Objective To evaluate clinical outcomes of mild-to-moderate or moderate functional mitral regurgitation（FMR）after aortic valve replacement （AVR） in patients with severe aortic stenosis （AS），and analyze prognostic factors of these patients with mild-to-moderate or moderate FMR （2＋to 3＋）. Methods From September 2008 to December 2011，a total of 156 patients with severe AS （peak aortic gradient （PAG）≥50 mm Hg） as well as FMR （2＋to 3＋） underwent surgical treatment in Zhongshan Hospital. There were 95 male and 61 female patients with their average age of 59.2±10.5 years. Detailed perioperative clinical data were collected，and postoperative patients were followed up. The ratio of FMRpreoperative/FMR postoperative was calculated. Patient age，gender，body weight，history of hypertension，ventricular arrhythmia，atrial fibrillation （AF），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD），left atrial diameter （LAD），pulmonary artery hypertension （PAH），PAG were assessed by logistic multivariate regression analysis. Results Six patients died postoperatively，including 4 patients with low cardiac output syndrome and 2 patients with refractory ventricular arrhythmia. Perioperative mortality was 3.8%. The average follow-up time was 20.3±8.5 months and follow-up rate was 85.3% （133/156）. Eight patients died during follow-up，including 3 patients with heart failure，2 patients with ventricular arrhythmia，and 3 patients with anticoagulation-related cerebrovascular accident. Multivariate regression analysis showed that FMR preoperative/FMR postoperative ratio was not correlated with age≥55 years，male gender，body weight≥80 kg，LVEDD≥55 mm，LVEF≤50%，history of hypertension or ventricular arrhythmia. However，LAD≥50 mm，PAH≥50 mm Hg，PAG≤75 mm Hg and preoperative AF were negatively correlated with postoperative FMR improvement. Conclusions Risk factors including LAD≥50 mm，PAH≥50 mm Hg，PAG≤75 mm Hg and preoperative AF are negatively correlated with postoperative improvement of FMR （2＋to 3＋）. Patients with severe AS and above risk factors should receive concomitant surgical treatment for their FMR during AVR，since preoperative FMR（2＋to 3＋）usually does not improve or even aggravate after AVR.
Interpretation of the complete scientific connotation of functional foods accurately prior to approval and registration based on animal tests and small sample size human food tests is challenging. Further technical evaluation after market introduction should be carried out on safety, health function and other aspects of those widely used commercial scale production products. According to the analysis report on the consumption situation of post-marketing population submitted when applying for product registration extension since the implementation of the functional food registration and filing management measures more than 3 years ago, the post-marketing evaluation report of functional food still lacks systematic and perfect evidence support. Based on the successful experience of evidence-based medicine and post-marketing evaluation evidence, this paper analyzes the post-marketing evaluation content, evidence source construction, evidence classification and classification of functional food, and puts forward the preliminary idea of constructing post-marketing evaluation evidence body of functional food safety and health function technology from multiple view points, so as to provide insights into evidence system research in this field in the future.
Temporal lobe epilepsy is the most common type of epilepsy in clinic. In recent years, many studies have found that patients with temporal lobe epilepsy have different degrees of influence in executive function related fields. This influence may not only exist in a certain field of executive function, but may be affected in several fields, and may be related to the origin site of seizures. However, up to now, there is no unified standard for the composition of executive function, and it is widely accepted that the three core components of executive function are working memory, inhibitory control and cognitive flexibility/switching. In addition, the International League Against Epilepsy proposed a new definition in 2010, and epilepsy is a brain network disease. There is a close relationship between brain neural network and cognitive impairment. According to the cognitive field, the brain neural network can be divided into six types: default mode network, salience network, executive control network, dorsal attention network, somatic motor network and visual network. In recent years, there has been increasing evidence that four related internal brain networks are series in a range of cognitive processes. The executive dysfunction of temporal lobe epilepsy may be related to the changes of functional connectivity of neural network, and may be related to the left uncinate fasciculus. This article reviews the research progress related to executive function in temporal lobe epilepsy from working memory, inhibitory control and cognitive flexibility, and discusses the correlation between the changes of temporal lobe epilepsy neural network and executive function research.
The treatment of open reduction and internal fixation was carried out in 480 cases of fractures offemoral shafts. Patients were followed up in an average of 7. 6 years, 50 cases, rate of occurrence of10. 4%, had varying degrees of functional impairment of knee. It was considered that thecharacteristics of fractures, the time of oporation , selection of incision , the types of internal fixationdevices, and the duration of external immobilization were the main causes related to the occurren...
The tendons of semitendinosus and biceps femoris were transposed in front of the popliteal vein in a "U" shaped loop with the purpose to impede the venous back-flow. This type of operation was used in 10 cases with the aim to treat incompetence of deep vein of the lower extremity. Following the operation, patients were under clinical observation and undertaken retrograde venographie examination. It was proved that the results after operation were satisfactory with the disapperance of symptoms and subsequent healing of ulcers.
Objective To investigate the method and the cl inical outcomes of reconstruction of the knee stability after resection of tumors of the proximal fibula. Methods The cl inical data were retrospectively analyzed, from 16 patients with tumors of the proximal fibula undergoing proximal fibular resections and reconstructions of the lateral collateral ligament and the tendon of the biceps femoris with anchors between January 2008 and December 2009 (test group). Five patients underwent proximal fibular resection but were not given reconstruction surgery at the same period as the control group. There was no significant difference in gender, ages, disease duration, and tumor site between 2 groups (P gt; 0.05). Lateral stress test was performed after operation; X-ray films were taken to measure the joint space. Musculoskeletal Tumor Society (MSTS) functional score system was used to evaluate the joint function. Results All incisions healed by first intention in 2 groups. Iatrogenic complete peroneal nerve function loss occurred in patients undergoing Malawer type II surgical resection. The patients in both groups were followed up 12 to 36 months, with an average of 30 months. One patient with osteosarcoma of the test group developed local recurrence, and died of lung and systemic metastases after 12 months; the other patients had no recurrence. At last follow-up, the results of knee lateral stress test were negative in the test group, and the joint space increased and was classified as grade A; the results of knee lateral stress test were positive in the control group, and the joint space was classified as grade D. The MSTS score was 97.5 ± 3.5 in the test group and 87.5 ± 3.5 in the control group, showing significant difference (t=2.85, P=0.01). Conclusion The reconstruction of the bony attachment of the lateral collateral ligament and the tendon of the biceps femoris with anchors after resection of the proximal fibula is a safe, rel iable, and simple technique to reconstruct knee stabil ity after resection of tumors of the proximal fibula.
Objective To evaluate the right ventricular function of the patients 2 years after surgery by ultrasonic cardiography (UCG) who underwent mitral valve replacement (MVR) concomitant tricuspid annuloplasty (TAP). Method We finally identified 36 patients required MVR with tricuspid valve annular dilation concomitant merely mild tricuspid regurgitaion (TR) based on preoperative UCG in our hospital between April and November 2012 year. All patients were randomly divided into two groups by digital table including a tricuspid annuloplasty group (a TAP group, n=18, 7 males and 11 females at age of 45.67±12.49 years) and a no-tricuspid annuloplasty group (a NTAP group, n=18, 6 males and 12 females at age of 45.44±10.48 years). General clinical data and extracorporeal circulation data were recorded. UCG evaluation was practiced preoperation, alone with 1 week, 6 months, and 2 years after surgery. Results Two years postoperative maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension-1(RVD1) , right ventricular fractional area change (RVFAC), 3D RV end-systolic volume (3DRVESV), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) of patients were all smaller in the TAP group than those in the NTAP group. Yet right ventricular ejection fraction (RVEF), percent shorting of tricuspid valve annulus (PSTVA) were greater in the TAP group than those in the NTAP group, although there was no statistical difference between the two groups in two years postoperative 3D RV end-diastolic volume (3DRVEDV). The patients in the TAP group had a superior trend than that of the NTAP group. Moreover, the patients' TR constituent ratio in the TAP group was much better than that of the NTAP group in 2 year after operation. Conclusions Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR is favorable for the recovery of their 2 years postoperative function of tricuspid valve and right ventricle. It is benefit to reduce patient's long term postoperative TR residues and exacerbation.
In order to solve the difficult problems of repair and reconstruction for severe deep burns with compound tissue defects of upper limb, 26 cases were treated with transplantation of compound tissue flap, vascularized by anastomosis of blood vessel or by vascular pedicle. Several kinds of reparative and reconstructive procedure could be performed simultaneously. Not only the tissue defect was repaired, but also the upper limb function was reconstructed in one stage operation. Owing to the presence of abundant vascular supply from the vascularized compound tissue and primarily closing the wounds, the anti-infection potency was high, then it was suitable for such conditions as fresh severe deep burn with infection and compound tissue defects. As a result, this technique provided the best chance to save upper limb from amputation. The duration required for treatment could be markedly shortened. All the cases successed. The long-term functional recovery was satisfactory. This method provided the possibility to solve effectively the difficult problem dealing with the severe deep burns with compound tissue defects of upper limb.
Objective To investigate the risk factors and preventions of functional delayed gastric emptying (FDGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Methods The clinical data of 41 patients after undergoing PPPD between 2003 and 2009 in this hospital were analyzed retrospectively.Results In all 41 cases, postoperative complications developed in 13 patients (31.7%), in which 7 patients developed FDGE (17.1%). The complications excluding FDGE (P=0.010) and diabetes (P=0.024) had remarkable relations with the FDGE in the univariate analysis; Compared with the non-FDGE patients, the albumin was declined obviously (P=0.020) while the serum direct bilirubin increased significantly (P=0.036) in the FDGE patients, while the development of FDGE had relation only with the albumin (P=0.039) and the complication of diabete (P=0.047) by the binary logistic regression analysis. Conclusion In the patients undergoing PPPD, preoperative control of the blood glucose, preoperative correction of hypoproteinemia and hyperbilirubinemia, and centralizing PPPD in high-volume have possibly positive significance for the prevention of FDGE.
OBJECTIVE To investigate the effects of targeted muscular injection of ciliary neurotrophic factor (CNTF) on the regeneration of injured peripheral nerves. METHODS The left sciatic nerves of 80 Sprague-Dawley rats were excised to form 6 mm defect and the two ends were bridged by silicone tubes, they were randomly divided into two groups, CNTF group and normal saline (NS) group. The CNTF group was given recombinant human CNTF, 1 mg/kg every other day for 30 days, and the NS group was given equal quantity of normal saline as NS group. The sciatic nerve functional index (SFI), electrophysiological assessment, morphometric analysis of axons, and choleratoxin horseradish peroxidase (CB-HRP) retrograde-labelling were measured postoperatively. RESULTS The SFI, electrophysiological parameters (nerve conduction velocity, latency and amplitude of compound muscle action potentials), myelinated axons counts, mean axons diameters and myelin sheath thickness, number of CB-HRP labelled ventral horn motor neurons of spinal cord were significantly higher in CNTF group than that of NS group. CONCLUSION Targeted muscular injection of CNTF can promote the regeneration of peripheral nerve and improve the nerve functional recovery.