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简介：BackgroundThoracoscopicminimallyinvasivepectusexcavatumrepair(Nussoperation)featuresitslittletrauma,simple,shortoperationtime,andgoodoutcomecomparedwithtraditionaltreatmentofpectusexcavatumsurgery-sternalelevation(Ravitchoperation)andsternalturnover.Theeffectoftheoperationonpatients’heartandheartfunctionremainsunclear.ThisstudyaimedtounderstandthechangesofelectrocardiogramandcardiacfunctionafterNussprocedure.MethodsFrom2008Januaryto2013July,thoracoscopicNussoperationwasperformedin217patientswithpectusexcavatum.Allthepatientsunderwentthepreoperative,postoperativedetectionofECGandcardiacfunctionin3monthsto1yearafteroperation.ResultsAfter3monthsto1yearfollow-up,arrhythmiaspersistedin46outof135patientswithpreoperativesymptoms(P<0.05);Strokevolumeandcardiacoutputsignificantlyincreased(P<0.05);Andcardiacparametersgreatlyimproved(P<0.05).ConclusionsMinimallyinvasiverepairofpectusexcavatumdeformitycancorrectthechestmalformation,alleviatearrhythmia,andimprovecardiacfunction.

简介：BackgroundLeftbundlebranchblock(LBBB)resultsinanalteredpatternofleftventricular(LV)activationandsubsequentcontraction.CardiacsynchronyandcardiacfunctionaredeterioratedbyLBBB.However,theeffectofLBBBhistoryonprogressiveheartdysfunctionandclinicalefficacyofcardiacresynchronizationtherapy(CRT)insuchpatientsarenotclear.InthisstudyweexploretheclinicalefficacyandpredictorofcardiacresynchronizationtherapyinLBBBheartdysfunction.MethodsTwenty-sevenLBBBpatientswithsevereheartfailureweretreatedwithCRT.Twenty-sixLBBBpatientswithoutCRTservedascontrol.During6monthsfollow-up,ECG,plasmaNT-proBNPandechocardiogramindexesweremeasured.ResultsComparedwithbaseline,NYHAfunctionalclassof23patients(85.2%)wasimprovedinCRTgroup.Comparedwithbaselineandcontrol,QRSduration(QRSd)wassignificantlymorenarrow(P=0.023,P=0.019),NT-proBNPwassignificantlylower(P=0.011,P=0.009),ventricularseptaltoleftventricularposteriorwalldelaytimeandleftventriculardyssynchronyindex(Ts-SD)weresignificantlyworse(P<0.05);leftventricularejectionfraction,leftventricularend-systolicvolume,mitralregurgitationareaweresignificantlyimprovedinCRTgroup(P<0.05).whentheLBBBhistorywas≥2yearsandQRSd≥155ms,thesensitivityandspecificityofCRTsuper-responsewere53.4%and85.6%respectively.ConclusionsCRTcanimprovethesynchronizationandhemodynamicofLBBBpatientswithheartdysfunction,theLBBBhistory≥2yearsandQRSd≥155msareoneoftheCRTsuper-responsepredictors.

简介：Objective:Toexploretheeffectofearlyenteralnutrition(EN)onpostoperativenutritionalstatus,intestinalpermeability,andimmunefunctioninelderlypatientswithesophagealcancerorcardiaccancer.Methods:Atotalof96patientswithesophagealcancerorcardiaccancerwhounderwentsurgicaltreatmentinourhospitalfromJune2007toDecember2010wereenrolledinthisstudy.TheyweredividedintoENgroup(n=50)andparenteralnutrition(PN)group(n=46)basedonthenutritionsupportmodes.Thebodyweight,timetofirstflatus/defecation,averagehospitalstay,complicationsandmortalityafterthesurgeryaswellastheliverfunctionindicatorswererecordedandanalyzed.Peripheralbloodsampleswerecollectedonthedays1,4and7aftersurgery.Theplasmadiamineoxidase(DAO)activityandD-lactatelevelweredeterminedtoassesstheintestinalpermeability.TheplasmaendotoxinlevelsweredeterminedusingdynamicturbidimetricassaytoassesstheprotectiveeffectofENonintestinalmucosalbarrier.Thepostoperativebloodlevelsofinflammatorycytokinesandimmunoglobulinsweredeterminedusingenzyme-linkedimmunosorbentassay(ELISA).Results:Afterthesurgery,thetimetofirstflatus/defecation,averagehospitalstay,andcomplicationsweresignificantlylessintheENgroupthanthoseinthePNgroup(P<0.05),whereastheENgrouphadsignificantlyhigheralbuminlevelsthanthePNgroup(P<0.05).Onthe7thpostoperativeday,theDAOactivity,D-lactatelevelandendotoxincontentsweresignificantlylowerintheENgroupthanthoseinthePNgroup(allP<0.05).Inaddition,theENgrouphadsignificantlyhigherIgA,IgG,IgM,andCD4levelsthanthePNgroup(P<0.05)butsignificantlylowerIL-2,IL-6,andTNF-αlevels(P<0.05).Conclusions:Inelderlypatientswithesophagealcancerorcardiaccancer,earlyENaftersurgerycaneffectivelyimprovethenutritionalstatus,protectintestinalmucosalbarrier(byreducingplasmaendoxins),andenhancetheimmunefunction

简介：BackgroundTherewerefewstudiestoexploretherelationshipbetweenpostoperativemeansystolicbloodpressure(PMSBP)within6haftercardiaccatheterizationandcontrast-inducednephropathy(CIN).MethodsFromJune2010toFebruary2013,299consecutivepatientsundergoingcardiaccatheterizationwererecruited.PatientswereclassifiedintoquartilesbasedonPMSBP(<112,112-120,121-131,and>132mmHg).Baselinedata,CINincidenceandin-hospitaloutcomeswerecomparedbetweenthegroups.LogisticregressionwasusedtoassesstherelationshipbetweenPMSBPandCIN.ResultsCINoccurredin26(8.7%)patients.TheincidenceofCINinPMSBPquartileswere15.3%(11/72),15.1%(11/73),2.4%(2/82)and2.8%(2/72)(P=0.001)respectively.Therewerenosignificantdifferenceinin-hospitaldeath,renalreplacementtherapyandintra-aorticballoonpump(IABP)supportbetweenthegroups(P>0.05).UnivariatelogisticregressionanalysisshowedthatPMSBPwassignificantlyassociatedwithCIN(OR=0.956,95%CI:0.928-0.986,P=0.004).Multivariatelogisticregressionanalysisfoundthatafteradjustingbaselineestimateglomerularfiltrationrate,age>75yearsandacutemyocardialinfarction,PMSBP<120mmHgwasstillanindependentriskfactorforCIN(OR=5.049,95%CI:1.820-14.009,P=0.002).ConclusionsLowerPMSBPwassignificantlyassociatedwithanincreasedriskofCIN.PMSBP<120mmHgwasanindependentriskfactorforCIN.Intensiveblood-pressurecontrolaftercardiaccatheterizationmightincreasetheriskofCIN.