Tertiary Referral Hospital In China Research Articles

Fetal and neonatal outcome in severe alloimmunization managed with intrauterine transfusion: 18-year experience in a tertiary referral hospital in China.

Hemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization, is an important cause of fetal and neonatal morbidity and mortality. However, fetal and neonatal outcome of HDFN managed with intrauterine transfusion (IUT) in China are unknown. In addition, fetal and neonatal outcomes according to the type of maternal red cell alloantibodies involved and outcomes of hydrops fetalis are also unclear. The objective of this study was to evaluate fetal and neonatal outcomes of severe red-cell alloimmunization treated by IUT, to compare the outcomes according to the type of antibody, and to investigate the perinatal and postnatal outcomes of hydrops fetalis due to red cell alloimmunization. A retrospective study of pregnancies affected by HDFN and managed with IUT at a tertiary care university hospital in China between January 2001 and December 2018 was performed. Fetal and neonatal outcomes were investigated, and comparison of outcomes depending on the type of antibody and comparison of outcome between hydrops fetalis and fetuses without hydrops were also conducted. 244 IUTs were performed in 81 fetuses from 80 pregnancies. Anti-RhD was the major etiology of HDFN requiring IUT (71.6%). The fetal survival rate was 90.1%. The survival rate of the hydropic fetuses was significantly lower than those of the non hydropic fetuses (61.2% vs. 95.6%) (P = 0.002**). Compared with non hydropic fetuses, hydropic fetuses had significantly lower gestational age and lower hemoglobin level at first IUT. The neonatal survival rate was 98.6%. Exchange transfusions were required in 26% of the neonates. 30.1% of neonates had late anemia and required top-up transfusions, and hydropic fetuses required more late top-up transfusions than fetuses without hydrops. No significant difference in fetal and neonatal outcomes was found among the four subgroups stratified by the antibody involved. Our study demonstrates that IUT is an effective and safe therapy for severe HDFN at our institution. Early detection and treatment of hydrops is critical for perinatal outcomes. Particular attention should be paid to late postnatal anemia in affected neonates and top-up transfusion is still commonly needed.

Efficacy of faecal microbiota transplantation in patients with progressive supranuclear palsy-Richardson's syndrome: a phase 2, single centre, randomised clinical trial

Faecal microbiota transplantation (FMT) has demonstrated efficacy in treating gastrointestinal (GI) diseases, such as Clostridium difficile infection (CDI) and inflammatory bowel disease (IBD). GI dysfunction is a frequent and occasionally dominating symptom of progressive supranuclear palsy-Richardson's syndrome (PSP-RS). However, it is not known whether FMT has clinical efficacy for PSP-RS. This 36-week, randomised, placebo-controlled, parallel-group, phase 2 clinical trial was performed at a university tertiary referral hospital in China. From August 15 2021 to December 31 2021, a total of 68 newly diagnosed patients with PSP-RS (male 40 [59%], female 28 [41%]) who had never received any antiparkinsonian medications were enrolled and randomly assigned to receive either healthy donor FMT (n=34, FMT group) or a mixture of 0.9% saline and food colouring (E150c) as sham transplantation (n=34, placebo group) through transendoscopic enteral tubing (TET). Two days after oral antibiotics, participants received 1 week of transplantation. After an interval of 4 weeks, retransplantation was performed. Then, the last transplantation was given after another interval of 4 weeks, and the participants were followed up for 24 weeks (week 36). Clinicaltrials.gov identifier: ChiCTR-2100045397. Among 68 patients who were randomised (mean age, 67.2 (SD 5.1); 40 [59%] were male, 28 [41%] were female), 63 participants completed the trial. Efficacy analyses were performed on the intention-to-treat (ITT) analysis set. At week 16, the mean PSP Rating Scale (PSPRS) scores (the primary outcome) improved from 40.1 (SD 7.6) to 36.9 (SD 5.9) in the FMT group, whereas the scores changed from 40.1 (SD 6.9) to 41.7 (SD 6.2) in the placebo group, for a treatment benefit of 4.3 (95% CI, 3.2-5.4) (P<0.0001). After 3-cycle intervention, symptoms of constipation, depression, and anxiety (the secondary outcome) improved significantly at week 16 in the FMT group compared with the placebo group, the majority of which were maintained at the 24-week follow-up (week 36). Our findings suggest that, compared with placebo, FMT treatment significantly improved motor and nonmotor symptoms in patients with PSP-RS, as well as reduced intestinal inflammation and enhanced the intestinal barrier by regulating the intestinal microbiota composition. The National Natural Science Foundation of China (No. 82122022, 82171248, 81873791, and 82230084), Natural Science Foundation of Henan Province for Excellent Young Scholars (no. 202300410357), and Henan Province Young and Middle-Aged Health Science and Technology Innovation Talent Project (YXKC2020033).

Families under pressure: A qualitative study of stressors in families of children with congenital heart disease.

The objective of this study was to better understand the stressors in families of children with congenital heart disease (CHD) to assist with formulating targeted stress management plans for such families. A descriptive qualitative study was undertaken at a tertiary referral hospital in China. Following purposeful sampling, interviews were conducted with 21 parents of children with CHD regarding the stressors in their families. Following content analysis, 11 themes were generated from the data and categorised into six main domains: the initial stressor and associated hardships, normative transitions, prior strains, the consequences of family efforts to cope, intrafamily and social ambiguity, and sociocultural values. The 11 themes include confusion regarding the disease, hardships encountered during treatment, the heavy financial burden, the unusual growth track of the child due to the disease, normal events becoming abnormal for the family, impaired family functioning, family vulnerability, family resilience, family boundary ambiguity induced by role alteration, a lack of knowledge about community support and family stigma. Various and complex stressors exist for families of children with CHD. Medical personnel should fully evaluate the stressors and take targeted measures before implementing family stress management practices. It is also necessary to focus on the posttraumatic growth of families of children with CHD and strengthen resilience. Moreover, family boundary ambiguity and a lack of knowledge about community support should not be ignored, and further research is needed to explore these variables. Most importantly, policymakers and healthcare providers should adopt a range of strategies to address the stigma of being in a family of a child with CHD.

Effects of enhanced hygiene measures on severe diarrhea and anastomotic leak after colorectal cancer surgery: the experience of a tertiary referral hospital in China.

The 2019 novel coronavirus (COVID-19) global pandemic has greatly changed the mode of hospital admissions. This study summarized and analyzed the incidence of severe diarrhea and anastomotic leakage during different periods for colorectal cancer surgery. From January 2017 to September 2020, 2,619 colorectal operations were performed in Peking Union Medical College Hospital. In contrast with previous years, enhanced hand hygiene training, more frequent ventilation of the wards, and separate bed treatments for patients were implemented in 2020. Data on incidence of severe diarrhea and anastomotic leakage were retrieved and collected. The number of cases of severe diarrhea after colorectal surgery was 32 (4.60%), 24 (3.33%), 32 (3.83%), and 11 (2.99%) in 2017, 2018, 2019, and 2020 respectively, while the incidence of anastomotic leakage was 3.30% (23/696), 3.75% (27/720), 2.87% (24/835), and 2.17% (8/368), respectively. There was no significant difference in the incidence of postoperative severe diarrhea or anastomotic leakage across the various years. The number of colorectal surgeries in 2020 was significantly decreased due to the COVID-19 pandemic. Among the different years, no difference was observed regarding the incidence of postoperative flora disorder or anastomosis leakage. Enhanced hygiene measures during the COVID-19 epidemic partially contributed to the decrease of severe diarrhea and anastomotic leakage.

Association between serum 25-hydroxyvitamin d and myeloperoxidase: A cross-sectional study of a general population in China.

BackgroundSeveral studies have found a strong association between cardiovascular diseases and myeloperoxidase (MPO) as a marker of oxidative stress. Although the anti-inflammatory effects of vitamin D in adults have been validated, evidence about the relationship between MPO and 25(OH)D is lacking. This study aimed to investigate the relationship between MPO and 25(OH)D in the general Chinese population.MethodsFrom November 2018 to August 2019, a total of 6414 subjects were enrolled in a tertiary referral hospital in China, which included 3,122 women and 3,292 men. The dependent and independent variables were MPO and 25(OH)D, respectively. The confounders included age, sex, body mass index, waist-hip ratio, smoking status, alcohol drinking status, calcium, and parathyroid hormone concentration.ResultsIn the fully adjusted model, we found that MPO decreased by 0.12 (95% CI −0.16, −0.08), ng/mL for each unit (1 nmol/L) increase in 25(OH)D. When 25(OH) D was divided into quartiles, compared with Q1 (< 41.4 nmol/L), the adjusted beta coefficients (β) of MPO in Q2–Q4 were −2.29 (95% CI, −4.31 to −0.27), −4.76 (95% CI, −6.83 to −2.69), and −6.07 (95% CI, −8.23 to −3.92), respectively (P for the trend < 0.0001). When 25(OH) D was divided according to clinical severity, compared with the severely deficient (< 30 nmol/L) s≥ 30, < 50 nmol/L) and sufficient groups (≥ 50 nmol/L) were −2.59 (95% CI, −5.87 to 0.69) and −5.87 (95% CI, −9.17 to −2.57), respectively (P for the trend < 0.0001).ConclusionAfter adjusting for age, sex, BMI, waist-hip ratio, smoking status, alcohol status, calcium, and PTH, circulating 25(OH)D was negatively associated with MPO.

Perceptions of Family Caregivers of Patients with Schizophrenia Towards Antipsychotics Associated Side-Effects in China:A Qualitative Study.

PurposeTo explore perceptions of antipsychotics associated side-effects among family caregivers of patients with schizophrenia.Patients and MethodsA descriptive qualitative study was applied in a tertiary referral hospital in China. Purposeful sampling of 18 family caregivers of patients with schizophrenia were interviewed about their perceptions towards antipsychotics related side effects.ResultsAccording to content analysis, three themes emerged from the data: (a) nightmare in the treatment with the categories of sleep disturbances; physical impairment; appearance impairment; (b) opposite attitudes toward side-effect with the categories of being vigilant; do not care; (c) diverse ways of coping side-effects with the categories of asking for help from professionals; self-determined; try any quack’s prescription.ConclusionThe side effects of antipsychotics not only damage the health of patients, but also increase the burden and stress of caregivers. However, caregivers have different attitudes and coping styles about the side effects of antipsychotics. Health professionals should be aware of the influence of individual background and cultural factors on caregivers’ attitudes towards drug side effects. Furthermore, health professionals should also provide caregivers with knowledge about drug side effects, coping skills, and appropriate management strategies to promote health outcomes for people with schizophrenia.

Co-harboring of Novel bla KPC-2 Plasmid and Integrative and Conjugative Element Carrying Tn6203 in Multidrug-Resistant Pseudomonas aeruginosa.

Many strains of the opportunistic pathogen Pseudomonas aeruginosa have acquired resistance to multiple antibiotics. Carbapenem-resistant P. aeruginosa poses a global healthcare problem due to limited therapeutic options for the treatment of infections. Plasmids and integrative and conjugative elements (ICEs) are the major vectors of antibiotic-resistance gene transfer. In our study, four carbapenem-resistant strains of P. aeruginosa were isolated from the same patient in a tertiary referral hospital in China, one of these was resistant to gentamicin and tobramycin. In this strain P33, we observed a non-transferable plasmid, pP33-2, carrying a novel blaKPC−2 gene segment (ISKpn27-blaKPC−2-ISKpn6-korC-ORF-klcA-IS26), which we concluded to have been formed by IS26-mediated gene cluster translocation. In addition, by comparing the chromosomes of the P. aeruginosa strains that belong to the same sequence type, we identified an ICE, ICEP33, adjacent to a prophage. The attL site of ICEP33 is identical to the terminal part of the attR site of the prophage. The ICEP33 element contains the transposon Tn6203, which encodes antibiotic and metal resistance genes. The insertion of ICEP33 in the chromosome mediates resistance to multiple antibiotics. Our study contributes to the understanding of the acquisition of antibiotic resistance in P. aeruginosa facilitated by mobile genetic elements.

Effectiveness of Rehabilitation Nursing versus Usual Therapist-Led Treatment in Patients with Acute Ischemic Stroke: A Randomized Non-Inferiority Trial.

PurposeTo determine the effectiveness of rehabilitation nursing program interventions in patients with acute ischemic stroke.Patients and MethodsAn assessment-blinded randomized controlled trial was conducted at a tertiary referral hospital in China. Eligible patients were stratified according to their weighted corticospinal tract lesion load and then randomly assigned to an experimental group (n = 121) or a control group (n = 103). The experimental group received rehabilitation nursing from well-trained, qualified nurses (30 minutes per session, two sessions per day for seven consecutive days). The control group received therapist-led rehabilitation with the same timing and frequency. Comparative analysis of the primary outcomes was performed to determine non-inferiority with a predetermined non-inferiority margin. The primary outcomes were the Motor Assessment Scale, Fugl-Meyer Assessment, and the Action Research Arm Test assessed at baseline and after seven days of treatment. The secondary outcomes were the modified Barthel Index, the National Institutes of Health Stroke Scale, and the modified Rankin Scale, evaluated before and after the intervention and at 4 and 12 weeks of follow-up.ResultsTwo hundred participants completed the trial. In both groups, all outcomes improved significantly after seven days and at follow-ups. The rehabilitation nursing program was non-inferior to therapist-led treatment with lower 95% confidence limits beyond the margins for primary outcomes (P < 0.001).ConclusionBoth treatments had comparable effects; however, no definite conclusion could be drawn. Adequately powered studies are required.

A Patient-Controlled Intravenous Analgesia With Tramadol Ameliorates Postpartum Depression in High-Risk Woman After Cesarean Section: A Randomized Controlled Trial.

Background: Postpartum depression (PPD) is a severe psychiatric disorder. Its risk is associated with the cesarean section (CS). Currently, there are few early intervention strategies for these women with PPD who underwent CS.Methods: This was a parallel-group randomized controlled trial of singleton pregnant women who underwent elective CS in a tertiary referral hospital in China from October, 2017 to September, 2019. After operation, patients received randomly tramadol patient-controlled intravenous analgesia (PCIA; 4 mg/ml; TRA group), hydromorphone PCIA (0.04 mg/ml; HYD group), or ropivacaine patient-controlled epidural analgesia (PCEA; 1.5 mg/ml; ROP group) for 48 h in a 1:1:1 ratio. Total blinding during hospitalization was not feasible due to differences between the PCEA and PCIA treatments. All investigators who performed the follow-up were blinded to the group assignment.Outcomes: A total of 1,230 patients were enrolled for eligibility. Intention-to-treat analysis showed reduced incidence of PPD in the TRA group (n = 27 [6.6%]) than that in the HYD (10.2%, OR 1.62, 95% CI 0.98~2.68; p = 0.059) and ROP groups (10.5%, OR 1.66, 95% CI 1.01~2.75; p = 0.046) at 4 weeks post-operation, however, the difference was not statistically significant (Bonferroni corrected p = 0.118, p = 0.098, respectively). Subgroup analysis in high-risk women (preoperative Edinburgh Postpartum Depression Scale [EPDS] ≥10) showed a significantly lower incidence of PPD in the TRA group (16.5%) than in the HYD (32.6%) and ROP groups (30.9%) (Bonferroni corrected p = 0.022 and p = 0.038, respectively). The per-protocol analysis yielded similar results. Reported adverse events (AEs) were mostly mild. None of the women or infant discontinued treatment due to AEs.Conclusions: Tramadol PCIA after CS in high-risk women can help to reduce the risk of PPD at 4 weeks after elective CS.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03309163?term=ETPPD&draw=2&rank=1; ClinicalTrials.gov (NCT03309163).

Clinical features and outcomes of adrenal schwannoma: a study of 13 cases from a single centre.

BackgroundAdrenal schwannomas (AS) are extremely rare neoplasms. This study shares our experience regarding the diagnosis and operative management of AS.MethodsClinical details, radiologic, laboratory, and pathologic findings as well as follow-up data were analysed retrospectively for 13 AS patients who accepted surgery at a tertiary referral hospital in China between 1 January 1996, and 31 December 2017.ResultsThe mean age of the patients at diagnosis was 44.7 ± 13.7 years (range 19–62 years; male: female ratio, 1:1.16), of whom seven patients had unilateral AS on the right side, and the remaining six on the left side. None of the cases were hormonally active. None of the 13 cases were diagnosed as AS by CT imaging before the operation. Among the patients, ten were asymptomatic. The mean preoperative size was 7.1 ± 3.2 cm (range 1.6–12.6 cm). All patients underwent surgery, with open adrenalectomy in five patients and laparoscopy in eight patients. The mean tumor size on pathologic examination was 6.8 ± 3.0 cm (range 3.0–11.7 cm). The surgical specimens were confirmed by pathological examination. During a median follow-up of 60.8 ± 17.7 months, no patients showed recurrence or metastasis.ConclusionThe preoperative diagnosis of AS remains difficult despite the advances in imaging examinations. After complete resection, the prognosis of AS is excellent.

A retrospective review of cochlear implant revision surgery: a 24-year experience in China.

We aimed to analyse the reasons behind the need for cochlear implant revision surgeries, as well as the rate at which they occur, to reduce the revision surgery rate for non-device failures. We also aimed to elucidate the cumulative survival and device survival rates in different age groups. This retrospective single cohort study reviewed 4563 cochlear implant surgeries and 119 revision surgeries performed at a tertiary referral hospital in China between 1996 and 2019. Kaplan-Meier curves were used to calculate the cumulative survival and device survival rates. The revision surgery rate was 2.61%. The reasons for revision included device (73.1%) and non-device (26.9%) failures. The most common reasons were hard device (47.1%) and non-device failure (28.6%). The 10- and 20-year cumulative survival rates were 96.8% and 96.7%, respectively. Younger children were more likely to undergo a second surgery. This study is the longest study about revision surgery in China. Cochlear implantation is a reliable treatment. It has a low complication rate in patients with sensorineural hearing loss. Children have a higher revision rate than adults. Doctors should be aware of each complication and perform the appropriate procedure.

Diagnostic values of Xpert MTB/RIF, T-SPOT.TB and adenosine deaminase for HIV-negative tuberculous pericarditis in a high burden setting: a prospective observational study

The diagnosis of tuberculous pericarditis (TBP) remains challenging. This prospective study evaluated the diagnostic value of Xpert MTB/RIF (Xpert) and T-SPOT.TB and adenosine deaminase (ADA) for TBP in a high burden setting. A total of 123 HIV-negative patients with suspected TBP were enrolled at a tertiary referral hospital in China. Pericardial fluids were collected and subjected to the three rapid tests, and the results were compared with the final confirmed diagnosis. Of 105 patients in the final analysis, 39 (37.1%) were microbiologically, histopathologically or clinically diagnosed with TBP. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR) for Xpert were 66.7%, 98.5%, 96.3%, 83.3%, 44.0, 0.338, and 130.0, respectively, compared to 92.3%, 87.9%, 81.8%, 95.1%, 7.6, 0.088, and 87.0, respectively, for T-SPOT.TB, and 82.1%, 92.4%, 86.5%, 89.7%, 10.8, 0.194, and 55.8, respectively, for ADA (≥ 40 U/L). ROC curve analysis revealed a cut-off point of 48.5 spot-forming cells per million pericardial effusion mononuclear cells for T-SPOT.TB, which had a DOR value of 183.8, while a cut-off point of 41.5 U/L for ADA had a DOR value of 70.9. Xpert (Step 1: rule-in) followed by T-SPOT.TB [cut-off point] (Step 2: rule-out) showed the highest DOR value of 252.0, with only 5.7% (6/105) of patients misdiagnosed. The two-step algorithm consisting of Xpert and T-SPOT.TB could offer rapid and accurate diagnosis of TBP.

New indices of arterial stiffness correlate with disease severity and mid-term prognosis in acute decompensated heart failure.

Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity pulse index (AVI) for the stiffness of central arteries and the arterial pressure volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population. This study aimed to investigate the relationship between the AVI, API and clinical parameters and outcomes in HF patients. A prospective cohort of patients with acute decompensated HF were enrolled within 6months, who were admitted to a tertiary referral hospital in China. Measurement of the AVI and API (AVE-1500, Shisei Datum, Tokyo, Japan) was performed on the day of admission and discharge. Patients were followed up to 6months for the composite endpoint of all-cause death and rehospitalization for HF. A total of 127 patients were recruited for analysis (60 ± 15years, 70% male). 80% of the patients were in New York Heart Association (NYHA) Class III or IV at admission with mean left ventricular ejection fraction (LVEF) of 34 ± 9%. During hospitalization, all patients received guideline-directed medical therapy if not contraindicated. The AVI (27.3 ± 5.0 vs. 28.6 ± 6.7, P = 0.002) and API (24.9 ± 4.9 vs. 26.0 ± 6.5, P = 0.05) were lower at discharge than at admission. By dividing the patients into mild to severe group based on systolic blood pressure (SBP) and LVEF or into tertiles according to the amino-terminal pro-brain natriuretic peptide (NT-proBNP), transmitral E velocity over mitral annular e' velocity (E/e' ratio), it was observed that the AVI increased with a higher level of NT-proBNP (P for trend < 0.001), a larger E/e' (P for trend < 0.001) and a lower LVEF (P for trend = 0.0183), while the API increased as the E/e' and systolic blood pressure became higher (both P for trend < 0.05). The improvement in AVI at discharge was correlated with LVEF (R = -0.3024, P < 0.05) and NT-proBNP improvement (R = 0.3118, P < 0.05), while the change in API was positively correlated with SBP change (R = 0.3897, P < 0.001). In 6months after discharge, there were 52 predefined events including 15 deaths and 44 rehospitalization for HF. Apart from the level of NT-proBNP, the AVI at discharge of ≥ 26 showed a trend of being associated with the composite outcome (HR 2.747, 95% CI 1.411-5.349, P < 0.001 for univariate analysis; HR 1.864, 95% CI 0.892-3.893, P = 0.09761 for multivariate analysis). New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and midterm prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.

Risk factors for surgical site infection after major oral oncological surgery: the experience of a tertiary referral hospital in China.

ObjectiveTo identify risk factors associated with surgical site infection (SSI) after major oral oncological surgery.MethodsThis retrospective study reviewed data from patients that underwent major surgery for oral cancer at a tertiary referral hospital in China between January 2005 and July 2016. SSI was diagnosed within 30 days. Demographic, cancer-related, preoperative, perioperative and postoperative data were analysed using descriptive statistics and univariate and multivariate analyses of the risk factors for SSI.ResultsA total of 786 patients were enrolled, of whom 125 had SSI (15.9%), which were all incisional. Independent risk factors for SSI, identified by multivariate analysis, were diabetes mellitus (odds ratio [OR] 2.147, 95% confidence interval [CI] 1.240, 3.642), prior radiotherapy (OR 4.595, 95% CI 1.293, 17.317) and oral–neck communication (OR 2.838, 95% CI 1.263, 7.604); and factors reflecting large extent resections were tracheostomy (OR 2.235, 95% CI 1.435, 3.525), anterolateral thigh flap (OR 1.971, 95% CI 1.103, 3.448) and latissimus dorsi flap (OR 4.178, 95% CI 1.325, 13.189).ConclusionsMultiple risk factors were associated with SSI after major oral oncological surgery. To minimize SSI risk, surgeons managing oral cancer patients should have a better understanding of the risk factors, including diabetes mellitus, prior radiotherapy, tracheostomy, oral–neck communication and flap reconstruction.

P4506New indices of arterial stiffness correlates with disease severity and mid-term prognosis in acute decompensated heart failure

Abstract Background Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity-pulse index (AVI) for the stiffness of central arteries and the arterial pressure-volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population. Purpose This study aimed to investigate the relationship between the AVI, API and clinical outcomes in HF patients. Methods A prospective cohort of patients with acute decompensated HF were enrolled within 6 months, who were admitted to a tertiary referral hospital in China. Measurement of the AVI and API (AVE-1500, Shisei Datum, Tokyo, Japan) was performed on the day of admission and discharge. Patients were followed up to 6 months for the composite endpoint of all-cause death and HF rehospitalization. Results A Total of 127 patients were recruited for analysis (60±15 years, 70% male). 80% of the patients were in New York Heart Association (NYHA) Class III or above at admission, who presented a mean left ventricular ejection fraction (LVEF) of 34±9%. During hospitalization, all patients received guideline directed medical therapy if not contraindicated. The AVI (27.3±5.2 vs. 28.6±6.7, p=0.002) and API (24.9±4.9 vs. 26.0±6.5, p=0.05) were lower at discharge than at admission. By dividing the patients into tertiles according to the amino-terminal pro-brain natriuretic peptide (NT-proBNP), LVEF, transmitral E velocity over mitral annular e' velocity (E/e' ratio) and systolic blood pressure (SBP) at admission, it was observed that the AVI increased with a higher level of NT-proBNP (p for trend &lt;0.001), a larger E/e' (p&lt;0.001) and a lower LVEF (p=0.001), while the API increased as the SBP became higher (p=0.005).The improvement in AVI at discharge was correlated with that in LVEF (R=-0.3024, p&lt;0.05) and NT-proBNP (R=0.3118, p&lt;0.05), while the change in API was positively correlated with that in SBP (R=0.3897, p&lt;0.001). In 6 months after discharge, there were 52 predefined events including 15 deaths and 44 HF rehospitalization. Apart from the level of NT-proBNP, the AVI at discharge of ≥26 showed a trend of being associated with the composite outcome (2.747, 1.411–5.349, p&lt;0.001 for univariate analysis; 1.8648, 0.8928–3.8949, p=0.0973 for multivariate analysis). Conclusions New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and mid-term prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.

Adrenal Ganglioneuroma: Features and Outcomes of 42 Cases in a Chinese Population.

Adrenal ganglioneuromas (AGNs) are extremely rare benign neoplasms. This study is to share our experience regarding diagnostic and operative management of these tumors. Clinical details as well as follow-up data were retrospectively analyzed in 42 primary AGN patients who received operative resection at a tertiary referral hospital in China between May 2005 and July 2016. The mean age of the patients at diagnosis was 35.3years (range 13-59years). Among the patients, 28 were asymptomatic. The mean preoperative size was 5.3±2.2cm (range 2.1-14.0cm), and 17 cases were larger than 5cm. All patients underwent operative resection as open adrenalectomy in 20 patients and laparoscopy in 22 patients. The mean tumor size on pathologic examination was 6.0±2.6cm (range 2.2-17.0cm). Laparoscopic operation showed its advantages over open surgery on the postoperative duration (5.0 vs. 7.3days, p<0.001) and estimated blood loss (69.5 vs. 157.5ml, p=0.047). No patient had recurrence or metastasis during a median follow-up of 70.5months (range 3.7-164.3months). We describe the largest AGN series reported to date. The preoperative diagnosis of AGN remains difficult despite of the progression of imaging examination. After complete resection, the prognosis of AGN patients is excellent. Laparoscopic approach has its advantages in the resection of AGNs.

Interventional Radiology in China: Current Status and Future Prospects.

Interventional Radiology in China: Current Status and Future Prospects.

Automated anesthesia carts reduce drug recording errors in medication administrations — A single center study in the largest tertiary referral hospital in China

AimTo clinically evaluate a type of patented automated anesthesia cart in medication administrations in anesthesia. Materials and MethodsThis was a prospectively randomized open label clinical trial. In 10 designated operating suits in the First Affiliated Hospital of Zhengzhou University, in China. 1066 cases originated from 10,812 medication administrations in anesthesia were randomized. 78 registered anesthesiologists managed the medication. The patients received medication administrations in anesthesia with either an automated or a conventional manual cart. American Society of Anesthesiologists (ASA) score, sex, duration of anesthesia and surgical specialty, errors in administration of medications (incorrect medication given (substitution), medication not given (omission) and drug recordings errors”), compliance and satisfaction were recorded. ResultsThe total error rate was 7.3% with the automated anesthesia carts (1 in 14 administrations) and 11.9% with conventional manual carts (1 in 8 administrations). Automated anesthesia carts significantly reduced the drug recording error rate compared to conventional manual carts (P<0.01). However, no significant difference of substitution or errors omission errors was found between groups of automated anesthesia carts and conventional manual carts. The anesthesiologists' compliance with the automated anesthesia carts was unsatisfactory, and all the errors in medication recordings with the automated anesthesia carts were due to the incorrect use of the carts. Most of the participating anesthesiologists preferred the automated anesthesia carts (P<0.05). ConclusionsThe utilization of automated anesthesia carts reduced the drug recording errors in medication administrations of anesthesia.

A qualitative study on nurses' reactions to inpatient suicide in a general hospital

AimsTo explore the impact of inpatient suicides on nurses working in front-line, the patterns of regulation and their needs for support. MethodsData were collected through purposive sampling by conducting semi-structured and individual in-depth interviews in a tertiary referral hospital in China. Colaizzi's seven-step phenomenological method was simultaneously used by two interviewers. ResultsReactions to inpatient suicides revealed three central themes: (1) inpatients were highly likely to commit suicide, (2) inpatient suicide was difficult to prevent, and (3) nurses lacked the necessary suicide prevention skills. Psychological responses mainly included shock and panic, self-accusation or guilt, sense of fear, and frustration. The impacts on practice were stress, excessive vigilance, and burnout. Avoidance and sharing of feelings played key roles in the regulation patterns of nurses. ConclusionsNurses who experienced inpatient suicide became stressed. Effective interventions must be implemented to improve the coping mechanisms of nurses against the negative consequences of inpatient suicide. The findings of this study will allow administrators to gain insight into the impacts of inpatient suicides on nurses in general hospitals. Such information can be used to develop effective strategies and provide individual support and ongoing education. Consequently, nurses will acquire suicide prevention skills and help patients achieve swift recovery.

Real world performance of cardiac magnetic resonance imaging in patients with clinical indications: initial experience from a tertiary referral hospital in China

Background Cardiac magnetic resonance (CMR) has been developed as an important imaging tool for cardiovascular diseases in clinical practice. However, there were few reports about the real world implementation of CMR with regard to its indications and findings. Methods 344 patients (48 ± 19 yrs, 63.4% male) with clinical indications for CMR were consecutively recruited in 10 months, at a tertiary referral hospital in China. Indications for CMR, quantifications of structure and function, late gadolinium enhancement (LGE), and diagnoses made by CMR were analyzed. Results The evaluation of heart failure and cardiomyopathies was the leading cause of referral that occurred in 164 (47.7%) patients, followed by coronary artery disease in 79 (23.0%) patients and ventricular arrhythmia in 65 (18.9%) patients. Quantitative analysis was available in 319 (92.7%) patients where the LV dilatation observed in 208 (65.2%) patients and RV dilatation in 46 (14.4%) patients, respectively. There were 157 (48.5%) patients detected with ventricular LGE, in whom 43 (27.4%) patients displayed typical ischemic pattern and the others had nonischemic pattern of various presentations. Except the undefined 74 (21.5%) cases, CMR assessment corrected an initial referral diagnosis in 73 (21.2%) patients and confirmed it in 197 (57.3%) patients. Conclusions All the referrals in this study were appropriate for CMR, mainly indicated for structure and function assessment. CMR helped to identify abnormalities that not detected by other imaging modalities, which would provide incremental diagnostic, therapeutic and prognostic information. Funding