease was rectum (68.64%). Sigmoid was the main location of colon cancer (68.64%), and anal-rectal cancer was main of rectal cancer (27.06%).ConclusionPopulation characteristics from DACCA database could initially reflect the trend of increasing weight and BMI of colorectal cancer patients, and also reflect the regional distribution characteristics based on geographic information. They would be the clues for further database research.
Objective To understand the residents’ demands and utilization of the community health services and provide a basis for the construction of reasonable medical service system. Methods From July to September 2015, a purposive sampling questionnaire survey on general team mode service to bring benefits to the community residents was conducted in 20 provincial-level administrative regions of the country. SPSS 13.0 software was used for data analysis. Results A total of 1 300 questionnaires were distributed, and 1 273 valid questionnaires were recovered. In the 221 residents who were aware of the composition of general team, the awareness rate of general team composed of traditional Chinese medical doctors and gynaecologists/pediatricians was low (70.14%, 75.11%, respectively). The awareness rate of medical services including disease diagnosis and treatment, health consultation, health education and prescription in the 1 273 residents was 70.46%, 61.19%, 59.62% and 67.56%, respectively; the residents’ top five willing to accept medical services was prescribing medicine (77.77%), infusion (74.08%), health consultation (73.21%), health education (70.54%), and planned immunization (64.49%). The biggest change of the 433 patients with chronic diseases before and after treatment in the community was the increase in self-health management (70.67%) and the healthy lifestyle improvement (56.35%). Conclusion Community general team should be oriented by the objective needs and real demands of the residents; based on the ability of medical services supply, the adjustment of the key points of medical services should be made and the rational use of medical services should be guided for the residents.
Surgical removal or destruction of the focal brain area is the main treatment for drug-resistant epilepsy, but it is not suitable for all patients. Epileptiologists in the United States have opted for a new type of palliative therapy called responsive neurostimulation (RNS). The RNS system continuously monitors the electrical activity of the brain in the area of possible seizures and places electrodes in the epileptic area to provide electrical stimulation when abnormal discharges are detected, stopping seizures. Controlled clinical trials have demonstrated the long-term effectiveness and safety of the RNS system, with continued improvement in seizure reduction rates over time. RNS system not only has a good effect on temporal lobe epilepsy and cortical functional area epilepsy, but also can dynamically monitor cortical EEG, so as to better understand the epilepsy status of each patient and provide personalized diagnosis and treatment. In this paper, the development history, structure, advantages and disadvantages of RNS system are reviewed, and its indications as palliative treatment for drug-resistant epilepsy are discussed.
ObjectiveTo understand the status of application of Colorectal Cancer Predicted Risk Online (CRC-PRO) in colorectal cancer screening, and to analyze the possible practical value in our country.MethodsThe research literatures on the colorectal cancer risk prediction tool of CRC-PRO at home and abroad were searched. The overview and application status of this tool were reviewed.ResultsCRC-PRO could predict the 10-year risk rate of individuals developing colorectal cancer. It could quickly provide clinicians with accurate estimates of patient risk to help clinicians and patients identify screening programs and improve prevention strategies.ConclusionsCRC-PRO can not only give specific probability of risk, but also easy to operate. But based on regional differences, in the promotion of CRC-PRO, it is necessary to carry out multi-center research in more diverse populations for more extensive clinical analysis and verification, to further expand the scope of application of this tool.
As the indications for transcatheter aortic valve replacement (TAVR) expand, multi-valve lesions are becoming more common in clinical practice. Moderate to severe atrioventricular regurgitation, particularly when persistent after TAVR, significantly increases the risk of adverse events. Therefore, many studies have evaluated factors that contribute to the improvement of atrioventricular regurgitation. However, this field remains controversial due to the heterogeneity of retrospective studies and the lack of randomized controlled trials. Despite advances in atrioventricular valve intervention techniques, evidence for atrioventricular regurgitation intervention after TAVR is still scarce. The management decision for atrioventricular regurgitation in patients who underwent TAVR is complex and must take into account the severity of valve disease, anatomical characteristics, quality of life, and procedural complexity. We conducted a review of atrioventricular regurgitation in patients who have received TAVR in hope that it will help decision-making in clinical practice.
Objective To systematically review the effectiveness of amiodarone in treating repurfusion arrhythmia (RA) after thrombolytic therapy for acute myocardial infarction (AMI), so as to provide high quality evidence for formulating the rational thrombolytic therapy for AMI. Methods Randomized controlled trails (RCTs) on amiodarone in treating RA after thrombolytic therapy for AMI were electronically retrieved in PubMed, EMbase, The Cochrane Library (Issue 3, 2012), CBM, CNKI, VIP and WanFang Data from inception to January, 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs involving 440 patients were included. The results of meta-analysis suggested that, compared with the blank control, amiodarone reduced the incidence of RA after thrombolytic therapy in treating AMI (RR=0.60, 95%CI 0.48 to 0.74, Plt;0.000 01) and the incidence of ventricular fibrillation (RR=0.47, 95%CI 0.26 to 0.85, P=0.01). It neither affected the recanalization rate of occluded arteries after thrombolytic therapy (RR=1.00, 95%CI 0.88 to 1.15, P=0.94) nor decreased the mortality after surgery (RR=0.33, 95%CI 0.10 to 1.09, P=0.07). Conclusion Current evidence indicated that, amiodarone can decrease the incidence of RA. Unfortunately, the mortality rate can’t be reduced by amiodarone. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion
Objective To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.
ObjectiveTo explore and analyze the nutritional risk and dietary intake of patients with coronavirus disease 2019 (COVID-19), and provide data support for nutritional intervention.MethodsCOVID-19 inpatients were investigated in Wuhan Wuchang Hospital and the People’s Hospital of Wuhan University (East Area) from March 9th to 16th, 2020 by Nutrition Risk Screening 2002 (NRS 2002) scale and designed questionnaire. The energy and protein requirements were calculated according to the standard of 30 kcal/(kg·d) and 1.2 g/(kg·d). The nutritional risk, energy and protein intake, body weight and body mass index and their changes in the mild and severe patients were analyzed. The energy and protein intake of the two types of nutritional risk patients was analyzed.ResultsA total of 98 patients with COVID-19 completed the investigation, in whom 46 (46.94%) had nutritional risk, including 32 (39.02%) with mild type and 14 (87.50%) with severe type; and the difference was statistically significant (P<0.001). Compared with the usual condition, the body weight and body mass index of the two types of patients significantly decreased (P<0.01 or P<0.001); the energy and protein intake in mild type patients were significantly higher than those in the severe type patients (P<0.001); compared with the requirement, the protein intake in the two types of patients were significantly lower than the demand, while the energy and protein intake in the mild type patients were significantly lower than the requirement (P<0.05 or P<0.01). The proportion of energy and protein intakes in patients with nutritional risk was significantly higher than that in patients without nutritional risk (P<0.001 or P<0.01); the energy and protein intakes in patients without nutritional risk was significantly higher than that in patients with nutritional risk (P<0.001); the protein intakes in patients with nutritional risk was obviously insufficient (P<0.001); while the energy intake of the patients without nutritional risk was higher than the requirement (P<0.001).ConclusionsCOVID-19 patients has high incidence of nutritional risk which was higher in the severe patients compared with the mild patients. Higher incidence and lower intake of energy and protein are in the severe patients compared with those in the mild patients. Patients with nutritional risk has a higher proportion of energy and protein inadequate intake and lower intake compared with the patients without nutritional risk.
【摘要】 目的 评估乳酸清除率与重症创伤患者预后的关系。 方法 回顾性分析2010年1－6月收住曲靖市第一人民医院ICU科的37例重症创伤患者的初始血乳酸值、第2次血乳酸值、乳酸清除率及患者的预后，将患者分为存活组和死亡组，比较两组患者初始血乳酸值、乳酸清除率的差异。 结果 两组患者年龄、性别、初始血乳酸值差异无统计学意义（Pgt;0.05）。存活组血乳酸清除率（48.26±21.57）%明显高于死亡组（11.71±20.88）%，差异有统计学意义（Plt;0.001）；当乳酸清除率≥13%时，能较好地预测患者生存，其灵敏度为96%，特异度为80%。 结论 乳酸清除率可用于评估重症创伤患者的预后。【Abstract】 Objective To evaluate the correlation between prognosis and lactate clearance in severe trauma. Methods The clinical data of 37 patients with severe trauma admitted between January and June 2010 in the First People′s Hospital of Qujin were analyzed retrospectively. These data included initial blood lactate concentration, second blood lactate concentration, lactate clearance rate, and prognosis of the patients. The patients were divided into survivor group and non-survivor group, and the differences of initial blood lactate concentration and lactate clearance rate between them were compared. Results There were no differences in age, sex, and the initial blood lactate concentration (Pgt;0.05) between the two groups. Compared with non-survivors, the survivors had a significantly higher lactate clearance [(48.26±21.57)% vs. (11.71±20.88)%, Plt;0.001]. Patients with a lactate clearance higher than or equal to 13% had a sensitivity of 96%, specificity of 80%, for predicting survival. Conclusion Lactate clearance rate can be used to predict the prognosis of severe trauma.