ObjectiveTo evaluate the effectivness of using high porous polyethylene lower eyelid spacers (Medpor LES) combined with the lateral tarsal-strip procedure for reconstruction of the eyelid closure function in paralytic lagophthalmus after facial palsy. MethodsBetween March 2008 and December 2012, 32 patients (32 eyelids) with hypophasis in facial palsy which all sorts of causes lead to were treated with Medpor LES combined with the lateral tarsal-strip procedure. Of 32 cases, 20 were male and 12 were female, aged from 20 to 72 years (mean, 46.8 years). The left eye was involved in 18 cases and the right eye in 14 cases with a disease duration of 1.5 months to 2 years (mean, 4.4 months). All the patients were shown as lower eyelid ectropion, lower eyelid retraction, exposure keratitis, and corneal ulcer, but no obvious upper eyelid retraction was observed. ResultsPrimary healing of incision was obtained in all patients. The edema time of the eyelid was from 5 days to 3 weeks (mean, 2 weeks). Conjunctival edema appeared in 4 cases after 2 weeks of operation, which was cured after expectant treatment. The patients were followed up 5-8 months (mean, 6 months). At 1 week, 3 and 6 months after operation, the height of palpebral fissure was reduced, and the degree of lagophthalmus and low eyelid retraction were significantly corrected (P<0.05), but no significant difference among different time points after operation (P>0.05). Outer canthus displacement occurred in 3 cases at 1 month postoperatively, and was cured after the lateral tarsal strip procedure. No lower eyelid ectropion, corneal exposure, or Medpor LES displacement and exposure occurred during follow-up. ConclusionMedpor LES combined with the lateral tarsal-strip procedure has good effectiveness for reconstruction of eyelid closure function in most cases of paralytic lagophthalmus after facial palsy.
ObjectiveTo describe a technique of side-to-side anastomosis of distal end of sequential vein grafts to small target arteries in coronary artery bypass grafting (CABG) and evaluate its clinical outcomes. MethodsTwelve patients received side-to-side anastomosis at distal end of sequential vein grafts during off-pump CABG in Beijing Anzhen Hospital between October 2012 and March 2013. There were 7 male and 5 female patients with their age of 68.0±3.6 years. To evaluate clinical outcomes of the technique,intraoperative graft blood flow,pulsatility index (PI) and postoperative echocardiography and electrocardiography were examined. ResultsAll the 12 patients successfully received off-pump CABG. Mean graft flow and PI near the distal end anastomosis were 21.1±8.6 ml/min and 2.1±1.0,respectively. Four patients who initially received end-to-side anastomosis underwent revision into side-to-side anastomosis intraoperatively,whose graft flow increased from 2 ml/min,7 ml/min,3 ml/min and 5 ml/min to 10 ml/min,32 ml/min,13 ml/min and 23 ml/min respectively,and whose PI decreased from 18.2,7.1,12.6 and 13.4 to 2.2,0.9,1.8 and 2.8,respectively. Distal end of target arteries were all posterior descending artery. The number of bypass grafts was 4.0±0.7. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome,malignant arrhythmias or perioperative myocardial infarction in this study. ConclusionSide-to-side anastomosis of distal end of sequential vein grafts to small target arteries in off-pump CABG can produce higher anastomotic patency. Long-term follow-up outcomes of this technique are needed before widely clinical application.
ObjectiveTo evaluate immediate outcomes of 8-0 Prolene sutures for distal anastomosis during off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 101 patients who underwent OPCAB in Department of Cardiac Surgery of Beijing Anzhen Hospital in 2010 and 2012 respectively were enrolled in this study. There were 87 male and 14 female patients with their age of 46-82 (61.35±8.24)years. All the 36 patients in 2010 received 7-0 Prolene sutures for distal anastomosis, and the 65 patients in 2012 received 8-0 Prolene sutures for distal anastomosis. After anastomosis, transit time flow measurement was used to measure blood flow indexes of graft vessels[left internal mammary artery (LIMA)and saphenous vein (SV)] including blood flow volume (BFV), pulsatility index (PI)and diastolic filling fraction (DF), which were compared between patients receiving 7-0 and 8-0 Prolene sutures. ResultsBFV of LIMA grafts with 8-0 Prolene sutures (n=44)was significantly larger than that with 7-0 Prolene sutures (n=30)[ (33.70±21.13)ml/min vs. (27.50±17.34)ml/min, P=0.032], while PI of LIMA grafts with 8-0 Prolene sutures was significantly smaller than that with 7-0 Prolene sutures (2.15±0.69 vs. 2.58±1.01, P=0.047). BFV and PI of SV grafts with 8-0 Prolene sutures (n=21) were not statistically different from those with 7-0 Prolene sutures (n=6)[ (34.19±16.00)ml/min vs. (29.00±15.48)ml/min, P > 0.05;2.07±0.53 vs. 1.95±0.55, P > 0.05]. DF of all the grafts was greater than 50%, and there was no statistical difference in DF between the 2 groups (P > 0.05). Conclusion8-0 Prolene sutures for LIMA-to-left anterior descending artery can improve BFV and decrease PI of LIMA grafts, which reflects better immediate graft patency of the distal anastomosis and helps improve surgical success rate and long-term prognosis.
ObjectiveTo explore the incidence of total occlusion of right coronary artery (RCA)and its treatment strategy during off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 1 153 patients with total RCA occlusion were chosen from 6 206 patients who underwent OPCAB in Beijing Anzhen Hospital from January 1, 2005 to December 31, 2012. There were 889 male (77.1%)and 264 female (22.9%)patients with their age of 45-78 years. The incidence of total RCA occlusion was calculated, and its treatment strategies were discussed. ResultsAmong 6 206 OPCAB patients, 1 153 patients (18.6%)had total RCA occlusion. All the 1 153 patients successfully received OPCAB, but 13 patients (1.1%)died postoperatively. Thirty-four patients (2.9%)had postoperative complications including cerebral infarction, mild to moderate pleural effusion and poor wound healing, all of whom were cured or improved, and all the other patients were discharged uneventfully. A total of 1 110 patients (97.4%)were followed up for 1 month to 7 years, and 30 patients were lost during follow-up. Angina symptoms disappeared in 758 patients and were relieved in 352 patients. During follow-up, 64-row helical CT of 586 patients with preoperative total RCA occlusion showed good graft patency, and echocardiography and nuclear myocardial scan showed improved left ventricular systolic function and myocardial blood flow. ConclusionThe incidence of total RCA occlusion is 18.6% in our study. Appropriate surgical strategies are needed according to individualized patient conditions to get satisfactory clinical outcomes.
ObjectiveTo comprehensively review the status quo, contents, and problems of health technology assessments (HTAs) on cardiovascular and cerebrovascular diseases in Chinese rural. MethodsThe CNKI, VIP, WanFang Data and CBM databases were searched for the HTAs on cardiovascular and cerebrovascular diseases in Chinese rural up to October 31st, 2013. Two reviewers independently screened literatures and extracted data, and then the qualitative method was used to systematically analyze the literatures' information and results. ResultsA total of 34 studies were included. Of which, 23 were descriptive studies and 11 were experimental studies. The studied populations were patients and ordinary residents who had received the service of cardiovascular and cerebrovascular diseases health technology in rural, as well as the grassroots medical technical personnel and promotion staffs who had developed the health technologies. HTAs on cardiovascular and cerebrovascular diseases in rural mainly included western medicine health technologies and traditional Chinese medicine (TCM) health technologies. The contents of HTA of the included literatures mainly included:effectiveness, acceptability, requirements, economic characteristics, safety and technical specific property. The results of the included literatures showed that the type of diseases involved in cardiovascular and cerebrovascular diseases in rural were not widely enough, the fields involved in assessment contents were single, lack of rigorous and comprehensive study design. ConclusionWe need more HTAs of cardiovascular and cerebrovascular diseases in rural, we also need to strengthen early prevention, promote a wider range of cardiovascular and cerebrovascular diseases health technology, strengthen promotion and application of both TCM health technologies and the combination of TCM and western medicine health technologies in cardiovascular and cerebrovascular diseases.
ObjectiveTo investigate Chinese psychiatrists' mental health. MethodsLiteratures published from January 1989 to March 31, 2013 were searched through Chinese network databases (CNKI, Weipu, Wanfang) and English network database (OVID). Factors of Symptom checklist-90 (SCL-90) were extracted and compared with Chinese norm. These were analyzed by Meta analysis method. ResultsEleven articles were obtained and analyzed, including 725 psychiatrists. The research illustrated that the differences between psychiatrists and Chinese norm of somatization[WMD=0.19, 95%CI (0.05, 0.33), P=0.008], depression[WMD=0.25, 95%CI (0.06, 0.43), P=0.009], anxiety[WMD=0.28, 95%CI (0.09, 0.47), P=0.004], hostility[WMD=0.15, 95%CI (0.01, 0.30), P=0.03], and phobia[WMD=0.11, 95%CI (0.02, 0.20), P=0.02] were significant, while the other 4 factors were not significant (P>0.05). ConclusionPsychiatrists' mental health is poor and intervention measures need to be adopted to improve psychiatrists' mental health.
ObjectiveTo compare mid-to long-term outcomes of selective coronary venous bypass grafting (SCVBG) using internal mammary artery (IMA) grafts and great saphenous vein (GSV) grafts for surgical treatment of diffuse right coronary artery atherosclerosis. MethodsWe retrospectively analyzed clinical data of 75 patients undergoing SCVBG in Beijing Anzhen Hospital from January 2003 to December 2012. GSV was used as grafts for SCVBG in 54 patients (GSV group), and IMA was used as grafts for SCVBG in 21 patients (IMA group). All the patients were followed up in November 2013. Their survival condition, recent relapse rate of angina, recent echocardiographic results and coronary CT angiography (CTA) were analyzed. ResultsOverall survival rate of IMA group was slightly higher than that of GSV group (100.0% vs. 83.3%), but survival curves showed no statistical difference in survival rate between the 2 groups (P=0.055). Coronary CTA showed significant blockage in GSV grafts and middle cardiac vein in patients in GSV group (n=39), while IMA grafts and middle cardiac vein in patients in IMA group (n=18) were mostly visible and patent (P < 0.001). Left ventricular ejection fraction (LVEF) of the 2 groups were significantly higher than preoperative values, but there was no statistical difference between the 2 groups. ConclusionCompared with SCVBG using GSV, SCVBG using IMA can significantly improve mid-to long-term patency of the grafts and middle cardiac vein, and is an efficacious procedure for diffuse right coronary artery atherosclerosis.
ObjectiveTo investigate the prevalence of subclinical hypothyroidism (SCH) in health check-up population of West China Hospital of Sichuan University from 2011 to 2012 and to discuss the relationship between SCH and metabolic syndrome (MS). MethodsThose who received thyroid function tests and health examination in the West China Hospital of Sichuan University from 2011 to 2012 were enrolled in the study. The data of medical history, blood pressure, height, weight, thyroid function, TG, HDL-C, FPG were collected. All data were analyzed by SPSS 18.0 software. ResultsA total of 11 976 persons (7 488 male and 4 488 female) received thyroid function tests. There were 1 820 persons (884 males and 936 females, 15.20%) who suffered from SCH. The SCH prevalence was significantly higher in females (20.86%) than that in males (11.81%) (P < 0.01). The people over 60 years old had the highest SCH prevalence. There were 1 145 persons (1 005 males and 140 females) suffered from MS among all 11 976 persons. The MS prevalence was significantly higher in males (13.42%) than that in females (3.12%) (P < 0.01). The SCH prevalence of the MS group was higher, which in the health group was lower (P < 0.01). The TSH level in the MS group was higher, while it was lower in the health group. ConclusionThe prevalence of SCH is higher in health check-up population; and SCH apparently increases the risk of morbidity of MS.
ObjectiveTo investigate the health technologies on diabetes prevention and management used in rural China and the assessment results of these health technologies, and to provide references for the selection and using of health technologies on diabetes prevention and management in rural China. MethodsWe searched VIP, CNKI, CBM and WanFang Data to collect survey studies and assessment reports of health technologies on diabetes prevention and management in rural China. The search date was up to July 15th, 2014. Two reviewers independently screened literature, and then the qualitative analysis was performed for the included studies. ResultsA total of 15 studies were included. The results of qualitative analysis showed that:the targeted populations were patients and ordinary villagers who had received the service or treatment of diabetes health technology in rural, as well as the grassroots medical technical personnel and promotion staffs who had developed the health technologies. Diabetes health technology studies in rural mainly included medical personnel health technology related knowledge training. The contents of health technology assessment involved effectiveness, acceptability, economic characteristics, requirements and technical specific property. ConclusionThere was limited researches on the investigation and analysis of health technologies on diabetes prevention and management in rural China, and evaluation content remains insufficient.