Along with the coming of aged society, the prevalence of heart valvular disease is significantly increasing, and the use of bioprosthetic valves for treating patients with severe valve disease has increased over the last two decades. As a consequence, a growing number of patients with surgical bioprosthesis degeneration is predicted in the near future. In this setting, valve-in-valve (ViV) transcatheter aortic/mitral valve replacement (TAVR/TMVR) has emerged as an alternative to redo surgery. A deep knowledge of the mechanism and features of the failed bioprosthetic heart valve is pivotal to plan an adequate procedure. Multimodal imaging is fundamental in the diagnostic and pre-procedural phases. The immediate and mid-term clinical and hemodynamic results have demonstrated the safety and feasibility of ViV techniques, but the development of these techniques faces several specific challenges, such as coronary obstruction, potential post-procedural mismatch and leaflet thrombosis. This article reviews the current status and prospects of ViV-TAVR technology in the treatment for biological valve degeneration, and suggests that ViV-TAVR should be promoted and implemented in existing medical centers with good surgical aortic valve replacement experience, so as to provide better treatment for patients.
目的:研究地震对非伤员的其他内外科危重患者急诊医疗的影响。方法:采用病例对照研究方法,研究和分析汶川地震发生前后一周急诊科内外科危重患者情况。结果:地震后内外科危重患者数量明显减少,转诊患者和救护车来诊比例降低,但抢救患者比例增加,优化处理流程后急诊诊疗时间明显缩短。结论:虽然地震期间急诊科内外科危重患者总量减少,但存在抢救患者比例增加和院前急救资源减少的问题。应该重视这部分患者的急救医疗需求以及优化处理流程。
Objective To build a score with the coagulation, inflammation indexes of sepsis patients, named Sepsis-Related Coagulo-Inflammatory Score (SRCIS), and then evaluate the prognostic capability of it in predicting the 28-day mortality of septic patients after the diagnosis. Methods In this prospective nested case-control study, we recruited septic patients according to the Sepsis 3.0 standards, who visited the Emergency Department, West China Hospital of Sichuan University from September 2017 to January 2018. Multiple factor analysis was conducted to confirm which coagulation or inflammation biomarkers were independent risk factors related to the 28-day mortality after their diagnosis. After that, the SRCIS was built based on those independent risk factors. Finally, receiver operating characteristic curve (ROC) analysis was conducted to verify its prognostic capability for the 28-day mortality of septic patients. Results A total of 123 cases were included. Among them, 17 patients died within 28 days, and the mortality rate was 13.8%. There were no significant differences in the demographic characteristics or comorbidities between the survival group and dead group (P>0.05). Multivariate logistic analysis showed that both activated partial thromboplastin time (APTT) [odds ratio (OR)=1.015, 95% confidence interval (CI) (1.017, 1.189), P=0.017] and C-reactive protein (CRP) [OR=1.100, 95%CI (1.006, 1.025), P=0.002] were independent risk factors for predicting the 28-day mortality of septic patients. ROC analysis indicated that the cut-off values of APTT and CRP predicting the 28-day mortality rate of sepsis were 39.25 seconds and 198.05 mg/L, respectively, and the areas under the curve (AUC) of them were 0.618 and 0.671, respectively. The results indicated that the mortality increased from 8.79% to 28.13%, when APTT prolonged to no less than 39.25 seconds (P<0.05). The mortality also increased from 8.89% to 27.27% when CRP elevated to no less than 198.05 mg/L (P<0.05). The AUC of SRCIS in predicting the 28-day mortality of patients with sepsis was 0.707, which was better than that of Sequential Organ Failure Assessment (SOFA) (AUC=0.681) and quick Sequential Organ Failure Assessment (qSOFA) (AUC=0.695). The corresponding 28-day mortality rates for patients with sepsis were 6.94%, 16.22%, and 42.86% (P<0.05), respectively, when the SRCIS score were 0, 1, and 2. Conclusions APTT and CRP are independent risk factors in predicting the 28-day mortality of patients with sepsis. Compared with traditional scoring systems such as SOFA and qSOFA, SRCIS performances better in predicting the 28-day mortality for patients with sepsis.
ObjectiveTo investigate the risk factors affecting the 28-day neurological outcome after admission of patients with sepsis complicated with consciousness disorder, create a simple scoring system, and evaluate its predictive value for the poor neurological outcome.MethodsWe retrospectively collected and analyzed the demographic data, clinical data, 28-day survival status and neurologic outcome of patients with sepsis complicated with disturbance of consciousness admitted to the Emergency Department of West China Hospital of Sichuan University between June 1st, 2017 and May 31st, 2018. Independent risk factors for the 28-day neurologic outcome of patients with disturbance of consciousness were obtained through univariate analyses and multiple logistic regression analysis, and then the continuous variables of risk factors were converted to binary variables according to the cut-off values from receiver operating characteristic (ROC) curve analysis, a simple scoring system was established and it’s predictive value for 28-day neurological outcome of patients with sepsis complicated with consciousness disorder was assessed.ResultsA total of 149 patients with sepsis complicated with consciousness disorder were included in this study, including 103 males (69.1%) and 46 females (30.9%), with an average age of (58.2±18.6) years old. There were 72 patients (48.3%) with poor outcome of neurological function on Day 28 after admission. Multiple logistic regression analysis revealed that total bile acid [odds ratio (OR)=1.040, 95% confidence interval (CI) (1.004, 1.077), P=0.027], blood ammonia [OR=1.014, 95%CI (1.001, 1.027), P=0.030], pulmonary infection [OR=3.255, 95%CI (1.401, 7.566), P=0.006], and Glasgow Coma Score (GCS) [OR=0.837, 95%CI (0.739, 0.949), P=0.005] were independent influencing factors for the poor neurological function in patients with sepsis complicated with consciousness disorder on Day 28 after admission. The area under the ROC curve predicting the 28-day poor neurological function was 0.754 [95%CI (0.676, 0.832)], and the sensitivity and specificity were 79.2% and 63.6%, respectively.ConclusionFor emergency patients with sepsis complicated with consciousness disorder, a simple scoring system based on early GCS, pulmonary infection, serum ammonia, and total bile acid has a favorable predictive value for short-term neurological function.
ObjectiveTo investigate the clinical features and influencing factors for new-onset atrial fibrillation (AF) early after coronary artery bypass grafting.MethodsThe clinical data of 339 patients undergoing coronary artery bypass grafting in our hospital from January 2012 to January 2019 were retrospectively analyzed. There were 267 males and 72 females with an average age of 37-83 (58.03±8.90) years. The clinical features and influencing factors for new-onset AF after surgery were investigated.ResultsThere were 234 patients of off-pump coronary artery bypass grafting (OPCABG), with 36 (15.4%) new-onset AF patients after operation, among whom 16.1% were males and 12.5% were females. There were 105 patients of on-pump coronary artery bypass grafting (CABG), with 39 (37.1%) new-onset AF patients, among whom 40.7% were males and 25.0% were females. The incidence was higher after the CABG surgery than that after the OPCABG surgery (37.1% vs. 15.4%, P<0.05). There was no statistical difference in the incidence rate between males and females (P>0.05). The incidence of new-onset AF after surgery was higher in ≥60 years patients for both operations (18.9% and 45.8%), which was significantly higher than that in <45 years patients (P<0.05). For both operations, the incidence of new-onset AF after surgery was high on the second day (24-48 h) after surgery, and most of the AF lasted for 1 day (P<0.05). The hypertension (OR=4.983, P=0.036), frequent premature atrial contraction or atrial tachycardia (OR=17.682, P=0.002), postoperative creatine kinase isoenzyme MB (CKMB) (OR=0.152, P=0.042), left anterior and posterior diameters (OR=17.614, P<0.001) and preoperative ejection fraction (OR=7.094, P=0.011) were influencing factors for new-onset AF after OPCABG. Diabetes (OR=11.631, P=0.020), other cardiac malformations (OR=29.023, P=0.002), frequent premature ventricular contraction or ventricular tachycardia (OR=0.047, P=0.001), and postoperative CKMB (OR=3.672, P=0.040) were influencing factors for new-onset AF after CABG.ConclusionThe incidence of new-onset AF after CABG is higher than that after OPCABG, and it increases with age increasing. There is no difference in the incidence between males and females. The influencing factors for the two operations are different.
ObjectiveTo investigate the prognostic value of acute kidney injury (AKI) in patients with severe pneumonia complicated with sepsis.MethodsWe retrospectively analyzed the demographic data, vital signs, laboratory examination and other data of 462 patients with severe pneumonia complicated with sepsis in the Department of Emergency West China hospital, Sichuan University from July 2015 to June 2016, as well as the 7-day and 28-day mortality, 28-day mechanical ventilation rate and 28-day intensive care unit (ICU) hospitalization rate. Multivariate logistic regression analysis was used to determine the correlation between AKI and 28-day mortality in patients with severe pneumonia complicated with sepsis at admission.ResultsA total of 462 patients with severe pneumonia complicated with sepsis were retrospectively enrolled in this study. AKI patients at admission had a higher proportion of 7-day (24.6% vs. 9.7%, P<0.001) and 28-day mortality (44.3% vs. 21.2%, P<0.001), 28-day mechanical ventilation rate (63.9% vs. 45.9%, P=0.009) and 28-day ICU admission rate (65.6% vs. 39.4%, P<0.001) than non-AKI patients. There was a significant difference between the two groups (P<0.05). The scores of systemic infection-related organ failure assessment and acute physiology and chronic health evaluationⅡof AKI patients at admission were significantly higher than those of non-AKI patients at admission (P<0.05). Multivariate logistic regression analysis showed that AKI at admission was an independent risk factor for 28-day mortality in patients with severe pneumonia complicated with sepsis [odds ratio: 2.266, 95% confidence interval (1.058, 4.854), P=0.035].ConclusionAKI at admission is helpful for identifying high-risk pneumonia patients complicated with sepsis, and thus may guide the clinical managements of precise medicine.
American Heart Association issued American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2020. A sixth link, recovery, has been added to both the adult out-of-hospital cardiac arrest chain and in-hospital cardiac arrest chain in this version of the guidelines to emphasize the importance of recovery and survivorship for resuscitation outcomes. Analogous chains of survival have also been developed for adult out-of-hospital cardiac arrest and in-hospital cardiac arrest. The major new and updated recommendations involve the early initiation of cardiopulmonary resuscitation by lay rescuers, early administration of epinephrine, real-time audiovisual feedback, physiologic monitoring of cardiopulmonary resuscitation quality, double sequential defibrillation not supported, intravenous access preferred over intraosseous, post-cardiac arrest care and neuroprognostication, care and support during recovery, debriefings for rescuers, and cardiac arrest in pregnancy. This present review aims to interpret these updates by reviewing the literature and comparing the recommendations in these guidelines with previous ones.