Objective To summarize the characteristics and management of pregnancy complicated with aortic dissection, and to explore the reasonable diagnosis and treatment plan. Methods The clinical data of 10 patients of pregnancy complicated with aortic dissection in Wuhan Tongji Hospital from January 2011 to June 2017 were collected. Their age was 25.2 (21-29) years. Results In the 10 patients, the majority (8 patients) were primipara, and most of them were in the late stages of pregnancy (5 patients) and puerperal (4 patients). Among them, 1 patient had gestational hypertension, and the blood pressure of the left and right upper extremities was significantly abnormal (initial blood pressure: left upper limb blood pressure: 90/60 mm Hg, right upper limb blood pressure: 150/90 mm Hg). The major clinical manifestations were severe chest and back pain which happened suddenly, with D-dimmer and C-creative protein increased which may be associated with inflammatory reaction. All patients were diagnosed by thoracoabdominal aortic CTA, including 5 patients of Stanford type A dissection and 5 patients of Stanford type B dissection. In the 10 patients, 1 patient refused surgery and eventually died of aortic rupture with the death of fetus before birth. And the remaining 9 patients underwent surgical treatment, 3 patients of endovascular graft exclusion for thoracic aortic stent graft, 2 patients underwent Bentall operation, 1 patient with Bentall + total aortic arch replacement + vascular thoracic aortic stent graft, 1 patient with Bentall operation combined with endovascular graft exclusion for thoracic aortic stent graft, 1 patient with Bentall + coronary artery bypass grafting, 1 patient of thoracoabdominal aortic vascular replacement. Among them, 1 patient underwent endovascular graft exclusion for thoracic aortic stent graft died of severe postoperative infection, and the remaining 8 patients were discharged from hospital. Nine patients were single birth, among them 5 newborn patients had severe asphyxia, 4 patients had mild asphyxia. Finally, 3 neonates died of severe complications, and the remaining 6 survived. Conclusion The ratio of pregnancy with Stanford type A aortic dissection is far higher than in the general population, the possibility of fetal intrauterine asphyxia is larger, but through active and effective surgical and perioperative treatment, we can effectively save the life of mother and fetus.
Objective To explore the correlation between adverse pregnancy outcomes and previous bearing status. Methods The related information of pregnant and postnatal women was extracted from 6825 hospitalized records in two general hospitals and one special hospital, which were selected by the method of cluster sampling, and the related rate and correlation analyses were calculated. Results Women who had abortion history were much easier to cause adverse pregnancy outcomes compared to those who had no abortion history, with the incidence rates of 16.83% and 13.31%, respectively; the incidence rates of adverse pregnancy outcomes of women who ever had zero, one, and two or more than twice of delivery were 14.14%, 16.34% and 22.78%, respectively; the rates of women on their third or more than third, second, first or zero pregnancy were 49.14%, 18.05%, 14.22% and 12.88%, respectively; and the rates of adverse pregnancy outcomes of women with abnormal and normal gestation history were 31.06% and 14.21%, respectively. Conclusion The previous abortion, delivery times and abnormal gestation history are highly related to adverse pregnancy outcomes. Therefore, in order to reduce adverse pregnancy outcomes, it is necessary to make an effective family planning and decrease abortion and pregnancy.
Objective To compare long-term outcomes following mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for native valve endocarditis (NVE). Methods Between November 1993 and August 2016, consecutive 101 patients with NVE underwent mitral surgery in our department, MVP for 52 patients and MVR for 49 patients. There were 69 males and 32 females at age of 38.1±14.9 years. The mean follow-up was 99.4±75.8 months. Results There was no statistical difference in cardiopulmonary bypass time, aortic cross-clamp time, in-hospital mortality, duration of mechanical ventilation, ICU stay or hospital stay after surgery between the two groups. Survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 97.6%, 97.6% for MVP, and 93.5%, 84.3%, 84.3%, 66.2% for MVR with a statistical difference between the two groups (P=0.018). There was no stroke in the patients with MVP during follow-up periods. However, stroke-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 93.9%, 89.4%, 70.2% for MVR patients with a statistical difference between the two groups (P=0.023). There was no statistical difference in recurrence of infection, perivalvular leakage and reoperation between the two groups. Composite endpoint-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 92.9%, 92.9% for MVP, and 91.3%, 79.6%, 75.8%, 51.0% for MVR with a statistical difference (P=0.006). Conclusion MVP is associated with better outcomes than MVR in the patients with NVE; generalizing MVP technique in the patients with NVE is needed.
ObjectiveTo investigate the incidence, pathogens, risk factors and clinical outcomes for ventilator- associated pneumonia (VAP) in children after tetralogy of Fallot (TOF) surgical correction, in order to offer reliable data for the prevention of VAP.MethodsThis was a retrospective study performed in Guangdong General Hospital and 181 children (121 males, 60 females, mean age of 11.2±10.4 months) undergoing surgical correction for TOF were included. ALL the children who received mechanical ventilation for 48 hours or longer between January 2013 and December 2017 were classified into a VAP group (n=44) and a non-VAP group (n=137). T test, χ2 test and multiple logistic regression analysis were used to identify the possible risk factors for VAP.ResultsThis study enrolled 181 patients , of which 44 were diagnosed as VAP. And the incidence of VAP was 24.3%. The most frequent isolated pathogen was Gram-negative bacteria (69.7%). Single factor analysis showed that the variables significantly associated with a risk factor of VAP were: hypoxic spells, preoperative pneumonia, preoperative mechanical ventilation support, cardiopulmonary bypass (CPB) time, reintubation, pulmonary atelectasis, low cardiac output syndrome (LCOS), intra-abdominal drainage and transfusion of fresh frozen plasma. The multiple logistic regression showed CPB time (OR=1.011), reintubation (OR=14.548), pulmonary atelectasis (OR=6.139) and LCOS (OR=3.054) were independent risk factors for VAP in children after TOF surgical correction. Patients with VAP had prolonged duration of mechanical ventilation, a longer ICU stay and longer hospitalization time.ConclusionsThe VAP rate in this population is higher than that reported abroad, which leads to prolonged duration of mechanical ventilation and a longer hospital stay. The effective measures for prevention of VAP should be taken according to the related risk factors for VAP to decrease the incidence of VAP in children after TOF surgical correction.
ObjectiveTo systematically evaluate the association between passive smoking during pregnancy and adverse birth outcomes in Chinese, as well as to provide evidence for the prevention of adverse birth outcomes. MethodsWe electronically searched the CNKI, VIP, WanFang Data, PubMed and EMbase databases to collected cohort studies about the association between passive smoking during pregnancy and adverse birth outcomes in Chinese. The search date was from January 1st 1980 to 30th August, 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk bias of included studies. Then meta-analysis was performed using RevMan 5.1 software. ResultsA total of 24 studies were included in the meta-analysis. The results of meta-analysis showed that, the passive smoking during pregnancy was associated with increased risks of preterm (RR=1.97, 95%CI 1.38 to 2.80), low birth weight (RR=1.94, 95%CI 1.37 to 2.76), birth defects (RR=2.01, 95%CI 1.58 to 2.56), neonatal asphyxia (RR=3.34, 95%CI 1.76 to 6.33), small-for-gestational age (RR=2.62, 95%CI 1.49 to 4.63), stillbirth (RR=3.10, 95%CI 2.00 to 4.80) and spontaneous abortion (RR=1.37, 95%CI 1.19 to 1.59). ConclusionPassive smoking during pregnancy is associated with increased risks of adverse birth outcomes.
Systematic evaluation of patient-reported outcome measures (PROMs) is crucial for identifying high-quality PROMs for research and clinical practice. It ensures reliable health outcomes data collection. But current PROMs systematic evaluation reports vary in quality and have many defects. To address this, in 2024, the guideline research team updated and published the COSMIN guideline V2.0 for PROMs systematic evaluation and two other tools in the Quality of Life Research. This paper interprets the guideline development team, method, and the core content of the COSMIN guideline V2.0. It also uses specific examples to promote standardized PROMs selection and clinical application, aiming to help domestic researchers improve the quality of such systematic evaluations.
ObjectiveTo evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).MethodsA prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.ResultsSix months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.ConclusionReduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.
Objective To identify the postoperative function and short-term outcome of Global Modular Replacement System (GMRS) for reconstruction of defect after removal of tumor so as to supply information for cl inical appl ication. Methods Between March 2007 and May 2009, 30 l imb-salvage cases reconstructed with GMRS were retrospectively reviewed, including 18 males and 12 females with a median age of 25 years (range, 11-57 years). The preoperative diagnoses were osteosarcoma in 15 cases, mal ignant fibro-histiocytoma in 4, giant cell tumor in 3, chondrosarcoma in 2, and Ewing’s sarcoma and angiosarcoma in 1 respectively. The duration of symptom ranged from 1 to 15 months with an average of 5.6 months. There were 4 revision cases at mean time of 3.4 years after index surgeries. The locations were the proximal femur in 3 cases, distal femur in 22 cases, and proximal tibia in 5 cases. According to Enneking stage, 2 cases were rated as stage IB, 1 as stage IIA, and 27 as stage IIB. Four cases were compl icated by pathologic fracture. Results The average operation time was 165 minutes (range, 120-240 minutes); the mean blood loss was 448.3 mL (range, 100-1 500 mL); and the mean resection length was 14.1 cm (range, 7.5-22.5 cm). All the wounds healed by first intention. All 30 patients were followed up 10-35 months (22.3 months on average). Local recurrence occurred in 2 cases (6.7%) at 5 and 14 months respectively and distal metastasis occurred in 5 cases (16.7%) at 4-12 months (7.3 months on average) postoperatively. One patient died of multiple lung metastases at 10 months postoperatively. Twenty-nine patients survived at last follow-up, including 25 cases of tumor-free survival and 4 cases of tumor bearing survival. Aseptic loosening occurred in 2 cases (6.7%) at 1.5 years and 2 years postoperatively respectively. Deep infection occurred in 1 case (3.3%) at 1 year postoperatively. At last follow-up, the Musculoskeletal Tumor Society (MSTS) 93 scores were 4.6% ± 0.7% for pain, 3.7% ± 0.9% for function, 3.2% ± 1.3% for satisfactory degree, 4.3% ± 0.9% for orthesis, 3.7% ± 0.7% for walking, 3.3% ± 1.0% for gait; total score was 75.9% ± 14.2%. The Toronto Extremity Salvage Score (TESS) score was 87.0 ± 7.0. Conclusion Reconstruction for defect after removal of tumor with GMRS has satisfactory short-term outcome with good function recovery and low compl ication rate.
Objective To observe the clinical effect of minimally invasive vitreoretinal (MIV) surgery combined with a modified suprachoroidal drainage surgery for retinal detachment associated with choroidal detachment (RRDCD). Methods A prospective clinical study. A total of 27 patients (27eyes) diagnosed as RRDCD were recruited in this study. There were 16 males and 11 females, with an average of (53.67±14.82) years. The mean intraocular pressure (IOP) was (8.2±2.1) mmHg (1 mmHg=0.133 kPa) and best corrected visual acuity (BCVA) of minimum resolution angle logarithm (logMAR) was 1.87±0.58. All subjects underwent 23G MIV combined a modified suprachoroidal drainage surgery, which 23G stab knife and 1 ml syringe needle were used for surgery. The visual outcome, IOP, rate of retinal reattachment and complications were comparatively analyzed preoperatively and postoperatively. Results At 1 day, 10 days, 1 month and 3 months after surgery, the average of logMAR BCVA were 1.62±0.67, 1.51±0.63, 1.39±0.54, 1.32±0.56 and the mean of IOP were (13.47±5.06), (14.43±4.09), (14.89±4.30), (15.38±3.37) mmHg, respectively. There were significant differences of logMAR BCVA and IOP between before and after surgery (F=6.19, 15.21; P＜0.05). Retinal reattachments were achieved in 27 eyes (100%) at 1 day and 10 days after surgery. At 1 month and 3 months after surgery, the rate of retinal reattachment were 88.89% (24 eyes) and 85.19% (23 eyes), respectively. No severe complications such as endophthalmitis and choroidal hemorrhage were found at follow-up visits. Conclusion MIV combined with a modified suprachoroidal drainage surgery is an effective and safe treatment for RRDCD, which can promote retina tear closure, improve visual acuity.
Objective To review recent advancement of the relationship between obesity and gastric cancer. Method We searched PubMed, Medline, EMBASE, Cochrane Library databases, CNKI, and WanFang database for recent clinical trials about the impact of obesity on occurrence, surgery outcomes, and prognosis of gastric cancer. Results Obesity significantly increased the risk of adenocarcinoma of esophagogastric junction (AEG), increased difficulty in radical operation of gastric cancer and complications of perioperative period, but it had no effect on the long-term operative outcomes. The association between obesity and the survival of gastric cancer was not clear. However, the better survival was observed in most researches of gastric cancer patients with excess body weight. Conclusions The relationship between obesity and gastric cancer is very complex, and there is no consistent conclusion. A reasonable body weight by a healthy lifestyle is expected to decline the incidence of AEG.