AIM To assess the predictive value of baseline parameters of ultrasound biomicroscopy (UBM) for angle widening after prophylactic laser peripheral iridotomy (LPI) in patients with primary angle-closure suspect (PACS). METHODS Angle-opening distance (AOD), trabecular iris angle (TIA), iris thickness, trabecular-ciliary process angle, and trabecular-ciliary process distance were measured using UBM performed before and two weeks after LPI. Iris convexity (IC), iris insertion, angulation, and ciliary body (CB) size and position were graded. Uni- and multivariate regression analyses were used to determine factors predicting the change in AOD (ΔAOD500, calculated as an angle width change before and after LPI) in all quadrants and in subgroup quadrants based on IC. RESULTS In 94 eyes of 94 patients with PACS, LPI led to angle widening with increases in AOD500 and TIA (P<0.01). Multivariable regression analysis showed that IC (P<0.001), CB position (P=0.007) and iris insertion (P=0.049) were significantly predictive for ΔAOD500. All quadrants were categorized into extreme IC (27.8%), moderate IC (62.3%), and absent IC (9.9%) subgroups. The AOD500 increased by 220% and no other predictive factor was found in the extreme IC quadrants. The AOD500 increased by 55%, and baseline iris angulation was predictive for smaller changes in ΔAOD500 in the moderate IC quadrants. CONCLUSION In PACS patients, quadrants with greater iris bowing predict substantial angle widening after LPI. Quadrants with a flatter iris, anteriorly positioned CB, and basal iris insertion are associated with less angle widening after LPI. Quadrants with iris angulation as well as a flatter iris configuration predict a smaller angle change after LPI.

Objective:To analyze the long-term outcomes of hybrid arch repair(HAR) treating aortic arch pathologies.Methods:Between January 2009 and January 2018, 87 consecutive patients underwent HAR for aortic arch pathologies at Beijing Anzhen Hospital. 76 were males. 2 cases were in zone 0, 46 cases were in zone 1, and 39 cases were in zone 2. The zones of the aortic arch were defined following the Ishimaru classification.Results:Five(5.7%) operative death occurred. 13 patients(19.1%) died during the follow-up. The overall survival rate was 88.4%, 83.3%, 83.3%, 49.8% at 1, 3, 5, 10 year, respectively. Multivariate Cox proportional risk analysis showed that stroke( HR=20.626, 95% CI: 2.698-157.685, P=0.004) was an independent risk factor for short-term death. Stroke( HR=16.234, 95% CI: 4.103-64.229, P<0.001) and spinal cord infury( HR=11.060, 95% CI: 2.150-56.893, P=0.004) were independent risk factors for long-term death. Conclusion:In conclusion, HAR could be an alternative procedure for the patients that are not suitable for open repair under the premise of strict control of indications. In the future, the risk assessment system and uniform operational indications for HAR should be further established.

总结2019年4月至10月期间使用J-Valve介入瓣膜成功完成介入瓣中瓣技术治疗3例三尖瓣生物瓣膜毁损的临床经验。经本院伦理委员会批准, 术前评估提示外科常规开胸体外循环手术中/高危风险, EuroSCORE Ⅱ评分为19.50%～25.45%。手术成功率100%, 1例术中输送器撤离时出现瓣膜轻度移位, 同时置入第2枚瓣膜。围手术期无死亡, 无脑血管事件, 无介入瓣移位或脱落。术后抗凝方案使用华法林抗凝6个月, 6个月后改为口服阿司匹林100 mg/天。定期复查超声心动图监测心脏功能、瓣膜流速和反流情况。术后随访26～32个月, 无死亡事件, 无脑血管事件, 无感染性心内膜炎等不良事件。术后患者自觉症状明显改善, 心功能分级≤Ⅱ级。肋间切口右心房穿刺使用J-Valve介入瓣中瓣技术可成功治疗三尖瓣生物瓣毁损, 为再次开胸手术风险高的患者提供了相对安全可行的选择。

目的:总结主动脉窦瘤(SVA)的外科治疗经验.方法:回顾性分析2011年1月至2018年5月,北京安贞医院的22例SVA治疗结果.结果:平均年龄(38.2±13.7)岁,14例(63.6％)为男性.SVA分别起源于右冠窦18例(81.8％),无冠窦3例(13.6％),左冠窦1例(4.5％).合并室间隔缺损11例(50.0％),合并主动脉瓣反流12例(50.0％).1例(4.5％)出现脑梗死后脑死亡.剩余21例患者顺利出院.20例患者接受随访,随访完成率95.2％.平均随访时间58.1个月.2例死亡,17例存活.1例超声心动图提示主动脉瓣中度反流,患者拒绝再次干预.余下患者未见窦瘤复发或残余分流.心脏功能NYHA分级I～Ⅱ级.3～8年生存率为90.9％.结论:外科修复SVAs的远期预后良好.治疗方案应在充分评估SVAs大小、与周围组织的解剖关系、主动脉瓣反流情况及合并心脏病变后确定.

目的:采用间接能量测定(IC)法及Harris-Benedict (H-B)法检测并计算中老年重症急性胰腺炎(SAP)患者静息能量消耗(REE)值,并探讨REE与中老年SAP患者预后的关系.方法:选取2017-11-2019-12期间于我院就诊的122例急性胰腺炎(AP)患者为研究对象,其中轻症AP患者(MAP组)54例,重症AP患者(SAP组)68例;采用IC法、H-B法分别计算患者REE水平并比较,并对患者进行急性生理与慢性健康状况Ⅱ(APACHE Ⅱ)评分及AP床旁严重度指数(BISAP)评分;比较不同APACHE Ⅱ评分、BISAP评分的SAP患者REE值水平;受试者工作特性曲线(ROC曲线)分析REE水平对SAP患者预后不良的预测价值.结果:SAP组APACHE Ⅱ评分、BISAP评分显著高于MAP组(P＜0.05);SAP组REE值显著高于MAP组,HB法测定的REE值均显著高于IC法(P＜0.05);APACHE Ⅱ评分＞18.23组、BISAP评分＞2.91组REE水平显著高于APACHE Ⅱ评分≤18.23组、BISAP评分≤2.91组(P＜0.05);预后不良组REE水平显著高于预后良好组(P＜0.05);REE水平预测SAP患者预后不良的曲线下面积(AUC)为0.897,截断值为1616.694 kcal/d,特异度为69.2％,敏感度为96.6％.结论:SAP组REE值显著高于MAP组,患者REE水平的测定可能有助于为重症患者提供能量供给,从而改善中老年SAP患者的营养不良状态,对疾病的转归和患者的预后有重要意义.

目的:探究静息能量代谢测定对腹部外科严重脓毒症患者预后评估的价值.方法:选取2018-02-2019-11期间民航总医院外科重症监护病房(SICU)收治的腹部外科严重脓毒症患者38例,分析间接能量测定法(IC法)计算的静息能量消耗值(REE)与H-B公式法、体重法计算的REE值的差异,依据急性生理与慢性健康状况评估Ⅱ(APACHE Ⅱ)评分和序贯器官功能衰竭评估(SOFA)评分分组,评价病情不同严重程度患者REE值的差异,并分析REE值与预后的相关性.结果:38例患者经IC法测定203次,呼吸商(RQ)在非正常范围内的患者构成比为42.36％,处于非正常代谢水平的患者构成比较高;IC法在第1天、第3天、第5天测得的REE值低于H-B法,高于体重法,且差异均有统计学意义(P＜0.05);APACHE Ⅱ评分≤15分与＞15分的患者REE值比较差异无统计学意义(P＞0.05),SOFA评分≤5分患者REE值低于＞5分的患者,差异有统计学意义(P＜0.05);REE值与SOFA评分呈负相关(r=-0.378,P＜0.05);REE值与APACHE Ⅱ评分无明显相关性(P＞0.05).结论:H-B法与体重法测量的REE值与IC法相比差异较大,临床上应按照IC法测得的REE值为患者提供营养支持,REE值与SOFA评分具有一定相关性,因此临床营养支持方面应充分考虑患者脏器功能状况,避免因营养过剩或营养不良加重脏器功能负担,以改善预后.

目的 探讨N-甲基-D-天冬氨酸(NMDA)受体介导的脊髓缺血-再灌注的保护机制.方法 将42只SD大鼠随机分为4组:非阻断组(n=6)、生理盐水组(n=12)、NMDA受体阻断剂K-1024(25mg/kg)组(n=12)和电压门控Ca2+通道阻断剂尼莫地平(0.5mg/kg)组(n=12),各组药物缺血前30 min腹腔注射.评价神经功能,观察并比较腰段脊髓组织学变化、神经递质氨基酸的释放、脊髓神经元型一氧化氮合成酶(nNOS)蛋白表达情况.结果 再灌注8h时,K-1024组大鼠行为学评分为(2.00±0.00)分,与生理盐水组[(5.83±0.41)分]和尼莫地平组[(5.00±1.00)分]相比差异有统计学意义(P＜0.05).K-1024组与生理盐水组和尼莫地平组相比运动神经元损伤更小.在缺血10 min后,各组谷氨酸浓度差异无统计学意义(P=0.731);K-1024组与生理盐水组比较nNOS蛋白表达明显下调(P＜0.01).再灌注8h后,K-1024组与生理盐水组比较nNOS蛋白表达明显上调(P＜0.05).结论 脊髓缺血期,K-1024是通过抑制NMDA受体,下调nNOS蛋白表达发挥脊髓保护作用;再灌注期,K-1024对脊髓的功能、结构和神经细胞生物活性有较好的保护作用.

Controlled mechanical ventilation (CMV) can cause diaphragmatic motionlessness to induce diaphragmatic dysfunction. Partial maintenance of spontaneous breathing (SB) can reduce ventilation-induced diaphragmatic dysfunction (VIDD). However, to what extent SB is maintained in CMV can attenuate or even prevent VIDD has been rarely reported. The current study aimed to investigate the relationship between SB intensity and VIDD and to identify what intensity of SB maintained in CMV can effectively avoid VIDD. Adult rats were randomly divided according to different SB intensities: SB (0% pressure controlled ventilation (PCV)), high-intensity SB (20% PCV), medium-intensity SB (40% PCV), medium-low intensity SB (60% PCV), low-intensity SB (80% PCV), and PCV (100% PCV). The animals underwent 24-h controlled mechanical ventilation (CMV). The transdiaphragmatic pressure (Pdi), the maximal Pdi (Pdi max) when phrenic nerves were stimulated, Pdi/Pdi max, and the diaphragmatic tonus under different frequencies of electric stimulations were determined. Calpain and caspase-3 were detected using ELISA and the cross-section areas (CSAs) of different types of muscle fibers were measured. The Pdi showed a significant decrease from 20% PCV and the Pdi max showed a significant decrease from 40% PCV (P<0.05). In vivo and vitro diaphragmatic tonus exhibited a significant decrease from 40% PCV and 20% PCV, respectively (P<0.05). From 20% PCV, the CSAs of types I, IIa, and IIb/x muscle fibers showed significant differences, which reached the lowest levels at 100% PCV. SB intensity is negatively associated with the development of VIDD. Maintenance of SB at an intensity of 60%-80% may effectively prevent the occurrence of VIDD.

目的:探讨运动对非体外冠状动脉旁路移植术后患者焦虑抑郁状态干预效果.方法:选择2018年1月至2019年6月,在北京安贞医院心脏外科单一手术组行非体外冠状动脉旁路移植术的患者258例,按照其术后6～ 12个月是否运动达标分为运动组和对照组,于术后6个月和12个月分别应用医院焦虑抑郁量表进行测评.结果:运动组患者术后12个月焦虑[(6.63±1.27)vs.(6.20±1.18),t=2.462,P=0.015]和抑郁[(6.05±0.93)vs.(5.67±1.05),t=2.683,P=0.008]得分低于术后6个月;术后12个月两组比较,运动组焦虑得分[(6.20±1.18)vs.(6.66±1.06),t=-3.262,P=0.001]低于对照组.结论:对于行非体外冠状动脉旁路移植术术后患者,达标的运动干预可以明显缓解患者的焦虑状态.

马方综合征(Marfan syndrome,MFS)是常染色显性遗传的结缔组织病,同时累及心血管、肺、眼、骨骼肌肉等多个系统[1].90％的MFS患者在10～12年内发生主动脉事件.主动脉扩张形成动脉瘤或夹层导致破裂成为MFS患者的最常见死因.如果未接受有效治疗,平均寿命不超过45岁.有效的外科干预改善了MFS患者的预后[2].随着研究的深入,应用药物预防MFS主动脉扩张成为当前的研究热点.我们回顾了现有的临床随机对照研究(randomized control trial,RCT),对目前临床应用的药物的有效性进行总结,为未来的研究提供新的观点.

目的:探讨非体外冠状动脉旁路移植术(OPCAB)与体外循环辅助下冠状动脉旁路移植术(ONCAB)对患者术后早期健康相关生存质量影响.方法:选取2015年1月至2016年12月,北京安贞医院单一手术组对408例患者施行了冠状动脉旁路移植术,根据是否应用体外循环将患者分为两组,OPCAB 术组(OP 组,n=239):男性161 例,年龄(63.64±8.13)岁;ONCAB 术组(ON 组,n=169):男性115例,年龄(63.75±8.28)岁.应用简明健康调查量表和西雅图心绞痛问卷测评两组患者术前、术后1个月、3个月、6个月、1年、2年和3年的得分.结果:全部病例共失访39例,随访率为90.4％.应用简明健康调查量表测评,两组内各维度均存在差异(P= 0.000);组间不同时间测评,OP组术后1个月[(39.75±1.27)vs.(39.12±1.00),F=5.579,P= 0.000]和3个月[(39.35±1.09)vs.(38.72±0.93),F =6.145,P=0.000]得分高于ON 组,术后2年[(61.37±1.98)vs.(61.83±1.80),F = -2.343,P= 0.020]和术后3年[(63.49±1.19)vs.(64.06±1.01),F=-4.890,P= 0.000]得分低于ON组.应用西雅图心绞痛问卷测评,组内各维度均存在差异(P= 0.000);术后3年OP组[(71.41+4.41)vs.(74.04±4.22),F = -5.915,P=0.000]得分低于ON组.结论:OPCAB术后早期健康相关生存质量优于ONCAB;术后1-2年,生存质量无差别;术后3年,患者健康相关生存质量低于接受ONCAB患者.

目的 总结主动脉窦瘤破裂的手术适应证、手术方法和预后.方法 回顾性分析2011年1月至2017年12月因主动脉窦瘤破裂于我院行外科手术治疗的130例患者资料.其中男性58例(44.62％)、女性72例(55.38％),年龄32～75岁,平均(52.72±13.87)岁.合并室间隔缺损55例(42.31％)、主动脉瓣关闭不全39例(30.00％)、房间隔缺损12例(9.23％)、三尖瓣关闭不全8例(6.15％)、二尖瓣关闭不全6例(4.62％)、主动脉夹层1例(0.77％)、其他心脏疾病9例(6.92％);破裂开口起源于右冠窦119例,起源于无冠窦11例.所有患者均在中低温体外循环下行手术治疗.结果 2例患者围术期死亡,余128例患者随访5个月至5年,术后心功能恢复至Ⅰ～Ⅱ级.结论 一旦发现主动脉窦瘤破裂,应积极予以治疗.

Objective To study the neuroprotective effects of moderate hypothermia (32 ℃) and profound hypothermia (20 ℃) on spinal cord ischemia-reperfusion in rats.Methods A subcutaneous heat exchanger is used to produce a low temperature of the spinal cord.The balloon blocked the thoracic aorta to induce spinal cord ischemia for 10 minutes.42 SD rats were randomly divided into 4 groups,group Ⅰ.Non-blocking group (37 ℃,6);Ⅱ.Normal temperature ischemia group (37 ℃,12);Ⅲ.moderate hypothermia group (32 ℃,12);Ⅳ.Profound Hyperthermia group (20℃,12).Six rats in groups Ⅱ,Ⅲ and Ⅳ were given ischemia for 10 minutes and the lumbar spinal cord was taken.The other 6 rats in each group were given reperfusion,and the neurological function was evaluated at 1,2,4,and 8 hours.All the samples from all three rats were examined by histological examination and analyzed.The release of neurotransmitter amino acids was observed by high pressure liquid chromatography,and N-Methyl-D-Aspartate R1 (NMDAR1) mRNA was detected by in situ hybridization.The test results were analyzed by t test.Results Hard palate and neuron necrosis occurred in the normal temperature ischemia-reperfusion group.In terms of histopathological findings,the Moderate Hyperthermia (32 ℃) group and the profound hypothermia (20 ℃) group were significantly better than normal temperature ischemia after reperfusion.After 10 minutes of spinal cord ischemia,The glutamate concentration and NMDAR1 mRNA expression in the profound hypothermia in the Moderate Hyperthermia (32 ℃) group and (20 ℃) group were significantly lower than those in the normal temperature ischemia group.After 8 hours of reperfusion,the concentrations of glutamate and NMDAR1 mRNA in the Moderate Hyperthermia (32 ℃) group and the profound hypothermia (20 ℃) group were significantly higher than those in the normal temperature control group.Spinal cord ischemia was 10 min.The glutamate concentration in the medium-low temperature (32 ℃)group was 10.88 ± 1.17 (t =27.292,P ＜0.01),and the deep hypothermia (20 ℃) group was 29.15 ± 4.86 (t =11.143,P ＜ 0.01),which was significantly lower than the normal temperature ischemia group (50.15 ± 5.03).the number of NMDAR1 mRNA positive cells in the low temperature (32 ℃) group was (19.18 ± 3.22) cells (t =-1.670,P ＞ 0.05),and that in the low temperature (20 ℃) group was (12.57 ±2.59) cells (t =4.154,P ＜0.01),which was significantly lower than that in the normal temperature ischemia group [(17.36 ± 2.56) cells].After reperfusion for 8 hours,the glutamate concentration in the medium-low temperature (32 ℃) group was 49.38 ± 13.26 (t =-8.407,P ＜ 0.01),and the deep hypothermia (20 ℃) group was 44.95 ± 2.12 (t =-23.933,P ＜ 0.01),which was significantly higher than the normal temperature ischemia group (14.08 ± 3.70);the number of NMDAR1 mRNA positive cells in the low temperature (32 ℃) group was (22.47 ± 5.40) cells (t =-5.437,P ＜ 0.01),and that in the deep hypothermia (20 ℃) group was (18.89 ± 3.98) cells (t =-4.042,P ＜ 0.01),which was significantly higher than that in the normal temperature ischemia group [(12.06 ± 3.45) cells].onclusion Mode moderate hyperthermia (32 ℃) and profound hypothermia (20 ℃) have protective effects on histopathology of spinal ischemia-reperfusion cord.The results of spinal ischemia-reperfusion after 8 hours indicate that spinal cord protection are still needed during reperfusion.

患儿男性,3个月,主因“咳嗽7d,加重3d”于2018年3月收住北京妇产医院怀柔妇幼保健院.患儿于入院前7d无明显诱因出现咳嗽,病初单声咳,无喘息及呼吸困难,无发热,偶有吐沫、流涕、喷嚏,家中未予特殊治疗.入院前3d患儿咳嗽逐渐加重,为阵发性,再次就诊于我院,门诊化验血常规:白细胞28.01×109/L,中性粒细胞19.8％,淋巴细胞75.3％,血红蛋白123g/L,血小板545×109/L,C反应蛋白0.16mg/L,胸片:双肺纹理增多,未见明显异常病变密度影,予口服“红霉素、小儿肺咳颗粒”2d,效果欠佳,咳嗽未减轻,并出现痉挛性咳嗽,发作3～4次/d,咳嗽后伴呼吸暂停、发绀及呛吐,夜间加重,遂再次来我院就诊,为进一步诊治收入院.患儿系其母G2P2,孕34周早产剖宫产出生,出生体重2800g.百日咳疫苗第一针尚未接种.否认肝炎、结核等传染病接触史,但与慢性咳嗽患者有接触史.

Objective To summarize the nutritional management strategies of patients undergoing electively gastrointestinal surgery.Methods This article reviewed the recent researches on perioperative nutritional management in electively gastrointestinal surgery,including four major directions:preoperative nutritional evaluation,glucose level control,nutritional type,and immunonutrition.Results At present,preoperative nutritional evaluation methods included anthropometry,laboratory tests,subjective global assessment (SGA),nutritional risk screening (NRS) 2002,Reilly nutritional risk screening,nutritional risk indicator (NRI),and so on.For preoperative nutritional assessment system,however,current data could not single out superiority for any nutritional assessment methods in the ability to predict surgery-related complications.The usage of enhanced recovery after surgery (ERAS) protocol to reduce surgical stress and preclude postoperative insulin resistance had recently been clearly linked to reductions in postoperative morbidity and adverse outcomes.There were specific criterias for perioperative parenteral and enteral nutrition in undernourished patients,who were defined in clinical guidelines recently,such as the Guidelines for Adult Perioperative Nutrition Support issued by Chinese Society of Parenteral and Enteral Nutrition (CSPEN).Several systematic reviews showed that immunonutrition could reduce both morbidity and length of stay after major electively gastrointestinal surgery.Conclusion Perioperative nutritional management can ensure patients benefit from nutritional support by nutritional assessment,can reduce the nutritional risk and metabolic disorder caused by operation,can achieve the goal of optimal nutrition support in surgical patients,and can ultimately reduce postoperative complications.

Objective To evaluate the intervention effect of applying admission mode of social psychological skills on patients with anxiety tendency after off - pump coronary artery bypass grafting(OPCAB). Methods A total of 138 patients, who received treatment in the expert outpatient service of Department of Cardiac Surgery in Beijing Anzhen Hospital,Capital Medical University from September 2014 to March 2015 and were identified with anxiety tendency at the end of the third month after OPCAB by hospital anxiety and depression scale(HAD),were selected as the research objects. The subjects were divided into intervention group(n = 79)and control group( n = 59)based on the admission mode of doctors. The admission mode of social psychological skills were applied in the intervention group,the traditional mode of admission was used in the control group. The scores of anxiety in HAD and self - conscious satisfaction of surgical outcomes at the end of the third and the sixth month after surgery were compared between the two groups. Results There was no significant difference in the score of anxiety in HAD and the score of self - conscious satisfaction of surgical outcomes at the end of the third month after surgery of patients in the two groups(P ﹥ 0. 05). The score of anxiety in HAD at the end of the sixth month after surgery in the intervention group was significantly lower than that in the control group,while the score of self - conscious satisfaction of surgical outcomes was&nbsp;significantly higher than that in the control group(P ﹤ 0. 01). The score of anxiety in HAD at the end of the sixth month after surgery was significantly lower than that at the end of the third month after surgery in the intervention group,while the score of self - conscious satisfaction of surgical outcomes was significantly higher than that at the end of the third month after surgery(P ﹤0. 05);the score of anxiety in HAD at the end of the sixth month after surgery was significantly lower than that at the end of the third month after surgery in the control group,while the score of self - conscious satisfaction of surgical outcomes was significantly higher than that at the end of the third month after surgery( P ﹤ 0. 05). Conclusion The application of admission mode of social psychological skills in patients with anxiety tendency after OPCAB can effectively alleviate the anxiety of patients and improve the patient's satisfaction of the effects of OPCAB.

Intracardic air embolism is uncommon, however it is a serious condition which frequently leads to catastrophic complications during or after invasive procedures resulting in significant morbidity and mortality. For a successful resuscitation of patients with intracardiac air embolism, hyperbaric oxygen therapy is critical. Still, due to a hyperbaric chamber’s unavailability at many hospitals and concerns about patient movement resulting in further embolism during transport, such treatment method is gradually diminishing. We present a case of acute-onset right-sided heart failure from massive intracardiac air embolism that was successfully treated with an intracardiac catheter aspiration procedure instead of hyperbaric oxygen therapy.  A 78-year old man with a history of hypertension, diabetes mellitus, and ischemic heart disease presented to the emergency department with dyspnea (NYHA FC III-IV) and chest discomfort. The patient had been complaining of coughs and sputum over the past week. In the morning of admission day, he had got an intramuscular injection at the hip. He had undergone coronary artery bypass graft three years ago and had been well until this present admission. ECG and chest X-ray were normal with no widening of the mediastinum or pleural effusion observed, and blood chemistry was also normal except for the high brain natriuretic peptide (BNP) level [952 (0–100 pg/mL)]. Transthoracic echocardiography (TTE) showed severe diastolic dysfunction and pulmonary hypertension with inferior vena cava (IVC) plethora. A chest CT was done, which revealed a large amount of air in the right atrium, right ventricle, and pulmonary artery (Figure 1A–1B). In addition, there were air bubbles in brachiocephalic veins, left subclavian and axillary vein, right internal jugular vein, and the pre-thyroid

Objective To evaluate effects of rosuvastatin and atorvastatin on blood lipid in patients after off-pump coronary artery bypass grafting(OPCABG).Methods Totally 354 patients with coronary artery disease who had OPCABG from January 2010 to June 2015 in Beijing Anzhen Hospital,Capital Medical University were randomly divided into rosuvastatin group(n =169) and atorvastatin group(n =185).After treatment,the rosuvastatin group took rosuvastatin 10 mg/d and the atorvastatin group took atorvastatin 10 mg/d based on conventional therapy;both groups were treated for 12 months.Liver function,renal function,myocardial enzyme,blood lipid and high sensitive C-reactive protein(hs-CRP) were tested before and 1,3,6,12 months after operation.Results Levels of total cholesterol (TC),triacylglycerol (TG),low density lipoprotein cholesterol (LDL-C) and hs-CRP 3,6,12 weeks after operation were significantly lower than those before operation in both groups [rosuvastatin group:(4.87 ±0.21),(4.35 ±1.04),(4.05 ±0.78) mmol/L vs (6.65 ±1.18) mmol/L;(2.58 ±0.67),(2.13 ±0.59),(1.70 ± 0.59) mmol/L vs (3.24 ± 1.21) mmol/L;(2.35 ± 0.20),(2.09 ± 0.49),(1.88 ± 0.73) mmol/L vs (3.52 ± 1.87) mmol/L;(2.5 ± 1.0),(2.1 ± 1.1),(1.7 ± 0.9) mg/L vs (3.2 ± 1.3) mg/L;atorvastatin group:(5.20 ±0.47),(4.56 ±0.83),(4.03 ± 0.43) mmol/L vs (6.55 ±0.94)mmol/L;(2.61 ±0.87),(2.21 ± 1.05),(1.79 ± 0.71) mmol/L vs (3.48 ± 1.19) mmol/L;(2.87 ± 0.97),(2.54 ± 1.10),(2.11 ± 1.11) mmol/L vs (3.68±1.91)mmol/L;(2.6±1.2),(2.3±1.0),(2.0±1.2)mg/Lvs (3.1±1.9)mg/L](P＜0.05).TC,TG,LDL-C,high density lipoprotein cholesterol and hs-CRP had no significant differences between groups before operation(P ＞ 0.05);1,3,6 weeks after operation,TC,TG and LDL-C in rosuvastatin group were significantly lower than those in atorvastatin group(P ＜0.05);12 weeks after operation,TG,LDL-C and hs-CRP in rosuvastatin group were significantly lower than those in atorvastatin group (P ＜ 0.05).No drug-related severe adverse reaction was observed.Conclusion Both rosuvastatin and atorvastatin are safe and effective for post-OPCABG patients;10 mg/d rosuvastatin is more effective than 10 mg/d atorvastatin.

Objective To determine the relationship between preoperative frailty and the occurrence of early postoperative delirium (POD) undergoing abdominal surgery in the older patients Method Patients 60 years or older undergoing abdominal surgery were enrolled. Frailty status also was measured preoperatively by Fried score. Independence in functional status was measured by the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Self-rating depression scales (SDS) was used to measure symptoms of depression. The incidence of POD was compared among the different frailty groups, a multilevel logistic regression model was used to explore factors associated with the risk of early postoperative delirium. Result One hundred and twenty three subjects (age from 60to 91, 73.58±6.23 years) were studied. Preoperative frailty was associated with increased postoperative delirium (frail 43.4% vs intermediately 20.6% vs no frail 2.8%, P<0.01) after abdominal surgery. Preoperative frailty score, ADL, and the SDS score were significantly associated with the development of POD. The multivariable logistic regression analysis showed that preoperative frailty score, ADL, IADL and SDS score were significantly associated with POD. Conclusion The preoperative frailty score may be used as a predictor of POD for the evaluation of elderly patients

Background: Though trabeculectomy is often performed on patients with medically refractive pigmentary glaucoma (PG), the clinical outcomes of surgical treatment on PG remain unknown. The aim of this study was to summarize the long-term efficacy and safety of trabeculectomy on PG. Methods: This was a prospective case series observational study. Eighteen consecutive PG patients were followed up for 8 years after trabeculectomy from May 2006 to April 2007. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, intraocular pressure (IOP) measurement, Humphrey visual field analysis (VFA), and stereoscopic funduscopy were performed on admission and every 6 months after the surgery. Postoperative IOP, VA, BCVA, VFA, adjunctive anti-glaucoma medication, treatment-related side-effects, changes in blebs, and main clinical findings in the anterior segment of PG were recorded and compared with the baseline. Results: Eighteen PG eyes from 18 patients, with average preoperative IOP of 34.5 ± 4.7 mmHg (range: 21–47 mmHg, 1 mmHg=0.133 kPa) were enrolled in this study. All enrolled patients completed the follow-up visits and required examinations. Eight years after trabeculectomy, all surgical eyes (18/18) had satisfactory IOP control with an average of 13.7 ± 2.5 mmHg (range: 9–19 mmHg), which was significantly lower than baseline (P = 0.001). Majority (15/18) of the PG eyes had stable VA, BCVA, VFA, and optic disc cupping parameters. Functional blebs still existed in 12/18 of the PG eyes at the last follow-up visit. Unanimously, pigmentation in the anterior segment attenuated with time after surgical treatment. No severe side-effects were recorded in any of the surgical eyes. Conclusions: All surgical PG eyes in this study had satisfactory IOP control 8 years after the surgery with well-preserved visual function. The long-term efficacy and safety of trabeculectomy are promising in PG patients.