Objective To introduce a new type of bileaflet mechanical prosthetic heart valve （GK bileaflet valve）and evaluate clinically the early hemodynamic effect and short term follow-up after its replacement. Methods Sixty-one patients with heart valve diseases were operated upon. The mitral valve replacement was performed in 34 patients, aortic valve replacement in 16 patients and double valve replacement in 11 patients. A total of 72 GK bileaflet mechanical valves were implanted, 45 in mitral position, and 27 in aortic position. Blood consistency and hemodynamics were monitored. Follow-up was carried out routinely to check whether there were some valve-related complications. Results There was no early mortality （〈30 d）. Only one patient died of trauma 2 months after the operation. Follow-up was 100% and extended 1 to 2. 5 years. Without valve-related complications all patients had lived for more than 1 to 2.5 years. In 98% （60/61） of survivors heart functional performance had improved to New York Heart Association class Ⅰ or Ⅱ . Conclusion Early clinical results and short term follow up demonstrate that GK bileaflet prosthetic heart valve exhibits excellent hemodynamic properties, satisfied blood consistency and a low incidence of valve-related complications. Midterm and long-term results should be observed further.
OBJECTIVE To explore the pathogenic mechanism of intrinsic muscle contracture after replantation of severed palm or wrist, and put forward the prevention and treatment methods. METHODS From 1985 to 1997, 48 cases were received replantation of severed palm or wrist, among them, 9 cases with thumb adductor contracture and 6 cases with intrinsic muscle contracture were occurred in different degree. Two cases with mild thumb adductor contracture were received conservative treatment, and 7 cases with moderate thumb adductor contracture and 6 cases with intrinsic muscle contracture were received operative treatment. The pathogenic mechanism, clinical results, and prevention methods were studied in those 15 cases. RESULTS The postoperative function recovery was better in 4 cases, moderate in 5 cases with thumb adductor contracture, and better in 3 cases, moderate in 1 case with intrinsic muscle contracture, and moderate in 1 case, poor in 1 case with intrinsic muscle contracture of cord-like induration. Followed up 1 to 10 years, no recurrence was observed in all of 15 cases. The incidence and degree of thumb adductor contracture and intrinsic muscle contracture were closely related to the ischemia time of replanting graft. CONCLUSION Prevention of thumb adductor contracture and intrinsic muscle contracture is most important in severed palm or wrist replantation. When the ischemia time of replanting graft is longer than 12 hours, the effective decompression in myofascial compartment is performed in time to reach satisfactory result.
Objective To estimate the efficacy and tolerability of combination of Amlodipine and different angiotensin-converting enzyme inhibitors (ACEIs) in comparison with Amlodipine monotherapy in the treatment of hypertension. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), PubMed, MEDLINE, EMbase, CBM, and CNKI (from their inception to August 2009) for relevant studies. Two reviewers independently retrieved randomized controlled trials (RCTs) according to the inclusion and exclusion criteria, assessed the methodological quality of included trials, and extracted data. Meta-analysis was performed by Stata 10.0 soft. Results Seventeen RCTs involving 3 291 patients were ultimately identified. The results of meta-analyses showed combination had a greater systolic blood pressure reduction (WMD=5.72, 95%CI 4.10 to 7.33, P=0.016) and diastolic blood pressure reduction (WMD=3.62, 95%CI 4.85 to 2.39, P=0.000) than monotherapy. Combination had fewer overall adverse events (RR=0.86, 95% CI 0.75 to 0.99) than that of monotherapy. Conclusion The results of meta-analyses indicate that combination provides a superior blood pressure control to that of monotherapy and has fewer adverse events and better tolerability in hypertensive patients.
【摘要】 目的 调查胃癌患者的营养风险及营养支持应用现状。 方法 2009年9月-2010年1月，对某三甲医院普外科收治的120例胃癌住院患者营养情况进行营养风险筛查2002（nutritional risk screening 2002，NRS 2002）评估，并就营养支持应用方式进行分析。 结果 所有患者中营养不足和营养风险的发生率分别为11.7%和27.5%；在33例有营养风险患者中，有26例（78.8％）接受了营养支持；在无营养风险的87例患者中，有30例（34.5％）接受了营养支持。 结论 对有营养风险的患者进行必要的营养支持，对于减少患者住院期间感染性并发症或其他不良临床结局的发生有积极作用。NRS 2002的方法简便，适用于胃癌患者的营养风险筛查，但医护人员需要进一步加强对肠外、肠内营养指南的认识。【Abstract】 Objective To investigate the clinical situation of nutritional risk screening for hospitalized patients with gastric cancer. Methods From September 2009 to January 2010, we applied nutrition risk screening 2002 (NRS 2002) to investigate the nutritional status of 120 hospitalized gastric cancer patients in the surgery department of a tertiary hospital, and analyzed the way of nutritional support for these patients. Results Among all the patients, the incidences of undernutrtion and nutritional risk were respectively 11.7% and 27.5%. Twenty-six out of the 33 nutritional risk patients received nutrition support, and 30 out of the 87 patients without nutritional risk received nutrition support. Conclusions Nutritional support for patients with nutritional risk is important in decreasing the occurrence of in-hospital infectious complications and other bad clinical outcomes. NRS 2002 is a simple and easy tool for predicting the nutrition risk in hospitalized gastric cancer patients, but the guideline of enteral nutrition and parenteral nutrition must be reinforced among doctors and nurses.
ObjectiveTo summarize the results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibody, total antibody and cellular immune function of COVID-19 convalescent patients one year after discharge, and to analyze the correlation between the SARS-CoV-2 antibody and the indexes of immune function. MethodsA total of 41 confirmed COVID-19 patients discharged from Chengdu Public Health Clinical Medical Center from January to April 2020 and followed up one year after discharge were included in the study as the research group, including 18 males and 23 females with an average age of 47.83±12.95 years. The results of SARS-CoV-2 IgG, total antibody and immune function indexes one year after discharge were collected in order to discuss the correlation of SARS-CoV-2 and cellular immune function. A total of 40 healthy employees of the hospital vaccinated against COVID-19 were randomly selected as the vaccine group, including 10 males and 30 females with an average age of 43.90±6.86 years. The SARS-CoV-2 antibodies between the two groups were compared. ResultsCD8+T cell count was higher and CD4+T/CD8+T was lower in male patients than those in female patients (all P<0.05). The IgG and total antibodies in patients with re-detectable positive RNA test were both higher than those in patients without re-detectable positive RNA test, but the differences were not statistically significant (P=0.158, 0.060). The positive rate of SARS-CoV-2 IgG in the research group was 80.5% (33/41). SARS-CoV-2 IgG was positively correlated with total antibody (P<0.001). There was a positive correlation between CD4+T cell count and SARS-CoV-2 IgG (r=0.455, P=0.003). The positive rate of SARS-CoV-2 IgG, SARS-CoV-2 IgG amount and total antibody amount in the research group were significantly higher than those in the vaccine group (all P<0.001). ConclusionSARS-CoV-2 IgG of most COVID-19 patients one year after discharge is positive, and their SARS-CoV-2 total antibody is significantly higher than people vaccinated against COVID-19, which suggests that patients infected with SARS-CoV-2 can obtain lasting protection, but the protection may be gradually weaken over time. The degree of antibody attenuation in patients with re-detectable positive RNA test may be weaker. In the convalescence stage, the dynamics of SARS-CoV-2 IgG may be closely related to cellular immune function.