Objective To investigate the correlation between glycosylated hemoglobin A1c (HbA1c) and severity of coronary artery lesions in young men with acute myocardial infarction (AMI). Methods Total 278 young men with AMI less than 45 years old were retrospectively studied, and all of them were admitted to hospital from January 2009 to December 2011, and had undergone coronary angiography. According to the results of coronary angiography, the patients were divided into three groups based on the number of artery lesions: the single group (156 cases), the double group (64 cases) and the triple group (58 cases). The relationship between the severity of coronary artery lesions and the following factors were observed: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), smoking history, drinking history and family history of early coronary artery disease. Results a) HbA1c levels were gradually raised in all the three groups, but the single group (6.39±1.67%) was significantly lower than the double group (6.91±1.63%) and the triple group (7.41±2.12%), with significant differences (Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in both the ST-segment elevation AMI (6.42±1.68% vs. 7.17±1.86%, Plt;0.05) and the non-ST-segment AMI (5.57±0.37% vs. 8.56±2.83%, Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in patients with diabetes millitus (8.31±1.83% vs. 8.59±2.02%, Plt;0.05) and in patients without diabetes millitus (5.56±0.33% vs. 5.74±0.37%, Plt;0.05); b) There were significant differences in SBP, TC, HDL-C, LDL-C and drinking history between the single group and the other two groups (all Plt;0.05), and there were significant differences in DBP and TG between the single group and the double group (all Plt;0.05); and c) The results of logistic regression analysis showed that, LDL-C (OR=1.790), HbA1c (OR=1.287) and SBP (OR=1.042) were the independent risk factors (all Plt;0.05) for multiple lesions in coronary arteries of young men with AMI. Conclusion Glycosylated hemoglobin A1c is an independent risk factor for multiple lesions in coronary arteries of young men with AMI.
Abstract： Objective To investigate the effect of intramyocardial injection of slow release microspheres of tannic acid （TA） on ventricular remodeling after acute myocardial infarction （AMI） in rats. Methods Slow release microspheres of TA were prepared and the release parameters in vitro were detected. AMI model in rats was induced. Eighty rats were enrolled and divided into 4 groups by random digital table：poly （lactic-co-glycolic acid） （PLGA） microspheres injection （PLGA group， n=24）， PLGA-TA microspheres injection （PLGA-TA group， n=24）， TA injection group （TA group， n=16） and normal saline injection group （NS group， n=16）. Heart function was evaluated by echocardiography after the injection. The structure of cardiac extracellular matrix （ECM） in the infarcted borderline area was evaluated at 4th week after the injection. Collagen content in the infarcted area was evaluated by hydroxyproline colorimetry assay at 2nd and 4th week after the injection. Results TA release was maintained at a constant rate from the microspheres for one month in vitro. Two weeks after the injection， left ventricular ejection fraction（LVEF）， left ventricular fraction shortening（LVFS）， left ventricular end-diastolic diameter（LVEDD） and left ventricular end-systolic diameter（LVESD） in PLGA-TA group and TA group were significantly better than those in the other two groups（P＜0.05）. Four weeks after the injection， LVEF， LVFS， LVEDD and LVESD in PLGA-TA group were significantly better than those in the other three groups （P＜0.05）. Four weeks after the injection， slow release microspheres of TA in the PLGA-TA group effectively improved the arrangement of ECM compared with TA group. Four weeks after the injection， collagen content in the infarcted area of PLGA-TA group was significantly higher than that in TA group（88.88±7.28 μg/mg dry weight vs. 72.43±9.02 μg/mg dry weight）， PLGA group（88.88±7.28 μg/mg drg weight vs. 71.97±6.06 μg/mg dry weight） and NS group（88.88±7.28 μg/mg dry weight vs. 68.86±7.55 μg/mg dry weight， F=7.162，P=0.003）， but there was no statistical difference in the collagen content of the infarcted area among TA group， PLGA group and NS group （P＞0.05） . Conclusion Intramyocardial injection of slow release microspheres of TA can maintain a constant release of TA for a comparatively long period， inhibit collagen matrix degradation， and effectively attenuate ventricular remodeling after AMI in rats.
Abstract： Objective To improve therapeutic outcomes for severe leftsided atrioventricular valve regurgitation (LAVVR) after repair of atrioventricular septal defect (AVSD) through discussing pathological changes of the valve and surgical management for these patients, and summarizing the medical experiences of perioperative managements. Methods We retrospectively analyzed the clinical data of 29 patients including 16 males and 13 females with LAVVR after repair of AVSD treated in Xinhua Hospital, Medical College of Shanghai Jiaotong University between January 1995 and December 2009. The age of these patients ranged from 4 to 62 years, averaging at 26.5. According the classification of New York Heart Association (NYHA), there were 10 patients of class Ⅱ, 17 of class Ⅲ and 2 of class Ⅳ before reoperation. Partial repair of AVSD had been carried out for 18 patients, and complete repair had been performed on 11 patients. At reoperation, valve rerepair was performed on 17 patients and mechanical valve replacement (MVR) was necessary in 12 patients. Results In the early period after operation, one patient died of multiple organ failure, one patient had a permanent pacemaker inserted because of complete atrioventricular block, and 1 patient aged 4 years got recovery after 56 hours of circulatory support for severe cardiac failure after reoperation. A mean follow-up of 8.2 years (6 months to 14 years) was done for 25 patients with 3 missing. During the follow-up for 14 patients undergone heart valve repair, there was no obvious acceleration of the forward blood flow of the leftside atrioventricular valve. Ten patients had mild or less LAVVR, 1 had moderate LAVVR and 3 underwent successful left atrioventricular valve replacement at 10 days, 3 years or 6 years after reoperation because of severe LAVVR. Clinical status, as assessed by the NYHA classification, improved after surgery for LAVVR in 25 patients who were followed up with 17 in NYHA class Ⅰ, 6 in class Ⅱ, and 2 in class Ⅲ. Podoid decreased significantly and cardiothoracic ratio was 0.53-0.67 (0.60±0.11) in chest Xray picture. There was no late death. Conclusion With timely surgical treatment, and appropriate surgical method, LAVVR after complete or partial AVSD repair can be managed with excellent shortterm and longterm outcomes.
Objective To review and summarize the surgical techniques and their outcomes for the treatment of lumbar spondylolysis in young patients by direct surgical repair. Methods Both home and abroad literature on the surgical techniques and their outcomes respectively for the treatment of lumbar spondylolysis in young patients by direct surgical repair was reviewed extensively and summarized. Results Direct surgical repair of lumbar spondylolysis can offer a simple reduction and fixation for the injured vertebra, which is also in accord with normal anatomy and physiology. In this way, normal anatomy of vertebra can be sustained. As reported surgical techniques of direct repair, such as single lag screw, hook screw, cerclage wire, pedicle screw cable, pedicle screw rod, and pedicle screw hook system, they all can provide acceptable results for lumbar spondylolysis in young patients. Furthermore, to comply strictly with the inclusion criteria of surgical management and select the appropriate internal fixation can also contribute to a good effectiveness. Within the various methods of internal fixation, pedicle screw hook system has been widely recognized. Conclusion Pedicle screw hook system fixation is simple and safe clinically. With the gradual improvement of this method and the development of minimally invasive technologies, it will have broad application prospects.
Objective To evaluate the therapeutic outcome of artificial total hip arthroplasty (THA) with collum femoris preserving for hip joint desease in young and middle-aged patients. Methods From March 2002 to March 2005, 26 cases (31 hips) of hip joint disease were treated with artificial THA with collum femoris preserving, including 19 males (23 hips)and 7 females (8 hips) and aged 32-48 years with an average of 37 years. In 31 hips, 17 left hips and 14 right hips were involved. There were 9 cases of osteoarthritis of the hip joint caused by avascular necrosis of the femoral head (ANFH), 7 cases of ANFH, 3 cases of femoral head necrosis caused by dysplasia of acetabular, 1 case of osteoarthritis of the hip joint caused by ankylosing spondyl itis, and 2 cases of rheumatoid arthritis; the course of disease was 2-11 years (5.6 years on average). Two cases of femoral neck fracture (Garden IV), and 2 cases of non-union femoral neck fractures (1 for Garden III and 1 for Garden IV), the course of disease was 5 days, 24 months, and 26 months. The prime symptoms were pain, difficult walk and l imp. All patients were taken X-ray to exclude osteoporosis. Results The right distal femur prosthesis of a bilateral patient cracked owing to excessive amputation of collum femoris, and fracture healed after symptomatic treatment. All the incisions healed by first intention and no compl ications occurred. All patients were followed up for 4-7 years, with an average of 5.6 years. One case had poor hip function because he did not follow rehabil itation procedure, and the others achieved good outcome with normal gait. One case complained of persistent pain 6 months after operation, and was rel ieved by administration of some non-steroidal antiinflammatory drugs and anti-osteoporosis drugs 6 months later. The X-ray films after operation and at last follow up showed good location of prosthesis and no bone resorption. Harris score at last follow-up was 91.31 ± 0.77, and it was significantly higher than that before operation (50.88 ± 0.90), (P lt; 0.05). The excellent and good rate was 93.5% (excellent in 11 hips, good in 18 hips, and fair in 2 hips). Conclusion Artificial THA with collum femoris preserving can retain more bone, be easier for revision, and has an excellent outcome.
Objective To evaluate the short-term cl inical outcomes of metal-on-metal total hi p resurfacing arthroplasty in treating osteonecrosis of the femoral head (ONFH) in young and middle-aged patients and to compare with patients of hip osteoarthritis at the same period. Methods From July 2006 to October 2008, 33 patients (45 hips) with ONFH (ONFH group) and 39 patients (45 hips) with osteoarthritis (osteoarthritis group) were treated with metal-on-metal total hipresurfacing arthroplasty. In ONFH group, there were 18 males (27 hips) and 15 females (18 hips) with an average age of 42.7 years (range 19-58 years), including 22 left hips and 23 right hips. The causes were trauma (4 cases), glucocorticoid (25 cases), drugs (2 cases), alcohol (1 case), and psoriasis (1 case). According to Steinberg classification, there were 10 hips at stage III, 18 hips at stage IV a, 13 hips at stage IV b, and 4 hips at stage IV c. The Harris score was 52.0 ± 4.6. The disease course was 1-12 years. In osteoarthritis group, there were 26 males (30 hips) and 13 females (15 hips) with an average age of 47.1 years (range 42-65 years), including 17 left hips and 28 right hips. The causes were degenerative arthritis (23 cases), trauma (11 cases), and ankylosing spondyl itis (5 cases). The Harris score was 57.0 ± 3.8. The disease course was 3-17 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention without compl ications of infection and thrombosis of deep vein of lower extremities. The patients were followed up for 26 months in ONFH group and 28 months in osteoarthritis group. Femoral neck fracture occurred in 1 case of osteoarthritis group after 4 months, who received total hip arthroplasty; no compl ication of prosthesis loosening, dislocation, incision infection, osteonecrosis, and bone absorption occurred in other patients. At last follow-up, the Harris scores were 93.0 ± 5.5 in ONFH group and 94.0 ± 2.4 in osteoarthritis group, showing no significant difference between two groups (P gt; 0.05); but there were significant differences between pre- and post-operation (P lt; 0.01). Conclusion The cl inical short-term outcomes ofmetal-on-metal total hip resurfacing arthroplasty to treat ONFH are satisfactory. It can achieve similar outcomes to that ofosteoarthritis group. More cases and long-term follow-up are needed to investigate long-term cl inical outcomes.
Objective To investigate the methodology and efficacy evaluation of ceramic on ceramic hip prosthesis in total hip arthroplasty for young patients. Methods The cl inical data from 65 patients (75 hips) who received ceramic on ceramic hip prosthesis for total hip arthroplasty between February 2004 and September 2006, including unilateral replacementin 55 cases and bilateral replacement in 10 cases. Of 65 patients, there were 41 males and 24 females with an average age of 43.2 years (range, 18-56 years), including 6 cases of femoral head comminuted fractures, 44 cases of aseptic necrosis femoral head, 7 cases of developmental dysplasia of hip with osteoarthritis, 3 cases of congenital dislocation of hip, 2 cases of traumatic arthritis secondary to postoperative acetabulum fracture, 1 case of rheumatoid arthritis, and 2 cases of ankylosing spondyl itis. The Harris score was 54.3 ± 6.7. The disease duration was 1 year and 4 months to 10 years and 7 months with an average of 3 years and 2 months. Results Heal ing of incision by first intention was achieved in all patients; no dislocation, infection, and deep venous thrombosis of lower l imbs occurred. All patients were followed up 3 years and 2 months to 5 years and 7 months with an average of 4 years and 9 months. The Harris score was significantly improved to 89.0 ± 9.4 at last follow-up, showing significant difference when compared with preoperative one (P lt; 0.01). The mean eversion angle and anteversion angle of the acetabular component were (43.6 ± 8.4)° and (21.5 ± 3.5)°, respectively. In follow-up period, no prosthetic loosening, subsidence, dislocation, and ceramic component fracture occurred. Osteolysis was not found in all the cases. Conclusion Ceramic on ceramic hip prosthesis in total hip arthroplasty for young patients can effectively decrease the compl ications of prosthetic loosening and subsidence caused by wearing of joint interface; the surgical skill is important in decreasing dislocation and fraction of ceramic on ceramic hip prosthesis.
Objective To explore an improved method of treating avascular necrosis of the femoral head in young adults by grafting the sartorius muscle iliac bone flap. Methods From September 1994 to August 2003, 68 patients (57 males, 11 females; age, 16-58 years) underwent of the transplant the sartorius muscle oliac bone flap into the femoral head after decompression of the femoral head medullary core and removal of the dead bone and the fibrous tissue in the femoral head. The transplantation was performed on 31 patients left-unilaterally, on 37 patients rightunilaterally, and on 7 patients bilaterally. The pathological causeswere as follows: alcoholism in 52 patients, prolonged use of hormones in 6, traumain the hip in 6, and undetermined cause in 4. Their illness course ranged from 8 months to 4 years. According the Ficat staging, 10 patients belonged to Stage I (11 sides), 27 patients to Stage Ⅱ (31 sides), and31 patients to Stage Ⅲ (33 sides). Results The follow-up of the 68 patientsfor 2.5-11 years averaged 5.2 years revealed that based on the Harris evaluation for the hip function, 23 patients had an excellent result, 33 had a good result, 10 had a fair result, and 2 had a poor result. The excellent and good resultsaccounted for 82.3%. There was no recurrence after operation. Conclusion Thismethod has the following advantages: the lesion focus can be eradicated; enoughdecompression can be achieved, and the blood circulation for the femoral head can be rebuilt. The grafting of the sartorius muscle iliac bone flap can bring the osteogenesis components to the femoral head, promoting the reconstruction of the bones. This method is suitable and effective for the patients with avascular necrosis of the femoral head (Ficat Grades Ⅰ, Ⅱ and Ⅲ) in young adults.
Objective To explore the characteristics of diagnosis and treatment for the rectal cancer in the young patients （≤40 years）．Methods The domestic and abroad literatures about the research on the progress of rectal cancer in the young patients were reviewed, the clinical data of patients with rectal cancer were compared between the young patients and the other age patients, the characteristics of diagnosis and treatment for the rectal cancer in the young patients were summarized．Results The onsets of the young patients with rectal cancer were related to the diet，lifestyle, and genetic factors．Compared with the older patients, more later stage, higher percentage of poor differentiation, earlier lymph node metastasis were found in the young patients with rectal cancer．Rectal cancer of the young patients was often misdiagnosed and with a poor prognosis．Currently，surgery assisted with neoadjuvant therapy was generally acknowledged as a better method．Conclusions It has specificity in epidemiology, pathology, treatment, prognosis, and so on for rectal cancer in the young patients, but surgery needs further research．
ObjectiveTo explore the clinical features and prognosis of ischemic cerebral infarction in young population,and to provide a reference for clinical prevention of cerebral infarction in young population. MethodsA total of 547 patients with ischemic cerebral infarction diagnosed between January 2008 and June 2013 were included,and the difference in clinical data and outcomes between young and old patients were retrospectively compared. ResultsThe 547 patients included 233 young and 314 old patients,and there were more male patients in young group.As compared to the old group,the proportion of hypertension was significantly lower in young group (51.9%,64.3%;P=0.004);while smoking (51.9%,5.7%;P=0.000) and alcoholism (53.2%,28.3%;P=0.000) were significantly higher in young group.Moreover,there were more patients with vascular malformations in young group than that in old group (7.3%,3.2%;P=0.028).And there were also more patients in young group received thrombolytic therapy and antiplatelet therapy (98.3%,86.9;P=0.000),and the prognosis of young patients was significantly better than that of old patients. ConclusionThe prognosis of young patients with ischemic stroke prognosis is relatively good,and changing bad habits would be an effective measure to prevent and reduce the occurrence of ischemic cerebral infarction in young population.