ObjectiveTo evaluate the value of 120 kV portal venous phase images combined with iodine maps created from dual-source dual-energy CT (DECT) for the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. MethodsThis prospective study enrolled 17 patients who underwent abdominal dual-source DECT within 72 hours from the onset of acute pancreatitis. All patients had received treatment in West China Hospital from May 2014 to August 2014. Comparison of the diagnostic value of 120 kV portal venous phase images alone and 120 kV portal venous phase images combined with iodine maps created from dual-source DECT was performed. ResultsSix of the 17 patients were found the presence of pancreatic necrosis (4 patients without obvious necrosis in the early stage developed to pancreatic necrosis, and 2 patients with the presence of necrosis in the early stage improved). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images for the diagnosis of pancreatic necrosis were 50.0% (3/6), 100% (11/11), and 82.4% (14/17), respectively, and it had a good diagnostic value (AUC=0.856, P=0.018). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images combined with iodine maps created from dual-source DECT for predicting pancreatic necrosis were 100% (6/6), 90.9% (10/11), and 94.1% (16/17), respectively, and this method had good value too (AUC=0.977, P=0.002), which higher than that of 120 kV portal venous phase images (P=0.002). ConclusionsThe 120 kV portal venous phase images combined with iodine maps created from dual-source DECT is helpful to improve subjective judgment in the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. It also contributes to the display of hypo-perfusion area of the pancreatic parenchyma, and has higher diagnostic value.
ObjectiveTo investigate the effects of the first neuron connection for the reconstruction of lower extremity function of complete spinal cord injury rats. MethodsForty adult female Sprague Dawley rats of 300-350 g in weight were selected to prepare the models of L1 transverse spinal cord injury. After 2 weeks of establishing model, the rats were randomly divided into control group (n=20) and experimental group (n=20). In the experimental group, the right hind limb function was reconstructed directly by the first neuron; in the control group, the other treatments were the same to the experimental group except that the distal tibial nerve and the proximal femoral nerve were not sutured. The recovery of motor function of lower extremity was observed by the Basso-Beattie-Bresnahan (BBB) scoring system on bilateral hind limbs at 7, 30, 50, and 70 days after operation. The changes of the spinal cord were observed by HE staining, neurofilament 200 immunohistochemistry staining, and the technique of horseradish peroxidase (HRP) tracing. ResultsAfter establishing models, 6 rats died. The right hind limb had no obvious recovery of the motor function, with the BBB score of 0 in 2 groups; the left hind limb motor function was recovered in different degrees, and there was no significant difference in BBB score between 2 groups (P>0.05). In the experimental group, HE staining showed that the spinal cord was reconstructed with the sciatic nerve, which was embedded in the spinal cord, and the sciatic nerve membrane was clearly identified, and there was no obvious atrophy in the connecting part of the spinal cord. In the experimental group, the expression of nerve fiber was stained with immunohistochemistry, and the axons of the spinal cord were positively by stained and the peripheral nerve was connected with the spinal cord. HRP labelled synapses were detected by HRP retrograde tracing in the experimental group, while there was no HRP labelled synapse in the control group. ConclusionDirect reconstruction of the first neurons is sufficient in the regeneration of corresponding neural circuit by the growth of residual axon; but the motor function recovery of the target muscles innervated by peripheral nerve is not observed.
ObjectiveTo investigate the protective effect and the regulation mechanism of oxaloacetate (OAA) on myocardial ischemia reperfusion injury in rats. MethodsSixty rats, weight ranged from 200 to 250 grams, were randomly divided into 6 groups:a negative control group, a sham operation control group, a model control group, an OAA pretreatment myocardial ischemia-reperfusion model group (three subgroups:15 mg/kg, 60 mg/kg, 240 mg/kg). We established the model of myocardial ischemia reperfusion of rats and recorded the internal pressure of left ventricle (LVSP), the maximal rate of left ventricular pressure change (±dp/dtmax) and left ventricular end diastolic pressure (LVEDP). We restored reperfusion 180 minutes after ligating the left anterior descending coronary artery 30 minutes and determinated cardiac troponin Ⅰ (cTn-I), lactate dehydrogenase (LDH), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px). We took out heart tissues, stained it and calculated the infarcted size. We used the Western blot to detect the expression of NF-E2 related factor 2 (Nrf2), Kelch-like ECH-associated protein-1 (Keap1) and heme oxygenase-1 (HO-1). ResultsCompared with the sham operation group, heart function indexes in the negative control group had no significant difference (P>0.05). But in the model control group there was a decrease (P<0.05) And the serum levels of LDH, cTn-I, and myocardial infarcted size were significantly increased (P<0.01). Compared with the model control group, heart function indexes in the OAA pretreatment groups improved, the serum LDH, cTn-I activity, and infarct size decreased (P<0.05), SOD and GSH-Px activity increased (P<0.05). And these results were statistically different (P<0.01) in the high dose OAA pretreatment groups. Compared with the model control group, the expression of Keap1 in the OAA pretreatment group was down-regulated (P<0.001) while total Nrf2, nucleus Nrf2 and its downstream HO-1 was up-regulated (P<0.001), which suggested that OAA enhanced antioxidant capacity by (at least in part) Keap1-Nrf2 pathway, resulting in reducing myocardial damage and protecting myocardium after acute myocardial ischemia reperfusion injury. ConclusionOxaloacetate can provide protective effects on myocardial ischemia reperfusion injury through down-regulating the expression of Keap1 and up-regulating the expression of Nrf2 and its downstream peroxiredoxins to improve antioxidant capacity.
ObjectiveTo compare the outcomes of repeated tricuspid valve surgery for patients with late severe tricuspid regurgitation (TR) after cardiac surgery through right anterior minithoracotomy and conventional median sternotomy approaches. MethodsBetween June 2002 and June 2013, 89 patients with late severe tricuspid regurgitation after cardiac surgery underwent repeated tricuspid valve surgery through right anterior minithoracotomy in our hospital. The patients were divided into two groups. Fifty one patients were in a minimally invasive group with 28 males and 23 females at age of 46.59±11.53 years. Thirty eight patients were in a conventional median sternotomy (conventional group) with 15 males and 23 females at age of 50.42±9.30 years. The outcomes of the two groups were compared. ResultsThere was no statisitcal difference in preoperative clinical data between two groups. All patients successfully underwent repeated tricuspid valve surgery. Tricuspid valve replacement (TVR) was performed in 68 patients (38 patients vs. 30 patients), and tricuspid valvuloplasty (TVP) was performed in 21 patients (13 patients vs. 8 patients). Compared with the conventional group, operation time, time of establishing cardiopulmonary bypass and postoperative in-hospital time were significantly shorter in the minimally invasive group (P<0.001). The postoperative drainage was significantly reduced in the minimally invasive group compared with the value of the conventional group (P<0.001). Three patients died in the early postoperative period (1 patient vs. 2 patients). In the conventional group, one patient needed re-exploration for bleeding and 2 patients had wound infection. At discharge, transthoracic echocardiography showed that all patients had no or mild TR and no paravalvular leakage occurred. During the follow-up (12-144 months), 4 patients died (2 patients vs. 2 patients). In the minimally invasive group, one patient underwent repeated TVR due to severe TR associated with infective endocarditis, and another patient had moderate TR. In the conventional group, one patient underwent repeated TVR due to mechanical valve thrombosis. ConclusionRight anterior minithoracotomy is safe, effective and reliable for patients with late severe TR after cardiac surgery. It has the similar effect of the correction of valvular lesions with conventional median sternotomy, but right anterior minithoracotomy has more benefits, including more, minimally invasive, less blood loss, shorter operation time and faster recover.
ObjectiveTo explore the result of of modified artificial chordae technique and annuloplasty in mitral valvuloplasty for mitral leaflet prolapse. MethodsWe retrospectively analyzed the clinical data of 112 patients underwent mitral valve repair with artificial chordae (expanded polytetrafluoroethylene, ePTFE) and annuloplasty in our hospital from January 2006 through June 2014.There were 69 males and 43 females at age of 5-73 (51.4±14.4) years.The double-armed ePTFE chordae was fixed at papillary muscle head using U shaped suture without pledget and passed through the prolapsing portion of leaflet twice.Then, annuloplasty was performed and correct chordal length was adjusted.After that, the chordae was passed through prolapsing scallop one more time and tied. ResultsAverage of 2.4±0.7 (range from 1 to 3) ePTFE artificial chordaes were implanted in each patient.Intra-operative transthoracic echocardiography showed no mitral regurgitation (MR) in 78 patients and tricuspid regurgitation in 34 patients.At discharge, no MR was in 72 patients, trivial MR in 39 patients, and mild MR in 1 patient.At end of follow-up of 41.5±24.8 months, moderate MR was in 3 patients.The freedom from moderate or severe regurgitation at 5 years after mitral valve repair was 95.1%±3.0%. ConclusionThis modified artificial chordae technique and annuloplasty are safe, simple, and effective in mitral valvuloplasty for mitral leaflet prolapsed.And the early and long-term results are satisfactory.