ObjectiveTo attempt an innovative mitral valvuloplasty by chained double stitching without shaping ring to repair ischemic mitral regurgitation (IMR) and to evaluate the clinical efficacy of this new procedure. MethodsWe retrospectively analyzed the clinical data of 12 patients with coronary artery disease and IMR underwent the innovative mitral valvuloplasty by chained double stitching without shaping ring in our hospital from August 2012 to December 2013. There were 10 males and 2 females at the mean age of 60±10 years ranging from 42 to 76 years. The cardiac functional parameters and condition of mitral regurgitation were compared among the period of preoperation, discharging and follow-up. ResultsTwelve patients were recovered and discharged from hospital with the New York Heart Association (NYHA) classification of heart function at class Ⅰ-Ⅱ. NYHA classification, grade of mitral regurgitation and regurgita- tion area were statistically improved on both the phase of discharge and follow-up compared with that of the pre-operation (P<0.05). Compared with preoperative left ventricular ejection fraction (LVEF), LVEF of discharging was statistically amelio- rative (P<0.05). And there was a statistic difference of NYHA classification of cardiac function in the phase of follow-up than that of discharging (P<0.05). ConclusionMitral valvuloplasty by chained double stitching without shaping ring is one reliable choice of treating IMR. The cardiac function and the living quality of the patients are statistically improved on the early stage and metaphase after operation, but long-term efficacy of this surgical procedure need be further assessed.
ObjectiveTo review the research progress of tissue engineered scaffolds and stromal-derived factor 1 (SDF-1) composite graft. MethodsThe recent papers about SDF-1 with different kinds of tissue engineered scaffolds were reviewed and analyzed. The primary mechanism of SDF-1 homing function for stem cells was retrospected. The results of different kinds of tissue engineered scaffolds carrying SDF-1 for repairing the injured tissues and organs were reviewed. ResultsIt is shown that SDF-1 combined with tissue engineered scaffolds will play a role of multipotent stem cells chemotaxis, however, the exact chemotaxis mechanism has not been fully understood. It still needs more researches of SDF-1 effects in vivo. ConclusionAlthough some research progress has been made in regeneration in situ of tissue engineered scaffolds combined with SDF-1, it will need to further study on the mechanism of chemotactic functions of SDF-1 and its influence on proliferation and differentiation of cells.
ObjectiveTo conclude the revision reason of unicompartmental knee arthroplasty (UKA) using computer-assisted technology so as to provide reference for reducing the revision incidence and improving the level of surgical technique and rehabilitation. MethodThe relevant literature on analyzing revision reason of UKA using computer-assisted technology in recent years was extensively reviewed. ResultsThe revision reasons by computer-assisted technology are fracture of the medial tibial plateau, progressive osteoarthritis of reserved compartment, dislocation of mobile bearing, prosthesis loosening, polyethylene wear, and unexplained persistent pain. ConclusionsComputer-assisted technology can be used to analyze the revision reason of UKA and guide the best operating method and rehabilitation scheme by simulating the operative process and knee joint activities.
ObjectiveTo compare the effectiveness of single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction by two methods. MethodsQualified for the selective standard, 120 patients with ACL injury between May 2010 and April 2013 were divided into 4 groups: double-bundle reconstruction was performed by the conventional procedure in 30 cases (group A); anatomic double-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group B); single-bundle reconstruction was performed by the conventional procedure in 30 cases (group C); and anatomic single-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group D). There was no significant difference in gender, age, disease duration, pathogenesis, injury side, Lysholm scores, International Knee Documentation Committee (IKDC) ratings, Lachman test, anterior drawer test, and pivot shift test among groups (P>0.05). The impingement between the ACL implants and intercondylar notch was evaluated with postoperative immediate MRI scan and the three-dimensional digital model. Lachman test, anterior drawer test, and pivot shift test results, Lysholm scores, and IKDC ratings were used to compare the effectiveness among groups after operation. ResultsThree-dimensional digital model after operation showed impingement in 11 cases (36.7%) of group A, 1 case (3.3%) of group B, 9 cases (30.0%) of group C, and no impingement in group D. The impingement rates of groups A and C were significantly higher than that of groups B and D (P<0.05), but no significant difference was found between groups A and C, and between groups B and D (P>0.05). All incisions healed by first intention, and no early complication was found. The patients were followed up 24-30 months (mean, 26 months). Lysholm scores, Lachman test, anterior drawer test, and pivot shift test results at 24 months after operation were significantly better than preoperative ones in 4 groups (P<0.05), but no significant difference was shown among groups (P>0.05). The IKDC ratings of groups B and D were significantly better than that of groups A and C (P<0.05); but there was no significant difference between groups A and C, and between groups B and D (P>0.05). ConclusionCompared with the conventional procedure, the individual anatomic single- and double-bundle reconstruction in the original ACL residual footprints has decreased impingement rate and increased IKDC rating.
ObjectiveTo investigate the feasibility to culture rabbit annulus fibrosus cells on the KLD-12 polypeptide nanofiber gel so as to search for the seed cells and the scaffolds for tissue engineering. MethodsThe rabbit annulus fibrosus cells were isolated with pancreatin and cultured; the cells at passage 3 were seeded on the KLD-12 polypeptide nanofiber gel to prepare the KLD-12 polypeptide/annulus fibrosus cells gel. The cell morphology change was observed by inverted microscope. The cell counting kit 8 (CCK-8) was used to detect the cell proliferation, and Calcein-AM/propidium iodide (PI) fluorescent staining to observe the cell vitality. The alcian blue method was used to measure the glycosaminoglycan (GAG) content, immunofluorescence technique to observe the collagen type II level, and real-time fluorescence quantitative PCR (RT-qPCR) to measure the mRNA expressions of Aggrecan and collagen type II. ResultsThe cells on the scaffolds grew well, showing round shape on the scaffolds and spindle or fusiform shape at the edge of the scaffold. The cell proliferation exhibited increasing trend with time, and it was significantly higher at 14 days than the other time points (P < 0.05), and on KLD-12 polypeptide nanofiber gel than on blank gel (P < 0.05). The ratios of living cells were 89.32%±8.58% at 5 days and 97.81%±1.09% at 14 days, showing no significant difference (t=-1.962, P=0.097). The GAG content gradually increased with culture time, reached the peak at 8 days, and then gradually decreased; the GAG content at 5, 8, and 11 days was significantly higher than that at 2 and 14 days (P < 0.05). The level of collagen type II was normal. The mRNA expressions of collagen type II and Aggrecan could be measured at 5 and 14 days; the relative expression levels of collagen type II and Aggrecan mRNA were significantly higher at 14 days than 5 days (P < 0.05). ConclusionThe rabbit annulus fibrosus cells on KLD-12 polypeptide nanofiber gel are able to grow well and to produce extracellular matrix, so KLD-12 polypeptide nanofiber gel has the potential to serve as a scaffold for the treatment of intervertebral disc degeneration.
ObjectiveTo describe a technique of side-to-side anastomosis of distal end of sequential vein grafts to small target arteries in coronary artery bypass grafting (CABG) and evaluate its clinical outcomes. MethodsTwelve patients received side-to-side anastomosis at distal end of sequential vein grafts during off-pump CABG in Beijing Anzhen Hospital between October 2012 and March 2013. There were 7 male and 5 female patients with their age of 68.0±3.6 years. To evaluate clinical outcomes of the technique,intraoperative graft blood flow,pulsatility index (PI) and postoperative echocardiography and electrocardiography were examined. ResultsAll the 12 patients successfully received off-pump CABG. Mean graft flow and PI near the distal end anastomosis were 21.1±8.6 ml/min and 2.1±1.0,respectively. Four patients who initially received end-to-side anastomosis underwent revision into side-to-side anastomosis intraoperatively,whose graft flow increased from 2 ml/min,7 ml/min,3 ml/min and 5 ml/min to 10 ml/min,32 ml/min,13 ml/min and 23 ml/min respectively,and whose PI decreased from 18.2,7.1,12.6 and 13.4 to 2.2,0.9,1.8 and 2.8,respectively. Distal end of target arteries were all posterior descending artery. The number of bypass grafts was 4.0±0.7. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome,malignant arrhythmias or perioperative myocardial infarction in this study. ConclusionSide-to-side anastomosis of distal end of sequential vein grafts to small target arteries in off-pump CABG can produce higher anastomotic patency. Long-term follow-up outcomes of this technique are needed before widely clinical application.
ObjectiveTo evaluate immediate outcomes of 8-0 Prolene sutures for distal anastomosis during off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 101 patients who underwent OPCAB in Department of Cardiac Surgery of Beijing Anzhen Hospital in 2010 and 2012 respectively were enrolled in this study. There were 87 male and 14 female patients with their age of 46-82 (61.35±8.24)years. All the 36 patients in 2010 received 7-0 Prolene sutures for distal anastomosis, and the 65 patients in 2012 received 8-0 Prolene sutures for distal anastomosis. After anastomosis, transit time flow measurement was used to measure blood flow indexes of graft vessels[left internal mammary artery (LIMA)and saphenous vein (SV)] including blood flow volume (BFV), pulsatility index (PI)and diastolic filling fraction (DF), which were compared between patients receiving 7-0 and 8-0 Prolene sutures. ResultsBFV of LIMA grafts with 8-0 Prolene sutures (n=44)was significantly larger than that with 7-0 Prolene sutures (n=30)[ (33.70±21.13)ml/min vs. (27.50±17.34)ml/min, P=0.032], while PI of LIMA grafts with 8-0 Prolene sutures was significantly smaller than that with 7-0 Prolene sutures (2.15±0.69 vs. 2.58±1.01, P=0.047). BFV and PI of SV grafts with 8-0 Prolene sutures (n=21) were not statistically different from those with 7-0 Prolene sutures (n=6)[ (34.19±16.00)ml/min vs. (29.00±15.48)ml/min, P > 0.05;2.07±0.53 vs. 1.95±0.55, P > 0.05]. DF of all the grafts was greater than 50%, and there was no statistical difference in DF between the 2 groups (P > 0.05). Conclusion8-0 Prolene sutures for LIMA-to-left anterior descending artery can improve BFV and decrease PI of LIMA grafts, which reflects better immediate graft patency of the distal anastomosis and helps improve surgical success rate and long-term prognosis.
ObjectiveTo evaluate the short-term result of proximal lengthening grafted stent and modified innominate artery cannula for Stanford A aortic dissection. Method We retrospectively analyzed the clinical data of 21 patients with Stanford A aortic dissection in our hospital between December 2012 and January 2015. There were 16 males and 5 females at a mean age of 57 years. All 21 patients underwent total arch replacement with proximal lengthening grafted stent and modified innominate artery cannula invented by our center. Result The mean operation time of 21 patients was 187.0±31.1 minutes, the mean cardiopulmonary bypass time was 116.0±32.0 minutes, the mean aortic block time was 87.0±23.0 minutes, the mean selective cerebral perfusion (SCP) time was 23.0±3.9 minutes, the mean breathing machanical ventilation time was 19.0±6.0 hours, and the mean intensive care unit stay time was 3.0±0.9 days. All patients had a good recovery after surgery. There was no death or severe complications. ConclusionThe technique of total arch replacement with proximal lengthening grafted stent and modified innominate artery cannula for Stanford A aortic dissection is effective, easy, and safe. The short-term result is satisfying.
ObjectiveTo evaluate the efficacy and safety of moistened versus dry misoprostol for mid-trimester pregnancy termination. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 11, 2015), Web of Science, WanFang Data, CBM and CNKI were searched to collect randomized controlled trials (RCTs) about misoprostol for mid-trimester pregnancy termination from inception to Nov. 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsFive RCTs involving 742 patients were included. The results of meta-analysis showed that, compared with dry tablet, moistened tablet could reduce induction-abortion interval (MD=-0.41, 95% CI-0.75 to-0.08, P=0.02), while there were no significant differences between two groups in completely abortion within 24 hours or 48 hours, nausea, vomiting, chill, fever, diarrhea, retained placenta, blood loss and total dose of misoprostol. ConclusionCurrent evidence shows that, compared with the dry misoprostol, the moistened misoprostol for treating mid-trimester pregnancy termination could reduce the induction-abortion interval without increasing adverse reactions. Due to the limited quality of quantity of included studies, more high-quality and large-scale RCTs are needed to prove the above conclusion.