Progress in the treatment of acute myocardial infarction (AMI)， chronic coronary artery disease and their immediate complications has led to an increasing number of surviving patients with residual left ventricular dysfunction. It has been shown that viable myocardium in post-AMI patients and chronic heart failure patients plays an important role in predicting their prognosis and making clinical decisions. Viable myocardium refers to myocardium with reversible contractile dysfunction that occurs in coronary ischemia or after ischemia-reperfusion, but still has contractile reserve. Myocardial microvascular integrity is in correspondence with myocardial viability. Myocardial contrast echocardiography can evaluate the microvascular integrity of myocardial dysfunctional areas in patients with AMI or chronic coronary artery disease, detect viable myocardium， predict the potential for functional recovery in dysfunctional areas following reperfusion， and provide clinicians with valuable information for individualized treatment.
Objective To summarize the current diagnostic and therapeutic advancement of solid pseudopapillary tumor of the pancreas. Methods Relevant literatures about the diagnosis and treatment of solid pseudopapillary tumor of the pancreas, which were published recently domestic and abroad were collected and reviewed. Results Solid pseudopapillary tumor of the pancreas is now considered to be a low-grade malignancy with characteristic clinical, imaging and pathological features. Resection is considered to be the optimal choice with favourable prognosis. Conclusion An awareness of the features may guide us to a correct diagnosis and treatment of this rare neoplasm, but the deep understanding of the disease needs the accumulation of more cases and fundamental research.
Objective To investigate the current situation of randomized controlled trials (RCTs) on the treatment of Sjogren’s syndrome with Traditional Chinese Medicine (TCM), and to assess whether there is adequate evidence for clinical practice. Methods Such databases as CNKI, VIP, CBM and PubMed were searched from their establishment date to June 2010 to collect the RCTs on the treatment of Sjogren’s syndrome with TCM according to the predefined inclusion criteria. And the quality was assessed by using the Jadad scale, the revised CONSORT statement and other self-defined indexes.Results Among 19 included RCTs, 1 literature scored four points, 4 scored two points, 13 scored one point, and 1 scored zero point according to Jadad scale; no RCT performed the allocation concealment. According to the CONSORT criteria, 19 RCTs accounting for 100% reported the diagnostic criteria, implement of interventions and result, 11 RCTs applied the 2002 international diagnosis and classification criteria of Sjogren’s syndrome, 17 RCTs carried out positive control including one based on the standard treatment, and two RCTs applied only blank control without placebo control. All RCTs took the comprehensive efficacy assessment as the outcome index, but only 6 RCTs (31.6%) assessed both clinical efficacy and TCM syndrome efficacy. Among 6 RCTs (31.6%) describing the random sequence, no RCT reported the detailed methods. Except 1 RCT (5.3%) carried out the double blinding, all the others were non-blind trials. And only 1 RCT adopted analog. Conclusion Currently, the methodology and reporting quality of studies on the treatment of Sjogren’s syndrome with TCM are not good enough to provide reliable evidence for clinical practice.
Objective To investigate the factors influencing the occurrence of postoperative pulmonary complications (PPCs) in liver transplant recipients and to construct Nomogram model to identify high-risk patients. Methods The clinical data of 189 recipients who underwent liver transplantation at the General Hospital of Eastern Theater Command from November 1, 2019 to November 1, 2022 were retrospective collected, and divided into PPCs group (n=61) and non-PPCs group (n=128) based on the occurrence of PPCs. Univariate and multivariate logistic regression analyses were used to determine the risk factors for PPCs, and the predictive effect of the Nomogram model was evaluated by receiver operator characteristic curve (ROC) and calibration curve. Results Sixty-one of 189 liver transplant patients developed PPCs, with an incidence of 32.28%. Univariate analysis results showed that PPCs were significantly associated with age, smoking, Child-Pugh score, combined chronic obstructive pulmonary disease (COPD), combined diabetes mellitus, prognostic nutritional index (PNI), time to surgery, amount of bleeding during surgery, and whether or not to diuretic intraoperatively (P<0.05). Multivariate logistic regression analysis showed that age [OR=1.092, 95%CI (1.034, 1.153), P=0.002], Child-Pugh score [OR=1.575, 95%CI (1.215, 2.041), P=0.001], combined COPD [OR=4.578, 95%CI (1.832, 11.442), P=0.001], combined diabetes mellitus [OR=2.548, 95%CI (1.024, 6.342), P=0.044], preoperative platelet count (PLT) [OR=1.076, 95%CI (1.017, 1.138), P=0.011], and operative time [OR=1.061, 95%CI (1.012, 1.113), P=0.014] were independent risk factors for PPCs. The prediction model for PPCs which constructed by using the above six independent risk factors in Nomogram had an area under the ROC curve of 0.806. Hosmer and Lemeshow goodness of fit test (P=0.129), calibration curve, and decision curve analysis showed good agreement with Nomogram model. Conclusion The Nomogram model constructed based on age, Child-Pugh score, combined COPD, combined diabetes mellitus, preoperative PLT, and time of surgery can better identify patients at high risk of developing PPCs after liver transplantation.
Objective To explore the application effect of day surgery nursing based on finite time theory in patients undergoing gastroesophageal reflux surgery. Methods A total of 108 patients undergoing gastroesophageal reflux surgery in Day Surgery Center of the First Affiliated Hospital of Air Force Medical University were enrolled and divided into control group (n=54, routine nursing) and study group (n=54, finite time theory intervention on basis of control group) according to random number table method between May 2023 and May 2025. The scores of Visual Analogue Scale (VAS) for pain before and after surgery, postoperative recovery indexes, total incidence of postoperative complications, scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before surgery and discharge, and patients satisfaction in the two groups were compared. Results After surgery, the VAS score in the study group was lower than that in the control group (2.86±0.31 vs. 3.58±0.39, P<0.05). The first leaving bed time, the first time for liquid intake, and the postoperative anal exhaust time in the study group [(6.23±0.68), (4.22±0.53), and (16.78±2.03) h, respectively] were shorter than those in control group [(8.24±1.34), (6.68±0.86), (19.14±2.21) h, respectively; P<0.05]. Before discharge, the scores of SAS and SDS in the study group (49.14±5.11 and 41.26±4.31, respectively) were lower than those in the control group (53.79±5.58 and 49.85±5.06, respectively; P<0.05). The scores of patients satisfaction with daytime medical treatment process, doctor-nurse-patient communication, service attitude of medical staff and health education methods in the study group (91.56±3.58, 93.27±3.24, 92.07±5.37, and 92.68±4.22, respectively) were higher than those in the control group (82.35±4.11, 83.51±5.20, 84.11±4.33, and 81.70±5.41, respectively; P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups (9.25% vs. 16.67%, P>0.05). Conclusion The day surgery nursing based on finite time theory can effectively alleviate postoperative pain, accelerate postoperative recovery, improve psychological state and nursing satisfaction in patients undergoing gastroesophageal reflux surgery.
Objective To analyze the influencing factors of single-center day surgery patients who are discharged from the hospital on the same-day, in order to provide reference and basis for the clinical practice of follow-up day surgery. Methods The electronic medical records of patients who underwent day surgery in the Day Surgery Center of the First Affiliated Hospital of the Air Force Military Medical University between February and October 2021 were analyzed retrospectively. The patients were divided into the same-day discharge group and non-same-day discharge group. The baseline data and perioperative indicators of the patients were analyzed. Results A total of 857 patients were included, including 264 patients (30.81%) in the same-day discharge group and 593 patients (69.19%) in the non-same-day discharge group. Univariate analysis showed that there were significant differences between the two groups in gender, age, body mass index, whether the first one, disease classification, anesthesia method, and intraoperative blood loss (P<0.05). Logistic regression analysis showed that gender, whether the first one, disease classification, surgical grade, anesthesia method, and intraoperative blood loss were independent factors affecting the delayed discharge of patients undergoing daytime surgery (P<0.05). Conclusions There are many factors that affect day surgery patients’ discharge. It is suggested that more rigorously screen patients for day surgery, improve medical technology, strengthen out-of-hospital continued care, and optimize management procedures, so as to shorten the time of patients in hospital and provide more information for patients, and provide more efficient and convenient medical services for patients.
Objective To investigate the cancellation of ambulatory surgeries based on doctor-patient assistants, analyze the reasons, and propose corresponding strategies in order to improve the utilization of medical resources and the operational efficiency of hospitals. Methods A retrospective analysis was conducted on patient data between May 2021 and October 2023, who successfully scheduled surgery at the Day Surgery Center of the First Affiliated Hospital of the Air Force Military Medical University and cancelled the surgery due to various reasons. The reasons for the cancellation were also analyzed. Results A total of 5691 surgeries were scheduled, and 27 surgeries were cancelled before admission, with a cancellation rate of 0.47%. A total of 5607 surgeries were completed, and 57 surgeries were cancelled on the day of surgery, with a cancellation rate of 1.01%. Among all departments, patients in Gastrointestinal Surgery Department and Urology Department had the highest cancellation rates before admission (1.61% and 0.68%, respectively), and the highest cancellation rates on the day of surgery (1.43% and 1.38%, respectively). The most common reason for cancellation before admission was surgical doctor business travel/other arrangements (22.22%). The most common reason for cancellation on the day of surgery was preoperative respiratory infections in patients (14.04%). ConclusionsThe establishment of doctor-patient assistant positions can to some extent help reduce the cancellation of ambulatory surgery before admission and on the day of surgery. For patients undergoing ambulatory surgery, preoperative education and evaluation should be strengthened, and management processes and systems should be improved, in order to reduce the cancellation rate of ambulatory surgery and improve hospital operational efficiency.
Abstract： Objective To evaluate graft patency at one year after coronary artery bypass grafting （CABG） and analyze the risk factors of graft occlusion. Methods We prospectively included 71 consecutive patients with coronary heart disease who underwent CABG in First Affiliated Hospital of Harbin Medical University from June to December 2010. There were 37 males and 34 females with their average age of 59.8±7.7 years. All the patients underwent CABG performed by the same surgeon， and received standard drug therapy after surgery. At 1 year after CABG， 256-slice multislice computed tomography （MSCT） angiography was performed to evaluate graft patency. All the patients were divided into two groups according to their graft patency during follow-up， including 16 patients in the occluded graft group and 55 patients in patent graft group. Preoperative， intra-operative and postoperative variables were collected. Univiariate analysis and logistic regress analysis were performed to analyze risk factors of graft occlusion. Results The graft patency was 91.0% （172/189） at 1 year after CABG. Univiariate analysis showed that pre-operative cholesterol （t=-2.389，P=0.017）， diffused coronary artery disease （χ2=4.449，P=0.042）， diameter of target vessels （t=5.064，P=0.000）， non-adherence to prescribed antiplatelet medications （χ2=10.175，P=0.008） were potential risk factors of graft occlusion after CABG. Logistic regress analysis showed that diameter of target vessels ［RR=0.014，95% CI （0.001，0.229），P=0.003］ and non-adherence to prescribed antiplatelet medications ［RR=13.375，95% CI （1.075，175.536），P=0.044］ were significant risk factors for graft occlusion. Conclusion The graft patency is satisfactory at 1 year after CABG. Graft patency after CABG is closely related to the stenosis degree of target vessels and adherence to prescribed antiplatelet medications after surgery.
Objective To observe the delaying effect of neural stem cell (NSC) transplantation on denervated muscle atrophy after peri pheral nerve injury, and to investigate its mechanism. Methods NSCs were separated from the spinal cords of green fluorescent protein (GFP) transgenic rats aged 12-14 days mechanically and were cultured and induced to differentiate in vitro. Thirty-two F344 rats, aged 2 months and weighed (180 ± 20) g, were randomized into two groups (n=16 per group). The animal models of denervated musculus triceps surae were establ ished by transecting right tibial nerve and commom peroneal nerve 1.5 cm above the knee joints. In the experimental and the control group, 5 μL of GFP-NSCsuspension and 5 μL of culture supernatant were injected into the distal stump of the tibial nerve, respectivel. The generalcondition of rats after operation was observed. At 4 and 12 weeks postoperatively, the wet weight of right musculus tricepssurae was measured, the HE staining, the Mallory trichrome staining and the postsynaptic membrane staining were adopted for the histological observation. Meanwhile, the section area of gastrocnemius fiber and the area of postsynaptic membrane were detected by image analysis software and statistical analysis. Results The wounds in both groups of animals healed by first intension, no ulcer occurred in the right hind l imbs. At 4 and 12 weeks postoperatively, the wet weight of right musculus triceps surae was (0.849 ± 0.064) g and (0.596 ± 0.047) g in the experimental group, respectively, and was (0.651 ± 0.040) g and (0.298 ± 0.016) g in the control group, respectively, showing a significant difference (P lt; 0.05). The fiber section area of the gastrocnemius was 72.55% ± 8.12% and 58.96% ± 6.07% in the experimental group, respectively, and was 50.23% ± 4.76% and 33.63% ± 4.41% in the control group, respectively. There were significant differences between them (P lt; 0.05). Mallory trichrome staining of muscle notified that there was more collagen fiber hyperplasia of denervated gastrocnemius in the control group than that in the experimental group at 4 and 12 weeks postoperatively. After 12 weeks of operation, the area of postsynaptic membrane in the experimental group was (137.29 ± 29.14) μm2, which doubled that in the control group as (61.03 ± 11.38) μm2 and was closer to that in normal postsynaptic membrane as (198.63 ± 23.11) μm2, showing significant differences (P lt; 0.05). Conclusion The transplantation in vivo of allogenic embryonic spinal cord NSCs is capable of delaying denervated muscle atrophy and maintaining the normal appearance of postsynaptic membrane, providing a new approach to prevent and treat the denervated muscle atrophy cl inically.
Objective To explore the effectiveness of mirrored three-dimensional (3D) printing technology in the treatment of hyperextension-type bicondylar tibial plateau fractures. Methods Retrospective analysis was performed on the clinical data of 11 patients with hyperextension-type bicondylar tibial plateau fractures treated using mirrored 3D printing technology between January 2021 and June 2024. There were 7 males and 4 females, aged 31-67 years (mean, 47.6 years). According to the three-column classification theory of the tibial plateau, all were three-column fractures. Among them, there were 3 cases of pure hyperextension-type injury, 6 cases of hyperextension-varus-type injury, and 2 cases of hyperextension-valgus-type injury. The preoperative tibial plateau posterior slope angle ranged from ?10.7° to 2.1° (mean, ?3.8°). Postoperatively, fracture healing and complications were observed. Reduction quality was assessed using the Rasmussen radiographic scoring system for the tibial plateau. Knee joint function was evaluated using the Hospital for Special Surgery (HSS) knee score. At last follow-up, the tibial plateau posterior slope angle and knee range of motion (ROM) were measured and compared with the contralateral healthy knee. For patients with long-term follow-up (follow-up time ≥2 years), signs of post-traumatic arthritis were observed on weight-bearing anteroposterior and lateral knee X-ray films and assessed using the Kellgren-Lawrence grading criteria. Results All surgeries completed successfully. During the perioperative period, 3 patients developed intermuscular venous thrombosis in the affected limb and 1 patient developed posterior tibial vein thrombosis; these resolved after fluid therapy and anticoagulation. All 11 patients were followed up 18-26 months (mean, 22.6 months). There was no postoperative complications such as incision infection, compartment syndrome, neurovascular injury, implant failure, or fracture redisplacement. One patient with a repaired posterolateral complex injury still had knee instability and underwent secondary posterolateral complex reconstruction at 7 months postoperatively, after which knee stability was restored. All fractures healed within 9-16 weeks (mean, 12.2 weeks). At last follow-up, imaging showed good reduction of the tibial plateau fracture, normal joint congruity, and no significant joint surface irregularity. The Rasmussen score for the affected side was 11-18 (mean, 16.2), with excellent results in 8 cases, good in 2 cases, and fair in 1 case, yielding an excellent-good rate of 90.9%. The posterior slope angle of the affected side was (7.7±1.5)°, showing no significant difference compared to the healthy side (8.1±1.4)° (t=?1.450, P=0.178). The HSS knee score was 80-98 (mean, 89.1), with excellent results in 9 cases and good in 2 cases, resulting in an excellent-good rate of 100%. Knee ROM was (130.4±3.5)°, showing no significant difference compared to the healthy side (131.8±3.4)° (t=?1.399, P=0.192). Five patients were followed up over 2 years. According to the Kellgren-Lawrence grading criteria, 4 cases were grade 0 and 1 case was grade 1, with no moderate or severe osteoarthritis. Conclusion Through preoperative planning and surgical simulation, mirrored 3D printing technology can accurately restore the posterior slope angle and articular surface of hyperextension-type tibial plateau fractures, resulting in satisfactory recovery of knee joint function.