Objective To analyze the influence of COPD on the structure and function of left ventricular. Methods Sixty-nine COPD patients ( mean age: 69. 0 ±7. 8 yrs) and forty healthy controls ( mean age: 67. 8 ±7. 6 yrs) were enrolled in this study. Both groups underwent Doppler echocardiography.Heart rate ( HR) were recorded. Left ventricular end-diastolic volume ( LVEDV) , left ventricular enddiastolic diameter ( LVEDD) , interventricular septum( IVS) , stroke volume ( SV) , and cardiac output ( CO)were measured. The changes of left ventricular were compared between the COPD patients and the healthy controls, and also between the COPD patients with or without chronic cor pulmonale. Results Compared with the healthy controls, movement range of IVS, LVEDD, LVEDV, and SV reduced significantly ( P lt;0. 05) , and HR raised significantly in the COPD patients ( P lt; 0. 05) . CO had no significant difference between two groups ( P gt;0. 05) . Sub-group analysis indicated that the thickness and movement range of IVSwere greater in the patients with cor pulmonale secondary to COPD than those without cor pulmonale ( P lt;0. 05) . Conclusions In COPD patients, left ventricular chamber size decreases, and left ventricular systolic function is impaired. Left ventricular function is impaired more severe in cor pulmonale secondary to COPD than COPD without cor pulmonale.
To evaluate the implantation effect of artificial vascular grafts with recombinant fibrinolytic enzyme factor II (rF II)-immobil ized lumina in animal test. Methods Four mm internal diameter (ID) polyurethane (PU) artificial vascular grafts were prepared by di pping and leaching method. The micro-pore size and morphology of the graft walls were observed by SEM. The graft lumina were immobil ized with rF II. Twenty hybrid male dogs [weighing (20 ± 1) kg] were used for animal model of carotid artery defect and were randomly divided into 3 groups: rF II -immobil ized PU group, no rF II -immobil ized PU group and expanded polytetrafluoroethylene (ePTFE) group. The vascular grafts were implanted for repairing injured segments of carotid artery in dogs. The general health state of animals was recorded. At 30 days and 60 days,the patency rate of every group was calculated. At 60 days IDs were measured, cell prol iferation in neointima was inspected by l ight microscope, morphology on neointima was observed by SEM. Results The ID of the PU vascular grafts was (3.74 ± 0.06) mm, wall thickness was 0.4-0.6 mm, the wall density was 0.25 g/cm3, the porosity was 79.8%, racical compl iance was 8.57%/100 mmHg. In the wall, micropores were well distributed and opened-pores structure was observed. Pore size was (140 ± 41) μm in the outside layer, pore size was (100 ± 3) μm in the inside layer, thickness ratio of outside / inside layers was 2 ∶ 1, the pore size was (40 ± 16) μm on the lumina surface. After operation the wounds on neck healed, all the animals survived and had no compl ication. At 30 days and 60 days after implantation, the patency rate for rF II -immobil ized PU group were 100% and 66.7%, for no rF II -immobil ized PU group were 66.7% and 33.3%, and for ePTFE group were 67.7% and 0 respectively, but at 60 days there were thrombosis at anastamotic sites of some grafts occluded. Before operation the IDs for rF II-immobil ized PU group, no rF II -immobil ized PU group and ePTFE group were (3.74 ± 0.06), (3.74 ± 0.06) and (4.00 ± 0.03) mm, at 60 days after operation the IDs were (4.51 ± 0.05), (4.31 ± 0.24) and (4.43 ± 0.12) mm respectively, showing no statistically significant differences between 3 groups (P gt; 0.05). Histological inspection indicated that at 15 days a layer of plasma protein deposited on the lumina, at 30 days some cells adhered to the lumina, at 60 days neointima could be observed on the lumina. Thickness of the neointima became larger with implantation time. At 60 days neointima thickness at proximal end, middle site and distal end ofgraft were (560 ± 22), (78 ± 5) and (323 ± 31) μm respectively for rF II -immobil ized PU group. The results of SEM showed that neointima surface consisted of flat and long cells which long axes ranged with blood flow direction and was similar to lumina morphology of carotid artery of dog. Conclusion Immobil ization of rF II to lumina of grafts could enhance fibrinolytic activity and inhibited formation of thrombo-embol ia which led to an increase in patency rate after implantation.
Objective To explore the effectiveness and failure causes of large-head metal-on-metal total hip arthroplasty (large-head MoM THA). Methods Between March 2007 and May 2010, 159 patients (183 hips) underwent large-head MoM THA, and the clinical data were analyzed. There were 50 females (54 hips) and 109 males (129 hips) with an average age of 50 years (range, 20-78 years). Single hip was involved in 135 cases (left hip in 69 cases and right hip in 66 cases) and double hips in 24 cases. The causes included femoral head necrosis in 74 cases (93 hips), Legg-Calve-Perthes in 1 case (1 hip), osteoarthritis in 18 cases (19 hips), developmental dysplasia of the hip in 17 cases (18 hips), osteoarthritis after hip septic infection in 8 cases (8 hips), traumatic arthritis of the hip in 6 cases (6 hips), femoral neck fracture in 17 cases (17 hips), ankylosing spondylitis in 8 cases (11 hips), rheumatoid arthritis of hip in 9 cases (9 hips), and adult onset Still’s disease in 1 case (1 hip). Before operation, visual analogue scale (VAS) was 6.59±0.87; Harris score was 45.99±8.07. Results Healing of incisions by first intention was achieved, and no operative complication occurred. The patients were followed up 1.2-8.2 years (mean, 6.1 years). Implant failure was observed in 15 cases (17 hips), and the 5-year survival rate of large-head MoM THA was 91.80% (168/183). The causes of implant failure after THA were inflammatory pseudotumor in 4 cases (4 hips), acetabular aseptic loosening in 3 cases (3 hips), osteolysis in 4 cases (5 hips), acetabular aseptic loosening combined with inflammatory pseudotumor in 3 cases (3 hips), and functional disused in 1 case (2 hips). Of them, 9 cases (11 hips) did not receive revision surgery for various reasons, while 6 cases (6 hips) underwent revision surgery at 1.2-5.4 years (mean 3.7 years) after large-head MoM THA. At last follow-up, VAS and Harris score were 1.72±1.48 and 81.37±10.75 respectively, showing significant differences when compared with preoperative scores (t=–35.547，P=0.000；t=33.823，P=0.000). The function was excellent in 44 hips, good in 89 hips, fair in 33 hips, and poor in 17 hips. Conclusion Large-head MoM THA has a high revision rate during mid- and long-term follow-up because of inflammatory pseudotumor, acetabular aseptic loosening, and osteolysis. Early revision can effectively improve the function of the hip and improve patients’quality of life.
ObjectiveTo analyze risk factors of early outcomes of mitral valvuloplasty (MVP)for the treatment of degenerative mitral regurgitation (DMR). MethodsClinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1, 2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients (86.4%)were followed up after discharge with their mean age of 51.21±12.78 years, including 76 males (66.7%). Preoperative risk factors of early outcomes of MVP were analyzed. ResultsAmong those patients, there were 25 patients with atrial fibri-llation (AF)(21.9%). Preoperative ejection fraction was 63.88%±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD)was 31.61±5.51 mm/m2. There were 66 patients (57.9%)with tricuspid regurg-itation, and 34 patients (29.8%)underwent concomitant tricuspid valvuloplasty including 10 patients (8.8%)who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF (36.8% vs. 18.9%, P=0.035), large LVEDD (34.02±3.76 mm/m2 vs. 31.15±5.68 mm/m2, P=0.042)and functional mitral regurgitation (15.8% vs. 1.1%, P=0.007). Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events (HR 0.002, 95% CI < 0.001-0.570, P=0.031). ConclusionsEnlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.
Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.
Objective To evaluate the effectiveness of multiple small-diameter drilling decompression combined with hip arthroscopy for early oeteonecrosis of the femoral head (ONFH). Methods Between March 2010 and December 2013, 91 patients with early ONFH were treated with the operation of multiple small-diameter drilling decompression combined with hip arthroscopy in 39 cases (53 hips, group A) or with drilling decompression alone in 52 cases (74 hips, group B). The patients in 2 groups had obvious hip pain and limited motion before operation. There was no significant difference in gender, age, etiology, effected side, stage of osteonecrosis, and preoperative Harris score between 2 groups (P>0.05). Results All operations succeeded and all incisions healed by first intention. The operation time was significantly longer in group A [(73.3±10.6) minutes] than in group B [(41.5±7.2) minutes] (t=8.726, P=0.000). Temporary of sciatic nerve apraxia after operation occurred in 2 patients of group A, and no complication occurred in other patients. Patients were followed up 24-52 months (mean, 39.3 months) in group A and 24-48 months (mean, 34.6 months) in group B. At last follow-up, the Harris scores were 83.34±8.76 in group A and 76.61±9.22 in group B, showing significant differences when compared between 2 groups (t=–4.247, P=0.029) and when compared with preoperative values in 2 groups (t=–10.327, P=0.001; t=–8.216, P=0.008). X-ray films showed that the collapse of the femoral head was observed in 6 hips (1 hip at stage Ⅰand 5 hips at stage Ⅱ) in group A, and in 16 hips (4 hips at stageⅠand 12 hips at stage Ⅱ) in group B; and hip arthroplasty was performed. The total effective rates were 88.68% (47/53) in group A and 78.38% (58/74) in group B, respectively; showing significant difference between 2 groups (χ2=5.241, P=0.041). Conclusion Multiple small-diameter drilling decompression combined with hip arthroscopy is effective in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, delaying the need for total hip arthroplasty in patients with early ONFH.
Reports about the application of transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis, whose valve sizes exceed the maximum recommended annular diameter of the largest artificial valve, is rarely in China. This paper reports an aortic stenosis patient characterized by large aortic annulus diameter with severe calcification and treated by TAVR. A comprehensive and careful operation plan was made before the operation. The anterior and posterior balloon dilatation and coronary artery protection were used during the operation. The patient was followed up for 2 years and was in stable condition.
Objective To study the effect of preparation conditions for small-diameter polyurethane(PU) vascular graft on microstructure and mechanical properties. Methods The small-diameter microporous PU artificial vascular grafts were prepared by dipping and leaching method. The dimension and microstructure were controlled by changing mold diameter, PU materials, salt sizes, salt to polymer ratio, times of dipping layers etc. The mechanical properties of PU grafts including radical compliance, water permeability, longitudinal strength, burst strength, and suture tearing strength were measured and the effect of the graft dimension and microstructure on their properties were studied. Results The internal diameter of grafts prepared was 2-4 mm depending on mold diameter. The wall thickness was 0.6-1.2 mmafter dipping 4-8 layers. The density was 0.23-0.49 g/cm3. The pore was 42-95 μm in diameter. The porosity was 56%80%. The radical compliance was 1.2%-7.4%·13.3 kPa-1 and higher compliances could be obtained by using moreelastic polyurethane, higher salt to polymer ratio, longer diameter and less wall thickness. The water permeability, mainly depending on salt to polymer ratio,diameter, and wall thickness, was 0.29-12.44 g／(cm2·min). The longitudinal strength was 1.55-4.36 MPa correlating with tensile strength of polyurethane and salt to polymer ratio. The burst strength was 60-300 kPa also depending on tensile strength of polyurethane and salt to polymer ratio. The suture tearing strength was 19.5-96.2 N／cm2 depending on tensile strength of polyurethanebut not on the angle of tearing and graft axial directions. The compliance and water permeability of Chronoflex grafts were higher than those of PCU1500 grafts, but longitudinal strength, burst strength, and suture tearing strength of PCU1500 grafts were better than those of Chronoflex grafts. Conclusion Small-diameter grafts with proper pore sizes, porosity, matching compliance can be obtained by selecting PU materials and optimizing the preparation conditions.
ObjectiveTo find the relationship between bicuspid aortic valve (BAV) and the dilatation or aneurysm of the aorta using electrocardiogram-gated computed tomography angiography (CTA). MethodsWe collected the clinical data of the BAV coexisting with suspected aortic dilatation or aneurysm from February 2012 through April 2015. A total of 124 patients were analyzed retrospectively. There were 97 males and 27 females at an anverage age of 50.35±16.26 years. According to the CTA, patients were classified into two groups: a pure BAV(without raphe) group and a BAV (with raphe) group. we recorded the aortic diameters, gender, age, and so on. ResultsOf the 124 patients, 91 (73.4%) had BAV with raphe, and 33 patients (26.6%) had pure BAV. The analysis revealed that the diameter of the annulus (23.90±3.34 mm vs. 21.74±3.46 mm, P=0.005), the sinuses of Valsalva (40.93±6.78 mm vs. 37.35±7.06 mm, P=0.022), the tubular portion of the ascending aorta (45.38±7.66 mm vs. 38.29±8.18 mm, P=0.0001), and the part of the aorta proximal to the innominate artery (34.19±4.98 mm vs. 30.23±6.62 mm, P=0.02) between patients with BAV with raphe and pure BAV had significant differences. And there was a significant difference in prevalence of dilatation of the aorta between patients with pure BAV and BAV with raphe [77/91 (84.6%) vs.18/31(58.1%), P=0.004]. Of the 91 BAV with raphe patients, we found 76 patients (83.5%) with right and left coronary cusps (R-L) fusion, 13 patients (14.3%) with right and non-coronary cusps (R-N) fusion, and 2 patients (1.2%) with left and non-coronary cusps (L-N) fusion. There was a statistical difference in the aortic root diameters between R-L fusion BAV and R-N fusion BAV. The diameter of the distal ascending aorta and proximal aortic arch between R-L and R-N fusion BAV had statistical differences. ConclusionsBAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Otherwise R-L fusion BAV is associated with increased diameters of the aortic root, while R-N fusion BAV is associated with increased diameters of the distal ascending aorta and proximal arch.
Objective To analyze the quantitative relationship between respiratory effort and inferior vena cava (IVC) diameter variability in healthy adults, and explore the effects of respiratory effort on the fluid responsiveness with IVC diameter variability. Methods From October 2022 to May 2023, a cross-sectional study was conducted in healthy young subjects who met the criteria. Respiratory effort was evaluated by using portable pulmonary function to measure the subjects’ inspiratory conditions in three states (quiet breathing, moderate inspiration, and maximal inspiration). At the same time, the IVC internal diameter was measured by bedside ultrasound and the IVC diameter variability was calculated. The correlation between inspiratory volume and IVC diameter variation was analyzed, and the receiver operator characteristic (ROC) curve was drawn. The sensitivity and specificity of fluid responsiveness induced by inspiratory effort were predicted according to the area under the ROC curve (AUC). Results A total of 95 subjects were screened, aged 27.13±5.77 years, of whom 30 (32%) subjects were males. During quiet breathing, 41.1% of subjects had IVC inner diameter variation ≥50%. For moderate inspiration, it was 68.4%. At maximum inspiration, this proportion is more than 85%. Inspiratory volume was moderately positively correlated with IVC diameter variation, and the correlation coefficient r=0.45. With the IVC diameter variation ≥50% as the positive criterion for fluid responsiveness, the AUC of fluid responsiveness induced by inspiratory effort was 0.73 (95% confidence interval 0.67 - 0.78, P<0.001), and the inspiratory volume threshold was 13 mL/kg ideal body weight when the maximum Youden index was 0.41. That is, moderate force breathing can induce fluid responsiveness, with sensitivity of 79.57% and specificity of 61.62%. Conclusion The degree of respiratory effort significantly affects the IVC inner diameter variation, and there may be false positives in the evaluation of fluid responsiveness according to IVC inner diameter variation in the case of spontaneous breathing.