Unveiling Cardiac Amyloidosis,its Characteristics,and Outcomes Among Patients With MR Undergoing Transcatheter Edge-to-Edge MV Repair

BackgroundMitral regurgitation (MR) and cardiac amyloidosis (CA) both primarily affect older patients. Data on coexistence and prognostic implications of MR and CA are currently lacking.ObjectivesThis study sought to identify the prevalence, clinical characteristics, and outcomes of MR CA compared with lone MR.MethodsConsecutive patients undergoing transcatheter edge-to-edge repair (TEER) for MR at 2 sites were screened for concomitant CA using a multiparametric approach including core laboratory ^99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid bone scintigraphy and echocardiography and immunoglobulin light chain assessment. Transthyretin CA (ATTR) was diagnosed by ^99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (Perugini grade 1: early infiltration; grades 2/3: clinical CA) and the absence of monoclonal protein, and light chain (AL) CA via tissue biopsy. All-cause mortality and hospitalization for heart failure (HHF) served as the endpoints.ResultsA total of 120 patients (age 76.9 ± 8.1 years, 55.8% male) were recruited. Clinical CA was diagnosed in 14 patients (11.7%; 12 ATTR, 1 AL, and 1 combined ATTR/AL) and early amyloid infiltration in 9 patients (7.5%). Independent predictors of MR CA were increased posterior wall thickness and the presence of a left anterior fascicular block on electrocardiography. Procedural success and periprocedural complications of TEER were similar in MR CA and lone MR (P for all = NS). After a median of 1.7 years, 25.8% had experienced death and/or HHF. MR CA had worse outcomes compared with lone MR (HR: 2.2; 95% CI: 1.0-4.7; P = 0.034), driven by a 2.5-fold higher risk for HHF (HR: 2.5; 95% CI: 1.1-5.9), but comparable mortality (HR: 1.6; 95% CI: 0.4-6.1).ConclusionsDual pathology of MR CA is common in elderly patients with MR undergoing TEER and has worse postinterventional outcomes compared with lone MR.     

Anal sphincter repair in patients with obstetric trauma

PURPOSE: This study was designed to determine whether advancing age affects the outcome of anal sphincter repair in patients with obstetric trauma and fecal incontinence. METHODS: Anal sphincter repair was performed on 24 patients younger than 40 (median age, 30) years and on 14 patients older than 40 (median age, 57) years. All patients had previous obstetric trauma. RESULTS: Twenty patients younger than 40 years (83 percent; 95 percent confidence interval, 63–95 percent) became continent, or incontinent to flatus only, after anal sphincter repair, whereas four patients had unchanged incontinence. Among patients older than 40 years, six patients (43 percent; 95 percent confidence interval, 18–71 percent) became continent, whereas eight patients remained incontinent (40 percent difference in functional outcome between younger and older patients; 95 percent confidence interval, 10–70 percent). CONCLUSION: Older females have a poorer outcome of anal sphincter repair for obstetric trauma compared with younger females.     

DNA microsatellite instability and mismatch repair protein loss in adenomas presenting in hereditary non-polyposis colorectal cancer

BACKGROUND AND AIM: Hereditary non-polyposis colorectal cancer (HNPCC), as its name implies, is associated with few adenomas, and the early evolution of colorectal neoplasia is poorly understood. In this study our aim was to clarify the genetic profiles of benign polyps in subjects with HNPCC using a combined molecular and immunohistochemical approach. METHODS: Thirty adenomas and 17 hyperplastic polyps were obtained from 24 affected HNPCC subjects. DNA was extracted from paraffin embedded tissue by microdissection and analysed for the presence of microsatellite instability (MSI) and mutations in five genes known to be targets in mismatch repair deficiency (TGFbetaRII, IGF2R, BAX, hMSH3, and hMSH6). Serial sections were stained by immunohistochemistry for hMLH1 and hMSH2. RESULTS: Twenty four (80%) of 30 adenomas showed MSI. Of MSI positive adenomas, 66.7% showed MSI at more than 40% of markers (high level of MSI (MSI-H)). Two of 17 hyperplastic polyps revealed MSI at one marker (low level of MSI (MSI-L)). A significant association was found between MSI-H and high grade dysplasia in adenomas (p=0.004). Eight of nine adenomas with mutations of coding sequences revealed high grade dysplasia and all nine were MSI-H. Four of the nine ranged in size from 2 to 5 mm. The presence of the hMSH6 mutation was significantly correlated with high levels of MSI (80% of markers) (p<0.02). Twenty four adenomas gave evaluable results with immunohistochemistry. One of six (17%) microsatellite stable, six of seven (86%) MSI-L, and 11 of 11 (100%) MSI-H adenomas showed loss of either hMLH1 or hMSH2. CONCLUSIONS: Most adenomas in subjects with a definite diagnosis of HNPCC show MSI (80%). The finding of MSI-L is usually associated with loss of expression of hMLH1 or hMSH2, unlike the situation in MSI-L sporadic colorectal cancer. The transition from MSI-L to MSI-H correlated with the finding of high grade dysplasia and mutation of coding sequences and may be driven by mutation of secondary mutators such as hMSH3 and hMSH6. Advanced genetic changes may be present in adenomas of minute size.     

Ischemic mitral valve repair: predictive significance of restrictive left ventricular diastolic filling

AIM: The aim of the present study was to evaluate the impact of left ventricular (LV) diastolic filling impairment on postoperative results in patients with low LV ejection fraction (EF) undergoing combined coronary artery bypass grafting (CABG) and mitral valve (MV) repair. METHODS AND RESULTS: Study population consisted of 53 patients with ischemic MV incompetence and LV systolic dysfunction (mean EF-26.1 +/- 6%), who underwent CABG with MV repair. Patients were divided into three groups according to the LV diastolic filling pattern. Study protocol included evaluation of perioperative mortality (30 days inhospital mortality), NYHA functional class, and two-dimensional Doppler echocardiographic examination preoperatively, 10-14 days, and 12 months after surgery. The highest perioperative mortality rate (33.3%), unimproved functional status (in 78.5% of the patients, NYHA functional class remained unchanged late after surgery), and hemodynamic deterioration (LV dilatation, progression of mitral regurgitation (MR) was observed in the restriction group). Though early after surgery, MR reduction was significant in this group, at even one year after surgery 85.7% of patients presented with >grade 1 of MR (P < 0.05). Logistic regression analysis showed that restrictive LV diastolic filling is an important independent preoperative marker (P = 0.035) of progression of MR late after MV repair. CONCLUSION: In patients with severe LV dysfunction undergoing combined CABG and MV repair, restrictive LV diastolic filling pattern is an important preoperative marker of high perioperative mortality rate, further negative remodeling of LV, and progression of mitral regurgitation late after MV repair.     

２０１１年全国健康教育机构传播材料制作状况分析

摘要：目的　分析２０１１年全国健康教育机构传播材料制作情况,以期为全国健康教育工作提供科学依据。
方法　采用自制调查表,全面调查全国各省（自治区、直辖市）、市、区县三级健康教育机构［包括独立健
康教育所、隶属疾病预防控制中心或卫生厅（局） 等的健康教育所（科）、卫生宣教科］２０１１ 年度健康教
育传播材料制作情况。结果　全国各级行政区已设置健康教育机构数为２６７８个,全国健康教育机构设置
率为８２．７０％,其中省级机构设置率为１００．００％、地市级机构设置率为９５．９３％、区县级机构设置率为
８０．３９％。各级机构制作的健康教育传播材料形式主要包括传单与折页、小册子与书籍、宣传画、音像制
品、手机短信与实物。按机构级别分类分析,省级机构自主制作传播材料居多,地市级模板制作传播材料
居多,区县级自主制作和模板制作材料均较少;按经济区划分析,东部、中部制作传单与折页、音像制品、
手机短信与实物种类和份数高于西部地区,西部地区以制作小册子与书籍、宣传画居多。结论　目前我国
健康教育传播材料种类和数量均有较大发展,但西部地区和区县级健康教育机构仍需加强传播能力建设。
关键词：健康教育;机构;传播材料;制作
中图分类号：Ｒ１９３　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０２ ０１４３ ０５     

鼻中隔穿孔实施鼻内镜手术治疗的临床体会

目的：观察鼻中隔穿孔患者采用鼻内镜手术治疗的临床体会。方法：收集60例鼻中隔穿孔患者,根据穿孔直径大小分为A、B、C三组,每组20例。其中A组穿孔直径小于0.5 cm,采用鼻内镜下鼻中隔黏骨膜瓣减张的方法,修补鼻中隔穿孔。B组0.5 cm＆lt;穿孔直径≤1.5 cm,采用自体大腿阔筋膜筛骨垂直板夹层的方法,修补鼻中隔穿孔。C组穿孔直径大于1.5 cm,采用带蒂鼻腔外侧黏骨膜瓣方法,修补鼻中隔穿孔。结果：所有患者随访半年后,发现A组患者均痊愈;B组患者8例好转,12例愈合;C组患者7例好转,13例愈合。结论：采用鼻内镜下手术是治疗鼻中隔穿孔的最佳措施,能够显著缓解患者的痛苦。修补术后的保湿,抗感染可以加快伤口愈合,依据穿孔大小选择副损伤最小的手术方式及移植材料,提高手术成功率。     

构建医院后勤网上报修管理系统的探讨

后勤部门作为医院管理中的重要职能部门,其工作涉及到医院的方方面面。随着医院规模的不断扩大,传统的手工报修方式已不能满足后勤日益增加的报修维修工作量,构建后勤网上报修管理系统势在必行。本文分析了医院水电气等设施报修维修中存在的问题,介绍了后勤网上报修系统的特点,重点阐述了系统的需求和构建要求,最后对系统的组成进行了介绍。     

医院物流信息系统在病区耗材管理中的应用

目的 :探讨医院物流信息系统在病区耗材管理中的应用效果。方法 :在某院消化科病房使用医院物流信息系统,引进"定数管理"概念,发行指定一次性材料、部门、数量的定数条码,通过回收扫描该定数条码来确认相关一次性材料在病区的消耗,并由库房对低于警戒数量的耗材主动发货补给。采用自身前后对照,比较2014年3月—2014年6月(实验前)及2014年6—9月(实验后)病区一次性耗材库存量及每周耗材管理所需护理工时有无统计学差异。结果 :实验后病区耗材库存量由(1.30±0.17)m3降至(0.28±0.10)m3(P0.05),每周耗材管理所需护理工时由(138.81±19.68)min降至(40.17±8.10)min(P0.01)。结论:医院物流信息系统可节约病区空间、降低存货成本,并大大降低护理人力资源成本,今后将扩大覆盖科室及耗材品种。     

医院医用耗材配送新模式探讨

介绍了医院物资管理的现状,提出了新院区物资管理的新模式,从职责、工作程序、物资发放流程以及物资存放新要求的角度加以阐述,并指出这种新模式对于促进申购计划、采购管理及仓储管理标准化、制度化、合理化具有积极的意义.     

利用马铃薯淀粉制备止血材料方法

目的：利用马铃薯淀粉为原料制备一种具有无毒性、无刺激性、价格低廉、吸水速率快、止血时间短的多微孔多聚糖止血材料。方法：将马铃薯生淀粉经过糊化、酶解、乳化交联、溶剂萃取、洗涤、喷雾干燥筛分、灭菌包装．制成多微孔多聚糖止血微球。结果：制成了止血微球、止血气雾剂、止血粉末3种多微孔多聚糖止血材料：颗粒粒径在50～80txm,均分子量在100000-1900000;吸水倍率在20～100倍;电子显微镜下显示呈圆形或卵圆形微球颗粒．大小均匀。结论：多微孔多聚糖止血材料具有无毒性、无刺激性、价格低廉、吸水速率快、止血时间短的优点,且原料来源丰富、吐产工芦简单可行右广阔酌应用箭导