Objective To systematically review the efficacy and safety of tyrosine kinase inhibitors combined with chemotherapy versus chemotherapy in advanced non-small cell lung cancer(NSCLC). Methods An electronically search was conducted in The Cochrane Library, PubMed and EMbase databases from inception to December 2016 to collect randomized controlled trials (RCTs) about tyrosine kinase inhibitors combined with chemotherapy versus chemotherapy for NSCLC. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 6 559 patients were finally included. The results of meta-analysis showed that: The median progression free survival (PFS) (HR=0.86, 95%CI 0.81 to 0.91, P<0.001) and objective response rate (ORR) (HR=1.43, 95%CI 1.20 to 1.70,P<0.001) of tyrosine kinase inhibitors combined with chemotherapy were significantly longer than those of the chemotherapy group. There were no significant differences between two groups in incidence of median overrall survival (OS) (HR=0.91, 95%CI 0.82 to 1.00,P=0.06), fatigue (RR=1.03, 95%CI 0.97 to 1.11, P=0.33), dyspnea (RR=1.01, 95%CI 0.91 to 1.13, P=0.82) and cough (RR=1.01, 95%CI 0.89 to 1.15, P=0.91). However, the incidence of neutrocytopenia (RR=1.16, 95%CI 1.05 to 1.28, P=0.003), thrombocytopenia (RR=1.46, 95%CI 1.23 to 1.73, P<0.001), diarrhea and hypertension (RR=2.91, 95%CI 2.28 to 3.71,P<0.001) of tyrosine kinase inhibitors combined with chemotherapy group were significantly higher than those of the chemotherapy group. The tyrosine kinase inhibitors combined with chemotherapy group had lower rate of anemia (RR=0.86, 95%CI 0.75 to 0.98,P=0.03). Conclusion Compared with chemotherapy alone, tyrosine kinase inhibitors combined with chemotherapy can improve the median PFS and ORR while it can be used as a treatment for advanced non-small cell lung cancer patients. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To summarize safety and effectiveness of cryomaze ablation procedure concomitant with valve surgery. Methods We retrospectively investigated the clinical data of 62 patients (24 males and 38 females) with mean age of 49.4±14.2 years who underwent cryomaze ablation procedure concomitant with valve surgery in our hospital from August 2013 through July 2015. The heart rhythm of the patients after surgery was supervised by 12-leads electrical cardiogram respectively. Results The rate of sinus rhythm restored right after surgery was 98.4%. The rate of sinus rhythm restored at the time of discharge was 93.4%. The rate of sinus rhythm restored 3 months, 6 months, 12 months, 18 months after surgery was 90.2%, 87.3%, 85.0%, 83.3% respectively. The one-year post-operation rate of sinus rhythm restored for the group of right minimal invasive thoracoscopic assisted mitral valve surgery was 90.5%. Longer duration for atrial fibrillation (>7 years) was a risk factor for the reoccurrence of atrial fibrillation 1 year after surgery (P<0.05). Conclusion Cryomaze ablation procedure concomitant with valve surgery is quite effective in treatment of rheumatic valve disease and atrial fibrillation. This approach is associated with fewer complications, comparable atrial fibrillation reoccurrence for short-term follow-up.
【 Abstract】 Objective To construct a lentiviral expression vector carrying Nogo extra cellular peptide residues 1-40(NEP1-40) and to obtain NEP1-40 efficient and stable expression in mammalian cells. Methods The DNA fragment ofNEP1-40 coding sequence was ampl ified by PCR with designed primer from the cDNA l ibrary including NEP1-40 gene, and then subcloned into pGC-FU vector with in-fusion technique to generate the lentiviral expression vector, pGC-FU-NEP1-40. The positive clones were screened by PCR and the correct NEP1-40 was confirmed by sequencing. Recombinant lentiviruses were produced in 293T cells after the cotransfection of pGC-FU-NEP1-40， and packaging plasmids of pHelper 1.0 and pHelper 2.0. Green fluorescent protein (GFP) expression of infected 293T cells was observed to evaluate gene del ivery efficiency. NEP1-40 protein expression in 293T cells was detected by Western blot. Results The lentiviral expression vector carrying NEP1-40 was successfully constructed by GFP observation， and NEP1-40 protein expression was detected in 293T cells by Western blot. Conclusion The recombinant lentivirus pGC-FU-NEP1-40 is successfully constructed and it lays a foundation for further molecular function study of NEP1-40.
Objective To compare two ways of establishing hyperlipidemia model in rats with fat emulsion.Methods Thirty male SD rats were randomly divided into three groups， which fed with normal diet （normal control group）， low concentration fat emulsion （low concentration fat emulsion group）， and high concentration fat emulsion （high concentration fat emulsion group）， respectively. All the rats were sacrificed and tested for serum total cholesterol （TC）， triglyceride （TG）， high density lipoprotein-cholesterol （HDL-C）， and low density lipoprotein-cholesterol （LDL-C）in two weeks after establishment. Results The levels of TC， TG， HDL-C， and LDL-C in the high concentration fat emulsion group were significantly higher than those in the normal control group and the low concentration fat emulsion group （P＜0.05）；the levels of TC， TG， and HDL-C in the low concentration fat emulsion group didn’t significantly differ from normal control group （P＞0.05）. Conclusions High concentration fat emulsion can be used to establish hyperlipidemia model in SD rats， low concentration fat emulsion is not suitable for establishing hyperlipidemia model in SD rats.
ObjectiveTo analyze the early and mid-term safety and effectiveness of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery.MethodsWe retrospectively reviewed the clinical data of 68 patients (28 males and 40 females with a mean age of 38.7±9.3 years) who underwent concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve and tricuspid surgery in the Department of Cardiovascular Surgery of the Second Xiangya Hospital from August 2013 to October 2017. The heart rhythm of the patients after surgery was supervised by 24 hour holter monitoring eletrocardiogram.ResultsNo death occurred during operation and follow-up. One patient underwent reexploration for bleeding. The rate of sinus rhythm restored at the time of discharge was 95.8%. The rate of sinus rhythm restored at 6 months, 12 months, 24 months, 36 months after surgery was 93.5%, 91.6%, 90.3% and 89.5% respectively.ConclusionConcomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery is quite safe and effective in treatment of rheumatic mitral valve disease and atrial fibrillation in the early and mid-term follow-up.
【摘要】 目的 探讨强直性脊柱炎合并脊柱骨折脱位的临床特点及手术治疗效果。 方法 2009年10月-2010年6月，共收治6例强直性脊柱炎合并脊柱骨折脱位患者，其中男5例，女1例；年龄38～76岁，平均48.6岁。下颈椎骨折脱位3例，2例为颈5-6、1例颈6-7；胸腰段骨折脱位3例，为胸10-11、胸11-12、胸12-腰1各1例。6例患者中除1例术前神经功能为Frankel分级 E级，其余5例均有不同程度的神经损伤。6例患者均行手术治疗，下颈椎骨折脱位采用前后联合入路复位及固定，胸腰段骨折脱位采用后路切开复位及椎弓根螺钉固定。术后观察手术节段内固定位置及骨融合情况，评估神经功能恢复情况，记录手术并发症。患者随访10~18个月，平均14.2个月。 结果 所有患者术后均未出现切口感染；脑脊液漏1例，换药对症处理3周后愈合。1例颈5-6骨折脱位患者行前路手术后第2天出现内固定移位，骨折椎再次脱位立即二次行前后联合入路复位固定术；3例术后神经功能由术前Frankel C级恢复至D级，2例无明显改善（术前均为A级），1例较术前加重（术前E级，术后为A级，经再次手术减压并康复治疗6个月后恢复至D级）。随访期间均达骨性融合，未出现内固定松动断裂移位现象。 结论 强直性脊柱炎脊柱骨折好发于下颈椎及胸腰段；对于下颈椎骨折脱位宜行前后联合入路复位固定，而胸腰段骨折宜行后路长节段椎弓根螺钉固定，术中应先充分减压后再精细复位，避免加重神经损伤。【Abstract】 Objective To explore the clinical characteristics of spinal fracture and dislocation in ankylosing spondylitis (AS) and its surgical treatment effect. Methods From October 2009 to June 2010, six cases with spinal fractures in AS underwent surgical treatment. There were 5 males and 1 female with an average age of 48.6 years (38-76 years old). The preoperative neural function of one case was grade E according to the Frankel classification and different degrees of neural damage could be found in other 5 cases. Three cases of lower cervical fractures underwent the operation with a combined posterior-anterior approach. Three cases of thoracolumbar fracture underwent the operation with posterior approach (posterior reduction, fixation with pedicle screws and bone graft). The situation of internal fixation and bone fusion was observed after operation, the neural function had been evaluated and the postoperative complications was recorded. Results All of the six patients were followed up for 10-18 months (mean 14.2 months). There was no incision infection. One patient with cerebrospinal fluid leakage was cured with conservative treatment for three weeks. One patient with C5-6 fracture and dislocation got anterior implant loosening and fracture-dislocation recurrence in the second day after the operation and underwent a combined posterior-anterior operation immediately. Three cases got remarkable neuronal function improvement after the operation. Two cases were remain primary situation. One case was aggravated from preoperative grade E grade to postoperative grade A and recovered to grade D after recovery treatment for 6 months. Bone fusion was achieved in all cases. There were no loosening and breakage of internal fixation in the later followed up. Conclusions Lower cervical and thoracolumbar spine are the usual locations of fracture in AS. A combined posterior-anterior surgical approach is effective for lower cervical fractures and posterior long-segmental reduction and the fixation is a desired select for thoracolumbar fractures.
Objective To analyze the current status and hotspots of surgical transmural ablation of atrial fibrillation using CiteSpace and VOSviewer. MethodsThe Web of Science Core Collection database was used as the data source. The CiteSpace 5.8.R3 and VOSviewer software were used to analyze the related studies on surgical transmural ablation of atrial fibrillation about the authors, countries/institutions, literature co-citation and keywords. Results A total of 109 articles were enrolled. Damiano RJ was the most prolific researcher, while Cox JL was the author with the highest number of citations. The United States was the leading country in this research field. The University of Washington was an important institution in the study of atrial fibrillation transmural ablation. The main hotpots were the effectiveness of surgical ablation, especially Cox-maze procedure, selection of the energy source of surgical ablation, combination of surgical and catheter ablations, and pulmonary vein isolation. ConclusionThis study visualizes the current research status of surgical ablation of atrial fibrillation. How to improve the effectiveness and transmurality of surgical ablation is a hot research topic in the surgical treatment of atrial fibrillation. The combination of electrophysiology mapping and surgical ablation may be the development direction in the surgical treatment of atrial fibrillation.
The minimally invasive cardiovascular surgery developed rapidly in last decades. In order to promote the development of minimally invasive cardiovascular surgery in China, the Chinese Minimally Invasive Cardiovascular Surgery Committee (CMICS) has gradually standardized the collection and report of the data of Chinese minimally invasive cardiovascular surgery since its establishment. The total operation volume of minimally invasive cardiovascular surgery in China has achieved substantial growth with a remarkable popularization of concepts of minimally invasive medicine in 2019. The data of Chinese minimally invasive cardiovascular surgery in 2019 was reported as a paper for the first time, which may provide reference to cardiovascular surgeons and related professionals.
Mitral valve replacement is one of the most common heart valve surgeries in China. In recent years, with the increase in degenerative valve diseases, older patients, and the progress of anti-calcification technology of biological valves, the proportion of mitral valve biological valve replacement has been increasing year by year. After the damage of traditional mitral valve biological valves, re-operation of valve replacement with thoracotomy is required. However, the adhesion between the heart and sternum, as well as the damage caused by cardiopulmonary bypass and cardiac arrest, can cause significant trauma to elderly patients and those with multiple organ dysfunction, leading to increased mortality and complication rates. In recent years, interventional valve surgery, especially transcatheter valve-in-valve surgery, has developed rapidly. This procedure can correct the damaged mitral valve function without stopping the heart, but there are still many differences between its technical process and conventional aortic valve replacement surgery. Therefore, organizing and writing multicenter expert recommendations on the technical process of transcatheter valve-in-valve surgery for damaged mitral valve biological valves is of great significance for the training and promotion of this technology.