Objective To analyze early and midterm outcomes and summarize clinical experience of mitral valve repair with artificial chordae for degenerative mitral regurgitation （MR）. Methods Clinical data of 78 patients with degenerative MR who underwent mitral valve repair with Gore-Tex artificial chordae from October 2008 to December 2011 in General Hospita1 of Shenyang Military Command were retrospectively analyzed. There were 47 male patients and 31female patients with their age of 52.7±9.6 years，who all had degenerative MR. Operation techniques included simple GoreTex artificial chordae replacement in 15 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet in 58 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet and Sliding technique in 5 patients. One to three （2.15±1.05） Gore-Tex artificial chordae were used for each patient，and annuloplasty ring was used for all the patients. Thirty-nine patients underwent concomitant tricuspid valvuloplasty. Intraoperative transesophagealechocardiography showed none obvious MR in 62 patients，trivial MR in 13 patients and mild MR in 3 patients. All thepatients were followed up after discharge. Echocardiography was used to evaluate heart function and MR degree duringfollow-up. Results There was no in-hospital death in this group. Postoperative complications included sinus bradycardiain 5 patients，supraventricular tachycardia in 8 patients，late cardiac tamponade in 1 patient，and permanent pacemakerimplantation in 1 patient. Seventy patients were followed up for 1-2 years with the follow-up rate of 89.74% （70/78）. Duringfollow-up，1 patient died of cerebral embolism 13 months after discharge，and all the other patients remained alive. There were 60 patients with NYHA classⅠand 9 patients with NYHA classⅡ. Echocardiography at 1 year after dischargeshowed that left atrial diameter，left ventricular end-diastolic diameter，left ventricular end-systolic diameter，and pulmonary artery systolic pressure were significantly smaller or lower than preoperative values （P＜0.05），left ventricular ejection fraction （68.00%±7.00% vs. 55.00%±6.00%） and cardiac output were significantly higher than preoperative values（P＜0.05），and MR degree （ratio of regurgitation beam area and left atrial area） was significantly reduced compared with preoperative MR degree （3.45%±5.56% vs. 39.55%±9.86%，P＜0.05）. No artificial chordae rupture was found. There were47 patients without MR and 22 patients with trivial MR during follow-up. Conclusion Gore-Tex artificial chordae replacement is a safe and effective surgical technique for the treatment of degenerative MR.
Objective To develop a modified short time inversion recovery (STIR) sequence grading system for lumbar intervertebral disc degeneration based on MRI STIR sequences, and to test the validity and reproducibility of this grading system. Methods A modified 8-level grading system for lumbar intervertebral disc degeneration based on routine sagittal STIR sequences and modified Pfirrmann grading system was developed. Between April 2011 and February 2012, 60 patients with different degrees of lumbar intervertebral disc degeneration were selected as objects of study, including 32 males and 28 females with an average of 50 years (range, 17-85 years). T2 weighted and STIR sequence images were obtained from the lumbar discs of L1, 2-L5, S1 of each object (total, 300 discs). All examinations were analyzed independently by 3 observers and a consensus readout was performed after all data collected. The validity and reproducibility were analyzed by calculating consistent rate and Kappa value. Results According to the grading system, there were 0 grade 1, 83 (27.7%) grade 2, 87 (29.0%) grade 3, 66 (22.0%) grade 4, 31 (10.3%) grade 5, 15 (5.0%) grade 6, 12 (4.0%) grade 7, and 6 (2.0%) grade 8. Intra-observer consistency was b (Kappa value range, 0.822-0.952), and inter-observer consistency was high to b (Kappa value range, 0.749-0.843). According to the consensus analysis, the total consistent rate was 82.7%-92.7% (mean, 85.6%). A difference of one grade occurred in 13.9% and a difference of two or more grades in 0.5% of all the cases. Conclusion Disc degeneration can be graded by using modified STIR sequence grading system, which can improve the accuracy of grading different degrees of lumbar intervertebral disc degeneration.
Objective To investigate the effects of xianl inggubao (XLGB) on subchondral bone and articular cartilage in the rat osteoarthritis model induced by anterior cruciate l igament transection (ACLT). Methods Twentyfour 3-month-old female SD rats were divided randomly into 3 groups (n=8): Sham group (group A), ACLT group (group B) and XLGB group (group C). The osteoarthritis model was made by ACLT in groups B and C, the joint cave was sutured after exposure of ACL in group A. After 4 days, XLGB was given at 250 mg/(kg·d) in group C and the equivalent amount of sal ine was given in groups A and B. After 12 weeks, the gross appearance of femoral condyles was observed, the degree of cartilagedegeneration was scored by Mankin scoring system. The immunostaining for MMP-13 was performed to investigate the effect of XLGB on prevention of cartilage matrix loss. The bone mineral density (BMD) measurement and bone histomorphometric analysis were done in subchondral bone of right distal femur and proximal tibia after 12 weeks. Results The gross appearance of femoral condyles showed that ulcer in the group C was smaller than that in group B after 12 weeks. The Mankin’s scale and IA value for MMP-13 in group C were markedly lower than those in group B (P lt; 0.05). BMD of the subchondral bone in the group B was significantly lower than those in the groups A and C (P lt; 0.05). The bone mass in group C were significantly higher than that in group B (P lt; 0.05). Conclusion Oral administration of XLGB (250 mg/ kg per day) for 12 weeks could prevent the cartilage degeneration of rats after ACLT, down-regulating MMP-13 and increasing subchondral bone mass might participate in this process.
Objective To introduce the research of mesenchymal stemcells(MSCs) transplantation for treating intervertebral disc degeneration. Methods The recent original articles about the MSCs transplantation for treating intervertebral disc degeneration were extensively reviewed. Results Transplanted MSCs in intervertebral disc can express chrondcyte-like phenotype in certain conditions, increase matrix synthesis and release intervertebral disc degeneration. Conclusion MSCs transplantation for treating intervertebral disc degeneration may be a future approach.
Objective To observe the clinical efficacy of intravitreal Ranibizumab on exudative agerelated macular degeneration (AMD).Methods The clinical data of 46 patients（52 eyes）with exudative AMD were analyzed retrospectively. All patients were diagnosed by examination of early treatment of diabetic retinopathy study (ETDRS) charts, color fundus photograph，fluorescein angiography（FFA）or indocyanine green angiography（ICGA）and optical coherence tomography（OCT）.They received intravitreal injection of 0.05 ml (10 mg/ml) Ranibizumab, once per month for 3 months. Further injection may be required if the monthly followup indicated. A total of 52 eyes received 214 times of injections, each eye received 2-6 injections (mean 4.12). The Followup duration was 12 months. Vision acuity, fovea thickness and CNV leakage before and after treatment were analyzed.Results At the 12th month after treatment, the mean letter of ETDRS charts was 37.80 (11.40 letters more that pretreatment index,Plt;0.01). FFA and (or) ICGA showed complete closures choroidal neovascularization (CNV) in 11 eyes（21.20%），partial closures in 34 eyes (65.40%)，no change in four eyes (7.70%)，lesion growth in two eyes（3.80%）and new lesion in one eye (1.90%).OCT indicated the average of fovea thickness was 187.50 mu;m (122.80 mu;m less than the pretreatment index, Plt;0.01).Conclusion Intravitreal injection of Ranibizumab for exudative AMD according to this therapeutic schedule was well tolerated，with an improvement in visual acuity，FFA or ICGA and OCT.
The introduction of anti-vascular endothelial growth factor (VEGF) therapy represents a landmark in the management of wet age-related macular degeneration (AMD). However, as a new therapy, several problems such as durability of the therapeutic effects, medication side effects, and medication selection have emerged. We should make appoint of improving the therapeutic effect and safety by realizing the limitation of the therapy, monitoring the clinical potential adverse reactions of anti-VEGF agents, and recommending individualized treatment.
Objective To evaluate the diagnostic value of Heidelberg retinal angiography(HRA) combined with optical coherence tomography (OCT) to detect neovascularization (CNV) in exudative agerelated macular degeneration (AMD) patients. Methods This is a cross-sectional study of a series of clinical cases. AMD diagnosis was established by international standard vision chart, Slit lamp microscope, direct or indirect ophthalmoscope examination. A total of 50 eyes (42 cases) of exudative AMD received HRA and frequency domain OCT scan. All 50 eyes received fundus fluorescein angiography (FFA) and frequency domain OCT simultaneously, and among them 15 eyes also received indocyanine green angiography (ICGA) at the same time. FFA and ICGA were carried out by conventional methods, CNV was localized by real-time localization technology of frequency domain OCT. In the radial and grid-like section from the areas with b fluorescence, image acquisition settings are 7 mu;m fault for each frame, 30 deg; intervals for radial section, 10 vertical and 10 horizontal scan lines for gridlike section. CNV can be divided into 4 types (typical CNV, partial typical CNV, occult CNV, CNV scarring) according to their boundaries demonstrated in FFA. Based on the features of the OCT images, there were 3 types of integrated image (sub-RPE type, sub-retinal type and mixed type). Results CNV was detected in all 50 eyes. There were 4 eyes (8%) of typical CNV, 11 eyes (22%) of partial typical CNV, 32 eyes (64%, including 27 eyes of RPE detachment and 5 eyes of passive late leakage) of occult CNV and 3 eyes (6%) of CNV scarring. There were 4 eyes (8%) of subRPE type (CNV under the RPE light band) , 16 eyes (32%) of subretinal type(interrupted light band of RPE and choroid capillary layer) and 30 eyes (60%) of mixed type of integrated image. Conclusion The image integration technology of the HRA and frequency domain OCT system provide a valuable tool to classify and measure CNV, which will benefit the clinical treatment of AMD patients.
Objective To observe the therapeutic effects of transpupillary thermal therapy (TTT) on exudative agerelated macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV).Methods The clinical data of 44 eyes of 41 patients with exudative AMD diagnosed by fundus fluorescein angiography (FFA) who had undergone 810 nmdiode laser were retrospectively analyzed. In the 44 eyes of 41 patients, there were 26 eyes of 24 patients had occult CNV,12 eyes of 12 patients had classic CNV,and 5 eyes of 5 patients had small classic CNV. According to the focus sizes, the diameters of beam spot was 1.2-3.0 mm,the power of laser was 160-400 mW,and the duration was 60 s.The frequency of photocoagulation was once to thrice with the mean of 1.48.The followup duration was 3-24 months with the mean of 10.8 months.Visual acuity, haemorrhage in ocular fundus,absorption of exudation, and the closure of CNV were examined in the followup examination.Results A total of 42 eyes of 40 patients were examined at the last time in the followup duration,in which the visual acuity kept still or improved in 35 eyes of 33 patients (83.34%) and reduced in 7 eyes of 7 patients (16.67%). The results of OCT revealed that 1 and 3 months after the treatment and at the last time of followup duration, the decrease rate of exudative liquid at the macular area was 79.5%,86.4%,and 88.1%, respectively. Three months after the treatment,the macular volume decreased significantly than that before the treatment (P=0.01).The results of FFA demonstrated that at the last time in the folowup duration,the closure rate of occult CNV,classic CNV,and small classic CNV was 79.16%,46.15%,and 60%,respectively.The exudates increased in 6 eyes of 5 paitnets,including 5 eyes of 4 patients with classic CNV and 1 eye of 1 patient with small classic CNV.Conclusion TTT is effective for AMD accompanied with occult CNV,classic CNV, and small classic CNV.
ObjectiveTo compare the effectiveness and radiological changes between KMC interspinous dynamic reconstruction and Coflex for degenerative lumbar spinal disorders and evaluate the clinical outcome of the KMC interspinous dynamic internal fixation for degenerative lumbar spinal disorders. MethodsA randomized controlled double-blind trial was conducted. Thirty-three patients with degenerative lumbar spinal disorders were divided into 2 groups between May 2011 and July 2012, 19 patients received Coflex treatment (group A), and 14 patients received KMC (group B). Single Coflex or KMC fixation was used. There was no significant difference in age, gender, disease duration, affected segment, and disease diagnosis between 2 groups (P>0.05). The Oswestry disability index (ODI) score and visual analogue scale (VAS) score were used to evaluate the effectiveness. The anterior disc height, middle disc height, posterior disc height, and foramen intervertebral height and width of operated segment were measured and compared between at preoperation and last follow-up on the X-ray films. Range of motion (ROM) of operated segment and adjacent segment was measured. ResultsThere was no significant difference in operation time, intraoperative blood loss, postoperative recovery time, and hospitalization time between 2 groups (P>0.05). The patients were followed up 12-24 months (mean, 16.2 months) in group A and 12-26 months (mean, 17.9 months) in group B. No shift, loosening, or breaking of internal fixation occurred. The ODI score and VAS score were significantly decreased at last follow-up when compared with preoperative scores (P<0.05); there was no significant difference in the ODI score and VAS score at preoperation and last follow-up, and in improvement rate at last follow-up between 2 groups (P>0.05). The middle disc height and posterior disc height, and foramen intervertebral height and width were significantly increased when compared with preoperative ones (P<0.05), while there was no significant difference in anterior disc height (P>0.05). At last follow-up, ROM of the operated segments was significantly improved when compared with preoperative one in 2 groups (P<0.05), but no significant difference was found at the upper adjacent level (P>0.05). There was no significant difference in ROM of the operated segment and upper adjacent segment between 2 groups at preoperation and last follow-up (P>0.05). ConclusionThe early effectiveness is satisfactory to treat degeneration lumbar spinal disorders with KMC interspinous dynamic internal fixation.
Stargardt disease (STGD) is an inherited disorder of retinal pigment epithelium. Three genes have been found to be implicated in STGD including Abca4 (adenosine triphosphate-binding cassette, sub-family A, member 4), Elovl4 (elongation of very long chain fatty acids protein 4) and Prom1 (prominin-1). Target genes can be delivered to the retina by various methods such as lentivirus (LV) vectors, adeno-associated virus (AAV) vectors and non-viral nano-particles. The Abca4-/-, Elovl4-/- and Prom1-/- mice model are used to study the pathogenesis mechanism and treatment of STGD. Retinal function improved significantly upon gene therapy in these models. Based on these works using animal model, phase Ⅰ/Ⅱa clinical trial of Abca4-associated STGD gene therapy are underway. AsaLV vector, equine infectious anemia virus (EIAV) is used to carry the Abca4 gene. These studies will evaluate three dose levels of the EIAV vector for safety, tolerability and biological activity. Moreover, some preclinical attempts to deliver Abca4 via AAV have been made usingamodified AAV vectors because of the large size of the ABCA4 cDNA. The good responses in animal models render STGDavery attractive object for human gene therapy after the successful of the phase Ⅰ/Ⅱ clinical trials of Leber′s congenital amaurosis.