Objective To evaluate the effectiveness and prospect of nontransplantation surgical cardiac remodeling for endstage cardiac valve disease by performing the remodeling operation (including anatomical and functional remodeling) after strict perioperative adjustment for endstage cardiac valve disease. Methods We retrospectively analyzed the clinical data of 31 patients, including 14 males and 17 females, with endstage cardiac valve disease who were treated with surgical cardiac remodeling operation from December 2005 to July 2009 in the 2nd Hospital of Anhui Medical University . Their age ranged from 27 to 74 years with an average age of 40.4 years. Continuous renal replacement therapy (CRRT) was carried out 3 days before surgery in all patients and intraaortic balloon pumping (IABP) was performed 1-3 days before operation in 9 patients. Among the patients, there were 13 patients of mitral valve replacement (MVR), 7 patients of aortic valve replacement (AVR), 4 patients of tricuspid valve replacement (TVR), and 7 patients of double valve replacement (DVR). At the same time, all patients underwent ventricular or atrial volume reduction operation, including 19 patients of left atrial partial excision or plication, 7 patients of partial left ventricular excision, 5 patients of left atrial and left ventricular volume reduction operation, 21 patients of partial right atrial excision, and 3 patients of partial right ventricular excision. Besides, there were 5 patients of De Vega plasty, 14 patients of annuloplasty and3 patients of coronary artery bypass grafting (CABG). The echocardiogram was used to observe the change of heart function, atrium and ventricular in patients on postoperative and follow -up period. Results After surgery, one patient died of low cardiac output syndrome, and one other patient gave -up because of incision and mediastinum infection after reoperation for hemorrhage. Twentynine patients were followed -up for 3 to 12 months with 1 case lost. During the follow- -up, 3 patients died, of whom 2 died of deterioration of heart function and 1 died of sudden stroke. In the 12th month during the follow -up, heart function of all other 25 patients showed obvious improvements with 12 classⅠ, 7 classⅡ, 3 classⅢ and 3 classⅣ heart function according to NYHA classification. At the end of the follow -up, ejection fraction (5400%±800% vs. 2500%±300%) and cardiac index ［3.30±0.50 L/(min·m2) vs. 1.10±0.30 L/(min·m2)］ were significantly higher than those before operation (P＜0.05), whereas left ventricular end diastolic diameter (5200±1000 mm vs. 9500±1200 mm) and left atrial diameter (3900±800 mm vs. 7000±1200 mm) both decreased significantly than those before operation (P＜0.05). Conclusion Cardiac remodeling operation for endstage cardiac valve disease after active adjustment and preparation can achieve similar results to operation for severe valve diseases, providing a new choice for endstage heart disease.
Objective To systematically evaluate the clinical efficacy and safety of fluticasone furoate in the treatment of bronchial asthma. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 2, 2016), CNKI, VIP, and WanFang Data to collect randomized controlled trials (RCTs) about fluticasone furoate for bronchial asthma from inception to Feb. 2016. 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. Results Six RCTs involving 4 383 patients were included. The results of meta-analysis showed that: (1) Fluticasone furoatevs. placebo: fluticasone furoate could not only significantly improve trough FEV1 (MD=0.10, 95%CI 0.05 to 0.15,P=0.000 2), but also improve the percentage of rescue-free in 24 hours and the symptom-free periods in 24 hours. Meanwhile, fluticasone furoate could not increase the adverse events rate (OR=1.38, 95%CI 0.28 to 6.77,P=0.69). (2) Fluticasone furoate plus vilanterolvs. fluticasone furoate alone: Compared with fluticasone furoate alone, fluticasone furoate plus vilanterol could significantly improve FEV1 (MD=–0.10, 95%CI –0.19 to –0.01,P=0.02) and 0–24 h wmFEV1 (MD=–0.10, 95%CI –0.19 to –0.01,P=0.02). the combination therapy also had better percentage of rescue-free in 24 hours and symptom-free periods in 24 hours without increasing the rate of adverse events (OR=–1.05, 95%CI –1.39 to –0.80,P=0.72). (3) Fluticasone furoatevs. fluticasone propionate: There were no significant differences between fluticasone furoate and fluticasone propionate in FEV1 (MD=–0.02, 95%CI –0.08 to 0.04,P=0.52), percentage of rescue-free in 24 hours and adverse events rate (OR=1.62, 95%CI 0.77 to 3.40,P=0.20). Conclusion Current evidence shows, fluticasone furoate could effectively improve the lung function and control the symptoms of asthma patients than placebo; fluticasone furoate plus vilanterol shows better effects than fluticasone furoate alone without increasing the adverse event rate. Fluticasone furoate and fluticasone propionate have similar effects, but fluticasone furoate is more convenient and could improve patients’ adherence. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To explore the safety and feasibility of general anesthesia with tracheal intubation in transcatheter aortic valve implantation (TAVI), and the key points in anesthetic management. Methods Twenty-five patients with aortic stenosis treated by TAVI in West China Hospital of Sichuan University between September 2012 and June 2013 were included in this study. General anesthesia with tracheal intubation was chosen. We recorded and analyzed the hemodynamics, blood gas, oxygen saturation data before and after anesthesia induction, before surgery, during rapid ventricular pacing, before and after aortic valve implantation. Besides, the incidence of perioperative complications and 30-day mortality were also recorded. Results All the 25 patients underwent the implantation surgery successfully. Two patients had the second implantation surgery due to moderate reflux. All the subjects in this study tolerated general anesthesia well without any anesthesia-related complications. There were 19 cases of newly developed or aggravated heart blocks, 7 of permanent pace maker, 2 of perioperative hemorrhage, 2 of cerebral vascular events, and 1 death case. Conclusioins General anesthesia with tracheal intubation can be utilized safely in patients undergoing TAVI. TAVI is a challenging technique in need of precise collaborations of multi-disciplines, in which anesthetists should play more as a leader in evaluation and decision-making during the surgery.
ObjectiveTo investigate the effect of nicotinamide mononucleotide adenosyl transferase 3 (NMNAT3) on the mitochondrial function and anti-oxidative stress of rabbit bone marrow mesenchymal stem cells (BMSCs) under oxidative stress in vitro by regulating nicotinamide adenine dinucleotide (NAD+) levels.MethodsThe bone marrow of femur and tibia of New Zealand white rabbits were extracted. BMSCs were isolated and cultured in vitro by density gradient centrifugation combined with adherent culture. The third generation cells were identified by flow cytometry and multi-directional induction. Overexpression of NMNAT3 gene was transfected into rabbit BMSCs by enhanced green fluorescent protein (EGFP) labeled lentivirus (BMSCs/Lv-NMNAT3-EGFP), and then the expression of NMNAT3 was detected by real-time fluorescence quantitative PCR (qRT-PCR) and Western blot and cell proliferation by cell counting kit 8 (CCK-8) method. BMSCs transfected with negative lentivirus (BMSCs/Lv-EGFP) and untransfected BMSCs were used as controls. The oxidative stress injury cell model was established by using H2O2 to treat rabbit BMSCs. According to the experimental treatment conditions, they were divided into 4 groups: Group A was normal BMSCs without H2O2 treatment; untransfected BMSCs, BMSCs/Lv-EGFP, and BMSCs/Lv-NMNAT3-EGFP in groups B, C, and D were treated with H2O2 simulated oxidative stress, respectively. The effects of NMNAT3 on the mitochondrial function of BMSCs under oxidative stress [changes of mitochondrial membrane potential, NAD+ and adenosine triphosphate (ATP) levels], the changes of anti-oxidative stress ability of BMSCs [reactive oxygen species (ROS) and malondialdehyde (MDA) levels, manganese superoxide dismutase (Mn-SOD) and catalase (CAT) activities], and the effects of BMSCs on senescence and apoptosis [senescence associated-β-galactosidase (SA-β-gal) staining and TUNEL staining] were detected after 24 hours of treatment.ResultsThe rabbit BMSCs were successfully isolated and cultured in vitro. The stable strain of rabbit BMSCs with high expression of NMNAT3 gene was successfully obtained by lentiviral transfection, and the expressions of NMNAT3 gene and protein significantly increased (P<0.05). There was no significant difference in the trend of cell proliferation compared with normal BMSCs. After treatment with H2O2, the function of mitochondria was damaged and apoptosis increased in all groups. However, compared with groups B and C, the group D showed that the mitochondrial function of BMSCs improved, the membrane potential increased, the level of NAD+ and ATP synthesis of mitochondria increased; the anti-oxidative stress ability of BMSCs enhanced, the levels of ROS and MDA decreased, and the activities of antioxidant enzymes (Mn-SOD, CAT) increased; and the proportion of SA-β-gal positive cells and the rate of apoptosis decreased. The differences in all indicators between group D and groups B and C were significant (P<0.05).ConclusionNMNAT3 can effectively improve the mitochondrial function of rabbit BMSCs via increasing the NAD+ levels, and enhance its anti-oxidative stress and improve the survival of BMSCs under oxidative stress conditions.
ObjectiveTo investigate the effect of LOC103693069 on hypoxic apoptosis of bone marrow mesenchymal stem cells (BMSCs). Methods BMSCs from 1-week-old Sprague Dawley rat bone marrow were isolated, cultured, and passaged by the whole bone marrow adherent culture method. After identification of adipogenic, chondrogenic, and osteogenic differentiation, the 3rd generation cells were treated with hypoxia under 5%O2, 1%O2, and anaerobic conditions. After 48 hours, the cell viability, apoptosis, and apoptosis-related proteins [hypoxia inducible factor 1α (HIF-1α), Caspase-3, B cell lymphoma/leukemia 2 (Bcl-2)] expressions were detected, and normal BMSCs were used as controls. Based on the research results, the concentration group with the most obvious apoptosis was selected and used for subsequent experiments. After 48 hours of hypoxia treatment, BMSCs were taken and analyzed by gene chip and real-time fluorescence quantitative PCR (qRT-PCR) to screen the most significantly down-regulated gene and construct their high-expression, low-expression, and negative control lentiviruses; BMSCs were transfected with the different lentiviruses, respectively. After qRT-PCR detection confirmed that the transfection was successful, the BMSCs were treated with hypoxia for 48 hours to observe the cell viability and the expressions of apoptosis-related proteins. ResultsAfter cell viability, apoptosis, and apoptosis-related proteins were detected, cell apoptosis was the most significant under anaerobic conditions after 48 hours. The above indicators were significantly different from other groups (P<0.05), and this group was used for treatment conditions for subsequent experiments. Gene chip analysis showed that after 48 hours of hypoxia treatment, AC125847.1, LOC102547753, AABR07017208.2, and LOC103693069 were significantly down-regulated in BMSCs, and the expressions of LOC103693069 was the most significant down-regulation detected by qRT-PCR (P<0.05). It was selected to construct lentivirus and transfect BMSCs. Afterwards, qRT-PCR detection showed the successful transfection into the cells. After hypoxia treatment, the apoptosis rate and the expressions of apoptosis-related proteins of BMSCs overexpressed by the gene were significantly reduced (P<0.05). Conclusion LOC103693069 can relieve the hypoxic apoptosis of BMSCs.
ObjectiveTo investigate the effectiveness of arthroscopic all-inside combined with outside-in “suture loop” repair for meniscus bucket-handle tear (BHT).MethodsBetween August 2016 and May 2019, 44 case of meniscus BHT were treated with arthroscopic all-inside combined outside-in “suture loop”. There were 29 males and 15 females with an average age of 26.6 years (range, 18-42 years). The causes of injury included sports injury in 31 cases, falling injury in 7 cases, and sprain in 6 cases. There were 32 cases of medial meniscus posterior horn tears and 12 cases of lateral meniscus posterior horn tears. The disease duration ranged from 6 weeks to 3 months. Thirty-three cases were complicated with anterior cruciate ligament rupture. All patients had normal lower limb alignment. The preoperative Lysholm score was 42.1±9.1. According to the evaluation criteria of MRI and Barrett et al., the healing of meniscus was evaluated, and the effectiveness was evaluated by Lysholm score.ResultsAll the 44 patients were followed up 8-36 months with an average of 16.8 months. At last follow-up, according to the evaluation criteria of Barrett et al., 39 cases were clinically healed, 5 cases were not healed, the clinical healing rate was 88.6%; according to MRI evaluation, 32 cases were completely healed, 7 cases were partially healed, and 5 cases were not healed, the total healing rate was 88.6%, and the complete healing rate was 72.7%. Lysholm score was 87.8±4.8, which was significantly different from that before operation (t=31.060, P=0.000).ConclusionArthroscopic all-inside combined with outside-in “suture loop” repair is a reliable and effective method for the meniscus BHT, which can obtain good joint function.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.
Objective To investigate the feasibility of MRI three-dimensional (3D) reconstruction model in quantifying glenoid bone defect by comparing with CT 3D reconstruction model measurement. Methods Forty patients with shoulder anterior dislocation who met the selection criteria between December 2021 and December 2022 were admitted as study participants. There were 34 males and 6 females with an average age of 24.8 years (range, 19-32 years). The injury caused by sports injury in 29 cases and collision injury in 6 cases, and 5 cases had no obvious inducement. The time from injury to admission ranged from 4 to 72 months (mean, 28.5 months). CT and MRI were performed on the patients’ shoulder joints, and a semi-automatic segmentation of the images was done with 3D slicer software to construct a glenoid model. The length of the glenoid bone defect was measured on the models by 2 physicians. The intra-group correlation coefficient (ICC) was used to evaluate the consistency between the 2 physicians, and Bland-Altman plots were constructed to evaluate the consistency between the 2 methods. Results The length of the glenoid bone defects measured on MRI 3D reconstruction model was (3.83±1.36) mm/4.00 (0.58, 6.13) mm for physician 1 and (3.91±1.20) mm/3.86 (1.39, 5.96) mm for physician 2. The length of the glenoid bone defects measured on CT 3D reconstruction model was (3.81±1.38) mm/3.80 (0.60, 6.02) mm for physician 1 and (3.99±1.19) mm/4.00 (1.68, 6.38) mm for physician 2. ICC and Bland-Altman plot analysis showed good consistency. The ICC between the 2 physicians based on MRI and CT 3D reconstruction model measurements were 0.73 [95%CI (0.54, 0.85)] and 0.80 [95%CI (0.65, 0.89)], respectively. The 95%CI of the difference between the two measurements of physicians 1 and 2 were (–0.46, 0.49) and (–0.68, 0.53), respectively. Conclusion The measurement of glenoid bone defect based on MRI 3D reconstruction model is consistent with that based on CT 3D reconstruction model. MRI can be used instead of CT to measure glenoid bone defects in clinic, and the soft tissue of shoulder joint can be observed comprehensively while reducing radiation.