Objective To analyze the clinical data and hematological indexes in elderly patients with chronic non-communicable diseases complicated with intrinsic capacity （IC）decline and to explore the influencing factors of IC decline.Methods A total of 332elderly patients with chronic non-communicable diseases were divided into 196patients with IC≥1 （IC decline group）and 136patients with IC=0（normal IC group）according to the results of IC evaluation on the second day after admission.The age,gender,body mass index,albumin,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,C-reactive protein （CRP）,D-dimer and other indexes were compared between two groups.Taking the age as a covariate,121pairs of patients were successfully matched by 1:1 matching the propensity score.After matching,the geriatric syndromes as frail/pre-frail,disability,delirium,pain and dysphagia were evaluated in two groups.Multivariate logistic regression was done to analyze the risk factors of IC decline in elderly patients with chronic non-communicable diseases.Results（1）Among 332patients,IC declined in 196patients,with IC decline rate of 59.0%.（2）Before matching,the patients were older in IC decline group[83 （78,87）years]than normal IC group[79（76,83）years]（U=8 220.000,P＜0.001）,the level of albumin was lower in IC decline group[（40.68±4.74）g/L]than that in normal IC group[（43.93±2.41）g/L]（t=8.095,P＜0.001）,the levels of low-density lipoprotein cholesterol,total cholesterol,CRP and D-dimer were higher in IC decline group[（2.42±0.96）mmol/L,（4.06±1.08）mmol/L,1.99（1.15,3.61）mg/L,0.25（0.14,0.39）mg/L]than those in normal IC group[（2.22±0.38）mmol/L,（3.86±0.55）mmol/L,0.93（0.77,1.57）mg/L,0.23（0.19,0.41）mg/L]（P＜0.05）,and there were no significant differences in the male ratio,body mass index,white blood cell count,triacylglycerol and high-density lipoprotein cholesterol between two groups（P＞0.05）.（3）After matching,the body mass index was lower in IC decline group[（23.94±3.75）kg/m~2]than that in normal IC group[（24.88±3.23）kg/m~2]（t=2.077,P=0.039）,the proportions of malignancies and dementia were higher in IC decline group（26.4%,10.7%）than those in normal IC group（15.7%,0）（χ~2=4.199,P=0.040；χ~2=13.738,P＜0.001）,and there were no significant differences in the proportions of male,solitary living,gastrointestinal diseases,type 2diabetes,hypertension,coronary heart disease,chronic obstructive pulmonary disease,chronic kidney failure,cerebral infarction and hepatopathy,age and Charson’s complication index between two groups （P＞0.05）.The incidences of frail/pre-frail,disability,pain,dysphagia and weak grip strength were higher in IC decline group （71.9%,43.8%,49.6%,16.5%,39.7%）than those in normal IC group （41.3%,24.0%,34.7%,5.8%,19.8%）（P＜0.05）,and there were no significant differences in the incidences of delirium,astriction,urinary incontinence,fall history,multiple medication,postural hypotension and sleep disorders between two groups（P＞0.05）.The white blood cell count,and levels of serum albumin and triacylglycerol were lower in IC decline group[（5.53±1.24）×10~9/L,（41.62±4.98）g/L,（1.20±0.63）mmol/L]than those in normal IC group[（6.07±1.72）×10~9/L,（43.84±2.43）g/L,（1.43±0.71）mmol/L]（P＜0.05）,the levels of CRP and D-dimer were higher in IC decline group[1.63（1.06,3.00）mg/L,0.28（0.15,0.43）mg/L]than those in normal IC group[0.93（1.35,1.76）mg/L,0.19（0.16,0.31）mg/L]（U=2 509.000,P＜0.001;U=5 430.000,P=0.033）,and there were no significant differences in levels of total cholesterol,hemoglobin,neutrophil count,lymphocyte count,platelet and other hematological indexes between two groups （P＞0.05）.Age （OR=1.159,95%CI:1.051-1.279,P=0.003）,total cholesterol（OR=1.599,95%CI:1.039-2.461,P=0.033）,CRP（OR=1.132,95%CI:1.028-1.675,P=0.029）and albumin（OR=0.826,95%CI:0.727-0.939,P=0.003）were the influencing factors of IC decline.Conclusion The elderly patients with chronic non-communicable diseases are prone to develop IC decline,and the advenced age,high CRP,high total cholesterol and low albumin are the risk factors of IC decline.

目的 探讨影响足月臀位外倒转手术成功相关因素.方法 回顾性分析2017年8月至2019年9月于郑州大学附属郑州中心医院实施臀位外倒转术的126例孕晚期单胎孕妇的临床资料,按外倒转手术结果分为成功组(n=75)和失败组(n=51),分析影响外倒转手术结果的相关因素,并比较2组孕妇分娩方式和并发症发生情况.结果 126例患者中,外倒转手术成功75例,总体成功率为59.5％(75/126),失败51例,总体失败率为40.4％(51/126);其中初产妇成功率为46.3％(31/67),经产妇成功率为74.5％ (44/59).2组孕妇的年龄、操作孕周、体质量指数、胎盘位置比较差异无统计学意义(P＞0.05);2组孕妇的产次、羊水指数、胎先露类型比较差异有统计学意义(P＜0.05).75例外倒转成功孕妇中,73例自然分娩,2例后续行剖宫产;51例外倒转失败孕妇均行剖宫产.成功组1例发生新生儿窒息,2组均无胎膜早破发生.结论 单胎臀位孕妇足月后行外倒转可以提高自然分娩成功率,术前应充分评估孕妇情况,重点关注产次、羊水指数、胎先露类型等因素.

Objective To evaluate the short-term follow-up of valve-sparing aortic root replacement in Marfan syndrome. Methods 54 patients, 38 males and 16 females;aged(20-50) years, mean(31. 26 ± 7. 80) years old. They were all diag-nosed with Marfan syndrome according to the criteria of Ghent in 1996. Preoperative ultrasound showed 5 cases with trace aortic valve regurgitation, a small amount of reflux in 12 cases, 22 cases in the middle amount of regurgitation, 15 cases with a large number of reflux. According to the surgery program it was devided into 2 groups, Bentall group(35 cases, Bentall surgery) and David group(19 cases, David surgery). Follow-up 12 months to 48 months, to compare the differences of the efficacy of differ-ent surgical options,before and after surgery. Results 2 cases died after operation, one patient in group bentall died of uncon-trollable bleeding and the other in group David died of pulmonary infection, multiple organ failure, and the remaining 52 cases recoveredwell.GroupbentallwhichCPB(141.09±15.483)min,aorticocclusion(93.82±15.06)min. GroupDavid,CPB (186.32 ±23.96)min, aortic occlusion(140.21 ±22.13) min. There are significant differences in postoperative EF value, left ventricular diameter and postoperative left ventricular systolic volume ( ESV ) , postoperative left ventricular end-diastolic volume(EDV), FS improvement with preoperative data(P<0. 05), and there were no significant differences(P>0. 05) be-tween the two groups. The early postoperative complications were no significant difference between the tuo groups, bue the late complications in group bentall was significantly higher than groups David. Patients were followed up for 12 months to 48 months, one patient in David group underwent aortic valve replacement surgery because of severe aortic regurgitation. One case ( abdominal aorta) in group Bentall underwent surgery due to recurrent dissection and 6 cases with bleeding, embolic complica-tions because of warfarin. Conclusion Valve sparing root replacement has provided satisfactory short-term outcomes for Marfan syndrome.

心脏血管瘤是一种十分罕见的原发性良性肿瘤,其临床表现主要取决于肿瘤的部位和大小,最常见的症状为心慌、胸闷、憋气及胸痛等.组织学上可将心脏血管瘤分为海绵状血管瘤、毛细血管瘤、蔓状血管瘤等,毛细血管瘤和海绵状血管瘤发生率相对较高[1].心脏海绵状血管瘤为体积小、有蒂或无蒂、海绵状结构,瘤体由不规则的血窦构成,窦间以纤维小梁分隔,瘤体与心壁间界限不清晰,即使在瘤体中心部的血管窦纤维间隔有时亦可见散在的心肌细胞[2].本研究选取郑州大学第一附属医院收治1例右心室海绵状血管瘤患者,对其临床特点、组织病理学检查结果进行总结,具体如下.

目的:分析非体外循环下冠脉搭桥术预后效果.方法:回顾性分析2013年3月-2016年7月我院本组行非体外循环下冠脉搭桥术411例,其中合并瓣膜疾病26例,高血压80例,糖尿病121例,慢阻肺75例,心律失常21例,脑血管意外14例.411例全部采胸骨正中切口,使用乳内动脉及大隐静脉为桥血管,连续缝合桥血管共1623支,平均(3.9±0.8)支.结果:400例患者于术后8 ～ 20小时顺利拔出气管插管,早期死亡(术后30天)1 3例,早期心梗1例,低心排综合征6例,脑血栓形成2例,2次开胸止血3例,房颤3例,消化道出血1例,刀口愈合不良2例.术后398例患者随访3 ～ 24个月,心绞痛症状消失.结论:非体外循环下冠脉搭桥术安全可行,创伤小,并发症少,预后效果满意.但其影响因素很多,有待进一步研究.

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是一种生殖功能障碍和糖代谢异常的内分泌异常综合征,是育龄期妇女最常见的排卵障碍性疾病.本病从内分泌变化到临床呈现高度异质性.持续无排卵、雄激素过多和胰岛素抵抗(insulin resistance,IR)是其重要特征[1].近年来随着对PCOS认识的提高,其病因,发病机制,诊断及治疗等方面取得了一定进展.本文从宏观角度对多囊卵巢综合征的病因,诊断及治疗等方面综述如下,为今后预防及研究本病提供参考意见,并提出需进一步研究的问题和思路:

子宫内膜异位症（endometriosis，EMT）可通过多种机制对育龄期妇女的生育能力产生不利影响，且影响相互叠加，具体机制不明，治疗方法也多种多样。现就引起子宫内膜异位症性不孕的机制及治疗方案的选择做一综述，为今后临床医生治疗本病，指导患者受孕提供参考意见。