ObjectiveTo investigate the effect and incidence of residual leakage after surgical repair of large ventricular septal defects with moderate to severe pulmonary hypertension using cross-linkage mattress suture, a suture method invented by us, as compared with interrupted mattress suture. MethodsWe retrospectively analyzed the clinical data of 41 patients of large ventricular septal defect with moderate to severe pulmonary hypertension underwent surgery using cross-linkage mattress suture in Beijing Anzhen Hospital from February 2011 through April 2013. The 41 patients were as a cross-linkage group (average age 18.7±12.3 years, the ratio of male to female 31:10). Another 41 patients, who were repaired using interrupted mattress suture, were retrospectively chosen by matching age, size and location of the defects, pulmonary artery pressure and vascular resistance with members from the cross-linkage group, and were assigned as a control group (average age 17.4±11.8 years, the ratio of male to female 31:10). ResultsThere was no operative mortality and no new perioperative atrioventricular conduction block. Postoperative echocardiography revealed the incidence of residual leakage was 31.7% (13/41) in the control group, 0% (0/41) in the cross-linkage group with a statistical difference (χ2=13.164, P=0.000). With a follow-up of 18.2±6.1 months, no late death and no new atrioventricular conduction block occurred. There was no statistical difference in New York Heart Association functional class or pulmonary artery pressure measured through echocardiography between the two groups. While there was a statistical difference in incidence of residual leakage between the the cross-linkage group and the control group (0% (0/41) versus 26.8% (11/41), χ2=10.499, P=0.001). ConclusionThere is a high incidence of residual leakage after the surgical repair of large ventricular septal defect complicated with moderate to severe pulmonary hypertension using interrupted mattress suture, while the use of cross-linkage mattress suture can effectively reduce the incidence of residual leakage.
Objective To study the diagnostic value of MRI for pulmonary embolism, so as to provide information for clinical decision. Methods The trials about MRI in the diagnosis of pulmonary embolism were searched in the following databases such as PubMed, EMbase, The Cochrane Library, CBM, CNKI and VIP. The data of the included trials were extracted, the methodological quality was evaluated in accordance with the quality assessment of diagnostic accuracy studies (QUADAS), and then meta-analysis was conducted using Meta-Disc 1.4 software. The weighted sensitivity and specificity were aggregated, as well as the summary receiver operating characteristic (SROC) curve. Further, the area under the curve (AUC) was calculated to evaluate the value of MRI in the diagnosis of pulmonary embolism. Results A total of 6 English articles involing 595 patients were included. The results of heterogeneity test revealed that there was statistical heterogeneity among the results of studies. According to the random effects model, the weighted sensitivity and specificity were 0.87 (95%CI 0.80 to 0.91), and 0.98 (95%CI 0.96 to 0.99), respectively; and the AUC was 0.988 7. Conclusion MRI is a better non-invasive method as a routine examination for pulmonary embolism. It shows fairly high sensitivity and specificity, and has a good clinical value.
Pulmonary arterial hypertension is a kind of intractable disease which threatens human health severely. The results of operation are unsatisfactory. Clinical drug therapy is the major treatment which aims to relieve symptoms, improve the quality of life, and prevent the disease from progressing. Over the last several years, the studies of stem cells provide a new direction for the treatment of pulmonary arterial hypertension. It's demonstrated that the therapeutic effects of stem cells are better than that of the traditional methods. With the deepening of the researches, the therapy of stem cells is more and more compelling. The therapy of stem cells for pulmonary arterial hypertension is reviewed in this paper.
Objective To investigate the prognostic value of B-type natriuretic peptide (BNP) for short-term all-cause mortality in patients with acute pulmonary embolism (APE). Methods Such databases as PubMed, EMbase, Central Register of Controlled Trials, CBM, and CNKI (from the date of their establishments to March 2010) were searched. The level of BNP and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was collected to conduct eligible cohort study for assessing their effects on APE prognosis. Quality assessment and data extraction were performed in those clinical trials in line with the inclusion criteria. Then, RevMan 5.0 software was applied to carry out meta-analyses. Results Sixteen relevant studies with 1 126 APE patients were included. Nine studies reported BNP level and seven studies reported NT-pro BNP level. There was less satistical and clinical Heterogeneity among the groups (P=0.94, I2=0; P=0.99, I2=0). The meta-analyses results showed: the BNP or NT-pro BNP level was closely related with the short-term all-cause mortality. SPE was 0.52, + LR was 1.87, –LR was 0.20, PPV was 0.16, NPV was 0.98, SROC area under the curve was 0.830 5, SE (AUC) = 0.033 5.Conclusion While elevated BNP levels can help to identify APE patients at a higher risk of death, the high negative predictive value of normal BNP levels is more useful for doctors to identify patients with less likelihood of adverse events so as to conduct a selective follow-up.
Objective To investigate and analyze the epidemic characteristics and factors of pulmonary tuberculosis (PTB) to provide foundation and make prevention and treatment policy. Methods Statistical analysis was conducted to analyze the current existing PTB prevention and control data in the Center for Disease Control and Prevention of Zhushan County and corresponding prevention and treatment policy was proposed. Results Since 1997 when PTB was included into B infectious diseases in Zhushan County, 4 431 cases of PTB had been reported by the end of 2009. Annual reported incidence rate was 74.73 per 100 000 and the disease was found in 17 towns. All seasons witnessed the incidence but winter and summer had more sufferer. The youngest patient was 4 months whereas the oldest was 86 years old. The majority of the patients were from 20 to 59 years old, peasants were the main patients, and the incidence of male was higher than that of female. The use of chemotherapy resulted in a significant decline of PTB death rate. Poor immunity of elder group, population flow caused by poverty, low detection rate of patients and AIDS were the major causes to PTB epidemic. A lack of prevention and treatment in the grassroots hospital and difficulty to fully implement the Directly Observed Treatment, Short-course (DOTS) strategy in remote areas were also bottlenecks to PTB control process. Conclusion The followings should be performed to improve the quality of DOTS strategy implementation: strengthen the government’s commitment, provide policy and funding safeguard, conduct health education and health promotion widely, reinforce management according to the law, fully implement the DOTS strategy, and fortify the prevention and control construction.
To assess the efficacy and safety of thrombolytic therapy. Electronic search was applied to the Cochrane Airways Group register (MEDLINE, EMBASE, CINAHL standardized searches) with the date up to 2003 April. Hand searched respiratory journals and meeting abstracts. All randomized controlled trials comparing thrombolytic therapy with heparin alone or surgical intervention (eg. embolectomy) met the inclusion criteria. Two reviewers independently selected trials, assessed trial quality and extracted the data.
ObjectiveTo investigate the effect of pulmonary rehabilitation on pulmonary function,perception of dyspnea and quality of life in stable COPD patients of different severity. Methods300 patients with COPD in stable stage were divided into a moderate COPD group (n=120),a severe COPD group (n=100) and a very severe COPD group (n=80). Each group was randomly subdivided into a control group and a treatment group. The treatment groups received pulmonary rehabilitation for 6 months in addition to usual care,and the control groups received usual care without pulmonary rehabilitation. Pulmonary function(FEV1),6 minute walking distance (6MWD),modified medical research council (mMRC) scale,and acute exacerbation frequency of COPD were compared before and after intervention and among groups. ResultsAfter pulmonary rehabilitation for 6 months,the quality of life score and 6MWD were significantly improved in the treatment groups with moderate,severe,very severe COPD,and the increscent of 6MWD was greatest in the severe COPD patients. The mMRC of the patients with very severe COPD improved significantly after pulmonary rehabilitation(P<0.05). Lung function before and after the intervention in three groups all showed no significant difference (P>0.05). The acute exacerbation frequency of the severe COPD patients was significantly reduced by pulmonary rehabilitation (P<0.05), while there was no significant change in the moderate and very severe groups (P>0.05). ConclusionPulmonary rehabilitation can improve exercise tolerance and quality of life of COPD patients with different severity,reduce acute exacerbation frequency in severe COPD,reduce the dyspnea degree in very severe COPD. Pulmonary rehabilitation is a cost-effective treatment for stable COPD.
Objective To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.
ObjectiveTo investigate the risk factors,characteristics and prognosis in Tibetan patients with venous thromboembolism. MethodsTibetan patients with VTE from plateau area,admitted in West China Hospital from January 2010 to December 2012,were recruited in the study. The VTE diagnosis was confirmed by CT pulmonary angiogram (CTPA) or vascular ultrasound examination. Risk factors,clinical symptoms,signs and laboratory tests were retrospectively investigated and follow-up by telephone interview was conducted. Results31 Tibetan VTE patients with 16 males and 15 females were included. The investigation of risk factors revealed that 15 patients suffered from obese(48.3%),10 patients suffered from highly viscous hyperlipidemia(32.3%). The most common clinical symptom was dyspnea(29%),followed by chest pain(19.4%),hemoptysis(16.1%) and cough(12.9%). The common signs were lower extremity edema(73.3%) and lung rale(36.7%). All the patients received anticoagulation therapy,and inferior vena caval filters were implanted in 2 patients. In two years' follow-up after discharge,2 patients died of tumor,2 died of pulmonary embolism,6 patients suffered from chronic embolization syndrome with lower extremity edema or pain,1 patient suffered from pulmonary hypertension after embolization,and thrombus in 20 patients disappeared or recanalized. ConclusionTibetans long-termly reside in high altitude areas with the eating habits of high-fat diet,which may increase the incidence of acquired risk factors such as viscous hyperlipidemia and obesity. There are no specific clinical symptoms and signs among Tibetan VTE patients,with dyspnea as the most common symptom and lower extremity edema as the most common sign. Patients with risk factors which can be eliminated in a short term have better prognosis.
In order to identify the incidence of nosocomial pulmonary infection in surgical critical care patients in our hospital, we studied 800 patients discharged from surgical intensive care unit between May 1992 to Dec. 1994. One hundred and six episodes of pulmonary infection were found in 96 cases, in which 20 cases had been re-infected. The infection rate was 12.0%. The age of patients, APACHE- Ⅱ score and duration in ICU were closely related to the incidence of pulmonary infection. Tracheal intubation, tracheotomy and mechanical ventilation were the predisposing factors. The prevalent pathogens were pseudomonas aeruginosa, acinetobacter, staphylococcus aureus and candida albicans. 54.7% of cases were infected with more than one pathogens, and 36.8% of cases had fungal infection. The prevention and treatment are also discussed.