Objective To investigate the knowledge level of Chinese cardiac surgeons regarding the management of infective endocarditis (IE), in order to identify the gap between clinical practices and the latest guidelines, and provide evidence-based support for improving the clinical management of IE. Methods A nationwide survey was conducted through an online questionnaire from December 5, 2024, to December 31, 2024. Descriptive analysis of the survey data was performed. Results A total of 67 valid responses were received from 18 provincial-level administrative divisions across China. While 56.7% (38/67) of respondents demonstrated familiarity with the modified Duke criteria, only 43.3% (29/67) comprehended the 2023 Duke- International Society of Cardiovascular Infectious Diseases criteria. Conversely, 43.3% (29/67) exhibited limited understanding of the former, and 56.7% (38/67) showed deficient knowledge of the latter diagnostic standards. Only 46.3% (31/67) reported proficiency in current IE management guidelines/consensus. Regarding surgical timing, 26.9% (18/67) advocated intervention within 7-14 days of antimicrobial therapy, 22.4% (15/67) during 14-28 days, and 10.5% (7/67) beyond 28 days. Notably, a significant proportion of respondents opted for delayed surgical intervention beyond guideline recommendations when managing patients with heart failure, uncontrolled infection, or neurological complications. Conclusion A knowledge gap and practice discrepancies exist among Chinese surgeons regarding the management of IE. There is an urgent need to promote updated concepts regarding surgical indications and timing for IE in order to optimize treatment strategies and improve patient prognosis.
Objective To find out the best time and investigate the indications for conversion to horacotomy in completely thoracoscopic lobectomy. Methods Between Sep. 2006 and Feb. 2009, 172 patients including 88 male and 84 female with the median age of 58.9 years, underwent completely thoracoscopic lobectomy. Postoperative pathology showed that there were 133 cases of primary lung cancer, 7 cases of lung cancer metastasis and other malignant tumors, and 32 cases of benign diseases. Among them, 46 patients had the tumor on the right upper lobe (RUL), 23 on the right middle lobe (RML), 31 on the right lower lobe (RLL), 36 on the left upper lobe (LUL) and 36 on the left lower lobe (LLL). Three incisions were made in all operations. The procedures of systematic lymphadenectomy and anatomic lobectomy were similar with routine thoracotomy. If there was mediastinal lymph node adhesion, metastasis or bleeding, the incision would be extended to 12-15 cm and the surgery would be converted to thoracotomy. According to whether the maximum tumor dimension was above 5 cm or under 3 cm, the patients were divided into two groups. At the same time, we also divided the patients into two groups based on whether thoracotomy was performed. The data of both two groups were compared respectively. Results All surgeries were carried out safely with no serious complications or perioperative deaths. The average surgical duration was 185 minutes, and the average blood loss was 213 ml. Thirteen operations were converted to thoracotomy with a conversion rate of 7.6%. Among them, 9 were interfered by lymph nodes and bleeding happened in 4 operations. Lobectomy was performed on 12 patients and pneumonectomy was performed on 1 patient after thoracotomy. For the 16 cases of tumor with its dimension larger than 5 cm, the average operation time was 187 minutes and the average blood loss was 203.8 ml, while for the 98 cases of tumor with its dimension smaller than 3 cm, the average operation time was 202 minutes and the average blood loss was 231.3 ml. The difference between these two groups was not statistically significant. Among the 13 cases of conversion to thoracotomy, the mean age of the patients was 68.7 years old and the average tumor dimension was 23.8 mm. For the 159 cases without thoracotomy, the average age was 59.3 years old and the tumor dimension averaged 27.8 mm. There was a significant difference between them (P=0.016). Conclusion Interference by lymph nodes and bleeding are the most important causes of conversion to thoracotomy in completely thoracoscopic lobectomy while size of tumor, fused fissure or plural adhesions can be always managed thoracoscopically.
ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset timelt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （Pgt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.
Obesity is a disease state characterized by the accumulation of abnormal or excessive fat that threatens human health. With the rapid development of the economy and society and the change in lifestyle, obesity is highly prevalent in our country and has become an important disease that threatens the health of the population. Different from traditional non-surgical treatments, metabolic and bariatric surgery has a definite curative effect, is not easy to rebound, has good safety, and has sufficient evidence of clinical benefit, which can make many obese patients, especially those with moderate to severe obesity, fully recover. The treatment of obesity has become an important means in the comprehensive treatment of obesity. This article intends to describe the application of bariatric metabolic surgery in the comprehensive treatment of obesity from three aspects: bariatric surgery indications, surgical method selection, and perioperative multidisciplinary intervention.
ObjectiveTo review the advances in the diagnosis and treatment of obstetric brachial plexus palsy (OBPP). MethodsThe incidence, risk factors, classification, and imaging tests of OBPP and indication, technique, and results of surgery were reviewed and summarized. ResultsThe incidence of OBPP is not declining in recent years. Birth weight of ≥4 kg, forceps delivery, and prepregnancy body mass index of ≥21 are considered to be major risk factors, and caesarean section delivery seems to be a protective factor. Neurophysiological investigations can be applied to qualitative diagnosis of OBPP, but can not to quantitative one. Sensitivity and specificity of both CT and MRI myelography are about 0.7 and 0.97, respectively. Narakas classification is widely used:C5, 6 injury as type I, C5-7 injury as type Ⅱ, C5-T1 injury as type Ⅲ, C5-T1 injury with Horner's syndrome as type IV. It is generally considered that the brachial plexus exploration should be undertaken for infants without spontaneous recovery of elbow flexion by a maximum of 3 months old; and 10% to 30% of patients may need nerve reconstruction surgery. It is advocated that traumatic neuroma of the upper trunk should be resected with nerve reconstruction. The final evaluation for surgical results should be at minimal 4 years for upper roots and 8 years for total roots. Scales of Mallet, Gilbert, and Raimondi are mostly used for assessing shoulder function, elbow function, and hand function. ConclusionBrachial plexus exploration should be undertaken for infants without flexion of elbow at the age of 3 months. Traumatic neuroma (even neuroma-in-continuity) resection followed by microsurgical reconstruction of the brachial plexus is favored.
To standardize the treatment of secondary hyperparathyroidism and effectively meet the needs of practical clinical work, we gathered experts and nursing experts from Departments of Thyroid Surgery, Nephrology, Endocrinology and Metabolism, Nuclear Medicine, Ultrasound, Anesthesiology, Cardiology, and other departments at West China Hospital of Sichuan University to solicit opinions. This consensus was finally established based on published guidelines and the best evidence in Chinese and English combined with clinical practice. This consensus is intended to summarize and conclude, to the greatest extent possible, the practical issues encountered in diagnosing and treating secondary hyperparathyroidism in perioperative settings and to provide recommendations for clinical practice.
Objective To approach the convenient prediction methods about surgical indications of adhesive ileus. Methods Two thousand and thirtyfour patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery, The First Affiliated Hospital of Anhui Medical University， and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions, including period of intestinal obstruction (X1), frequency of attack (X2), history of operation on abdominal region (X3), continuous and severe abdominal pain (X4), severe or frequent vomiting (X5), severe abdominal distention (X6), hemafecia (X7), fever (X8), heart rate (X9), shock or hypotension (X10), touching a swell ansa intestinalis (X11), hypoactive bowel sound (X12), peritonitis (X13), white blood cell (WBC) count of peripheral blood (X14), obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film (X15), peritoneal cavity free air (X16), and seroperitoneum whether or not by B ultrasonic examination (X17) were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis. Results Eight items were included in the prediction model by the method of forward stepwise which were X1, X2, X4, X9, X13, X14, X15, and X17, respectively. The probability of operation could be calculated by the following formula: logit(P)=expZ/（1+expZ）, where, Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17}， which X1（1）, X1（2）, and X1（3） were periods of intestinal obstruction 3－5 d, 5－7 d, and ≥7 d, respectively. X9(1) and X9(2) were heart rates of 60－100/min and ≥100/min, respectively. X14(1) and X14(2) were WBC counts of peripheral blood of (10-20)×109/L and ≥20×109/L， respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%, sensitivity was 96.17%, specificity was 99.53% in 1 992 patients. The coincidence was 96.20%, sensitivity was 90.00%, specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital. Conclusion The prediction schedule is a good useful value, but the coefficients is corrected following the cases increasing.
Abstract： Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.