Objective To investigate the relationship between the elbow flexion angle and the cubital tunnel pressure in patients with cubital tunnel syndrome. Methods Between June 2010 and June 2011, 63 patients with cubital tunnel syndrome were treated. There were 47 males and 16 females with an average age of 59 years (range, 31-80 years). The lesion was at left side in 18 cases and at right side in 45 cases. During anterior transposition of ulnar nerve, the cubital tunnel pressure values were measured at full elbow extension, elbow flexion of 30, 60, and 90°, and full elbow flexion with microsensor. The elbow flexion angle-cubital tunnel pressure curve was drawn. Results The cubital tunnel pressure increased smoothly with increased elbow flexion angle when the elbow flexed less than 60°, and the pressure increased sharply when the elbow flexed more than 90°. The cubital tunnel pressure values were (0.13 ± 0.15), (1.75 ± 0.30), (2.62 ± 0.34), (5.78 ± 0.47), and (11.40 ± 0.62) kPa, respectively at full elbow extension, elbow flexion of 30, 60, and 90°, and full elbow flexion, showing significant differences among different angles (P lt; 0.05). Conclusion The cubital tunnel pressure will increase sharply when the elbow flexes more than 90°, which leads to the chronic ischemic damage to ulnar nerve. Long-term ischemic damage will induce cubital tunnel syndrome.
In recent years, target temperature management (TTM) has been increasingly applied to cardiac arrest patients, and programs and strategies for TTM are in a constant state of update and refinement. This paper analyzes and proposes relevant strategies from the concept of TTM, its clinical application status for cardiac arrest patients in domestic and international medical institutions, its deficiencies in the clinical practice, and factors affecting the development of TTM, with a view to providing a realistic basis for the development of high-quality TTM in medical institutions.
ObjectiveTo investigate the natural outcome of spontaneous closure of iatrogenic atrial septal defect (IASD) in patients with atrial fibrillation after transseptal catheterization and the influencing factors affecting its healing.MethodsA total of 122 patients who underwent percutaneous left atrial appendage occlusion in West China Hospital, Sichuan University from September 2014 to February 2018 were selected for observation and follow-up. General information of the patients was collected. Each patient underwent transthoracic echocardiography and transesophageal echocardiography before the surgery or 45 days, 3 months, 6 months and 1 year after the surgery, observing the atrioventricular size, cardiac function and atrial septal defect size. The natural outcome of IASD and influencing factors and prognosis of IASD were analyzed.ResultsThe healing rate increased gradually with the follow-up time; the median healing time was 180 days [95% confidence interval (169.5, 190.5) days]. The difference in the effect on IASD healing rate between the gender and atrial fibrillation type was not significant (P>0.05); being older than 70 years old was the influence factor for the IASD healing rate (P<0.05). There was no statistically difference in right heart size and systolic and diastolic function between the unhealed group (n=18) and the healed group (n=63) after a 1-year follow-up (P>0.05), but the left ventricular size was bigger in the unhealed group than that in the healed group (P<0.05). The follow-up time points had a significant effect on the size of the left atrium, and the left atrium in the healing group after 1 year follow-up was significantly smaller than before. There was no significant difference among the different follow-up time points and no interaction between grouping and follow-up time (P>0.05). ConclusionsWith the extension of follow-up time, the healing rate increases gradually. Larger left atrium and ventricular size and the age over 70 may be related to the healing of IASD.
Objective To evaluate the clinical efficacy and safety of endovascular therapy for spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods The clinical data of 17 patients with SISMAD, who were treated at author's hospital during the period from March 2009 to May 2016, were retrospectively analyzed. According to the Sakamoto angiographic classification, patients were divided into typeⅠ (n=3), typeⅡ (n=5), and type Ⅲ (n=9). Three patients with type Ⅰ were treated with conservative treatment first, and then 2 were treated with endovascular therapy as the poor reaction. The other patients were treated with endovascular treatment right a way. Results Conservative treatment was success in 1 case, 16 patients were treated with endovascular treatment, the technical success rate was 100%, one stent was used in 11 patients and two stents were used in 5 patients, and the blood in the true lumen of superior mesenteric artery (SMA) restored, no major complications occurred. Seventeen patients were followed-up for 3-36 months (mean of 19 months) and the followed-up rate was 100%, no abdominal pain occurred in 17 cases, CTA showed that no dissecting aneurysm was observed and the stents were patent of SMA. Conclusion Interventional therapy is a safe and effective method for SISMAD.
Objective To study the effect of the intracavity thrombolysis, aspiration of debris, percutaneous transcathete angioplasty (PTA) and percutaneous transtuminl angioplasty and stenting (PTAS) on treating peripheral arterial obliterans disease (PAOD). Methods From May 1994 to May 2008, interventional treatment was performed in 285 patients with PAOD. Intracavity thrombolysis and aspiration of debris were performed in 63 patients suffering from acute arterial occlusion. Intracavity thrombolysis and PTA were performed in 61 patients suffering from arteriostenosis combined with acute occlusion. Intracavity thrombolysis, PTA and PTAS were performed in 161 patients suffering from chronic arteriostenosis occlusion. Results Total success rate was 98.25% (280/285). The success rate in intracavity thrombolysis and aspiration of debris was 96.83% (61/63), with 88.89% (56/63) of the blood vessels restored, 7.94% (5/63) of the blood vessels partially restored, and another 3.17% (2/63) failed. The success rate in intracavity thrombolysis and PTA was 85.25% (52/61). The success rate in PTA and PTAS was 98.14% (158/161). The total complication rate was 7.02% (20/285), of them the local thrombolysis and thromboclasis accounting for 7.94% (5/63), the local thrombolysis and PTA accounting for 14.75% (9/61), the PTA and stent implantation accounting for 3.73% (6/161). Conclusion Percutaneous transluminal treatment for stenotic and occlusive lesions of peripheral artery can effectively keep the blood vessel unobstructed for a long time and raise the haemodynamics index remarkably.
Objective To investigate long-term echocardiography characteristics and their clinical significance of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 204 patients who underwent prosthetic MVR and finished echocardiography examination at least 5 years after surgery in West China Hospital of Sichuan University. There were 44 male patients and 160 female patients with their age of 23 to 73 （50.9±10.6）years. Postoperatively， all the patients were followed up for 5-15 （7.9±2.3）years and regularly received echocardiography examination at the outpatient department. Analysis variables included left atrium （LA） dimension， left ventricle （LV） dimension，right atrium （RA） dimension， right ventricle （RV） dimension， left ventricular ejection fraction （LVEF） and effective orificearea （EOA） of the mitral valve. Results Long-term echocardiography showed that LA and LV dimensions were signifi-cantly smaller than preoperative dimensions （P＜0.05）， while RA and RV dimensions were not statistically different from preoperative dimensions （P＞0.05）. Long-term LVEF was significantly higher than preoperative value （P＜0.05）. Long-term EOA was 1.1-4.8 （2.3±0.5）cm2， including EOA of 1.1-1.4 cm2 in 7 patients （3.4%，7/204），and 1.6-1.9 cm2in 42 patients （20.6%，42/204）. During long-term follow-up， 7 patients underwent their second heart surgery， including2 patients with prosthetic valve dysfunction， 1 patient with prosthetic perivalvular leak and severe hemolytic anemia，3 patients with severe tricuspid regurgitation which were not improved after medication treatment， and 1 patient with moderateaortic valve stenosis and regurgitation. Two patients had left atrial thrombosis during follow-up， including 1 patient who died of endocarditis 7 years after surgery， and another patient who was still receiving conservative therapy and further follow-up. Conclusion Concomitant tricuspid or aortic valve disease should be actively treated during MVR， and postoperative patients need better follow-up. Many patients after MVR need long-term cardiovascular medication treatment during follow-up in order to improve their heart function and long-term survival rate.
Objective To discuss the clinical effect and value of stent placement combined with mechanical aspiration thrombectomy for acute iliofemoral venous thrombosis with iliac vein occlusion. Methods From October 2004 to December 2011， interventional treatment were performed in 273 patients with acute iliofemoral venous thrombosis and iliac vein occlusion， including left side of 235 cases and right side of 38 cases. Antegrade femoral vein under local anesthesia， an 8-14F catheter was inserted into iliofemoral vein with the guidance of guide wire to aspirate thrombus directly， 53 patients used 18-24F large lumen sheath to aspirate thrombus. As for the femoralpopliteal vein thrombus， a “cross sheath” was inserted to affected iliac vein with the help of guide wire capture technique， a guide wire was introd-uced to popliteal vein， then a Fogarty balloon catheter was inserted and extracted thrombus to iliac vein， mechanical aspiration thrombectomy was performed again. After iliofemoral vein thrombus were removed completely， percutaneous transluminal angioplasty （PTA） and stenting were performed for stenosis or occlusion displayed by venography. Results Thrombus removal were completely cleared （degreeⅢ） in 219 cases （80.22%）， partly cleared （degreeⅡ） in 49 cases （17.95%）， and minimal cleared （degreeⅠ） in 5 cases （1.83%）. The effect of stent placement：were cured in 235 cases （86.08%）， excellent in 29 cases （10.62%）， mild in 2 cases （2.57%）， and invalid in 7 cases （0.73%）. Total effective rate was 99.27% （271/273）， the average days in hospital was 7.5 days. Tumescence and pain of affected limb disappeared or relieved after interventional therapy for 1-2 days. The followe up effect：3-6 months， 7-12 months， 13-24 months， and 25-36 months after treatment of iliac vein patency were 94.87%，93.73%，87.08%，and 84.13% respectively. Conclusion Mechanical aspiration thrombectomy combined with stent placement for acute lower extremity deep venous thrombosis and iliac vein obstruction is an effective and safe treatment for its notable therapeutic effect and the short hospitalization time.
Objective To discuss the clinical effect and value of minimally invasive therapy on lower extremity deep venous thrombosis （DVT）. Methods The clinical data of 911 patients with acute lower extremity DVT from April 1998 to December 2011 were analyzed retrospectively. There were 489 males，422 females；the age ranged from 23-86 years old with （58.72±11.95） years old. Five hundred and sixty-eight patients occurred on the left leg，343 patients on the right leg. There were 487 cases of central type，166 cases of peripheral type，258 cases of mixed type. All the patients were implanted inferior vena cava filter under local anesthesia，then inserted an 8-14 F catheter via the femoral vein of the affected limbs to suck mechanically thrombus. Five hundred and twenty-seven cases of iliofemoral vein thrombus were inserted into sheathing canal with the help of technique of guide wire griped. The guide wire could be plugged into femoral vein，even more far，with the help of sheathing canal. Following the guide wire，a diameter-10 mm balloon catheter was used to pull the thrombus to iliac vein，with the watching of DSA，so it could be sucked from iliac vein. Before sucking thrombus，a diameter-12 mm balloon was put into the confluence of inferior vena cava and iliac vein，in case of thrombus fall off with blood flow to block inferior vena cava. Results Among 911 patients，423 cases were only treated by sucking thrombus，275 cases sucking thrombus plus endovascular thrombolysis，91 cases sucking thrombus plus endovascular thrombolysis plus percutaneous transluminal angioplasty （PTA），122 cases sucking thrombus plus endovascular thrombolysis plus PTA plus stenting，the average hospital stay was 7.5 d. ① Discharge success rate：907 （99.56%） cases were successful by interventional therapy，4 （0.44%） cases were failed. Nine hundred and eleven patients were performed mechanical thrombus suction，which was 556 cases of gradeⅢ，142 cases of gradeⅡ，213 cases of gradeⅠ. Among 213 cases of gradeⅠ，there were 91 cases only underwent PTA treatment for economic reasons or advanced stage malignant tumors，122 cases underwent PTA plus stenting. The circumferences of affected limb and the differences of circumference of healthy and affected limbs knees above and below 15 cm at discharge were significantly smaller than those at admission （P＜0.01）. Twenty-seven cases underwent anticoagulation and thrombolytic therapy after operation，which occurred mild subcutaneous bleeding，gum bleeding，epistaxis，hematuria，and the symptoms were disappearance after adjusting drugs. All the patients did not appear to complications such as bleeding，vessel dissection. ② Follow-up effective rate：After 6 to 12 months follow-up，there were 714 （78.38%） cases of excellent，136 （14.92%） cases of good，57 （6.26%） cases of middle，4 （0.44%） cases of poor. After 13 to 24 months follow-up，there were 691 （76.18%） cases of excellent，151 （16.65%） cases of good，65 （7.17%） cases of middle；65 cases occurred restenosis that the PTA and stent placement was underwent again， blood flow of 58 cases completely restored，blood flow of 7 cases partly recovered，and the contrast agent didn’t retent. After 25 to 36 months follow-up，there were 681 （75.08%） cases of excellent，128 （14.11%） cases of good，98 （10.81%） cases of middle；98 cases of limb swelling were not satisfied，and the patients still had a sense of pain after walking，but the symptoms obviously improved as compared with preoperative symptoms，the patients were advised to wear stretch socks with no further interventional therapy. Conclusions Minimally invasive therapy on lower extremity DVT can eliminate thrombus from venous cavity more early，restore the unobstructed flow instantly，preserve the function of venous valve in a greater degree. It has an advantage of minimally invasive，less complications，and notable clinic effect of short-term and medium-term follow-up.
【摘要】 目的 評價2型糖尿病（type 2 diabetes mellitus，T2DM）患者動態血糖監測（continuous glucose monitoring，CGM）的準確性及其相關因素。 方法 2009年1月—2010年1月共納入患者530例，其中口服降糖藥治療者和胰島素強化治療者各265例。應用動態血糖監測系統（美國Medtronic MiniMed公司）連續監測3 d，同時每天輸入4次指尖血糖值（self-monitoring of blood glucose，SMBG）進行校正。用直線回歸分析CGM值與SMBG的相關性，用Clarke誤差表格分析一致性，用平均絕對差（mean absolute relative difference，MAD）評價準確性，并分析MAD的相關因素。 結果 ①共收集到6 350對CGM值[（9.66±3.54） mmol/L]與SMBG值[（9.64±3.38） mmol/L]，兩者差異無統計學意義（Pgt;0.05）。Pearson相關性分析顯示，兩者呈正相關（r=0.959，Plt;0.001）。②Clarke誤差表格分析顯示:99.89%的點位于A區和B區，其中92.37%血糖值位于A區，7.72%位于B區，其余7對（0.11%）位于D區。③總體MAD值為7.2%（5.5%~9.5%），通過分析每天的MAD值見到，隨著監測時間的延長，CGM結果的MAD值逐漸降低，而準確性逐漸升高。 ④胰島素強化治療組患者MAD值高于口服藥治療組患者（Plt;0.05），多元逐步回歸分析顯示，MAD值與糖化血清白蛋白水平呈獨立負相關（β=-0.134， Plt;0.01），與胰島素強化治療呈獨立正相關（β=0.117， Plt;0.05）。 結論 ①動態血糖與毛細血管血糖具有良好的相關性、一致性及準確性。 ②CGM結果的準確性除了受監測時間的影響外，還可能與患者的降糖治療方案有關。【Abstract】 Objective To assess the accuracy of continuous glucose monitoring (CGM) for patients with type 2 diabetes mellitus (T2DM), and its correlated factors. Methods From January 2009 to January 2010, 530 patients with T2DM were enrolled in this study, including 265 subjects taking oral hypoglycemic agents and the other 265 subjects taking intensive insulin treatment. All the subjects underwent CGM (American Medtronic MiniMed) for three days. Meanwhile, capillary glucose values through self-monitoring of blood glucose (SMBG) were inputted four times a day for adjustment. The correlation of CGM value and capillary glucose value was analyzed by linear regression method. The consistency was analyzed by Clarke error grid. Mean absolute relative difference (MAD) was used to assess accuracy and correlated factors of MAD were also analyzed. Results ① A total of 6 350 pairs of CGM and SMBG values were collected [(9.66±3.54) mmol/L vs. 9.64±3.38) mmol/L,Pgt;0.05]. Pearson correlation analysis showed that CGM value was positively correlated with SMBG value (r=0.959,Plt;0.001). ② Clarke error grid demonstrated that 99.89% of paired SMBG-CGM values were located in zone A and zone B and the remaining seven pairs (0.11%) of glucose values were located in zone D. ③ The overall MAD value was 7.2% (5.5%-9.5%). According to the analysis of daily MAD value, MAD value decreased, while accuracy elevated gradually with monitoring time. ④ MAD value of intensive insulin treatment group was higher than that of the oral hypoglycemic agent treatment group (Plt;0.05). And stepwise multiple regression analysis indicated that MAD value had negative correlation with glycated albumin level (β=-0.134, Plt;0.01) and positive correlation with intensive insulin treatment (β= 0.117,Plt;0.05). Conclusions ① The results of CGM are accurate, and have good correlation and consistency with capillary glucose. ② Besides monitoring time, the accuracy of continuous glucose monitoring may be also associated with hypoglycemic treatment strategy.
ObjectiveTo investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. MethodsThe clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. ConclusionPersonalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.