常州市区污水管道渗漏的试验

为探寻污水管道的渗漏特性,本文在常州市区选取6处污水管段,采用容积法从管材、管径、管龄、埋深四个方面对其渗漏特性进行了试验研究。研究发现,对于外渗特性,管径越大,渗漏量越大;钢筋混凝土管渗漏量较大,HDPE管和球墨铸铁管渗漏量较小且相当;大管径的钢筋混凝土管渗漏速率要大于小管径的HDPE管和球墨铸铁管;对于内渗特性,管径越大,渗漏量和渗漏速率越大,但12h内的差距不明显;日间12h内,前6h的渗漏速率大于后6h的渗漏速率;夜间12h的渗漏速率开始回升。污水管道渗漏量与管龄、埋深有关,管底深度≤5.38m,管道渗漏呈现外渗特性,管底深度≥5.63m,管道渗漏呈现内渗特性。

饮用水管网生物膜中弧菌数量影响因素研究

研究饮用水管网中管材、管龄、管径等因素对生物膜弧菌数量的影响。采集中国东部某市管网生物膜样本12份,用硫代硫酸盐-柠檬酸盐-胆盐-蔗糖琼脂培养基分离培养弧菌,并用弧菌科细菌生化鉴定系统鉴定并计数。结果表明,弧菌检出率为50%(6/12)。在管龄相近的不同管材管壁生物膜中,弧菌数量为球墨铸铁管(212±39.40CFU/cm^2)>镀锌钢管(4.85±1.03CFU/cm^2)>不锈钢复合管(0.66±0.21CFU/cm^2),并且球墨铸铁管中的弧菌数量与其他管材间差异有统计学意义(P<0.05),而在塑料管中未检出弧菌;而不同管龄的球墨铸铁管以及镀锌钢管生物膜中弧菌数量变化不明显;在不同管径(公称直径为200、150和300mm)的球墨铸铁管生物膜中,弧菌数量分别为2.65×10~3±204、212±39.40和44.20±6.88CFU/cm^2。综上表明,管材对生物膜弧菌数量有较大的影响,其中,以球墨铸铁管中的弧菌数量最多;因此,饮用水管段的铺设应考虑铸铁管的潜在弧菌风险。

管网因素对水中金属含量及赋存形态的影响

为研究输配水过程中管网因素管材、管龄、供水距离对水中金属元素赋存形态的影响,文中以南方N市实际管网水为研究对象,采用电感耦合等离子体质谱法测定水中16种金属元素总量、悬浮态和可溶态含量。结果表明:灰口铸铁管的管网水中铁总量与两形态含量比球墨铸铁管略高。对于在役的球墨铸铁管,当管龄小于5年或大于20年,管网水中总铝、总铁、总锰略高,但增幅有限;当管龄为6~20年时,其对管网水中铁、锰、铝含量的影响并不显著;当灰口铸铁管管龄为21~32年时,随管龄的增加,管网水中铝、铁、锰的总量和两形态含量逐渐增加;随供水距离的增加,管网水中铝、铁、锰的总量、两形态含量略有增加,锌略有下降。建议在条件允许下,优先选择球墨铸铁管为新建供水管道和老旧灰口铸铁管的替换管材;对管龄小于5年或大于20年的球墨铸铁管,应加强水质监测和冲洗排放频率;在供水距离大于15 km的管网点位可适量补加氯,以减少管道内壁铁等金属元素的释放。

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

Age scope of high-risk population for esophageal cancer in Ci county

AIM: To define the age scope of high-risk population for esophageal cancer (EC) in Ci county. METHODS: The results of endoscopic examination of 2 013 subjects, cytological screening of 16 763 persons and records of 9 265 patients with EC were analyzed by Ridit methods, the standard age group was 45-49 year group. RESULTS: The average age of patients with moderate esophageal epithelium dysplasia by endoscopic examination was 53.5 years, of severe esophageal epithelium dysplasia, 51.4 years, early EC, 55.6 years. The average age of stage one severe epithelium dysplasia (SEEDⅠ) by cytological screening was 51.2 years, of stage two severe epithelium esophageal dysplasia (SEED Ⅱ) 51.6 years, of advanced EC 61.7 years. In the group of 40-year olds, the value of Ridit by pathological diagnosis was 0.46, 95% CI, 0.45-0.47, that by cytological diagnosis was 0.45, 95% CI, 0.43-0.47. As the age increased at five-year intervals, the value of Ridit increased significantly. CONCLUSION: In Ci county of a high incidence area of EC, the age definition of high-risk population should be above 45 years.

Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft

Objective To evaluate the outcome of off-pump coronary artery bypass grafting （OPCABG） using a bilateral internal mammary artery （BIMA） Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients （196 males and 12 females） underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33-78 years. A total of 167 （80.2%） cases had triple-vessel disease. Left main stem disease was found in 33 （15.9%） cases, and double-vessel disease was found in 8 （3.9%） cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries （IMAs）, and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery （LIMA） in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intm-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions.

Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

Cardiovascular care for older adults： hypertension and stroke in the older adult

1 Introduction Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults.

Predisposing factors for atrial fibrillation in the elderly

Atrial fibrillation （AF） in the elderly occurs as a consequence of cardiovascular aging and an age related increase of comorbidity. Several predisposing factors for AF have been identified for the overall AF population. Most of them, cardiovascular disease in particular, play a role in younger and older patients. The longer time period during which these risk factors can cause structural changes that ultimately lead to AF may, at least in part, explain the association between age and AF. In addition, less well defined age-related changes in cellular electrophysi- ologic properties and structure predispose to AF in the elderly.

Catheter ablation of atrial fibrillation in the elderly

Background Atrial fibrillation （AF） catheter ablation has emerged as a promising treatment strategy for AF, but has not been widely adopted in the elderly population. The present study aimed to determine the safety and efficacy of AF catheter ablation in the elderly popula-tion. Methods and Results The study population consisted of 316 patients with paroxysmal AF who underwent left atrial ablation. Ninety-five patients were≥65 years （48 males, mean age 68.9 ± 3.0 years old） and 221 patients were〈65 years old （130 males, mean age 52.5 ± 10.4 years old）. After a mean follow-up period of 34.0 ± 15.1 months, 55 （57.9%） patients in the elderly group were free from ar-rhythmia recurrence compared with 149 （67.4%） patients in the younger group （P=0.169）. Procedural complications were uncommon in both study groups. In logistic regression analysis, left atrial diameter （P=0.003）, hypertension （P=0.001）, dyslipidemia （P=0.039）, and coronary artery disease （P=0.018） were independent predictors of AF recurrence in the elderly population. Conclusions Catheter ablation of AF is safe and effective in older patients. Invasive strategies should be considered as an alternative choice in symptomatic elderly patients with AF.

Advanced age and the clinical outcomes of transcatheter aortic valve implan-tation

Aortic valve stenosis （AS） is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation （TAVI） has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the ef-fect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular in-jures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.

Evaluate the Possibility of Cracking Pipe on Water Supply Network under the Age of Pipe

Minimizing water loss in water supply networks is one of the objectives for protecting water resources. Currently, the large amount of water loss is mainly due to leakage of the pipeline network. The leaking of pipe can be caused by incorrect construction, impacted by external forces, or corroded pipe material and aging. Therefore, to control and predict the cracking area on pipe, it is necessary to collect data about pipe conditions, approve the solution of technology improvement and define the ability of pipe capacity from setting up to the first preparing time. This paper will demonstrate how to evaluate corrosion pipe under the age of pipe and the impact level of internal pressure pipe at different times, and will put forward solution of effective leaking management on water supply network.

Efficacy of intraductal ultrasonography in the diagnosis of non-opaque choledocholith

AIM: To evaluate the efficacy of intraductal ultrasonography (IDUS) in the diagnosis of non-opaque, common bile duct stones. METHODS: A total of 183 patients (102 males, mean age 73 years; 81 females, mean age 70 years) with suspected common bile duct stones diagnosed through abdominal computed tomography (CT), magnetic resonance imaging (MRI), and abdominal Type-B ultrasound were included in the study. The diagnosis was confirmed through endoscopic retrograde cholangiopancreatography (ERCP) followed by IDUS. RESULTS: A total of 183 patients with suspected common bile duct (CBD) stones were included in the study as follows: 36 patients with high-density CBD stones, 68 patients with sand-like stones, 44 patients with low-density stones, 21 patients with ampullary cancer, and 14 patients with pancreatic cancer. Conventional imaging revealed 124 cases of choledochectasia, and only 36 cases of suspected CBD stones; ERCP revealed 145 cases of CBD stones with three missed diagnoses. IDUS revealed 148 cases of CBD stones, 21 cases of ampullary tumors, and 14 cases of pancreatic cancer. CONCLUSION: IDUS was more effective in the diagnosis of bile duct stones than ERCP, upper abdominal CT or upper abdominal MRI.

Prevalence of cardiovascular disease in subjects hospitalized due to chronic obstructive pulmonary disease in Beijing from 2000 to 2010

Objectives To investigate the overall prevalence of cardiovascular disease （CVD） in subjects hospitalized for chronic obstructive pulmonary disease （COPD）,and explore the prevalence of the major CVD complications and trends in patients with COPD over a 10-year period.Methods Medical records in the PLA General Hospital,Beijing Union Medical College Hospital,and Beijing Hospital from 2000/01/01 to 2010/03/03 were retrospectively reviewed.A total of 4960 patients with COPD were reviewed in the study （3570 males,mean age,72.2 ± 10.5 years; 1390 females,mean age,72.0 ± 10.4 years）.Results The prevalence of CVD in COPD patients was 51.7％.The three most prevalent CVDs were ischemic heart disease （28.9％）,heart failure （19.6％）,and arrhythmia （12.6％）.During the 10-year study period,the prevalence of various CVDs in COPD patients showed a gradual increasing trend with increasing age.There was higher morbidity due to ischemic heart disease （P ＜ 0.01） in male COPD patients than in the female counterparts.However,heart failure （P ＜ 0.01）and hypertension （P ＜ 0.01） occurred less frequently in male COPD patients than in female COPD patients.Furthermore,the prevalence of ischemic heart disease decreased year by year.In addition to heart failure,various types of CVD complications in COPD patients tended to occur in younger subjects.The prevalence of all major types of CVD in women tended to increase year by year.Conclusions The prevalence of CVD in patients hospitalized for COPD in Beijing was high.Age,sex and CVD trends,as well as life style changes,should be considered when prevention and control strategies are formulated.

Management of chronic heart failure in the older population

Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

Impact of age-related comorbidity on results of colorectal cancer surgery

AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: According to age, 403 patients operated on for CRC in our department were divided into group A (< 70 years old) and group B (≥ 70 years old) and analyzed statistically. RESULTS: Rectal localization prevailed in group A (31.6% vs 19.7%, P = 0.027), whereas the percentage of R0 resections was 77% in the two groups. Comorbidity rate was 46.2% and 69.1% for group A and B, respectively (P < 0.001), with a huge difference as regards cardiovascular diseases. Overall, postoperative morbidity was 16.9% and 20.8% in group A and B, respectively (P = 0.367), whereas mortality was limited to group B (4.5%, P = 0.001). In both groups, patients who suffered from postoperative complications had a higher overall comorbidity rate, with preexisting cardiovascular diseases prevailing in group B (P = 0.003). Overall 5-year survival rate was significantly betterfor group A (75.2% vs 55%, P = 0.006), whereas no signif icant difference was observed considering disease-specif ic survival (76.3% vs 76.9%, P = 0.674). CONCLUSION: In spite of an increase in postoperative mortality and a lower overall long-term survival for patients aged ≥ 70 years old, it should be considered that, even in the elderly group, a signif icant number of patients is alive 5 years after CRC resection.

Age related differences and outcome of patients with Takotsubo syndrome

Background Takotsubo syndrome （TS） is an important cardiac disease that affects predominantly postmenopausal women. This study was conducted to determine the impact of age on the short- and long-term outcome of TS patients. Methods ＆ Results The data from a collective of 114 TS patients with a mean follow-up of 1591 ：E 1079 days was retrospectively analysed. The study population was divided into two groups （≤ 65 and 〉 65 years） so as to evaluate the impact of age on the short- and long-term mortality of TS patients. In-hospital eventslike life-threatening arrhythmias （14.58% vs. 9.09%; P = 0.036）, need for mechanical respiratory support （41.66% vs. 28.78%; P = 0.15） as well as inotropic agent use （22.91% vs. 15.15%; P = 0.29）, although not reaching the statistical cut-of, tended to occur more often in the younger group. Heart failure was more common in the elderly age group （P = 0.03）. The use of multivariate analysis ruled out age as a significant marker of long term mortality （HR： 1.0; 95% CI： 0.9-1.0; P = 0.60）. Conclusions Age does not influence the clinical course of TS in terms of the short- as well as long-term outcome. The study revealed a higher incidence of life threatening arrhythmias in the younger patient age-group and a higher incidence of heart failure among the older group of patients.

Science and the practice of cardiovascular medicine in the geriatric population

1 Why is the demograpy important? In the half century 2000-2050,there will be a virtual tsunami of aging in the United States.The anticipated increase in the population older than age 65 is 140%,and for the population older than age 85,389%.More than half of the current U.S.population can anticipate living to age 80,with a contemporary life expectancy at age 75 of 11 years,and at age 85 of 6 years.

Echocardiography in centenarians： characteristics, utility and follow-up

Background Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocar- diography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. Methods A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. Results 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years （101 - 1.4 years）. In 82 of the centenarians evaluated （72%）, no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% （n = 26） of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% （n = 5） of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure （P = 0.02）. After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months （range 0.03 to 145 months）, with no difference if there was a change or no change in manage- ment （P = 0.21）. Conclusions Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardio- grams in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic assessment. These findings may question the overall utility of echocardiography in these late survivors.

CT image morphology features of pulmonary sclerosing hemangiomas

Objective: The aim of the study was to analyze the CT morphology features of pulmonary sclerosing hemangiomas (PSHs) and improve the diagnosis ability of this disease.Methods: The 18 cases of pulmonary sclerosing hemangioma (PSH) confirmed by operation and histopathology from August 2002 to May 2009 were collected,including 17 females and 2 males,aged from 19 to 60 years old,with an average age of 43 years.All the cases underwent plain CT scan,among them,16 cases received enhanced CT scan.Results: The 18 cases had isolated mass.Mean long-axis diameter of these lesions was (2.7 ± 1.3) cm (range,1.9–4.2 cm).Of all cases,5 cases (27.8%) were round in shape,9 cases (50%) were oval,4 cases (22.2%) were lobulated,and 14 cases (77.8%) were smooth margin.The air meniscus sign was in 2 cases (11.1%),and the halo sign in 3 cases (16.7%).Two cases (11.1%) contained small nodular calcification,the remaining 16 cases (70%) were homogeneous density,the CT density of the masses ranged from 24–47 HU,and the mean value was 35 HU.Sixteen cases received enhanced scan,the welt vessel sign was in 8 cases (44.4%),1 case showed less enhancement,5 cases showed marked homogeneous enhancement and 10 cases showed intense and patchy heterogeneous enhanced.The CT density of the enhancing masses ranged from 60–110 HU,the mean value was 35 HU,and the net enhancement value was 14–80 HU,the mean value was 55 HU.Conclusion: PSH should be considered in middle-aged female whose CT found that single round or oval pulmonary nodules,with smooth margin,or associated with the air meniscus sign,the halo sign,or the marked enhancement.