ObjectiveTo explore the feasibility and the practical value of conserving upper limb lymph nodes in axillary lymph node dissection (ALND) for early breast cancer. MethodsFrom August 2007 to January 2010, 124 patients with early breast cancer were studied and divided into two phases: phase one, from August 2007 to July 2008; phase two, from August 2008 to January 2010. Five milliliter of methylene blue was injected subcutaneously in ipsilateral forearm in all the patients before operation to locate the upper limb lymph nodes. Routine ALND was performed in 22 patients of phase one. The level Ⅱ lymph nodes and the upper limb lymph nodes were separated from the axillary lymph nodes, respectively. The lymph nodes of level Ⅱ were investigated by combining touch cytology with frozen section during operation. The lymph nodes of level Ⅰ, Ⅱ, Ⅲ, and the upper limb lymph nodes were investigated postoperatively by routine pathological examination to evaluate the feasibility of conserving the upper limb lymph nodes. One hundred and two patients in phase two were divided randomly by lottery into control group (30 cases), and conserving group (72 cases) in which upper limb lymph nodes were selectively conserved. The surgical procedure for control group was same as the phase one blue stained upper limb lymph nodes, in the conserving group were conserved selectively when the lymph nodes metastasis of level Ⅱ were not detected by combining touch cytology with frozen section during operation. The data were collected and analysed on pathological results of all patients and arm circumference was compared between control group and conserving group. Results Total 119 of 124 patients (96.0%) were found with blue stained upper limb lymph nodes. The concordance rate was 99.2% (123/124) between the intraoperative combining pathological method and the postoperative routine pathological examination. No upper limb lymph node metastasis was found in the phase one and the control group of phase two with level Ⅱ group negative. The incidence of arm lymphedema in the control group and the conserving group with level Ⅰ and Ⅱ lymph nodes dissection was 18.2% （4/22） and 20% （1/51）, respectively on 6 months after operation. The difference was statistically significant （χ 2=6,34， Plt;0.05）. ConclusionsMethylene blue being injected subcutaneously in ipsilateral upper limb can be used to show validly lymph nodes of upper limb in the axillary region. ALND with selectively conserving upper limb lymph nodes when level Ⅱ lymph nodes negative in metastasis, can prevent postoperative arm lymphedema.
In order to study the influence of tympanic membrane lesion and ossicular erosion caused by otitis media on the hearing compensation performance of round-window stimulation, a human ear finite element model including cochlear asymmetric structure was established by computed tomography (CT) technique and reverse engineering technique. The reliability of the model was verified by comparing with the published experimental data. Based on this model, the tympanic membrane lesion and ossicular erosion caused by otitis media were simulated by changing the corresponding tissue structure. Besides, these simulated diseases’ effects on the round-window stimulation were studied by comparing the corresponding basilar-membrane’s displacement at the frequency-dependent characteristic position. The results show that the thickening and the hardening of the tympanic membrane mainly deteriorated the hearing compensation performance of round-window stimulation in the low frequency; tympanic membrane perforation and the minor erosion of ossicle with ossicular chain connected slightly effected the hearing compensation performance of round-window stimulation. Whereas, different from the influence of the aforementioned lesions, the ossicular erosion involving the ossicular chain detachment increased its influence on performance of round-window stimulation at the low frequency. Therefore, the effect of otitis media on the hearing compensation performance of round-window stimulation should be considered comprehensively when designing its actuator, especially the low-frequency deterioration caused by the thickening and the hardening of the tympanic membrane; the actuator’s low-frequency output should be enhanced accordingly to ensure its postoperative hearing compensation performance.
Objective To analyze the characteristics of sternal Mycobacterium tuberculosis (Mtb) infection after cardiac surgery. Methods An electronic search was conducted for publicly available cases of sternal Mtb infection after cardiac surgery in PubMed, Web of Science, Wanfang database, and CNKI since their inception up to 18 July 2023, and 2 researchers analyzed the characteristics of the included cases and extracted relevant data. Results A total of 26 patients were included in 15 studies, 16 males and 10 females, aged 5-80 (61.9±15.6) years. Previous surgical history included coronary artery bypass grafting in 14 cases (53.8%), valve surgery in 8 cases (30.8%), congenital heart surgery in 3 cases (11.5%), and aortic surgery in 2 cases (7.7%). The main symptoms and signs were incisional abscesses, poor healing, mostly with pain, with or without erythema, and usually without systemic symptoms such as low-grade fever, night sweats, and weight loss. 13 cases reported a postoperative time to discovery of infection with a mean of 11.8 (0.5-60) months, and 9 cases reported an interval between discovery of infection and diagnosis with a mean of 12.1 (1.5-62) months. Confirmation of the diagnosis was mainly by Mtb culture of cleared bone tissue or pus, pathology and antacid staining. One case died of cardiac arrest before diagnosis. After the diagnosis of 25 cases, 13 cases received only anti-tuberculosis treatment, of which 11 cases received surgical treatment before diagnosis; 12 cases received anti-tuberculosis and surgical treatment, and all 25 cases were successfully cured. The duration of anti-tuberculosis treatment ranged from 6 to 12 months. Conclusion Sternal Mtb infection after cardiac surgery has a long incubation period, early diagnosis is difficult, the rate of missed diagnosis and misdiagnosis is extremely high, and timely diagnosis and treatment can significantly improve the prognosis.
Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, and ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.
ObjectiveTo investigate the early clinical efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) for multivessel coronary artery disease. MethodsThe patients who received off-pump coronary artery bypass grafting in the Central China Fuwai Hospital of Zhengzhou University from June 2021 to June 2023 were enrolled. Patients were divided into two groups according to the operative technique used, including a traditional midline sternotomy group where the full median sternotomy was performed, and a left chest small incision group where left anterior mini-thoracotomy was performed. The clinical data of the two groups were compared. ResultsA total of 143 patients were enrolled, including 70 patients in the traditional midline sternotomy group and 73 patients in the left chest small incision group. The age of the patients in the left chest small incision group and the traditional midline sternotomy group was 63.8±8.0 years and 63.0±7.8 years, respectively; the proportions of males were 69.9% and 74.3%, respectively. The differences were not statistically significant (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the left chest small incision group were converted to thoracotomy. The patients in the left chest small incision group showed less postoperative drainage within postoperative 24 hours (239.4±177.7 mL vs. 338.0±151.9 mL, P<0.001), lower perioperative blood transfusion rate [32.9% (24/73) vs. 51.4% (36/70), P=0.028], higher postoperative myoglobin level within postoperative 24 hours [366.1 (247.9, 513.0) ng/mL vs. 220.8 (147.2, 314.9) ng/mL, P<0.001], shorter intensive care unit stay [45.5 (31.5, 67.5) h vs. 68.0 (46.0, 78.5) h, P=0.001] and postoperative hospital stay (10.8±4.0 d vs. 13.1±5.3 d, P=0.028] compared to the traditional midline sternotomy group. There was no significant difference in the incidence of major adverse cardiac and cerebrovascular event between the two groups [2.7% (2/73) vs. 2.9% (2/70), P=1.000]. ConclusionCompared to the full median sternotomy, MICS CABG leads to a good clinical result with smaller trauma, faster overall recovery, and less perioperative blood transfusion.
Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of 64.16±8.24 years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1∶1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, and other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications were similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.