Based on an analysis of the relative shaft-to-hole position and attiude errors, as well as of the mechanics and Kinematics in the process of automatic assembly of industrial robots, the paper studies the principle of ...Based on an analysis of the relative shaft-to-hole position and attiude errors, as well as of the mechanics and Kinematics in the process of automatic assembly of industrial robots, the paper studies the principle of construction of dynamic wrists. Type I-3 and Ⅱ-6 dynamic compliant wrists have been designed and made. Prblems in the production of compliant elements and the connection between compliant elements and wrists were also solved. A study on the results of tests of the function of two kinds of dynamic compliant wrists shows that the dynamic compliant wrist's compliancy function can be improved by adding metallic materials having higher longitudinal and transverse rigidity into the softer elstomer. And the design Principle is proved to be feasible and practicable. It can be expected that the use of dynamic compliant wrist will greatly lower the technical requirements of the shaft-hole assembly and the requirements in the resetting accuracy.展开更多
We report the case of a ten-year-old boy who had often presented with respiratory distress since born. Chest X-ray showed an enlarged right ventricle. Echocardiography demonstrated characteristic features of Fallot＇s...We report the case of a ten-year-old boy who had often presented with respiratory distress since born. Chest X-ray showed an enlarged right ventricle. Echocardiography demonstrated characteristic features of Fallot＇s tetralogy and the left pulmonary artery could not be visualized. However, cardiac catheterization disclosed that the left pulmonary artery had an anomalous origin in the ascending aorta. The patient underwent total surgical correction of the defects. Nine days later, he was discharged. We present the results of a literature review of the incidence, physiopathological, clinical, diagnostic, and surgical characteristics of this rare disease.展开更多
Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT whi...Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT which were surgically treated with different kind of procedures.Resul t.All procedures performed successfully except that the CBT was not excised in 4cases.No operative mortality was observed.There were2postoperative hemiple gia,4hypoglossal nerve impairment ,2glossopharyngeal nerve impairment ,1va gus nerve impairment ,and1accessory nerve impairment.One patient presented p ostoperative cranial nerve impairment in glossopharyngeal,vagus and hypoglossa l nerves.Two patients developed local recurrence during the long-term follow-up.Conclusion.Complete surgical excision was possible in each patient if th e diagnosis had been cor-rectly made through selective preoperative angiography ,vessel ultrasound Doppler and other examinations.Reasonable surgical procedur e and Matas training were necessary to the successful surgical treatment and t hus decrease the complicative incidence rate of carotid chemodectomas.展开更多
Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were t...Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.展开更多
SILENT extra-adrenal retroperitoneal paragangliomas (PGLs) arise from dispersed paraganglias which tend to be symmetrically distributed in close relation to the aorta and sympatheticnervous system. They are rarely enc...SILENT extra-adrenal retroperitoneal paragangliomas (PGLs) arise from dispersed paraganglias which tend to be symmetrically distributed in close relation to the aorta and sympatheticnervous system. They are rarely encountered in everyday surgical practice.展开更多
Objective The Veterans Specific Activity Questionnaire （VSAQ） has been used to assess exercise tolerance. Nevertheless, there is no val- idated Chinese version. The aim of this study is to determine whether a questi...Objective The Veterans Specific Activity Questionnaire （VSAQ） has been used to assess exercise tolerance. Nevertheless, there is no val- idated Chinese version. The aim of this study is to determine whether a questionnaire-based method using the Chinese version of VSAQ （the modified VSAQ） is a practical tool to assess exercise tolerance of Chinese elderly with coronary heart disease. Methods One hundred thirty consecutive elderly patients who were diagnosed with coronary heart disease （CHD） （mean age 68.9 -4- 6.0 years） referred for treadmill exercise testing （TET） for clinical reasons were included in the study. They were asked to complete a questionnaire for clinical characteristics information on age, sex, history, exercise habits, medications, the original VSAQ and the modified VSAQ. We investigated the relationship between exer- cise tolerance in metabolic equivalents （METs） estimated by VSAQ and that obtained by TET. Results The METs by the original VSAQ and the modified VSAQ did not difference significantly （P = 0.528）. The modified VSAQ scores were significantly correlated with the METs oh- mined by TET （r = 0.819, 95% CI： 0.7534）.873, P 〈 0.01）, and the scores of original VSAQ also correlated with the METs by TET （r = 0.804, 95% CI： 0.7454）.854, P 〈 0.01）. The Bland-Altman graph analysis showed few values outside the limits of agrcement, suggesting good precision between the METs estimated by questionnaire and the METs obtained by TET. Conclusions The Chinese version of the VSAQ confirmed its validity and equivalence to the original version, especially when evaluating individuals with coronary heart disease and older adults. The results showed that the VSAQ is a valuable tool to assess the exercise tolerance.展开更多
Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the ...Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.展开更多
Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We com...Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.展开更多
Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of...Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. Results Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. Conclusion It is essential to make a proper surgical strategy, which can reduce postoperative com- plications.展开更多
Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has...Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.展开更多
Background Transradial coronary procedure （TRP） traumatizes the radial artery （RA）, especially resulting in changes to arterial wall morphology. This study explored the significance of the early onset of traumatic...Background Transradial coronary procedure （TRP） traumatizes the radial artery （RA）, especially resulting in changes to arterial wall morphology. This study explored the significance of the early onset of traumatic effects to wall layers of the RA following the first TRP （FTRP） and repeat TRP （RTRP） using very-high-frequency ultrabiomicroscopy （VHFUBM）. Methods A total of 1431 patients that re- ceived TRP were divided into the FTRP group that comprised 781 patients and the RTRP group that comprised 650 patients depending on the number of procedures. Two-dimensional RA images were acquired by 30-55 MHz ultrasound one day before and one day after the pro- cedure. Results After TRP, the incidence of intimal tears, medial dissections and external elastic lamina fracture were greater in the RTRP （P 〈 0.001）. The RTRP group showed significantly thicker intimal thickness （IT）, media thickness （MT）, adventitia thickness and all complex layer thicknesses as compared with the FTRP group （P 〈 0.001）. Conclusions Multivariate linear regression analysis discovered that repeated TRP and other observations were independent predictors of increased IT in post-operative RA. VHFUBM provides an approach to study structural and histopathological injury in the wall layers of RA which showed increased trauma to the RA following RTRP.展开更多
Gonghe bridge is a double level cable-stayed concrete bridge with a single-cable-plane of single cable tower. Its span is 114+120 m and a whole length of 236 m. The gliding scaffold equipment is used for the first tim...Gonghe bridge is a double level cable-stayed concrete bridge with a single-cable-plane of single cable tower. Its span is 114+120 m and a whole length of 236 m. The gliding scaffold equipment is used for the first time in the long span cable-stayed bridge construction to reduce the construction time limit. In the process of construction, to make sure a safe connection among concrete objects with different ages, the single-supporting and single-suspension system is adopted before the concrete pouring. While the double-supporting and single-suspension system is applied after con- crete pouring. These construction systems with gliding scaffold equipment are first introduced in long span ca- ble-stayed bridge and presented in detail[1]. The practice shows that these gliding scaffold systems have many advan- tages over the traditional ones.展开更多
Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Cha...Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.展开更多
Objective To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. Methods Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in C...Objective To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. Methods Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy. Results All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction. Conclusion Surgical repair is the best choice for PA of AVF for renal hemodialysis.展开更多
Objective： To compare function recovery of left ventricle after off-pump and on-pump coronary artery bypass （OPCAB and ONCAB） using Tel index. Methods： Twenty-four patients with coronary artery disease were enroll...Objective： To compare function recovery of left ventricle after off-pump and on-pump coronary artery bypass （OPCAB and ONCAB） using Tel index. Methods： Twenty-four patients with coronary artery disease were enrolled, twelve of which received OPCAB and the others underwent ONCAB. Left ventricular ejection fraction （LVEF）, E/A ratio at mitral orifice and Tel index were measured using transthoracic echocardiography before surgery and 3-7 days, 1 month, 3 months and 6 months after surgery. Results：Tel index of both groups decreased 3-7 days after surgery, with OPCAB group＇s lower than ONCAB group＇s. The difference between pre-and post-OPCAB was significant （P〈0.01）, but not for ONCAB group （P〈0.05）. Tel index of ONCAB decreased more significant than that of OPCAB 1 month after surgery, there was statistical difference between 3-7 days and 1 month after surgery in ONCAB （P〈0.01）. Afterwards, Tel index of the 2 groups decreased steadily with no significant difference between them at other time points. LVEF and E/A ratio decreased at first, then increased gradually, with no statistical differences between the 2 groups at all time points. Conclusion： The recovery of left ventricular function after OPCAB is earlier than ONCAB. Tel index is more sensitive than LVEF and E/A ratio in detecting cardiac function recoveries and can be considered as an accurate and simple method to evaluate left ventricular systolic and diastolic function.展开更多
Objective. Spleen transplanlation has developed to be an effective strategy for hemophilia A. But it has not been reported up to date that which kind of established solutions is most suit...Objective. Spleen transplanlation has developed to be an effective strategy for hemophilia A. But it has not been reported up to date that which kind of established solutions is most suitable for perfusion and preservation of spleen. This study aimed to establish some experiences with the comparison among Hartmann’s solution, Collins’ solution and WMO I solution, in order to instruct the clinical spleen transplantation. Methods. After the splenic artery and vein were dissociated clearly, three kinds of perfusion solutions began to perfuse the corresponding segments of spleen with a randomized sequence. When the efferent fluids from the splenic vein became clear, the perfused spleen segments were preserved for different durations with the same perfusing solution to calculate the survival rate of splencocyte(SRS) and were examined with light and electron microscopy. Results. Among the three solutions, SRS with WMO I solution was significantly higher than those of the other two(P< 0.001). The perfused spleen with WMO I solution showed the slightest morphological changes and a significant longer preservation duration than those with the other two(P<0.05 or P< 0 01). Conclusion. Among the three solutions, WMO I solution was most suitable for perfusion and preservation of spleen.展开更多
To evaluate the effects of carotid endoarterectomy in the treatment of extracranial cerebrovascular disease, 26 cases with internal carotid stenosis were performed by three different kinds of surgical endoarterectomy....To evaluate the effects of carotid endoarterectomy in the treatment of extracranial cerebrovascular disease, 26 cases with internal carotid stenosis were performed by three different kinds of surgical endoarterectomy. The satisfactory results were achieved in all the patients, with no complications and mortality occurring. Endoarterectomy is the effective way to treat the extracranial cerebrovascular disease.展开更多
Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstandi...Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsy- chological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.展开更多
文摘Based on an analysis of the relative shaft-to-hole position and attiude errors, as well as of the mechanics and Kinematics in the process of automatic assembly of industrial robots, the paper studies the principle of construction of dynamic wrists. Type I-3 and Ⅱ-6 dynamic compliant wrists have been designed and made. Prblems in the production of compliant elements and the connection between compliant elements and wrists were also solved. A study on the results of tests of the function of two kinds of dynamic compliant wrists shows that the dynamic compliant wrist's compliancy function can be improved by adding metallic materials having higher longitudinal and transverse rigidity into the softer elstomer. And the design Principle is proved to be feasible and practicable. It can be expected that the use of dynamic compliant wrist will greatly lower the technical requirements of the shaft-hole assembly and the requirements in the resetting accuracy.
文摘We report the case of a ten-year-old boy who had often presented with respiratory distress since born. Chest X-ray showed an enlarged right ventricle. Echocardiography demonstrated characteristic features of Fallot＇s tetralogy and the left pulmonary artery could not be visualized. However, cardiac catheterization disclosed that the left pulmonary artery had an anomalous origin in the ascending aorta. The patient underwent total surgical correction of the defects. Nine days later, he was discharged. We present the results of a literature review of the incidence, physiopathological, clinical, diagnostic, and surgical characteristics of this rare disease.
文摘Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT which were surgically treated with different kind of procedures.Resul t.All procedures performed successfully except that the CBT was not excised in 4cases.No operative mortality was observed.There were2postoperative hemiple gia,4hypoglossal nerve impairment ,2glossopharyngeal nerve impairment ,1va gus nerve impairment ,and1accessory nerve impairment.One patient presented p ostoperative cranial nerve impairment in glossopharyngeal,vagus and hypoglossa l nerves.Two patients developed local recurrence during the long-term follow-up.Conclusion.Complete surgical excision was possible in each patient if th e diagnosis had been cor-rectly made through selective preoperative angiography ,vessel ultrasound Doppler and other examinations.Reasonable surgical procedur e and Matas training were necessary to the successful surgical treatment and t hus decrease the complicative incidence rate of carotid chemodectomas.
文摘Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.
文摘SILENT extra-adrenal retroperitoneal paragangliomas (PGLs) arise from dispersed paraganglias which tend to be symmetrically distributed in close relation to the aorta and sympatheticnervous system. They are rarely encountered in everyday surgical practice.
文摘Objective The Veterans Specific Activity Questionnaire （VSAQ） has been used to assess exercise tolerance. Nevertheless, there is no val- idated Chinese version. The aim of this study is to determine whether a questionnaire-based method using the Chinese version of VSAQ （the modified VSAQ） is a practical tool to assess exercise tolerance of Chinese elderly with coronary heart disease. Methods One hundred thirty consecutive elderly patients who were diagnosed with coronary heart disease （CHD） （mean age 68.9 -4- 6.0 years） referred for treadmill exercise testing （TET） for clinical reasons were included in the study. They were asked to complete a questionnaire for clinical characteristics information on age, sex, history, exercise habits, medications, the original VSAQ and the modified VSAQ. We investigated the relationship between exer- cise tolerance in metabolic equivalents （METs） estimated by VSAQ and that obtained by TET. Results The METs by the original VSAQ and the modified VSAQ did not difference significantly （P = 0.528）. The modified VSAQ scores were significantly correlated with the METs oh- mined by TET （r = 0.819, 95% CI： 0.7534）.873, P 〈 0.01）, and the scores of original VSAQ also correlated with the METs by TET （r = 0.804, 95% CI： 0.7454）.854, P 〈 0.01）. The Bland-Altman graph analysis showed few values outside the limits of agrcement, suggesting good precision between the METs estimated by questionnaire and the METs obtained by TET. Conclusions The Chinese version of the VSAQ confirmed its validity and equivalence to the original version, especially when evaluating individuals with coronary heart disease and older adults. The results showed that the VSAQ is a valuable tool to assess the exercise tolerance.
文摘Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.
文摘Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.
文摘Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. Results Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. Conclusion It is essential to make a proper surgical strategy, which can reduce postoperative com- plications.
文摘Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.
文摘Background Transradial coronary procedure （TRP） traumatizes the radial artery （RA）, especially resulting in changes to arterial wall morphology. This study explored the significance of the early onset of traumatic effects to wall layers of the RA following the first TRP （FTRP） and repeat TRP （RTRP） using very-high-frequency ultrabiomicroscopy （VHFUBM）. Methods A total of 1431 patients that re- ceived TRP were divided into the FTRP group that comprised 781 patients and the RTRP group that comprised 650 patients depending on the number of procedures. Two-dimensional RA images were acquired by 30-55 MHz ultrasound one day before and one day after the pro- cedure. Results After TRP, the incidence of intimal tears, medial dissections and external elastic lamina fracture were greater in the RTRP （P 〈 0.001）. The RTRP group showed significantly thicker intimal thickness （IT）, media thickness （MT）, adventitia thickness and all complex layer thicknesses as compared with the FTRP group （P 〈 0.001）. Conclusions Multivariate linear regression analysis discovered that repeated TRP and other observations were independent predictors of increased IT in post-operative RA. VHFUBM provides an approach to study structural and histopathological injury in the wall layers of RA which showed increased trauma to the RA following RTRP.
文摘Gonghe bridge is a double level cable-stayed concrete bridge with a single-cable-plane of single cable tower. Its span is 114+120 m and a whole length of 236 m. The gliding scaffold equipment is used for the first time in the long span cable-stayed bridge construction to reduce the construction time limit. In the process of construction, to make sure a safe connection among concrete objects with different ages, the single-supporting and single-suspension system is adopted before the concrete pouring. While the double-supporting and single-suspension system is applied after con- crete pouring. These construction systems with gliding scaffold equipment are first introduced in long span ca- ble-stayed bridge and presented in detail[1]. The practice shows that these gliding scaffold systems have many advan- tages over the traditional ones.
文摘Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.
文摘Objective To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. Methods Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy. Results All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction. Conclusion Surgical repair is the best choice for PA of AVF for renal hemodialysis.
基金Supported by Scientific Technology development Foundation of Shanghai(024119028)
文摘Objective： To compare function recovery of left ventricle after off-pump and on-pump coronary artery bypass （OPCAB and ONCAB） using Tel index. Methods： Twenty-four patients with coronary artery disease were enrolled, twelve of which received OPCAB and the others underwent ONCAB. Left ventricular ejection fraction （LVEF）, E/A ratio at mitral orifice and Tel index were measured using transthoracic echocardiography before surgery and 3-7 days, 1 month, 3 months and 6 months after surgery. Results：Tel index of both groups decreased 3-7 days after surgery, with OPCAB group＇s lower than ONCAB group＇s. The difference between pre-and post-OPCAB was significant （P〈0.01）, but not for ONCAB group （P〈0.05）. Tel index of ONCAB decreased more significant than that of OPCAB 1 month after surgery, there was statistical difference between 3-7 days and 1 month after surgery in ONCAB （P〈0.01）. Afterwards, Tel index of the 2 groups decreased steadily with no significant difference between them at other time points. LVEF and E/A ratio decreased at first, then increased gradually, with no statistical differences between the 2 groups at all time points. Conclusion： The recovery of left ventricular function after OPCAB is earlier than ONCAB. Tel index is more sensitive than LVEF and E/A ratio in detecting cardiac function recoveries and can be considered as an accurate and simple method to evaluate left ventricular systolic and diastolic function.
文摘Objective. Spleen transplanlation has developed to be an effective strategy for hemophilia A. But it has not been reported up to date that which kind of established solutions is most suitable for perfusion and preservation of spleen. This study aimed to establish some experiences with the comparison among Hartmann’s solution, Collins’ solution and WMO I solution, in order to instruct the clinical spleen transplantation. Methods. After the splenic artery and vein were dissociated clearly, three kinds of perfusion solutions began to perfuse the corresponding segments of spleen with a randomized sequence. When the efferent fluids from the splenic vein became clear, the perfused spleen segments were preserved for different durations with the same perfusing solution to calculate the survival rate of splencocyte(SRS) and were examined with light and electron microscopy. Results. Among the three solutions, SRS with WMO I solution was significantly higher than those of the other two(P< 0.001). The perfused spleen with WMO I solution showed the slightest morphological changes and a significant longer preservation duration than those with the other two(P<0.05 or P< 0 01). Conclusion. Among the three solutions, WMO I solution was most suitable for perfusion and preservation of spleen.
文摘To evaluate the effects of carotid endoarterectomy in the treatment of extracranial cerebrovascular disease, 26 cases with internal carotid stenosis were performed by three different kinds of surgical endoarterectomy. The satisfactory results were achieved in all the patients, with no complications and mortality occurring. Endoarterectomy is the effective way to treat the extracranial cerebrovascular disease.
文摘Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsy- chological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.
