Abstract: Objective To evaluate the longterm results of surgical treatment of tetralogy of Fallot (TOF) in adults and discuss the perioperative treatment skills. Methods From January 2000 to March 2008, 149 patients older than 14 years with tetralogy of Fallot received surgical treatment in Changhai Hospital. Among the patients, there were 78 males and 71 females with ages ranged from 14 years to 53 years and the average age was 26.3 years. Twenty patients had previous pulmonary arterial shunts before radical treatment. A total of 129 patients underwent primary radical treatment. Thirtyeight patients received a right ventricular outflow tract patch, 107 patients had transannular patch, and 4 patients had homograft aorta with valves. Results Hospital mortality was 4.0%(6/149). Four patients died of low cardiac output syndrome (LCOS), and multiple organ failure, and 2 patients died of acute renal failure. The postoperative complications included pleural effusion in 11 patients, pulmonary edema in 10 patients, severe LCOS in 9 patients, severe cardiac arrhythmia in 7 patients, reoperation for excessive bleeding in 7 patients, reintubation in 6 patients, and residual ventricular septal defect (VSD) in 5 patients (two of them had reoperation for residual VSD repair and 2 received transcatheter closure of VSD). One hundred and thirtyfour patients were followed up for 3 to 102 months (47.2±28.6 months) with a followup rate of 93.7%(134/143). Late death occurred in 2 patients, one of whom died of secondary infective endocarditis and the other had a sudden death 29 months after operation. During the followup, one patient had residual VSD (2 mm), but had a normal life. The peak systolic right ventricletopulmonary artery pressure gradient exceeded 40 mmHg in 4 patients. Two patients had severe pulmonary regurgitation. A total of 132 patients survived and had an improved life. One hundred and twentyone patients had class Ⅰ heart function (NYHA), and 11 patients in class Ⅱ. Conclusion The pathophysiologic conditions of the patients with tetralogy of Fallot in adults are very complicated due to longterm right ventricle outlet stricture and chronic hypoxia. Preoperative evaluations and postoperative treatment of complications are necessary. The systemicpulmonary arterial shunts should be performed when hypotrophy of the pulmonary arteries or left ventricles exists. Repair of tetralogy of Fallot in adults has acceptable morbidity and mortality rates with goodlongterm outcomes.
Objective To evaluate the effectiveness and safety of external fixation (EF) and open reduction and internal fixation (ORIF) for unstable distal radius fractures in adults. Methods We searched MEDLINE (1966 to September 2008), Cochrane Central register of controlled Trials (The Cochrane Library, Issue 3, 2008), EMbase (1974 to September 2008), CBM, CNKI, and collected randomized controlled trials (RCTs) of EF and ORIF for unstable distal radius fractures in adults. The quality of the included studies was critically assessed and data analyses were performed with the Cochrane Collaboration’s RevMan 5.0 software. Results Seven RCTs involving 634 patients were included, of which 269 were in EF group, and 293 were in ORIF group. Only 1 study had relative high quality, all the others had some limitation in randomization, blinding, and allocation concealment. The results of meta-analyses showed that, 1) about the effectiveness: according to the Gartland and Werley grade standard, the ORIF group was better than the EF group with statistic difference (RR=1.50, 95%CI 1.11 to 2.03, P=0.008); because of the original studies did not offer the detailed data including pad strength, grip strength, flexion-extension, radial deviation, and ulnar deviation, we only processed a descriptive analysis; and 2) about complications: the infection rate of the pin track was higher in the EF group than that in the ORIF group with statistic difference (RR=0.24, 95%CI 0.08 to 0.76, P=0.02); but there were no differences between the two groups in reflex sympathetic dystrophy (RSD) (RR=0.88, 95%CI 0.30 to 2.56, P=0.82), extensor tendon rupture (RR=3.93, 95%CI 0.45 to 34.62, P=0.22), and compartment syndrome (RR=3.13, 95%CI 0.51 to 19.09, P=0.22). Conclusions Compared with EF, ORIF is much better based on Gartland and Werley grade standard, and causes much less infection. Because of the limited quality and quantity of the included studies, more proofs are required from more RCTs with large sample.
ObjectiveTo highlight the characteristics of bronchial foreign body in Adults. MethodsThe clinical data of three patients with bronchial foreign body were analyzed and related literatures were reviewed. ResultsForeign bodies in three patients were all located in right bronchi. Their initial diagnoses were tumor, pneumonia and foreign body, respectively. They all didn't offer a definite history of foreign body aspiration. Foreign bodies in three patients were diagnosed and treated by bronchoscopy. Through reviewing 978 related literatures, we found 2920 cases of bronchial foreign body in adults. 75.00% of them didn't offer a history of foreign body aspiration. 80.13% of them were misdiagnosed as other diseases before bronchoscopy, such as pneumonia(31.23%), lung cancer(25.21%), tuberculosis(5.81%), bronchiectasis(6.58%) and asthma(12.47%). Some of them were misdiagnosed for over 30 years. ConclusionsBronchial foreign bodies in adults are easily misdiagnosed. Bronchoscopy plays an important role in diagnosis and treatment of bronchial foreign body.
Respiratory viruses are important pathogens responsible for community- and hospital-acquired pneumonia in adults. Outbreaks of highly pathogenic viruses in recent years have made us aware of the difficulty and importance of diagnosis and treatment of viral pneumonia. This review summarized the current status of diagnosis and treatment of viral pneumonia in adults so as to improve our understanding of it.
ObjectivesTo systematically review the influence of antiepileptic drugs on bone mineral density and bone metabolism in adults.MethodsPubMed, EMbase, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the influence on antiepileptic drugs on the bone mineral density and bone metabolism in adults from inception to April 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 studies were included. The results of meta-analysis showed that: VPA could decline the bone mineral density of lumbar spine (SMD=–0.39, 95%CI –0.65 to –0.13, P=0.003); CBZ (SMD=–0.71, 95%CI –1.08 to –0.33, P=0.000 2) and VPA (SMD=–0.3, 95%CI –0.58 to –0.02, P=0.03) could decline the bone mineral density of femoral neck; CBZ could decline the bone mineral density of total hip (SMD=–0.47, 95%CI –0.84 to –0.10, P=0.01). Serum 25-hydroxy vitamin D3 was decreased in OXC group (SMD=–0.67, 95%CI –1.28 to –0.05, P=0.03); serum calcium was decreased in CBZ (SMD=–0.49, 95%CI –0.78 to –0.20, P=0.000 8), LEV (SMD=–0.83, 95%CI –1.15 to –0.51, P<0.000 01) and OXC (SMD=–0.48, 95%CI –0.90 to –0.05, P=0.03) group; serum phosphorus was decreased in LEV group (SMD=–11.36, 95%CI –12.97 to –9.76, P<0.000 01). Serum alkaline phosphatase was increased significantly in LEV (SMD=6.79, 95%CI 5.78 to 7.80, P<0.000 01) and CBZ (SMD=1.90, 95%CI 1.35 to 2.44, P<0.000 01) group.ConclusionsCurrent evidence shows that treatment with antiepileptic drugs may be associated with an decreasing bone mineral density and influence bone metabolism in epileptic adults. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectivesTo systematically review the prevalence of asthma in adults (>14 years old) in China.MethodsPubMed, Web of Science, CENTRAL, CINAHL, WanFang Data, CBM, CNKI, and VIP databases were electronically searched to collect cross-sectional studies on the prevalence of asthma in Chinese adults from January 2000 to December 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software.ResultsA total of 67 cross-sectional studies, involving 1 381 673 subjects and 19 871 adult asthma patients were included. The results of meta-analysis showed that the prevalence rate of asthma in adults in China was 1.81% (95%CI 1.59% to 2.01%). The subgroup analysis showed that the prevalence rates of asthma in males and females were 1.87% and 1.76%, respectively. The prevalence rates were 2.16% in the northeast region, 1.34% in the central region, 1.63% in the eastern region and 2.23% in the western region. The prevalence rates were 0.73%, 1.53%, and 2.81% in 15-40 years old, 41-60 years old, and >60 years old, respectively. The prevalence rates were 3.07% in illiteracy population, 1.69% in primary school population, 1.46% in junior middle school population, 1.01% in senior high school population and 0.98% in college and above population. The prevalence rates were 2.23%, 2.10%, 1.17%, 1.45%, 1.09%, and 1.41% in agriculture, forestry and animal husbandry personnel, workers, public officials, business and service personnel, military personnel, and other occupations, respectively. The prevalence rates were 1.41% and 1.59% in Han and other ethnic populations, respectively. The prevalence rates were 2.03% in cities and 1.99% in rural areas. And the prevalence rates were 1.22% in 2000 to 2005, 2.07% in 2006 to 2010, 2.25% in 2011 to 2015, and 2.62% in 2016 to 2019.ConclusionsThe prevalence rate of asthma in Chinese adults is higher, which is different due to the influence of age, sex, region, education, and occupation.