ObjectiveTo explore the value of multi-slice CT angiography (MSCTA) in peripancreatic vascular invasion of pancreatic carcinoma. MethodsThirty-eight patients with pancreatic carcinoma were detected by MSCTA technology before operation. The peripancreatic vascular invasion of pancreatic carcinoma was evaluated by multi-planar reconstruction (MPR) and maximum intensity projection (MIP) combined with axial image, and compared with the surgical results. ResultsThe MSCTA results showed that there were 12 patients (31.6%) with vascular invasion in 38 patients with pancreatic carcinoma, and the surgical results showed that there were 16 patients (42.1%) with vascular invasion. There was a b fit goodness of two results (kappa=0.665, P=0.000). The sensibility and specificity of MSCTA was 68.8% (11/16) and 95.5% (21/22), respectively. ConclusionsMSCTA technology has a high correct rate in evaluation of peripancreatic vessel encroached by pancreatic carcinoma, the MSCTA result has a b consistency to the surgical result. It has a value of clinical application in evaluation of peripancreatic vessel encroached by pancreatic carcinoma.
Objective To compare the effects of transthoracic device closure and surgical closure on ventricular septal defect systemically. Methods A systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Chinese Clinical Trial Register, ClinicalTrials. gov and Wanfang Database up to July 31, 2016. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted using RevMan 5.0 and Stata 14.0 software. Results Eleven studies were identified, including 5 RCTs and 6 cohort studies involving 2 504 patients. For success rate, there was no statistical difference between the transthoracic closure group and the surgical closure group in RCT (RR=0.99, 95%CI 0.96 to 1.03, P=0.70); the success rate in the transthoracic closure group was lower than that in the surgical closure group in the cohort study (OR=0.21, 95%CI 0.08 to 0.55, P=0.002). Both results of RCTs and cohort studies showed that compared with surgical closure, transthoracic device closure reduced duration of the operation (RCT MD=–79.38, 95%CI –95.00 to –63.76, P<0.000 01; cohort studyMD=–66.26, 95%CI –71.20 to –61.31, P<0.000 01) and hospital stay (RCTMD=–2.10, 95%CI –2.65 to –1.55, P<0.000 01; cohort studyMD=–3.99, 95%CI –6.03 to –1.94, P=0.000 1), and the patients with blood transfusion (RCT RR= 0.04, 95%CI 0.01 to 0.11, P<0.000 01; cohort studyOR=0.01, 95%CI 0.00 to 0.13, P=0.001). In the transthoracic closure group the risk of postoperative arrhythmia reduced (RCT RR=0.20, 95%CI 0.13 to 0.32, P<0.000 01; cohort studyOR=0.46, 95%CI 0.31 to 0.67, P<0.000 1). In the transthoracic closure group a higher postoperative valvular regurgitation risk in RCT induced (RR=1.45, 95%CI 1.07 to 1.96, P=0.02) and the rate of postoperative valvular regurgitation in cohort study reduced (OR=0.43, 95%CI 0.20 to 0.92, P=0.03). However, there was no statistical difference in postoperative residual shunt (RCT RR=0.96, 95%CI 0.57 to 1.62, P=0.89; cohort study OR=0.52, 95%CI 0.12 to 2.25, P=0.38). Conclusion Transthoracic device closure can shorten duration of the operation, hospital stay and reduce the patients with blood transfusion and post- and intraoperative arrhythmia risk. Therefore, transthoracic device closure may be a better approach for some ventricular septal defect patients.
Objective To explore the safety, effectiveness, and mid-term efficacy of total thoracoscopic mitral valvuloplasty (MVP) with chordal replacement (CR) and quadrangular resection (QR) for the treatment of mitral regurgitation (MR), and to provide reference for guiding the development and selection of clinical diagnosis and treatment methods for MR patients. Methods A prospective randomized controlled study was performed to collect patients with MR who underwent MVP at the Department of Cardiovascular Surgery, Leshan People's Hospital from January 2021 to March 2022. They were randomly divided into a CR group and a QR group by using a random number table, and were followed up for 12 months after the operation. The medical history, perioperative data and adverse cardiac endpoint events during the follow-up period were collected. The differences in surgical efficacy between the two groups were evaluated and compared, and the Kaplan-Meier method was used to compare the differences in survival rates between the two groups of patients. Results A total of 100 patients were enrolled. There were 46 patients in the CR group, including 27 males and 19 females with an average age of 49.50±9.23 years; there were 46 patients in the QR group, including 24 males and 22 females with an average age of 49.91±11.48 years. The aortic occlusion time in the CR group was longer than that in the QR group (P<0.05). Other surgical indicators, including total surgical time, extracorporeal circulation time, ventilator-assisted time, ICU hospitalization time, size of the valve ring, concomitant surgery during the same period, and the incidence of perioperative complications were not statistically different between the two groups (P>0.05). The left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) of the two groups before discharge after the surgery were significantly improved compared to those before surgery (P<0.05). There was a statistical difference in LVEF between the two groups before discharge after the surgery (P<0.05). There was no statistical difference in clinical efficacy between the two groups (P>0.05). Kaplan-Meier analysis showed that the overall incidence of exemption from mild and above mitral regurgitation 12 months after the surgery in the CR group and QR group was 84.8% and 89.1%, respectively. According to the log-rank test, there was no statistical difference in the overall survival curve between the two groups (χ2=0.356, P=0.551). Conclusion CR and QR are both safe and effective methods for the treatment of simple posterior MR.
ObjectiveTo investigate the influence of mechanical and biological valves on clinical benefits of elderly patients with valvular heart disease.MethodsWe retrospectively analyzed the clinical data of 280 elderly patients with valvular heart disease treated by valve replacement between 2008 and 2014 year. The patients were divided into two groups by tendency score matching including a group A with biological valves and a group B with mechanical valves. Finally, there were 96 patients in each group. There were 43 males and 53 females at age of 64.41±6.52 years in the group A, 44 males and 52 females at age of 64.07±6.20 years in the group B.ResultsThe bleeding rate of skin and mucosa of the group B was significantly higher than that of the group A (P<0.05). There was no statistical difference in mortality within 30 days after operation, all-cause mortality, re-hospitalization rate, re-valve replacement rate, combined atrial flutter/atrial fibrillation ratio, drug use, incidence of cerebral infarction, cerebral hemorrhage, new peripheral vascular embolism and visceral hemorrhage, heart function (NYHA) classification, the cumulative survival rate of all the patients during follow-up (P=0.63), or the cumulative survival rate of the patients with no thrombus/hemorrhage (P=0.75) between the two groups (P>0.05).ConclusionMechanical valve replacement and bioprosthetic valve replacement in the treatment of valvular heart disease in the elderly can achieve similar clinical benefits and both have clinical application value.
Objective To analyze the clinical efficacy and safety of endostar or carboplatin combined with endostar intracavitary perfusion in the treatment of malignant serous cavity effusion. Methods We retrospectively reviewed the clinical data of 78 cancer patients with malignant serous cavity effusion who received paracentesis and intracavitary endostar, or carboplatin combined with endostar in Shengjing Hospital of China Medical University between November 2011 and November 2016. There were 42 males and 36 females at a median age of 62 years ranging from 17 to 78 years. According to treatment methods, 78 patients were divided into two groups, in which 33 patients received intracavitary endostar combined with carboplatin (a combination group, 15 males and 18 females at a median age of 56 years ranging from 17 to 66 years), and 45 patients received intracavitary endostar (an endostar group, 27 males and 18 females at a median age of 63 years ranging from 38 to 78 years). The efficacy and safety of two methods were analyzed and compared. Results The response rate in the combination group was 75.8%, which was higher than that in the endostar group (60.0%, P=0.035). In quality of life improvement, there was no statistical difference between the two groups (P=0.113). The incidence of fatigue, myelosuppression and gastrointestinal reactions in the endostar group was significantly lower than that of the combination group (P=0.006, 0.000 and 0.017, respectively). Analysis of long-term efficacy revealed that the median time to progress (TTP) in the combination group and endostar group was 171 days and 143 days, respectively (P=0.030). Conclusion Intracavitary infusion of endostar alone, or carboplatin combined with endostar is effective and tolerable for controlling malignant serous cavity effusion. But for the patients with poor physical state who can not tolerant platinum perfusion, intracavitary infusion of endostar alone can be adopted to control malignant serous cavity effusion.
Objective To learn and analyse the current clinicians’ knowledge and attitudes towards patient safety, and to provide relevant evidence for future medical education. Method We conducted a survey on clinicians mainly in West China Hospital of Sichuan University with group random sampling method. We analysed the data on the clinicians’ knowledge and attitudes with SPSS softerware. Result Totally 300 questionnaires were distributed, of which 258 were completed adequately. The results showed the clinicians’ knowledge on patient safety was poor, however, the respcnse from the clinicians in Outpatient Department were better than those in Inpatient Department. The majority of the clinicians (above 95.00%) were willing to learn the knowledge of patient safety. Conclusion As the clinicians are willing to learn the knowledge of patient safety positively, it is necessary to integrate patient safety education into the current medical education curriculum.