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.
To summarize the medium-term cl inical result of bio-derived bone transplantation in orthopedics with tissue engineering technique. Methods From December 2000 to June 2001, 10 cases of various types of bone defect were treated with tissue engineered bone, which was constructed in vitro by allogenous osteoblasts from periosteum (1 × 106/ mL) with bio-derived bone scaffold following 3 to 7 days co-culture. Six men and 4 women were involved in this study, aged from 14 to 70 years with a median of 42 years. Among them, there were 2 cases of bone cyst, 1 case of non-union of old fracture, 6 cases of fresh comminuted fracture with bone defect, and 1 case of chronic suppurative ostemyel itis. The total weight of tissue engineered bone was 3-15 g in all the cases, averaged 7.3 g in each case. Results The wound in all the case healed by first intention. For 7 year follow up, bone union was completed within 3.0 to 4.5 months in 9 cases, but loosening occurred and the graft was taken out 1 year after operation in 1 case. The X-ray films showed that 9 cases achieved union except one who received resection of the head of humerus. No obvious abnormities were observed, and the function of affected l imbs met daily l ife and work. Conclusion Bio-derived tissue engineered bone has good osteogenesis. No obvious rejection and other compl ications are observed in the cl inical appl ication.
Objective To explore the factors associated with clinic follow-up of old patients with colorectal cancer and provide more evidence to improve the efficiency and quality of clinic follow-up after sugery. Methods The data of 253 patients who were underwent sugery because of old colorectal cancer in our hospital from January 2009 to May 2010 were reviewed. Data about the rate and times of clinic follow-up within 6 months after operation were collected via Hospital Information Systerm, then the follow-up rate was calculated, and to analyse the possible factors associated with follow-up times and rate. Results The total follow-up rate was 84.2%（213/253）, and the total times of follow-up was between 0 to 24 times per one, （4.08±0.03）times on average. On the times of follow-up, patients inside the city was higher than that outside, patients with medical or postoperative complications were higher than those without, and patients with a stoma was lower than that without, and the differences were statistically significant （P＜0.05）.While on the follow-up rate, patients underwent a radical sugery or with a stoma were lower than those not or without, and the differences were statistically significant （P＜0.05）. Conclusions The clinic follow-up of old colorectal cancer patients is not satisfactory, and the possible factors associated with follow-up times or rate are the distance between residence and hospital, have medical complications or not, have postoperative complications or not, radical sugery or not, and with a stoma or without.
ObjectiveTo explore the efficacy of an innovative approach of follow-up in patients implanted with permanent pacemaker (DDD). MethodsA total of 400 patients who underwent permanent pacemaker (DDD) implantation between June 2011 and June 2013 were included in the present study. Patients were randomly assigned to the innovative and conventional follow-up groups in a 1：1 manner (200 patients in each group). The baseline characteristics were well balanced with no statistically significant differences in the mean age, proportion of male sex, prevalence of hypertension, position of the electrode or the device used between the two groups. At the end of the follow-up, patient outcomes were compared between the two groups. ResultsThe outcomes of patients were better in the innovative follow-up group, with higher degree of satisfaction, better state of health, lower incidence of complications, and less frequent readmission and follow-up visits (all P<0.05). ConclusionThe innovative approach of follow-up considerably improves patient outcomes, and can be useful in future clinical practice.
ObjectiveTo explore the influencing factors for lost follow-up of diabetic patients, looking for suitable follow-up methods for patients in the region of Central and Western China, in order to help ensure the quality of follow-up, improve the rate of follow-up and provide a basis for improving the quality of patients' continuous nursing outside of the hospital. MethodsContinuous nursing was carried out for 600 patients discharged from our department by two full-time diabetes education nurses from September 2012 to April 2014. The data of outside hospital patients who were lost in the follow-up were retrospectively analyzed. According to the sequential order of the patients, they were divided into three groups. The difference among the three groups of patients was analyzed and the effect of nursing intervention on patients' follow-up loss was also analyzed. ResultsThe rate of lost follow-up for the three groups were 29.4%, 20.3%, and 12.2%. Big classroom participation rate was 29.4%, 50.5%, and 57.5%. The lost follow-up rate of group three using team comprehensive management pattern was lower than that in group 1 with traditional supervision intervention. The age of the patients who were lost in the follow-up concentrated under 40 and above 75 years old. The patients with a disease history longer than 10 years with more complications were more likely to be lost in the follow-up. The main reason for lost follow-up was self-conceit and lack of awareness of the follow-up. ConclusionDiversified ways of follow-up can complement each other which can reduce the rate of lost follow-up.
The main purpose of this study is to observe and analyze the characteristics and the clinical significance of long-term echocardiogram data in patients after mechanical aortic valve replacement operation. Fifty-five cases were recruited over 5 years after mechanical aortic valve replacement operation, with complete echocardiogram examination profiles. The 55 subjects were divided into predominate aortic stenosis group and predominate aortic regurgitation group, based on preoperative examinations. And another way of division was also carried out that according to the effective orifice area index (EOAI), the subjects were divided into three groups, i.e., severe prosthesis-patient mismatch (PPM) group, moderate PPM group, and non PPM group. Characteristics of long-term echocardiogram data of the subjects were analyzed. Patients with aortic stenosis showed significantly decreased thickness of intraventricular septum and left ventricular posterior wall about half a year after operation (P<0.05). Half a year after operation, patients with aortic regurgitation showed decreased left ventricular internal dimension diastole and left ventricular internal dimension systole, and increased ejection fraction (P<0.05). Differences in mean aortic valve pressure gradient, forward blood flow across the aortic valves, and ejection fraction were not significant among those with severe PPM, moderate PPM, and non PPM groups (P>0.05). Number of cases of ascending aorta dimension increased as time goes on and pathogenesis of other valve diseases. A conclusion could be drawn that the heart function of patients with aortic valve disease could be improved after mechanical aortic valve replacement operation, but pathologies in other valves and ascending aorta might be increased, and therefore periodical postoperative echocardiogram evaluation with long tem pharmaceutical therapy could be necessary.
ObjectiveTo investigate long-term echocardiographic outcomes of patients after mitral and aortic valve replacement and their clinical significance. MethodsA total of 204 patients who underwent mitral and aortic valve replacement from January 1999 to June 2008 in West China Hospital of Sichuan University, and had been followed up with echocardiography for longer than 5 years were enrolled in this study. There were 60 male and 144 female patients with their age ranging from 15 to 74 (48.42±11.00)years. Postoperative follow-up time was 5 to 13 (6.34±2.05)years. Preoperative and follow-up echocardiographic results were compared. ResultsCompared with preoperative results, postoperative left atrial diameter (LA)and left ventricular diameter (LV)significantly decreased (P < 0.05), while right ventricular diameter (RV), left ventricular ejection fraction (LVEF)and left ventricular fractional shortening (LVFS)significantly increased (P < 0.05). Right atrial diameter (RA)did not change significantly (P > 0.05). In the patients mainly with mitral stenosis preoperatively, postoperative LA, LV, left atrial area (LAA), left atrial volume (LAV), mitral mean pressure gradient (MPGmv), velocity time integral (VTImv)and pressure half time (PHTmv)significantly decreased (P < 0.05), while mitral effective orifice area (EOAmv)and effective orifice area index (EOAImv)increased significantly (P < 0.05), but peak E velocity (Emv)did not change significantly (P > 0.05). In the patients mainly with mitral regurgitation preoperatively, postoperative LA and LV decreased significantly (P < 0.05), while LAA, LAV, MPGmv, VTImv, PHTmv, EOAmv and EOAImv did not change significantly (P > 0.05). In the patients mainly with aortic stenosis preoperatively, postoperative LV, interventricular septal thickness (IVS), left ventricular mass (LVM), left ventricular mass index (LVMI), aortic peak forward flow velocity(Vav)and mean pressure gradient (MPGav)significantly decreased (P < 0.05), while aortic effective orifice area (EOAav)and effective orifice area index (EOAIav)significantly increased (P < 0.05), but left ventricular posterior wall thickness (LVPW)did not change significantly (P > 0.05). In the patients mainly with aortic regurgitation preoperatively, postoperative LV, LVM, LVMI, EOAav and EOAIav decreased significantly (P < 0.05), while Vav and MPGav increased significantly (P < 0.05), but IVS and LVPW did not change significantly (P > 0.05). In mitral position, compared with patients with 25 mm prosthesis, Emv, MPGmv and VTImv of patients with 27 mm prosthesis were significantly smaller (P < 0.05), but there was no statistical difference in PHTmv, EOAmv or EOAImv between the 2 groups (P > 0.05). In aortic position, compared with patients with 21mm prosthesis, Vav, MPGav and VTIav of patients with 23 mm prosthesis were significantly smaller (P < 0.05), while EOAav and EOAIav were significantly larger (P < 0.05). In mitral position, 38 patients (21.3%)had moderate prothesis-patient mismatch (PPM)and 4 patients (2.3%)had severe PPM. In aortic position, 50 patients (24.5%)had moderate PPM and 43 patients (21.1%)had severe PPM. Consti-tuent ratio of long-term tricuspid regurgitation (TR)degree of patients after tricuspid valvuloplasty (TVP)significantly improved (P < 0.05), but constituent ratio of long-term TR degree of patients without TVP significantly deteriorated (P < 0.05). ConclusionsLeft ventricular function and hemodynamic outcomes in the long term are significantly better than preoperative results after double valve replacement, but they are still far from normal. PPM in aortic position is more severe than that in mitral position. Since residual or aggravated TR is very common in the long term, concomitant TVP should be considered more positively for patients undergoing surgery for left-sided valvular disease.
Objective To present early follow-up results of surgical closure of ruptured sinus of Valsalva aneurysm (RSVA). Methods We retrospectively analyzed the clinical data of 32 patients with RSVA or combined with RSVA in our hospital between January 2010 and December 2014. There were 20 males, 12 females aged 37.6±11.2 years. All the patients were surgically corrected under cardiopulmonary bypass. Results The mean cardiopulmonary bypass time was 79±18 min and the mean aortic cross-clamp time was 53±9 min. Except that 1 patient had the first degree A-V block and 2 patients with delayed wound healing, there was no other complication in the early postoperative period. One patient with surgically corrected RSVA was with infective endocarditis after 3 months follow-up. Most patients were with better New York Heart Association (NYHA) functional classⅠor Ⅱat the end of the follow-up. Conclusion Surgical closure of RSVA is a safe and effective alternative to surgery with early follow-up results.
Objective To explore the pain after discharged in patients with radical total gastrectomy under painless ward management, and to analyze the causes of pain in order to guide the treatment strategy after discharge. Methods Retrospective analysis was performed on the pain data of 82 patients who underwent radical total gastrectomy in The First Affiliated Hospital of Air Force Military Medical University from December 2015 to April 2017, and the situation of pain was followed-up at 2 weeks, 1 month, 2 months, and 3 months after discharged. Results Mild pain occurred in 25 patients at the 2 weeks after discharged; mild pain occurred in 38 patients and moderate pain occurred in7 patients at the first month after discharged; mild pain occurred in 31 patients and moderate pain occurred in 4 patients at the second month after discharged; 19 patients had mild pain at the third month after discharged. There was no significant difference in pain scores between male patients and female patients, <60 years old patients and ≥60 years old patients, patients’ operative time<180 min and patients’ operative time ≥180 min, patients’ intraoperative blood loss<200 mL and patients’ intraoperative blood loss ≥200 mL at the all time points, including the second week, the first, the second, and the third month after discharge ( P>0.05). Conclusion Painless ward management can effectively control the degree of pain in discharged patients who underwent radical total gastrectomy.
ObjectiveTo evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement (CADR) for patients with cervical spondylotic radiculopathy (CSR).MethodsThe data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than 10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years (range, 40-70 years). The disease duration was 2-144 months (mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments (C3, 4 in 2 cases, C4, 5 in 6 cases, C5, 6 in 18 cases, C6, 7 in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups (P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion (ROM), loss of ROM (ROM<3°) at last follow-up, Cobb angle and incidence of local kyphosis, paravertebral ossification (PO) grading. The clinical evaluation indexes included neck disability index (NDI) and overall efficacy (Odom’s score).ResultsAll patients were followed up 121-153 months (mean, 130 months). The results of radiographic evaluation indexes showed that within group comparison, except that the Cobb angle of the operated level was significantly decreased (P<0.05) in both 2 groups, there was no significant difference in global cervical ROM and segmental ROM between preoperation and last follow-up (P>0.05). Except that the loss of ROM (ROM<3°) at last follow-up and high-grade PO at last follow-up in group B were significantly higher than those in group A (P<0.05), there was no significant difference in other radiographic evaluation indexes between 2 groups (P>0.05). The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups (P<0.05) at last follow-up. There was no significant difference in the NDI at preoperation and at last follow-up, the decline of NDI at last follow-up, and the overall efficacy evaluated by Odom’s score between 2 groups (P>0.05). The excellent and good rate of overall efficacy reached 100% in both groups.ConclusionCADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.