【摘要】 目的 评价聚四氟乙烯人工听骨在慢性中耳炎听力重建中的应用效果。 方法 回顾性分析2008年8月〖CD3/5〗2009年12月慢性中耳炎手术中接受聚四氟乙烯部分/全人工听骨赝复物(Partial/Total ossicular replacement prostheses,PORP/TORP,美国美敦力公司)行听骨链重建的50例患者50只耳的临床资料及随访结果。比较听力学资料完整的39例39只耳手术前及手术后3～6个月语言频率(05、1.0、2.0 kHz)气导平均听力及气骨导差(airbonecap,ABG)。 结果 随访3～16个月,50只耳手术后1～3个月均干耳,手术后1个月鼓膜愈合良好。9只耳手术中人工听骨表面未置入耳屏软骨,其中1只耳手术后3个月人工听骨脱出,1只耳手术后2个月鼓膜内陷,人工听骨外端盘面外突。39只耳手术前气导听力为3667～9500 dB,平均为(5970±1433) dB;骨导听力为330～5170 dB,平均为(2278±1161) dB;手术后气导听力平均为(4660±1703) dB,与手术前比较,差异有统计学意义(Plt;001)。手术前ABG为10～60 dB,平均为(3700±1212) dB。手术后ABG平均为(2620±1156) dB,与手术前比较,差异有统计学意义(Plt;001)。手术后气导听力提高1000～3000 dB者(手术后听力提高有效)共24只耳,有效率为615%(24/39)。 结论 聚四氟乙烯人工听骨是慢性中耳炎体重建听骨的理想材料,手术后取得良好的听力结果,远期疗效需进一步观察。【Abstract】 Objective To evaluate the effects of hearing reconstruction in chronic otitis meadia with prothesis. Methods Retrospective reviews were performed in 50 patients(50 ears)who had undergone Teflon Partial/Total ossicular replacement prostheses (PORP/TORP) implants from August 2008 to December 2009. Audiometric measurements (the average hearing threshold at 05, 10, 20 kHz) were taken in 39 patients (39 ears) preoperatively and postoperatively. Comparisons of preoperative and postoperative mean air condition and air bone gap (ABG) were performed. Results All patients were followed up for three to 16 months, and the surgery resulted in a dry ear and a healing drum without perforation in all 50 patients. Of the nine patients without tragus cartilage interposed between the drum and the prosthesis, one patient occured prothesis extrusion, and one patient had retraction of the eardrum. The mean air conduction of the 39 patients before and after surgery were (5970±1433) dB and (4660±1703) dB. The mean air bone gap (ABG) was (3700±1212) dB before operation, while it was elevated to (2620±1156) dB when followed up (Plt;001). The surgical treatments were found to be successful (postoperative mean air condition improved 10.0030.00 dB) in 24 ears (615%). The effectiveness was 615%. Conclution Teflon could be an ideal material for ossicular reconstruction in chronic otitis media, and the hearing improvement is obtained after operation, but the problem of extrusion has not been solved at present, and the longterm effects should be surveyed.
Artificial intelligence belongs to the field of computer science. In the past few decades, artificial intelligence has shown broad application prospects in the medical field. With the development of computer technology in recent years, doctors and computer scientists have just begun to discover its potential for clinical application, especially in the field of congenital heart disease. Artificial intelligence now has been successfully applied to the prediction, intelligent diagnosis, medical image segmentation and recognition, clinical decision support of congenital heart disease. This article reviews the application of artificial intelligence in congenital cardiology.
Objective To investigate the values of cytokines in evaluating the severity and prognosis of patients with coronavirus disease 2019 (COVID-19). Methods A total of 205 COVID-19 patients in Wuhan Leishenshan Hospital were retrospectively analyzed. According to the severity of the disease, patients were divided into common group (n=117), severe group (n=69) and critical group (n=19). The patients’ basic condition and cytokine related parameters were collected, the differences between the three groups were compared and their values in assessing the severity and prognosis of COVID-19 patients were analyzed. Results There were statistically significant differences in the age, severe acute respiratory syndrome coronavirus 2 nucleic acid test results, interleukin (IL)-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α among the three groups of patients (P<0.05). Correlation analysis showed that the age, severe acute respiratory syndrome coronavirus 2 nucleic acid test continued to be positive for 20 days, IL-6 level, IL-10 level, IL-2 receptors level, IL-8 level and tumor necrosis factor-α level were related to the classification of COVID-19. The correlation coefficient rs was 0.354, 0.187, 0.366, 0.327, 0.329, 0.273 and 0.157, respectively (P<0.05). The levels of IL-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α in dead patients with COVID-19 were higher than those in surviving patients (P<0.05). Multivariate analysis showed that age [odds ratio (OR)=1.034, 95% confidence interval (CI) (1.006, 1.063), P=0.016], IL-6 level [OR=1.030, 95%CI (1.006, 1.055), P=0.015], IL-10 level [OR=1.088, 95%CI (1.003, 1.179), P=0.042] and IL-2 receptor level [OR=1.003, 95%CI (1.001, 1.005), P=0.001] were independent risk factors for common COVID-19 to become severe or critical. Conclusion The levels of cytokines in COVID-19 patients are closely related to the severity and prognosis of the disease.
Cardiovascular diseases are the leading cause of death and their diagnosis and treatment rely heavily on the variety of clinical data. With the advent of the era of medical big data, artificial intelligence (AI) has been widely applied in many aspects such as imaging, diagnosis and prognosis prediction in cardiovascular medicine, providing a new method for accurate diagnosis and treatment. This paper reviews the application of AI in cardiovascular medicine.
ObjectiveTo study the clinical characteristics of patients with partial and transitional atrioventricular septal defects (P/TAVSDs) in our hospital, and to evaluate the early follow-up outcomes from a real-world research perspective.MethodsThe clinical data of all patients diagnosed with P/TAVSDs from January 1, 2018 to July 12, 2020, in our hospital were collected, and all patients' examination results were used as the real-world follow-up data, univariable Cox risk proportional model was used to analyze the outcomes. A total of 93 patients were finally included in the analysis, 72 with partial and 21 with transitional AVSD. There were 38 males and 55 females at age of 182.0 months (20.0 d to 779.5 months).ResultsUnivariable Cox proportional risk model suggested that at least one cardiac malformation (HR=15.00, 95%CI 3.00 to 75.00, P=0.001), preoperative moderate or greater mitral regurgitation (HR=6.60, 95%CI 1.70 to 26.00, P=0.007), and preoperative moderate or greater tricuspid regurgitation (HR=13.00, 95%CI 3.10 to 51.00, P<0.0001) were risk factors for moderate or greater postoperative atrioventricular valve regurgitation.ConclusionChildren with coarctation of the aorta or partial pulmonary vein connection, moderate or greater preoperative mitral regurgitation, and moderate or greater preoperative tricuspid regurgitation need to be alerted to the risk of moderate or greater postoperative atrioventricular valve regurgitation. Real-world data, with relaxed statistical P values and combined expertise, can suggest clinical conclusions that are close to those of high-quality retrospective studies.
ObjectiveTo review the characteristics of patients who underwent atrioventricular septal defects (AVSD) repair with prosthetic valve ring implantation in our hospital, and to analyze the safety and effectiveness of this intervention.MethodsThe clinical data of all patients diagnosed with AVSD who received surgery repair and prosthetic valve ring implantation from January 1, 2018 to July 12, 2020 in Guangdong Provincial People's Hospital were collected and analyzed. There were 22 patients with 9 males and 13 females at a median age of 35.00 (14.10, 53.00) years. There were 9 (40.9%) patients with prosthetic half or full rings placed on the left atrioventricular valve and 18 (81.8%) patients with prosthetic half or full rings placed on the right atrioventricular valve. ResultsThe median postoperative hospital stay was 7.00 (6.00, 8.80) d, and the postoperative mechanically assisted ventilation time was 11.00 (6.25, 19.00) h. There were 2 (9.1%) patients of moderate or higher postoperative atrioventricular valve regurgitation, 1 on the left and 1 on the right. There was one patient (4.5%) of the postoperative residual septal defect. There was no left ventricular inflow or outflow tract obstruction and no postoperative residual atrial septal defect during the follow-up of 152.00 (124.00, 1 030.00) d.ConclusionImplantation of a prosthetic ring is safe and effective in patients with AVSD, and the structural strength of the ring may be improved after the implantation. The physiological development of the AVSD annulus after prosthetic ring implantation and the results of long-term follow-up needs further attention.
ObjectiveTo sum up the experience of the primary modified single-patch (MSP) technique applied in our hospital for children with complete atrioventricular septal defect (CAVSD).MethodsThe clinical data of 141 children who underwent primary MSP technique for CAVSD between June 2009 and December 2017 were retrospectively analyzed, including 62 males and 79 females with a median age of 6 (3, 11) months and a median weight of 5.8 (4.5, 7.0) kg. According to Rastelli classification, there were 116 patients in type A, 14 in type B and 11 in type C. Among them, 15 patients were diagnosed with Down’s syndrome. Cardiopulmonary bypass time, aortic cross clamp time, atrioventricular valve regurgitation and other clinical data were recorded during and after operation. ResultsPostoperatively, 17 patients suffered from severe left atrioventricular valve regurgitation (LAVVR) and 6 patients severe right atrioventricular valve regurgitation (RAVVR). In the follow-up period, 5 patients suffered from severe LAVVR and 1 patient severe RAVVR. Left ventricular outflow tract obstruction (LVOTO) appeared in 1 patient during follow-up period and none at the end of follow-up. There were 5 early deaths and 2 late deaths. Twelve patients underwent reoperation with a median interval time of 268 (8, 1 270) days.ConclusionMSP technique is a wise surgical strategy for CAVSD children with good outcomes, improved postoperative mortality and decreased atrioventricular valve regurgitation.
ObjectiveTo quest the risk factors of poor prognoses in children with tetralogy of Fallot (TOF) during perioperative period and evaluate its clinical application values.MethodsA retrospective analysis of the clinical data of 119 children who underwent one-stage correction of TOF in Guangdong Provincial People's Hospital from September 2016 to January 2019. The cohort includes 75 males and 44 females, with ages ranging from 3.2-137.1 (13.2±1.4) months and weights ranging from 4.6-21.0 (8.3±0.2) kg. Perioperative poor prognosis was defined as duration of mechanically assisted ventilation >48 h or secondary intubation, vasoactive-inotropic score (VIS) within 48 h >40, postoperative length of stay >14 d, and the occurrence of the major adverse events. Major adverse events were defined as early death, malignant arrhythmia, low cardiac output syndrome, non-fatal cardiac arrest, postoperative reintervention, diaphragm paralysis, and other clinical complications. Univariate and multivariate logistic analyses were used to analyze the correlation between risk factors and poor prognoses.ResultsThere was 1 perioperative death, and 9 with major adverse events. Variables selected by Least Absolute Shrinkage and Selection Operator (LASSO) included 2 preoperative variables (McGoon index, aortic root diameter index) and 4 intra-operative variables [left-right direction of bicuspid pulmonary valve, total length of right ventricular outflow tract (RVOT) incision index, pulmonary valve with commissurotomy, and minimum temperature in cardiopulmonary bypass (CPB)]. Univariate and multivariate logistic analyses were used to the above factors, respectively. The variables with statistical significance (P≤0.05) were McGoon index, aortic root diameter index, left-right direction of bicuspid pulmonary valve, and minimum temperature in CPB. A nomogram was established based on the above factors, and the results showed that the left-right direction of bicuspid pulmonary valve was more risky than the tricuspid pulmonary valve and the anterior-posterior direction of bicuspid pulmonary valve. The lower the McGoon index, the higher aortic root diameter, and the lower temperature in CPB, the higher risk of poor prognostic events in children with TOF.ConclusionThe left-right direction of the pulmonary bicuspid valve has a higher risk of poor prognosis than the tricuspid pulmonary valve and the anterior-posterior direction of bicuspid pulmonary valve. With the smaller McGoon index and the larger aortic root diameter, the risk of poor prognoses in children with TOF is higher. The temperature in CPB being lower than medium-low temperature obviously relates to the high incidence of poor prognostic events, which can be used as an auxiliary reference standard for decision-making in pediatric TOF surgery in the future.
ObjectiveTo compare the benefits and drawbacks of primary patch expansion and pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). MethodsA retrospective study was conducted on the patients who were diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD) and underwent primary right ventricular-pulmonary artery connection surgery at our center between January 2010 and December 2020. The patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: the whole pericardial tube right ventricular-pulmonary artery connection group (pericardial tube group), and the patch expansion right ventricular-pulmonary artery connection group (patch expansion group). The patients' general clinical data and cardiopulmonary bypass data were documented, and the cardiac CT data obtained before and after the surgery were compared with the clinical and imaging data. ResultsFinally 51 patients were collected, including 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. There were 19 patients in the pericardial tube group, with a median age of 17.17 (7.33, 49.67) months, and 32 patients in the patch expansion group with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter, McGoon index, and Nakata index were significantly increased after treatment (P<0.001). However, the pericardial tube group required a longer occlusion time (P<0.001). The rate of reoperation was high, with 72.5% of patients requiring further surgery. Specifically, 26 (81.3%) patients in the patch expansion group and 12 (63.2%) patients in the pericardial tube group finally completed radical resection. There was no statistical difference observed in the long-term cure rate or mortality between the two groups. Conclusion In patients with PA/VSD, the use of patch expansion or pericardial tube right ventricular-pulmonary artery connection as the initial palliative treatment strategy can promote the development of pulmonary vessels and provide a favorable basis for subsequent radical operations. However, compared to pericardial tube, patch expanded right ventricular-pulmonary artery connection is a simpler procedure to perform and retains some of the intrinsic pulmonary artery development potential, thus making it a preferred procedure.
Objective To modify the sewing technique of a hand-made bicuspid pulmonary valve using the expanded polytetrafluoroethylene in right ventricle outflow tract reconstruction for summarizing the short-term experience. Methods The patients with complex congenital heart diseases and concurrent contaminant pulmonary regurgitation that underwent right ventricle outflow tract reconstruction through the bicuspid pulmonary valve were enrolled. The postoperative artificial valve function and right ventricle function indexes were evaluated. Results A total of 17 patients were collected, including 10 males and 7 females, with an average age of 18.18 years and an average weight of 40.94 kg. Of 17 patients, 16 used valved conduit for the reconstruction of the right ventricle outflow tract with the size ranging from 18 to 24 mm. There was no patient requiring mechanical circulatory support and no in-hospital death. During the follow-up with a mean period of 12.89 months, only one vale dysfunction occurred without any complications and adverse events (P<0.001). Postoperative right atrium diameter, right ventricle diameter, and tricuspid regurgitation area significantly decreased in contrast to those preoperatively (P<0.05). Conclusion Sewing the bicuspid pulmonary valve utilizing 0.1 mm expanded polytetrafluoroethylene is a feasible, effective, and safe technique of right ventricle outflow tract reconstruction in the field of complex congenital heart diseases.