Transcatheter aortic valves implantation have been widely used in patients with high risk of non-surgical or surgical procedures since the first implantation in 2002, and have achieved good therapeutic results. However, as one of the main complications after transcatheter aortic valve implantation, paravalvular regurgitation seriously affects the outcome of patients. This article reviews recent researches on transcatheter aortic valve paravalvular regurgitation, and summarizes the influencing factors of paravalvular regurgitation after transcatheter aortic valve implantation and the corresponding countermeasures. This review can provide guidance and reference for clinical application and research of transcatheter aortic valves.
Traditional surgical aortic valve replacement is associated with a high risk of serious complications, especially in elderly patients with other preoperative diseases and unable to undergo thoracotomy. Therefore, transcatheter aortic valve implantation (TAVI) is now the accepted standard treatment for patients with symptomatic severe aortic stenosis at elevated risk for conventional surgical valve replacement. Currently, guidelines propose the use of dual antiplatelet therapy for the prevention of thromboembolic events after TAVI in the patients without an indication for oral anticoagulation. While, this strategy is empiric and largely based on expert consensus extrapolated from the arena of percutaneous coronary intervention. Antithrombotic therapy is associated with a significant occurrence of both thrombotic and bleeding complications, thus, the balance between thrombotic and bleeding risk is critical. This review summarizes current guidelines and the evidence underpinning them and explores the rational for using antiplatelet and/or anticoagulant strategies after TAVI.
Objective To review the current research status on the diagnosis and treatment of fracture-related infection (FRI). Methods The research literature in the field of FRI both domestically and internationally in recent years were widely reviewed, and the research progress of FRI from the aspects of definition and classification, epidemiological characteristics, diagnosis and treatment elaborated, in order to provide reference for clinical practices. Results In recent years, specific classifications for FRI have gradually emerged. FRI is characterized by high incidence, high recurrence, high disability rates, and significant economic costs. Key diagnostic points include clinical signs and symptoms, imaging tests, serological biomarkers, pathogen identification, and histopathological examination. Treatment principles encompass debridement, management of implants (retention or removal), systemic and local antibiotic use, reconstruction of bone and soft tissue defects, and functional and psychological rehabilitation. Conclusion Although FRI is a catastrophic complication following limb bone trauma, early precise diagnosis and standardized treatment are key to improving cure rates, reducing recurrence, and enhancing patients’ quality of life.
Objective To review the progress in the treatment of acute Achilles tendon rupture. Methods Recent literature about the treatment of acute Achilles tendon rupture was reviewed and analyzed. Results Treatments of acute Achilles tendon rupture include operative and non-operative treatments. Operative treatments include open surgery and percutaneous minimally invasive surgery. Compared with non-operative treatment, operative treatment can effectively reduce the re-rupture incidence, but it had higher complication incidences of wound infection and nerve injury. Although early functional rehabilitation during non-operative treatment could reduce the re-rupture incidence, there is no consistent orthopaedic device and guideline for functional rehabilitation. Conclusion Both operative and non-operative treatments have advantages and disadvantages for the treatment of acute Achilles tendon rupture. No consistent conclusion is arrived regarding functional recovery. Future studies should explore the strategy of early functional rehabilitation during non-operative treatment and its mechanism of promoting tendon healing.
【Abstract】ObjectiveTo investigate the effects and mechanism of Panax Notoginseng saponins (PNGS) on rat liver during cold preservation. Methods Using isolated perfusion of rat liver model (IPRL), Fura-2 method was used to measur the concentration of calcium ion in hepatic cells which had been preserved in DMEM solution with different concentration of PNGS added and cold preserved for 2 hours. Liver function, metabolic products of oxygen free radicals, energy substance and aucount of biliary flow as well as morphological study were measured from liver tissue which had been cold preserved in lactate riuges’s solution containing different dosages of PNGS for 24 hours and 30 minutes reperfusion.ResultsThe contents of intracellur calcium of the rat hepatocytes,MDA, AST, ALT, LDH were lower than those in the control group,but SOD, ATP, TAN, EC and bile production were higher than those in the control group(P<0.01).During 200-600 mg,the protective effects of the PNGS were correlated with the dosage and manifest dosagedependence(Plt;0.01),800-1000 mg were not significant(Pgt;0.05). ConclusionPNGS relieve the injury of the rat liver during cold preservation. The mechanism might through inhibition calcium overload, improve the energy metabolism, play a role against free radical injury realize.
Objective To identify the heart sounds of aortic stenosis by deep learning model based on DenseNet121 architecture, and to explore its application potential in clinical screening aortic stenosis. Methods We prospectively collected heart sounds and clinical data of patients with aortic stenosis in Tianjin Chest Hospital, from June 2021 to February 2022. The collected heart sound data were used to train, verify and test a deep learning model. We evaluated the performance of the model by drawing receiver operating characteristic curve and precision-recall curve. Results A total of 100 patients including 11 asymptomatic patients were included. There were 50 aortic stenosis patients with 30 males and 20 females at an average age of 68.18±10.63 years in an aortic stenosis group (stenosis group). And 50 patients without aortic valve disease were in a negative group, including 26 males and 24 females at an average age of 45.98±12.51 years. The model had an excellent ability to distinguish heart sound data collected from patients with aortic stenosis in clinical settings: accuracy at 91.67%, sensitivity at 90.00%, specificity at 92.50%, and area under receiver operating characteristic curve was 0.917. Conclusion The model of heart sound diagnosis of aortic stenosis based on deep learning has excellent application prospects in clinical screening, which can provide a new idea for the early identification of patients with aortic stenosis.
Objective To investigate the impact of red blood cell suspension infusion across various perioperative periods on patients with valvular heart disease. Methods The patients with valvular heart disease admitted to Tianjin Chest Hospital from 2018 to 2020 were selected. Based on the timing of perioperative red cell suspension infusion, patients were categorized into three groups: a group 1 receiving intraoperative red cell suspension infusion, a group 2 receiving red cell suspension infusion within 24 hours after entering the ICU, and a group 3 receiving red cell suspension infusion at both time points. The laboratory results, perioperative blood component infusion volume, and other relevant parameters were retrospectively analyzed. After propensity score matching, the differences in different variables among the three groups were compared. Results After propensity score matching, 102 patients were enrolled, including 52 males and 50 females, with an average age of (61.74±10.58) years. There were 34 patients in each group. The preoperative hemoglobin (Hb) value of the group 2 was significantly higher than that of the group 1 and the group 3, and the amount of red cell suspension and autoblood transfusion was the lowest (P<0.05). In the group 1, Hb was the highest after surgery, Hb was the highest within 24 hours after surgery. HCT was the highest within 24 hours after surgery (P<0.05). The group 1 had the lowest plasma, platelet and cryoprecipitate infusion volumes, and the shortest cardiopulmonary bypass time, aortic occlusion time, postoperative ICU stay and hospital stay, and the least blood loss, total drainage volume (P<0.05). The difference between postoperative Hb and preoperative △Hb1 was significantly increased in the group 1 (P<0.05). Conclusion The intraoperative infusion of suspended red blood cells in patients with heart valves can be used to indicate to clinicians that patients have a better prognosis at discharge, review and follow-up.
Objective To compare the differences of transcatheter edge-to-edge repair (TEER) between trans-apical and trans-femoral groups in the treatment of mitral regurgitation. Methods A retrospective study was conducted on the patients who underwent TEER surgery at Tianjin Chest Hospital from February 2023 to October 2024. Patients were divided into two groups based on the surgical approach: trans-apical approach group and trans-femoral approach group. Baseline conditions, perioperative and postoperative 6-month survival status, and echocardiographic follow-up indicators were collected and compared between the groups. The primary endpoint indicators were all-cause mortality and device success rate. Secondary endpoint indicators included catheterization duration, heart failure readmission rate, and incidence of moderate or greater mitral regurgitation. Results A total of 33 patients were included, with 16 in the trans-femoral approach group and 17 in the trans-apical approach group. The average age was (69.85±7.86) years, and 17 patients (51.5%) were male. There were no statistically significant differences between the two groups in demographic characteristics, STS scores, comorbidities (except for diabetes), and laboratory tests. The proportion of patients with preoperative heart function≥grade Ⅲ was higher in the trans-apical approach group (88.2% vs. 43.8%, P=0.007), and the left ventricular end-diastolic diameter was smaller [(58.41±7.13)mm vs. (65.81±11.58) mm, P=0.033]. The catheterization operation time was shorter in the trans-apical approach group [40.00 (30.00, 61.00) min vs. 74.00 (56.25, 108.25) min, P=0.002]. There were no statistically significant differences between the two groups in all-cause mortality, device success rate, and heart failure readmission rate. Conclusion TEER surgeries via different approaches might have the same safety and efficacy. The trans-apical TEER surgery is simpler to operate, has a shorter learning curve, and is easier for beginners to master.
Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P>0.05). There were no statistical differences in intraoperative data between the two groups (P>0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.
目的 探討早產兒配方奶及水解蛋白奶在住院早產低出生體重兒喂養過程中,在胃腸保護作用方面有無差異,以期進一步有效指導入院低體重兒乳制品的合理選擇。 方法 收集新生兒科NICU 2008年2月-2010年8月收治的早產低出生體重兒156例,采用回顧性調查分析方法,通過翻閱病歷收集新生兒的性別、孕周、出生體重、開奶日齡、持續喂養天數以及所患疾病。按照喂養開奶類型不同分為水解蛋白奶喂養組(A組,111例)和早產兒配方奶喂養組(B組,45例)。 結果 兩組患兒性別、開奶日齡、持續喂養天數、胎齡、疾病分布上均無統計學差異(P>0.05),A組和B組的胃腸功能障礙各臨床特點發生概率無統計學差異。 結論 在住院生命體征相對穩定的早產低出生體重兒,無論是早產兒配方奶喂養還是水解蛋白奶喂養,其患兒的喂養不耐受發生情況無統計學差異。