Mitral regurgitation is the most prevalent valvular heart disease, with a poor prognosis that brings a heavy burden to population health and socio-economics. Transcatheter repair is a relatively mature technique for mitral regurgitation, but is strict in anatomical screening and the reduction of regurgitation is limited. With the advance in techniques and technology, transcatheter replacement has become an attractive treatment modality for mitral regurgitation in succession to transcatheter repair. At present, several replacement devices have initiated clinical trials to establish feasibility. Early data has shown that transcatheter replacement for mitral regurgitation is safe and effective, which needs to be confirmed with larger population and longer follow-up. Besides, some technical challenges remain to be addressed, in order to increase accessibility of this innovative technology.
Objective To investigate the change characteristics of brain natriuretic peptide(BNP) after offpump coronary artery bypass grafting (OPCAB), and observe the relationship of BNP with atrial fibrillation, intensive care unit(ICU) stay time, time of withdrawing trachea tube, and usage of intraaortic balloon pump(IABP). Methods We retrospectively analyzed the clinical data of 168 consecutive patients with coronary artery diseases who underwent OPCAB in Beijing Anzhen Hospital from September 2009 to March 2010. There were 133 males and 35 females with an age of 60.77±9.32 years. BNP was determined before operation, on the operative day just after operation, and day 1, 2 and 3 after operation. At the same time, the relationship between BNP and ICU stay time, time of withdrawing trachea tube, occurrence of atrial fibrillation, and usage of IABP were also recorded. Results There were two inhospital deaths, due to low cardiac output syndrome, infection and circulatory failure respectively. BNP increased significantly after operation with the peak level occurring 1 day after operation, after which it decreased gradually. BNP level in patients with their left ventricular ejection fraction(LVEF) under 50% was significantly higher than that in patients with LVEF equal to or above 50% before and after operation(the median BNP level at the second postoperative day: 2 198.20 pg/ml vs. 531.65 pg/ml, Plt;0.05). BNP in patients using IABP was significantly higher than that in patients without using IABP before and after operation(the median BNP level at the first postoperative day: 5 066.75 pg/ml vs. 745.20 pg/ml, Plt;0.05). The ROC value was 0.834 when perioperative BNP was used to predict the possibility of using IABP. BNP in patients with postoperative atrial fibrillation was also significantly higher than that in patients without atrial fibrillation(the median BNP level at the first postoperative day: 1 070.60 pg/ml vs. 747.80 pg/ml, Plt;0.05). BNP was positively correlated with using IABP(at the third postoperative day: r=0.437, Plt;0.05), prognosis(at the first postoperative day:r=0.224, Plt;0.05), time of withdrawing trachea tube(at the third postoperative day: r=0.440, Plt;0.05), ICU stay time(at the third postoperative day: r=0.477, Plt;0.05). Conclusion BNP can be considered as one of the diagnostic criteria for ventricular dysfunction, and preoperative high BNP level is a risk factor for using IABP and ICU stay time equal to or longer than 3 days.
目的:〖HT5”SS〗探討原發性喉部惡性淋巴瘤的臨床診斷治療方案,提出早期診斷此類疾病的合理有效方法。〖HTH〗方法:〖HTSS〗對臨床29例病理確診原發于喉部的惡性淋巴瘤患者臨床資料進行回顧性分析,并且與同時期原發于鼻腔鼻竇的惡性淋巴瘤患者臨床資料對比分析。〖HTH〗結果:〖HTSS〗29例原發性喉部惡性淋巴瘤病例均進行了手術干預,在術中或術后病理明確診斷后進行了后繼的放射及化學綜合治療,病員的平均住院日較原發于鼻腔鼻竇的惡性淋巴瘤患者為長。〖HTH〗結論:〖HTSS〗本病的合理有效的診斷治療,需早期明確診斷和判定病變累及范圍,在盡可能早期獲取病理診斷基礎上,提高對喉部影像學的認識,對于此類疾病及時制訂合理有效的治療方案,獲得更好的預后有著重要意義。
目的：研究青蒿琥酯誘導人胃癌SGC-7901細胞凋亡作用及其可能機制.方法：應用流式細胞術（FCM）、透射電鏡（TEM）等方法檢測不同濃度下青蒿琥酯對人胃癌SGC-7901細胞生長的影響，并應用Western Blot法檢測凋亡相關基因Bcl-2、Bax的表達水平。結果：經青蒿琥酯處理后，人胃癌SGC-7901細胞凋亡率升高，并具有時間濃度依賴性（Plt;0.05），癌細胞被阻滯于G0/G1期；電鏡觀察腫瘤組織中散在凋亡細胞及凋亡小體；Western Blot法檢測到凋亡相關基因Bcl-2表達減弱，Bax表達增強（Plt;0.05）。結論：青蒿琥酯能有效抑制人胃癌SGC7901細胞增殖并誘導其凋亡，其機制可能與下調凋亡相關基因Bcl-2、上調Bax表達有關。
Mitral valve regurgitation is one of the most common heart valve diseases, of which secondary mitral valve regurgitation (sMR) has large proportion and poor prognosis. For patients who still have symptoms after the guideline-directed management and therapy, the effects of surgery are controversial, and transcatheter therapy provides a new option. Transcatheter edge-to-edge repair has become one of the recommended therapies by the guidelines, meanwhile transcatheter mitral valve annuloplasty and transcatheter mitral valve replacement are developing. However, the etiological mechanism of sMR is complex and diverse. There is an interaction between cardiac function and structure and sMR in dynamic change. It brings challenges to the selection of indicators and evaluation timing. The complex anatomical structure also makes it more difficult to design instruments and select surgical methods. This paper reviews the challenges and progress of transcatheter therapy for sMR.
【摘要】 目的 探討無癥狀人群高尿酸血癥與高甘油三酯血癥的相關性，為臨床疾病的預防和治療提供實驗基礎研究。 方法 回顧分析2008年5月-2009年5月門診體檢中200名無臨床癥狀高血尿酸者（A組）的血脂檢查情況，并與同期200例血尿酸正常者（B組）的血脂檢查情況進行比較分析。A組：男121例，女79例；年齡20～60歲，平均43歲。男性患者血尿酸gt;420 mmol/L，女性患者gt;360 mmol/L。 B組：男115例，女85例；年齡20～60歲，平均41歲。男性患者血尿酸為99～420 mmol /L，女性患者為99～360 mmol/L。兩組性別和年齡差異無統計學意義（Pgt;0.05）。 結果 A組甘油三酯、總膽固醇、低密度脂蛋白、高密度脂蛋白分別為（3.09±0.98）、（4.05±1.07）、（3.38±0.98）、（1.30±0.51）mmol /L；B組為（1.65±0.86）、（3.99±0.99）、（2.97±0.89）、（1.41±0.66）mmol /L。 A組甘油三酯較B組比較，差異有統計學意義（Plt;0.01）；總膽固醇、低密度脂蛋白、高密度脂蛋白比較，差異無統計學意義（Pgt;0.05）。經相關性分析，A組血尿酸與甘油三酯呈正相關（r=0.69， Plt;0.01）。 結論 血尿酸代謝與甘油三酯代謝之間有一定的聯系。【Abstract】 Objective To explore the correlation between hyperuricemia and hypertriglyceridemia in asymptomatic people to provide the basic information for clinical prevention and treatment. Methods The blood lipid (TG, TC, LDL, and HDL) levels in 200 asymptomatic individuals with high uric acid (A group) and 200 sex-and age-matched ones with normal serum uric acid (B group) were examined and the results of the two groups were compared. Results The concentration of triacylglycerol, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were (3.09±0.98), (4.05±1.07), (3.38±0.98), and (1.30±0.51) mmol/L, respectively in group A; and were (1.65±0.86), (3.99±0.99), (2.97±0.89), and (1.41±0.66) mmol /L, respectively in group B. The concentration of TG in group A was obvious higher than that in group B (Plt;0.01). However, the differences of their total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were not significant (Pgt;0.05). The increase of TG was obvious compared with TC(Plt;0.01), LDL (Plt;0.01), and HDL (Plt;0.01) in group A; while the comparisons in group B were not significant (Pgt;0.05). Conclusion Uric acid metabolism correlates with triacylglycerol metabolism.
At present, interventional therapy for structural heart disease is in a period of vigorous development. Among them, transcatheter aortic valve replacement, as a representative of the interventional treatment of heart valve disease, has made rapid progress, which is a bright spot in the field of cardiovascular disease. The future development of transcatheter tricuspid valve repair/replacement is also promising. With the availability of important clinical evidence, the indications of transcatheter aortic valve replacement have been extended to the full risk range of severe aortic stenosis. More and more data showed that transcatheter mitral and tricuspid valve interventions could effectively alleviate patients’ symptoms and improve their prognosis. Transcatheter valve interventions have developed rapidly and have made tremendous progress in China. This article will review and interpret the important progress in the field of transcatheter valve interventions.
As the indications for transcatheter aortic valve replacement (TAVR) expand, multi-valve lesions are becoming more common in clinical practice. Moderate to severe atrioventricular regurgitation, particularly when persistent after TAVR, significantly increases the risk of adverse events. Therefore, many studies have evaluated factors that contribute to the improvement of atrioventricular regurgitation. However, this field remains controversial due to the heterogeneity of retrospective studies and the lack of randomized controlled trials. Despite advances in atrioventricular valve intervention techniques, evidence for atrioventricular regurgitation intervention after TAVR is still scarce. The management decision for atrioventricular regurgitation in patients who underwent TAVR is complex and must take into account the severity of valve disease, anatomical characteristics, quality of life, and procedural complexity. We conducted a review of atrioventricular regurgitation in patients who have received TAVR in hope that it will help decision-making in clinical practice.
Objective To explore the effectiveness of artificial hemi-knee prosthesis reconstruction for bone defects after resection of pediatric osteosarcoma. Methods A retrospective analysis was conducted on the clinical data of 18 children with osteosarcoma who met the selection criteria and were treated between January 2016 and December 2019. There were 11 males and 7 females, aged 6-10 years (mean, 8.9 years). Osteosarcoma located in the distal femur in 11 cases and the proximal tibia in 7 cases. Among them, 12 cases were conventional osteosarcoma and 6 cases were small cell osteosarcoma, with a disease duration of 1-9 months (mean, 3.1 months). All patients received 2 cycles of preoperative chemotherapy with doxorubicin, cisplatin, and ifosfamide. After en bloc tumor segment resection, bone defects were reconstructed using custom-made artificial hemi-knee prostheses. Rehabilitation training was initiated at 8 weeks postoperatively under the protection of a knee immobilizer brace, combined with 4 cycles of adjuvant chemotherapy. During follow-up, lower limb growth length and limb shortening (compared with the healthy side) were measured, and limb function was evaluated using the Musculoskeletal Tumor Society-93 (MSTS-93) scoring system. Results All surgeries were successfully completed, with an operation time of 2.0-3.1 hours (mean, 2.4 hours) and intraoperative blood loss of 180-320 mL (mean, 230.0 mL). Incisional edge necrosis occurred in 1 case at 10 days postoperatively, while the incisions of the remaining 17 patients healed by first intention. One case developed periprosthetic infection caused by Staphylococcus aureus at 1 week postoperatively, which was cured after symptomatic treatment. All 18 patients were followed up 60-96 months (mean, 74.2 months). No local tumor recurrence was observed during follow-up. Imaging examinations showed prosthesis loosening in 2 cases, while the prosthesis of other patients were well-positioned. At last follow-up, the knee joint range of motion was 80°-120° (mean, 106.7°). The MSTS-93 score was 16-29 (mean, 24.7), with 12 cases rated as excellent, 5 good, and 1 fair. The patients’ height increased by 12.8-20.0 cm (mean, 15.5 cm), the lower limb growth length was 6.0-13.0 cm (mean, 9.7 cm), and limb shortening was 1.8-4.6 cm (mean, 3.1 cm). There was no significant difference in MSTS-93 scores, lower limb growth length, or limb shortening between the distal femur group and the proximal tibia group (P>0.05). Conclusion Artificial hemi-knee prosthesis reconstruction can preserve the adjacent normal epiphysis of the knee joint, maximize limb growth potential, and reduce adult limb length discrepancy, making it a suitable reconstruction option for children with knee osteosarcoma.
Surgical bioprosthetic valve in the mitral position typically degenerates in 10-15 years, when intervention is required again. In the past, redo surgical mitral valve replacement has been the only treatment choice for such patients suffering from bioprosthetic valve failure, despite the even higher risk associated with redo open-heart surgery. In recent years, transcatheter valve-in-valve implantation in the mitral position has evolved as an reasonable alternative to redo surgery for the treatment of surgical mitral bioprosthetic valve failure. Here we report an 81-year-old female patient with surgical mitral bioprosthetic valve failure, who successfully underwent valve-in-valve transcatheter mitral valve replacement via the transfemoral-transseptal approach. The procedure was successful owing to comprehensive CT imaging work-up, despite the technical challenges associated with bilateral giant atria and small left ventricle.