Objective To explore the safety and efficacy of mobile APP in telemanagement for patients who received oral warfarin anticoagulant therapy after mechanical heart valve replacement. Methods A prospective cohort study was performed. According to the inclusion and exclusion criteria, a total of 80 patients who underwent mechanical heart valve replacement for more than half a year and received oral warfarin anticoagulant therapy in outpatient department were included in our hospital from January 1, 2017 to December 31, 2017. These patients were divided into a telemanagement group (40 paitents, telemanagement using mobile APP) and a control group (40 patients, anticoagulant management in outpatient clinics) according to patients' wishes and local hospital international normalized ratio (INR) monitoring conditions. After 12-month follow-up, clinical effect of the two groups was compared. The INR, time in therapeutic range (TTR), fraction in therapeutic range (FTTR), anticoagulation-related complications and patient satisfaction were analyzed. Results During the follow-up period of anticoagulation, there was no significant difference in INR between the two groups (P=0.732). The average interval of INR monitoring in the telemanagement group was 3-65 (21.4 ± 12.5) days, while that in the control group was 7-93 (39.6 ± 14.7) days (P=0.012). TTR was 42.7% (6 027.6 d/14 116.0 d) in the control group and 67.9% (10 168.6 d/14 972.0 d) in the telemanagement group (P=0.018). And FTTR in the two groups was 45.6% (144/316) and 67.1% (432/644), respectively (P=0.015). No serious thromboembolism or hemorrhage events occurred in the 80 patients during the 12-month follow-up period. There was no significant difference in the incidence of anticoagulation-related complications, general bleeding and embolism between the two groups (P>0.05). Conclusion For patients with stable anticoagulation after cardiac mechanical valve replacement, it is safe and effective to telemanagement by mobile APP. Telemanagement can increase the frequency of anticoagulation monitoring without increasing anticoagulation risk, meanwhile, it also could obtain more convenient and rapid consultation, save time and economic costs,and improve the quality of life and patient satisfaction.
ObjectiveTo acquire the flow law of outpatient and emergency visits in a large general hospital. MethodsBy sampling monthly amount of outpatient and emergency from January 2005 to December 2013 of a large general hospital in Guangzhou, the trend of the time series was analyzed and calculated the seasonal index of the amount of hospital outpatient and emergency visits with the use of long-term trends method. ResultThe flow law of patients in the hospital outpatient and emergency was significantly affected by seasonal factors, and different month had its own variation characters. The seasonal indexes were the highest in March, July, August, November and December (seasonal index >105%), while the lowest in January, February, October (seasonal index <95%). ConclusionBased on analysis of the outpatient and emergency visits and causes with hospitals, decision makers and hospitals should make reasonable allocation of medical resources and provide evidence for the scientific decisions of hospital management. Thus, ensure the safety of patients.
In order to study the Titanium-bone interaction and integration mechanism, the titanium implant was implanted in the tibia of 9 Newzealand rabbits, and the Ti-bone interface performed for 1, 3, and 6 months were examined and analyzed by fluorescence microscope and advanced TOF-SIMS techniques. The results showed that Ti-bone tissue was integrated closely in a very reactive manner. Both physical and chemical integration occurred in the Ti-bone interface. The Ti-bone could diffuse into the bone tissue though the diffusion was very limited. It was up to 100 microns in depth during the early period. The diffusion density was high, and later in a smooth distribution. Furthermore, while Ti+ diffused into the bone tissue, other elements such as Ca+, OH-, O-, etc, could also diffuse into titanium in exchange. The growth pattern around the bone tissue was in two fashions, one was implantefugal and the other was implantopetal. In this study, based on the ionic distribution, osmosis and impurity elements distribution, the Ti-bone integration mechanism was discussed at molecular and atomic level.
Objective To analyze the risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer patients. Methods The clinical records of 771 lung cancer patients undergoing lobectomy between May 2012 and June 2016 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. According to different length of hospital stay (LOS), 771 patients were divided into two groups, a normal LOS group and a PLOS group. In the normal LOS group, there were 551 patients including 234 females and 317 males with a median age of 59 years, whose LOS was shorter than 8.0 days. In the PLOS group, there were 220 patients including 72 females and 148 males with a median age of 60 years, whose LOS was no less than 8.0 days. Then, we analyzed the independent risk factors of PLOS by multivariate logistic regression analysis. Results Univariate analysis showed that risk factors for PLOS included male, arrhythmias and atrioventricular block, smaller FVC%, unilateral pneumonectomy, operation and anesthesia duration, intraoperative blood loss and number of lymph node dissection in the operation (P<0.05). Multivariate logistic regression analysis showed that the age ≥75 years (OR=4.100, 95%CI 1.677 to 10.026), unilateral pneumonectomy (OR=2.563, 95%CI 1.473 to 4.460), FVC% < 89.05% (OR=1.500, 95%CI 1.020 to 2.206), numbers of lymph node dissection≥ 13.5 (OR=1.826, 95%CI 1.262 to 2.642), operation duration≥126.5 min (OR=1.858, 95%CI 1.200 to 2.876) and arrhythmia (OR=2.944, 95%CI 1.380 to 6.284) were independent risk factors of PLOS (all P<0.05). Conclusion LOS is influenced by age, surgical type, FVC%, numbers of lymph node dissection, arrhythmia and operation duration. Careful assessment and appropriate management of risk factors are helpful to improve postoperative recovery after lobectomy for lung cancer patients.
Objective To discuss influence of spinal surgery on quality of life (QOL) of patients with late-period spinal metastatic tumor and to explore if spinal surgery could influence on survival time of patients or not. Methods From July 2007 to March 2009, we identified patients who were eligible for the observational study hospitalized in Changzheng Hospital, the Second Military Medical University in Shanghai, China. All eligible patients were divided into two groups depending on whether they would receive spinal surgery or not. Then, all eligible patients completed five QOL assessments using the Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire when they were diagnosed as late-period spinal metastatic tumor, after 1-month treatment, after 3-month treatment, after 6-month treatment, and after 9-month treatment. Survival time of each patient was also recorded. Results We identified 312 patients who were eligible for the study (surgery group, 147 cases; and non-surgery group, 165 cases). There was no significant difference in survival time between the two groups (χ2=3.167, P=0.075). Within 9 months, the surgery group had significantly higher physical well-being scores, emotional well-being scores, functional well-being scores and total QOL scores than the non-surgery group. Conclusion The results of this study suggest that spinal surgery can significantly improve the QOL of patients with late-period spinal metastatic tumor, but cannot prolong the survival time.
Objective To study the relationship between the expression ratio of induced nitric oxide synthase (iNOS) over glial fibrillary acidic protein (GFAP) and the time of injury after brain concussion in rat, in order to acquire a new visual angle for determining injury time of cerebral concussion. Methods Eighty-five healthy Sprague-Dawley rats were divided into three groups randomly: model group (n=25), experimental group (n=55), and control group (n=5). The rats in the model group were used to confirm the attack hight to make the model of brain concussion; according to the time of execution, rats in the experimental group were then subdivided into 11 groups with 5 rats in each subgroup, and their execution time was respectively hour 0.5, 1, 3, 6, 12, 24, 48, 96, 168, 240, and 336; the rats in the control group were executed after fed for 24 hours. After the model of cerebral concussion was established through freefalling dart method, hematoxylin-eosin staining and immunohistochemistry staining of iNOS and GFAP were conducted for the brain of the rats. All related experimental results were studied by using microscope with image analytical system and homologous statistics. Results The ratio of positive expression of iNOS over that of GFAP increased gradually during hour 0.5- 3 after injury in brain (from 5.03 to 10.47). At the same time, the positive expression of iNOS increased significantly (from 14.61% to 37.45%). However, the increase of the positive expression of GFAP was not obvious. Between hour 3 and 12, the ratio began to decline to 4.98, which was still at a high level, and during the same time period, the positive expressions of iNOS and GFAP also experienced the same change pattern. Later, the ratio began to decline between hour 12 and 336 after injury (from 4.98 to 0.95). All ratios at this time were lower than those between hour 0.5 and 12. The positive expression of iNOS and GFAP both increased to a climax before declining. Conclusions The ratio of positive expression of iNOS over GFAP and the respective change pattern of iNOS and GFAP can be used as the evidence of estimating the injury time of cerebral concussion. We can use the ratio of two or more markers to provide a new visual angle for concluding the concussion injury time.
目的:分析脑出血死亡时间及死因,找出脑出血不同死亡时间的主要死因,为制定脑出血不同时间的相应救治措施提供依据。方法:回顾性总结分析２１１ 例脑出血死亡病例的死亡时间、主要死因,找出不同死亡时间对应的主要死因。 结果: (１)死亡时间:≤３ 天 ９１ 例、４~７天 ５２ 例、８~１４ 天 ４２ 例、１５~２１ 天１８ 例、２２~２８ 天 ７ 例、≥ ２９ 天 １ 例。(２)死亡原因:１６９ 例死于脑疝及中枢性呼吸、循环衰竭;20例死于肺部感染;１０ 例死于消化道出血;4 例死于多器官功能衰竭;４ 例死于心脏病变(如心脏猝死、心肌梗塞、心功能衰竭);其它４例(痰窒息、肾功能衰竭、肝功能衰竭)。(３)不同死亡时间主要死亡原因:≤３ 天 ９０ 例死于脑疝及中枢性呼吸、循环衰竭,仅 １ 例死于消化道出血;４～７ 天４７ 例死于脑疝及中枢性呼吸、循环衰竭,３ 例死于肺部感染,死于心脏病变及其它各１例;８~１４ 天 ２９ 例死于脑疝及中枢性呼吸、循环衰竭,８ 例死于肺部感染,２ 例死于消化道出血,死于心脏病变、多器官功能衰竭、其它各 １ 例;１５~２１ 天 ７ 例死于肺部感染,５ 例死于消化道出血,３ 例死于脑疝及中枢性呼吸、循环衰竭,死于心脏病变、多器官功能衰竭、其它各１例;２２～２８天死于消化道出血、肺部感染各２ 例,死于心脏病变、多器官功能衰竭、其它各１ 例,已无死于脑疝及中枢性呼吸、循环衰竭者;２９ 天后死于多器官功能衰竭１ 例。结论: 脑出血死亡时间不同,其主要死亡原因不同。临床应该针对不同死亡时间的主要死因制定相应救治方案,以降低死亡率。
目的 探讨改良电休克治疗（MECT）中影响脑电抽搐时间的因素。 方法 回顾性分析2011年10月－2011年12月经MECT的111例精神障碍患者的临床资料，利用Pearson相关分析方法进行统计，分析异丙酚用量、性别、设定电量、动态阻抗等因素对脑电抽搐时间的影响。 结果 男性异丙酚用量平均值大于女性。女性的年龄、能量设定百分比、静态阻抗、动态阻抗均大于男性。与抽搐发作时间相关的因素是年龄、设定能量百分比。异丙酚剂量与脑电抽搐时间无相关。以脑电抽搐时间≥25 s为判定标准，男性的反应率高于女性。 结论 行MECT时，需考虑患者年龄对发作时间的影响，异丙酚可安全用于MECT中。
Objective To evaluate the long-term anticoagulation outcomes of target international normalized ratio (INR) 1.60 to 2.20 and weekly dosage adjustment of warfarin in patients after mechanical heart valve replacement. Methods Outpatients after mechanical heart valve replacement at least 6 months were registered continually from July 2011 to July 2016 in department of cardiothoracic surgery at Zigong No.4 People's Hospital and West China Hospital. There were 1 690 females (70.62%) and 703 males (29.38%) with a median age of 47 years, ranging from 14 to 80 years. All patients were followed up for 6-61 months. Target INR was 1.60 to 2.20 and warfarin dosage were adjusted weekly. Unexpected bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were recorded and calculated to evaluate the outcome of anticoagulation management. Results A total of 2 393 patients with 26 521 INR values were included for data analysis. INR values varied from 0.90-8.39 (1.82±0.45) and required weekly doses of warfarin were 1.75-61.25 (21.72±7.39) mg. TTR of target INR and acceptable INR was 59.38% (1 449 514.0 days/2 441 060.0 days) and 73.57% (1 795 971.0 days/2 441 060.0 days), respectively. FTTR of target INR and acceptable INR were 50.71% (13 450 times/26 521 times), 65.25% (17 305 times/26 521 times). During the follow-up , anticoagulation-related complications included: cerebral infarction in 21 patients (complete recovery in 18 patients, physical activity disorder in 3 patients), cerebral hemorrhage in 4 patients (death in 1 patient, complete recovery in 3 patients), severe gastrointestinal bleeding in 3 patients (completely recovered) and uterine bleeding in 1 patient (surgical removal of the uterus). Conclusion Target INR 1.60–2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement is reasonable and safe.