目的:探討visfatin與老年2型糖尿病及其大血管并發癥和相關代謝指標的關系。方法:將66例老年糖尿病患者分為合并大血管病變組（MCV）35例和非大血管病變組（nMCV）31例，并選64例健康人做對照。采取酶聯免疫測定法（ELISA）測定空腹血清visfatin濃度；并測定各組的空腹血糖、胰島素、血壓和血脂水平；用胰島素抵抗指數（HOMAIR）HOMAIR評價胰島素抵抗，分析各指標間的相關性及與大血管并發癥的相關性。結果:①老年2型糖尿病組血清visfatin濃度高于正常對照組，差異有統計學意義（Plt;0.01）。但正常對照組與2型糖尿病組中nMCV組比較，visfatin濃度差異無統計學意義（Pgt;0.05）。②老年2型糖尿病組中大血管病變組（MCV）血清visfatin濃度明顯高于非大血管病變組（nMCV），差異有統計學意義（Plt;0.01）。③相關分析顯示，老年2型糖尿病組血清visfatin濃度與腰圍（WC）、甘油三酯（TG）均呈顯著正相關，與性別、年齡、HOMAIR呈正相關。進一步以visfatin為應變量，以年齡、性別、BMI、WC、收縮壓（SBP）、舒張壓（DBP）、總膽固醇（TC）、甘油三酯（TG）、低密度脂蛋白膽固醇（LDL-C）、高密度脂蛋白膽固醇（HDL-C）、空腹血糖（FPG）、空腹胰島素（FINS）、HOMAIR為自變量進行多元逐步回歸分析，TG、WC和年齡是血清visfatin獨立相關因素。④在老年T2DM組，以有無大血管并發癥為應變量（Y=1，n=0），各指標為自變量，進行logistic回歸分析，visfatin進入回歸方程。結論:血清visfatin與2型糖尿病的發病不相關，但在老年2型糖尿病中與其大血管并發癥有關。
Severe heart and great vessel injuries were a fatal traumatic entity. How to improve the survival rate of these victims still was a challenge to date. This paper included： the pathogenesis and resuscitation of commotio eordis ; traumatic pericardial rupture associated with heart luxation and/or diaphragmatocele in pericardial cavity; indication selection of emergency room thoracotomy for severe heart injury and traumatic aortic disruption treated with endovascular stent graft. For the purpose of increasing our recognition of the severe trauma and making the early diagnosis and management as early as possible. The main relative references published in recently 5 years were reviewed.
ObjectiveTo summarize the surgical management of complicated mediastinal tumor involving the heart or great vessels. MethodsWe retrospectively analyzed the clinical data of 38 patients with complicated mediastinal tumor invading the heart and large blood vessels underwent extended thymectomy in our hospital between February 1997 and May 2014. There were 26 males and 12 females at age of 41.3± 13.6 years ranking from 4 to 68 years. Multiple personalized procedures were applied within the 38 patients and some patients underwent more than one procedure. Besides the resection of mediastinal tumor, 3 patients underwent partial right atrial resection. Sixteen patients underwent resection, plasty or grafting vessels. Ten patients took partial excision and repair of pericardium. Eight patients underwent pulmonary wedge resection. Two patients underwent lobectomy. Two patients required cardiopulmonary bypass. ResultAll operations were completed successfully. There was no perioperative mortality. The operating time was 105-282 min and blood loss was 200-1 500 ml. The postoperative complications rate was 23.7%. The incidence of ICU admission was 47.4% with an average ICU stay of 1.8 days. The average length of post-operative hospital stay was 11.2 days. The five-year survival rate was 57.0%. ConclusionSurgical resection of mediastinal tumor invading the heart or great vessels is complicated and highly risky. However, desirable clinical outcome can be achieved with comprehensive perioperative assessment and appropriate surgical procedures.
ObjectiveTo compare the choriocapillaris flow density and choroidal vessel volume (CVV) of acute and chronic central serous chorioretinopathy (CSC).MethodsA cross-sectional observational clinical study. A total of 64 eyes of 64 patients (CSC group) diagnosed with CSC at Department of Ophthalmology of West China Hospital of Sichuan University from May 2019 to October 2020, and a total of 64 eyes of 64 age and gender matched healthy volunteers (control group) during the same period were included in this study. In the CSC group, there were 34 patients with acute CSC (acute CSC group) and 30 patients with chronic CSC (chronic CSC group). There was no significant difference in age (t=－0.041) and sex composition ratio (χ2=0.191) between CSC group and control group (P＞0.05). There were statistically significant differences in age (t=－1.872) and sex composition ratio (χ2=8.778) between acute CSC group and chronic CSC group (P＜0.05). Swept source optical coherence tomography angiography (SS-OCTA) was performed using VG200D. The scanning mode was 512×512 and scannig range was 12 mm × 12 mm. The choriocapillaris flow density of the 3 mm, 6 mm, 12 mm circular area and 1-3 mm ring, 3-6 mm ring, and 6-12 mm ring, and the CVV of the of the 3 mm, 6 mm, 12 mm circular area was automatically generated by the built-in software (v1.28.6). The age, choriocapillaris flow density and CVV were compared between two groups using independent sample t test.ResultsCompared with the control group, the choriocapillaris flow density decreased in the CSC group, and there were statistically significant differences in the 3 mm, 6 mm circular area (t=－7.210, －4.040; P＜0.001). There were statistically significant differences between CSC group and control group in the 3 mm, 6 mm, 12 mm circular area (t=1.460, 12.270, 11.250; P＜0.05). Compared with the acute CSC group, the choriocapillaris flow density decreased in the chronic CSC group, and there were statistically significant differences (P＜0.05) in the 3 mm, 6 mm circular area (t=3.230, 2.330), the total and four quadrants of 1-3 mm ring (t=2.780, 2.060, 2.140, 2.620, 3.770), the superior quadrants of the 3-6 mm ring (t=2.550), and the superior and temporal of 6-12 mm ring (t=3.070, 2.610). There was no significant difference of CVV in the 3 mm, 6 mm and 12 mm circular area between the acute CSC group and the chronic CSC group (t=0.250, 0.070, －0.110; P＞0.05).ConclusionCompared with acute CSC, chronic CSC exhibits significant decreased choriocapillaris flow density and no change in CVV.
Macular choroidal macrovessel (MCM) is a recently reported rare choroidal vascular abnormality, characterized by a distinctly thickened choroidal vessel extending from the macular area to the temporal periphery area in fundus examinations. MCM may be an abnormal dilatation of the posterior ciliary artery. The diagnosis of MCM relies on multimodal imaging examinations, with indocyanine green angiography and optical coherence tomography being particularly critical, while optical coherence tomography angiography serves as an essential supplementary and non-invasive alternative. Due to its rarity, ophthalmologists generally have limited awareness of MCM. In clinical practice, it is essential to be familiar with the clinical manifestations and imaging characteristics of MCM, to improve diagnostic levels, enhance differentiation capabilities, and minimize the occurrence of misdiagnosis.
Objective To review and analyze the statistics of laboratory critical values in the Department of Cardiovascular Surgery in order to improve the procedures of dealing with these values and provide references for the enhancement of the nursing level. Methods We retrospectively analyzed laboratory critical values of 236 inpatients in the Department of Cardiovascular Surgery from April 2013 to April 2014. General data of the patients including the type of critical values, the critical value, distribution, clinical processing time and complications related to the critical values. Results A total of 208 laboratory critical values of 185 inpatients were analyzed including abnormal blood potassium was involved in 99 (47.60%); abnormal blood glucose was involved in 13 (6.25%); abnormal blood sodium was involved in 11 (5.29%); abnormal blood troponin was involved in 13 (6.25%); and 72 cases had other kinds of critical values (34.62%). A total of 136 critical values were closely related to the Department of Cardiovascular Surgery. Among them, 60 cases had a processing time of 15 minutes or shorter. After re-examination, 16 were confirmed to be fake critical values; and 11 critical values did not need to be treated according to the condition of the patients. There were altogether 27 cases of complications related to critical values, including 23 cases of arrhythmia related to abnormal blood potassium, 2 cases of abnormal muscle strength caused by abnormal blood sodium, and 2 cases of hypoglycemia. After the critical values were handled, related complications disappeared without any recurrence. Conclusions Perfect regulatory regime and process of recording and handling laboratory critical values are important for nurses in our department to carry out more accurate measures in treating these critical values including abnormal blood potassium, blood glucose, blood sodium, and blood troponin, etc. In order to continuously improve medical and nursing quality, nurses should pay more attention to the identification and treatment of laboratory critical values.
ObjectiveTo explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. MethodsFrom December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. ResultsThere were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.
Objective To investigate the protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection. Methods A total of 180 patients with Standford type A aortic dissection undergoing elective major vascular surgery in our hospital from July 2014 to March 2016 were enrolled. There were 123 males and 57 females with age ranging from 19 to 68 years and weight of 50-85 kg. The patients were randomly divided into two groups. Patients in group A (n=92, 65 males, 27 females, mean age of 45±21 years) received intraoperative autologous blood recovery; while those in group B (n=88, 58 males, 30 females, mean age of 43±24 years) received autologous platelet rich plasma (APRP) and intraoperative autologous blood recovery. The whole process of platelet separation was completed before heparinization. The relevant indicators of blood coagulation function before the induction of anesthesia (T1), before heparinization (T2), immediately postoperatively (T3) and 1 h (T4), 24 h (T5) postoperatively were measured. Cardiopulmonary bypass, aortic cross-clamping time, drainage volume at postoperative 1 h, 24 h and allogeneic blood transfusion volume were recorded. Results The whole blood volume of group B in the platelet separation in emergency was 1 305±110 ml, and collected platelet rich plasma was 275±30 ml, platelet counts (630±220)×109/L, accounting for 25%±5% of platelets of whole blood, and platelet separation time was 32±9 min. Compared with group A, platelet count at postoperative 1 h in group B was significantly higher; drainage volume at postoperative 1 h, 24 h, allogeneic red blood cells, plasma transfusion volume and allogeneic platelet infusion rate decreased significantly (P<0.05). Group B had less postoperative complications (P<0.05). Conclusion Preoperative autologous plateletpheresis combined with intraoperative autologous blood recovery can significantly improve the coagulation function of patients with vascular surgery, and reduce the amount of allogeneic blood transfusion and postoperative bleeding.