Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.
As one of the first batch of pilot universities for the education reform of clinical medicine master program, Sichuan university has conducted in-depth research on the training models in medical schools from home and abroad since 2013. Relying on the platform of medical education collaboration, we have explored and gradually formed the “five early” education model for clinical medicine master program. This article summarizes the practical experience of “five early” education model from six dimensions, namely, PDCA management system, rules and regulations, platform support, database construction, case database construction and international exchange. In addition,, the achievements in the training of medical talents with comprehensive qualities are presented from the aspects of clinical skills, scientific research achievements, international exchanges and frontier innovation, The goal is to provide effective experience for clinical medical personnel training.
Objective To evaluate the long-term anticoagulation outcomes of target international normalized ratio (INR) 1.60 to 2.20 and weekly dosage adjustment of warfarin in patients after mechanical heart valve replacement. Methods Outpatients after mechanical heart valve replacement at least 6 months were registered continually from July 2011 to July 2016 in department of cardiothoracic surgery at Zigong No.4 People's Hospital and West China Hospital. There were 1 690 females (70.62%) and 703 males (29.38%) with a median age of 47 years, ranging from 14 to 80 years. All patients were followed up for 6-61 months. Target INR was 1.60 to 2.20 and warfarin dosage were adjusted weekly. Unexpected bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were recorded and calculated to evaluate the outcome of anticoagulation management. Results A total of 2 393 patients with 26 521 INR values were included for data analysis. INR values varied from 0.90-8.39 (1.82±0.45) and required weekly doses of warfarin were 1.75-61.25 (21.72±7.39) mg. TTR of target INR and acceptable INR was 59.38% (1 449 514.0 days/2 441 060.0 days) and 73.57% (1 795 971.0 days/2 441 060.0 days), respectively. FTTR of target INR and acceptable INR were 50.71% (13 450 times/26 521 times), 65.25% (17 305 times/26 521 times). During the follow-up , anticoagulation-related complications included: cerebral infarction in 21 patients (complete recovery in 18 patients, physical activity disorder in 3 patients), cerebral hemorrhage in 4 patients (death in 1 patient, complete recovery in 3 patients), severe gastrointestinal bleeding in 3 patients (completely recovered) and uterine bleeding in 1 patient (surgical removal of the uterus). Conclusion Target INR 1.60–2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement is reasonable and safe.
ObjectiveTo evaluate the quality of warfarin anticoagulant therapy in patients with stable stage after mechanical valve replacement surgery, to observe the effect of compound salvia miltiorrhiza tablet on the anticoagulant effect of warfarin in patients after mechanical valve replacement, and to understand the impact of genetic polymorphisms of VKORC1, CYP2C9 and CYP4F2 on warfarin resistance in patients with mechanical valve replacement in the stable period.MethodsFrom July 2011 to February 2014, 1 831 patients who had ≥ 6 months after mechanical valve replacement surgery were enrolled at the outpatient follow-up. The basic clinical data were recorded. Anticoagulant therapy uses a target international normalized ratio（INR, 1.60–2.20) and a weekly warfarin dose adjustment strategy. Forty-six patients who needed compound salvia miltiorrhiza tablet were screened and the INR values. Before and after taking tablets were recorded and compared. The patients were divided into three groups according to the percentile of warfarin dosage including a warfarin sensitive patients group, a control patients group, and a warfarin resistance patients group. And 101 of them were selected. TIANGEN blood DNA Kit blood genomic DNA extraction kit was used to extract samples and polymerase chain restriction fragment length polymorphism (PCR-RELP) was used to determine the genotypes of patients. The detected gene loci included CYP4F2: rs2108622C>T locus; VKORC1:1639G>A locus; VKORC1:1173C>T locus; CYP2C9*2: rs1799853C>T locus; CYP2C9*3:1061A>C locus.ResultsThe time in therapeutic range (TTR) and fraction of time in therapeutic range (FTTR) in the target INR range of the patients included in the study period was 27.2% and 49.4%, respectively, and the TTR and FTTR in the acceptable INR range was 34.25% and 63.36%, respectively. Before and after the addition of compound salvia miltiorrhiza tablets, the INR value was 1.55±0.03 and 1.69±0.30, respectively, and the difference was statistically different (P<0.05). A total of 101 patients with genetic testing, in which the C/T composition of the VKORC1: 1173C>T locus increased in the warfarin sensitivity, contrast and warfarin resistance patients, while the ratio of allelic loci of C/T in CYP2C9*3: 1061A>C loci decreased in turn. There was no difference in the CYP4F2 gene, VKORC1639 gene, and CYP2C9*2 locus. The IWPC model predicts that warfarin dose is only consistent with the actual warfarin dose in warfarin sensitive patients.ConclusionRelatively low TTR and FTTR are acceptable in patients with stable stage after mechanical valve replacement. It is beneficial to the patients with compound salvia miltiorrhiza tablets in terms of some appropriate patients. VKORC1: 1173C>T site and CYP2C9*3: 1061A>C site mutation is the main pharmacological gene factor of warfarin dose sensitivity and warfarin resistance in stable period after mechanical valve replacement. The IWPC dose prediction model is only consistent with the actual dose of warfarin sensitive patients.
Objective To investigate the expression of FLIP in the lung of rats and the protective effect in development of acute lung injury( ALI) with the adenovirus vector carrying FLIP gene( Ad-FLIP)inhaled. Methods Forty-eight rats were randomly divided into four groups, with 12 rats in each gruop. In treatment group, ALI rats model was eatablished by LPS intraperitoneal injection and then inhaled Ad-FLIP vector. In prevention group, the animals were infected with Ad-FLIP vector before ALI model wasestablished. Two control groups of treatment and prevention received Ad-EGFP vectors respectively.Pathological changes of lung were observed under light microscope. Wet/dry weight ( W/D) of lung lobes and lung permeability index( LPI) were also measured. The mRNA and protein expressions of FLIP in lungwere investigated by RT-PCR and immunohistochemistry, respectively. Results Lung histopathological changes were alleviated, the index of W/D and LPI were significantly lower, the expressions of FILP mRNA and protein in the lung were elevated both in the treatment group and prevention group compared to thecontrol groups ( all P lt;0. 01) . Conclusion Ad-FLIP transfection can up-regulate the expression of FLIP in lung of rats, and might protect respiratory membrane and lessen pulmonary edema to prevent the development of ALI.