Objective To compare the assisting function between a new paraaortic counterpulsation device (PACD) and the intraaortic balloon pump (IABP) in acute severe heart failure in sheep. Methods Eight healthy adult small fattailed sheep were chosen in our study. The selfmade PACD (with a stroke volume of 55 ml) was anastomosed to the descending aorta through a valveless graft, and an intraaortic balloon (with a stroke volume of 40 ml) was placed in the descending aorta for the purpose of counterpulsation assisting. Acute severe heart failure model was established by snaring coronary artery branches. The hemodynamic changes of both devices were recorded during, before and after the counterpulsation assisting. Results Eight heart failure sheep models were successfully set up. Cardiac output (CO), pulmonary capillary wedge pressure (PCWP), mean arterial pressure (MAP) and left ventricular end diastolic presssure (LVEDP) after the heart failure were significantly different compared with basic value (t=-8.466, 34.083, 25.767, -5.219, P=0.000). After IABP and PACD assisting, the mean aortic diastolic pressure (MADP) didn’t significantly or did increase (38.34±7.13 mm Hg vs. 38.42±6.81 mm Hg, P=0.418; 38.34±7.13 mm Hg vs.54.14±10.13 mm Hg, P=0.001), and the degree of increasing between the two methods showed a significant difference (P=0.010); LVEDP didn’t significantly decrease (7.43±2.54 mmHg vs. 7.32±2.14 mm Hg, P=0.498; 7.43±2.54 mm Hg vs. 6.53±1.91 mm Hg, P=0.821), and there was no significant difference between the two methods in the change (P=0.651); the coronary sinus flow (CSF) didn’t significantly or did increase (86.63±7.71 ml/min vs. 87.04±6.53 ml/min, P=0.981; 86.63±7.71 ml/min vs. 110.52±11.03 ml/min, P=0.000), and there was a significant difference in the change of CSF between the two methods (P=0.000). IABP didn’t significantly decrease the left carotid artery flow (LCAF) (131.07±21.26 ml/min vs. 128.36±20.38 ml/min, P=0.689), while PACD increased it (131.07±21.26 ml/min vs. 151.29±18.37 ml/min, P=0.008), and there was a significant difference in the change of pressure waveform between the two methods (P=0.002). The thrombus, thrombosis and ischemic necrosis were not found in the hematosac of PACD, artificial blood vessels, heart, lung, liver or kidney of the animal. No apparent abnormalities of the pathohistological sections were detected under optical microscope. Conclusion IABP has no assisting function for the heart of animal with severe heart failure. However, PACD can improve hemodynamic parameters like MADP, returned blood volume in the coronary artery and perfusion volume into the brain, which may become a promising implantable device for severe heart failure.
Objective The immunogenicity of tissue engineered skins is still vague, though it has been appl ied cl inically for several years. To observe the evidence of immunologic rejection of tissue engineered skins transplanted to severe combined immunodeficiency (SCID) mice, which are implanted human splenic lymphocytes to construct human immunesystem. Methods Tissue engineered skins and acellular dermic matrix were constructed in vitro. Twenty SCID mice, aging4-6 weeks and weighing 16-17 g, were randomly divided into four groups equally (n=5). The tissue engineered skins, human foreskins from circumcision and acellular dermic matrix were transplanted to groups A, B, and C, respectively; group D was used as a control. After 2 weeks of transplanting, 3 × 107 human splenic lymphocytes were injected into every SCID mouse intraperitoneally. After 4 weeks, the morphology, histology, immunohistochemistry and human IgG immunofluorescence were used to observe immunologic rejection. Results Group A showed that transplanted tissue engineered skins had the bilayer structure of dermis and epidermis, which was similar to the normal human skin structure. Group B showed that the transplanted human foreskins still retained normal structure of human skin. Group C showed that acellular dermic matrix were located in situ and had no sign of degradation. After injecting human splenic lymphocytes into the SCID mice, no inflammatory cells infil itration were observed basically in groups A, C, and D; the inflammatory cells infil itration of group B were significantly higher than that of other 3 groups (P lt; 0.05). The results of anti human keratin 14 monoclonal antibody (mAb) staining and anti human type IV collagen mAb staining were positive in group A; no positive cells for CD3, CD4, and CD8 were observed in groups A, C, and D; and many positive cells for CD3, CD4, and CD8 were observed in group B. The results of IgG immunofluorescence staining was negative in group A, C, and D, and positive in the great vessel wells of group B. Conclusion The immunogenicity of tissue engineered skins is very weak, and tissue engineered skins would not be rejected by host immune system after transplantation.
ObjectiveTo explore the effects of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviation: PPH+sphincterotomy) on postoperative wound margin edema and anal function in patients with severe mixed hemorrhoids.MethodsEighty-five patients with severe mixed hemorrhoids admitted to this hospital from February 2017 to February 2018 were selected as the study subjects, then they were divided into a PPH group (n=42) and PPH+sphincterotomy group (n=43) according to the different treatment methods. The patient in the PPH group was treated with the PPH, while in the PPH+sphincterotomy group was treated with the partial internal anal sphincterotomy on the basis of the PPH group. The clinical efficacy, degree of pain, edema of wound margin, anal function, and the recurrence rate of symptoms were observed in two groups.Results① There were no significant differences in the baseline data such as the gender, age, course of disease, grading of internal hemorrhoids, and symptoms between the two groups (P>0.05). ② The total effective rate of the PPH+sphincterotomy group was significantly higher than that of the PPH group [100% (43/43) versus 90.48% (38/42), χ2=4.297, P=0.038]. ③ The VAS score of the PPH+sphincterotomy group was significantly lower than that of the PPH group on the 3rd and 7th day after the treatment (P<0.05), the VAS score of each group at the 3rd or 7th day after the treatment was significantly lower than that before the treatment (P<0.05), and it was significantly lower on the 7th day than that on the 3rd day after the treatment (P<0.05). ④ The postoperative wound margin edema in the PPH group was more serious than that in PPH+sphincterotomy group (χ2=20.237, P<0.001), and the score in the PPH group was significantly higher than that in the PPH+sphincterotomy group (t=13.514, P<0.001). ⑤ The resting pressure of anal canal after the treatment was significantly lower than that before treatment (P<0.05), and the diastolic pressure of anal canal after the treatment was significantly higher than that before the treatment (P<0.05) in the two groups. The resting pressure of anal canal in the PPH+sphincterotomy group was significantly lower than that in the PPH group and the diastolic pressure of anal canal was significantly higher than that in the PPH group (P<0.05) after the treatment. ⑥ In addition, the total recurrence rate of symptoms at 1 year in the PPH+sphincterotomy group was significantly lower than that of the PPH group [6.98% (3/43) versus 23.81% (10/42), χ2=4.647, P=0.031].ConclusionPPH+sphincterotomy could effectively relieve symptoms of severe mixed hemorrhoids, improve clinical efficacy, and reduce recurrence rate.
ObjectiveTo compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) in oncology and non-oncology patients with severe aortic stenosis (AS).MethodsA computer-based search in PubMed, The Cochrane Library, EMbase, CBM, CNKI and Wanfang databases from their date of inception to December 2021 was performed, together with reference screening, to identify eligible clinical trials. Two investigators screened the articles, extracted data, and evaluated quality independently. RevMan 5.3 and Stata 12.0 softwares were used for meta-analysis.ResultsThe selected 8 cohort studies contained 57 988 patients, including 12 335 cancer patients and 45 653 non-cancer patients. The results of meta-analysis showed that in patients with cancer, the 30-day mortality [OR=0.74, 95%CI (0.65, 0.84), I2=0%, P<0.000 01], stroke [OR=0.87, 95%CI (0.76, 0.99), I2=0%, P=0.04] and acute kidney injury [OR=0.81, 95%CI (0.76, 0.85), I2=49%, P<0.000 01] were lower than those in patients without cancer. The 1-year mortality [OR=1.46, 95%CI (1.15, 1.86), I2=62%, P=0.002] and late mortality [OR=1.51, 95%CI (1.24, 1.85), I2=61%, P<0.000 1] were higher in patients with cancer.ConclusionIt is effective and safe in cancer patients with severe AS undergoing TAVI. However, compared with patients without cancer, it is still high in long-term mortality, and further study of the role of TAVI in cancer patients with AS is necessary.
This article described the clinical diagnosis and treatment of a patient with bicuspid aortic stenosis occurring severe mitral regurgitation during transcatheter aortic valve replacement. Before transcatheter aortic valve replacement, the patient’s information about medical history, signs, evaluation of CT and echocardiography were collected. After discussion by the heart team, the trans-femoral aortic valve replacement was performed. After the valve was placed during the procedure, a severe mitral regurgitation occurred. No clear causes were found, and the patient’s hemodynamics was stable. The patient recovered well during follow-up, so surgery and other treatments were not considered. This article discussed the possible mechanism and solutions of mitral regurgitation during transcatheter aortic valve replacement, and owned certain value for similar cases to refer to.
摘要:目的：探討纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中的臨床應用價值。方法：237例慢阻肺合并重度呼吸衰竭患者,隨機分為纖支鏡經口引導氣管插管組(纖支鏡組)125例和喉鏡經口引導氣管插管組(喉鏡組)112例,分別在纖支鏡和喉鏡引導下按常規進行氣管插管術。結果：纖支鏡組和喉鏡組一次獲得插管成功率分別為984%和920%(P＜005),平均插管時間分別為（613±391） min 和（926±415） min(P＜005)。纖支鏡組有5例患者出現咽喉部少量出血,并發癥發生率為40%;喉鏡組共有12例發生并發癥,并發癥發生率為107%(P＜005),其中齒、舌、咽或喉部損傷6例,反射性嘔吐致誤吸2例,單側肺通氣1例,插入食管2例,心跳呼吸驟停1例。結論：纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中是一種簡便快速、成功率高和并發癥少的有效方法,值得臨床推廣應用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.
ObjectiveTo observe the character of spino-pelvic sagittal alignment in patients with high-grade L5 isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation.
MethodBetween January 2009 and June 2014, 25 patients with high-grade L5 isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method:the balanced pelvis subgroup (n=14) and unbalanced pelvis subgroup (n=11) . The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively.
ResultsAll patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P<0.05) , while the TK was significantly smaller than that of control group (P<0.05) . In the balanced pelvis subgroup, LSA, LL, and SVA at last follow-up significantly decreased while TK significantly increased when compared with preoperative ones (P<0.05) . In the unbalanced pelvis subgroup, LSA, PT, and SVA at last follow-up significantly decreased while SS, LL, and TK significantly increased when compared with preoperative ones (P<0.05) . The preoperative LSA and PT in the unbalanced pelvis subgroup were significantly greater, while SS, LL, and TK were significantly smaller than those of balanced pelvis subgroup (P<0.05) ; while at last follow-up, significant differentce was found only in LSA between 2 subgroups (P<0.05) .
ConclusionsThe LSA should be paid more attention in surgery to assure recovery of the sagittal balance because patients with high-grade L5 isthmic spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.
