Predictive indicators for the efficacy of targeted therapy/immunotherapy for hepatocellular carcinoma / 临床肝胆病杂志

Hepatocellular carcinoma （HCC） is a common malignancy in China， and molecular-targeted drugs and immune checkpoint inhibitors for the treatment of advanced HCC are currently a research hotspot； however， there are large individual differences in the treatment outcome of advanced HCC. In order to further screen for the population with benefits from such treatment， predict treatment outcome， and improve disease prognosis， this article summarizes the studies on predicting the efficacy of targeted therapy/immunotherapy for HCC， so as to provide a reference for developing individualized treatment regimens for patients with advanced HCC.

A prospective multicenter clinical trial study of a domestic HeartCon third-generation magnetic and hydrodynamic levitation LVAD for the treatment of 50 cases of end-stage heart failure / 中华胸心血管外科杂志

Objective:To analyze and evaluate the safety and efficacy of a Chinese domestically manufactured Heart Con-type implantable third-generation magnetic and hydrodynamic levitation left ventricular assist device(LVAD) for the treatment of end-stage heart failure(ESHF), by reporting the results of eleven-center clinical trial on 50 cases.Methods:This study was a multicenter clinical trial, designed by means of prospective, multicenter and single-group target value. 50 subjects with ESHF were competitively enrolled and treated with HeartCon as the LVAD in eleven centers. The primary efficacy measure was survival, defined as either the subjects experiencing the transition to heart transplantation(HT) or myocardial recovery assisted by the device within 90 days, or as successfully assisted by the LVAD for full 90 days after implantation. The target survival rate was 60%, other observations included implantation success rate, mortality, pump failure needing replacement or emergency heart transplantation.Results:All enrolled 50 patients received LVAD implantation successfully, 46 survived with the pump for 90 days, 1 patient transitioned to heart transplantation, and 3 patients experienced pump thrombosis, within which 2 patients underwent pump replacement and continued to live with the pump for 90 days, and the other one received emergency heart transplantation. There were no dropout subjects. The survival rate at full 90 days after HeartCon implantation was 100%. The survival rates with pump in the full set analysis and the protocol set analysis were 96.00% and 95.92% respectively, which were higher than the target value of 60%. The differences were both statistically significant( P<0.05). Conclusion:The results of the multicenter clinical trial with the largest sample size in China using domestically manufactured third-generation LVAD has demonstrated that, HeartCon is a safe and effective LVAD to treat ESHF patients.

Efficacy and safety of programmed death-1 inhibitor combined with transarterial chemoembolization and anti-angiogenic drugs in treatment of advanced hepatocellular carcinoma / 临床肝胆病杂志

Objective To investigate the efficacy and safety of programmed death receptor-1 (PD-1) inhibitor combined with transarterial chemoembolization (TACE) and anti-angiogenic drug tyrosine kinase inhibitor (TKI) versus TACE combined with TKI in the treatment of advanced hepatocellular carcinoma (HCC) and related influencing factors for prognosis. Methods An analysis was performed for all patients who received TACE+TKI+PD-1 inhibitor and some patients who received TACE+TKI in The First Affiliated Hospital of Air Force Medical University from June 2018 to July 2021. Related clinical data were collected, and propensity score matching (PSM) was used to balance the baseline characteristics between groups. The chi-square test was used for comparison of categorical data between two groups; the Wilcoxon rank-sum test was used for comparison of the number of TACE procedures between two groups; the Kaplan-Meier method was used to analyze overall survival (OS), and univariate and multivariate Cox regression models were used to analyze the influencing factors for prognosis. Results A total of 181 patients with advanced HCC were screened out, among whom 50 patients were treated with TACE+TKI+PD-1 inhibitor; after PSM, 40 patients treated with TACE+TKI+PD-1 inhibitor were enrolled as observation group and 40 patients treated with TACE+TKI were enrolled as control group. At the end of follow-up, the median follow-up time was 28.6 (95% confidence interval [ CI ]: 22.1-35.1) months, and the median OS was 15.9 (95% CI : 7.5-24.2) months in the observation group and 11.2 (95% CI : 5.0-17.5) months in the control group. The Cox regression analysis showed that the application of PD-1 inhibitor (hazard ratio [ HR ]=0.42, 95% CI : 0.23-0.80, P =0.008), the number of TACE procedures ( HR =0.67, 95% CI : 0.46-0.99, P =0.043), Child-Pugh class ( HR =2.40, 95% CI : 1.15-5.00, P =0.019), and vascular invasion ( HR =3.42, 95% CI : 1.11-9.42, P =0.031) were independent influencing factors for prognosis. The incidence rate of grade > 2 adverse events was 40% for both the observation group and the control group, and there was no significant difference between the two groups ( P =0.818). Conclusion Compared with TACE+TKI, TACE+TKI+PD-1 inhibitor can significantly prolong the OS of patients in advanced HCC, with relatively controllable adverse events.

Relationship between SIRI and early neurological deterioration in basal ganglia cerebral hemorrhage and construction of Nomogram predictive model / 国际外科学杂志

Objective:To investigate the association between systemic inflammation response index (SIRI) and early neurological deterioration (END) in patients with basal ganglia hemorrhage (BGH), and then set up a prediction Nomogram model for END.Methods:The retrospective cohort study was conducted. A total of 146 patients with BGH from January 2016 to December 2018 were chosen in the Affiliated Jiangyin Hospital of Southeast University Medical College. The patients were divided into the END group ( n=34) and non-END group ( n=112), according to whether END occurred or not. The normally distributed data were presented as the mean±standard deviation ( Mean± SD), and the groups were compared using the t test. The non-normally distributed data were expressed as M ( P25, P75), and this data was analysed via the Kruskal-Wallis test. Categorical variables were described as numbers of patients (%) and compared using chi-square analysis or Fisher exact test, as appropriate. Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors of END occurrence, and the relationship with SIRI. Then, each factor was scored by Nomogram method to construct the prediction model. Receiver operating characteristic curve (ROC) was drawn to assess the predictive value of SIRI and Nomogram model in the occurrence of END. Results:Univariate analysis showed that the occurrence of END was associated with hematoma volume, presence of intraventricular hemorrhage, blood glucose, lymphocyte count and SIRI ( P<0.05). Multivariate logistic regression analysis showed that hematoma volume ( P<0.001), presence of intraventricular hemorrhage ( P=0.012) and SIRI ( P=0.023) are independent risk factors for END occurrence. ROC curve analysis showed that SIRI has certain predictive value for END occurrence, and the optimal cut-off value was SIRI=5.40×10 9/L. Then these risk factors were incorporated into the Nomogram. Statistically analysis showed the model had a good predictive value, and the model combining the SIRI and other prognostic factors (AUC=0.869, 95% CI: 0.804-0.935, P<0.001) showed more favorable discriminative ability than the model without the SIRI (AUC=0.811, 95% CI: 0.734-0.889, P<0.001) and the model using the SIRI only (AUC=0.716, 95% CI: 0.622-0.810, P<0.001). Conclusion:SIRI is closely correlated with the occurrence of END in patients with BGH, and the nomogram model combining the SIRI has a more accurately predictive value, which improved the early identification and screening of END, and patient outcomes.

Efficacy and safety of ombitasvir/paritaprevir/ritonavir and dasabuvir combined with ribavirin in Asian adult patients with chronic HCV genotype 1b infection and compensated cirrhosis / 中华肝脏病杂志

Objective@#To evaluate the efficacy and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily and dasabuvir (DSV) 250 mg twice daily combined with ribavirin in adult patients of Mainland China with chronic HCV genotype 1b infection and compensated cirrhosis. @*Methods@#An open-label, multicenter, phase 3 clinical trial study was conducted in mainland China, Taiwan, and South Korea. Adult patients with compensated cirrhosis (Metavir score =F4) who were newly diagnosed and treated for hepatitis C virus genotype 1b infection with ombitasvir/paritaprevir/ritonavir and dasabuvir combined with ribavirin for 12 weeks were included. Assessed SVR rate of patients obtained at 12 and 24 weeks after drug withdrawal. Efficacy and safety were evaluated in patients who received at least one time study drugs. @*Results@#A total of 63 patients from mainland China were enrolled, 62 of whom (98.4%) had a baseline Child-Pugh score of 5 points. The overall rate of SVR12 and SVR24 in patients was 100% (95% CI: 94.3% to 100.0%). Most of the adverse events that occurred were mild. The incidence of common (≥10%) adverse events and laboratory abnormalities included elevated total bilirubin (36.5%), weakness (19.0%), elevated unconjugated bilirubin (19.0%) and conjugated bilirubin (17.5%), and anemia (14.3%). Three cases (4.8%) of patients experienced Grade ≥ 3 adverse events that were considered by the investigators to be unrelated to the study drug. None patients had adverse events leading to premature drug withdrawal. @*Conclusion@#Mainland Chinese patients with chronic HCV genotype 1b infection and compensated cirrhosis who were treated with OBV/PTV/r plus DSV combined with RBV for 12 weeks achieved 100 % SVR at 12 and 24 weeks after drug withdrawal. Tolerability and safety were good, and majority of adverse events were mild.

Properties of decellularized rabbit carotid artery with two different cross-linked technologies: A comparative study / 中南大学学报(医学版)

Objective:To compare the properties between decellularized rabbit carotid artery with different cross-linked technologies.Methods:The decellularized rabbit carotid arteries were randomly divided into a photo-oxidation group and a procyanidins group.One group was cross-linked with photo-oxidation and the other group was cross-linked with procyanidins.The in vitro or in vivo properties of the two groups were evaluated by testing heat-shrinking temperature,max tensile strength and the max elongation or by testing tissue structure,inflammatory reaction and calcification degree.Results:The heat-shrinking temperature,max tensile strength and the max elongation were similar in the two groups (P＞0.05).The tissue structure and inflammatory reaction were also similar in the two groups.Mthough the result of Von-Kossa calcium salt stain was slightly different,the calcium content was lower in the procyanidins group than that in the photo-oxidation group (P＜0.05).Conclusion:The grafts by two cross-linked technologies show excellent mechanical capability,lower immunogenicity,good biological stability and anti-calcification ability.The procyanidins group shows a better anti-calcification property than the photo-oxidation group.

Research progress on relationship between intestinal microbiota and chronic liver diseases / 中华全科医师杂志

The relationship of intestinal microbiota with multifarious diseases becomes a hot spot of research in recent years,and accumulated evidence indicates that the intestinal microbiota also plays a key role in chronic liver diseases.Due to special anatomical location between the liver and the intestinal tract, the conditions of liver and intestinal microbiota are extensively interacted.This article reviews the current research progress on the relationship between intestinal microbiota and chronic liver diseases.

Effect of super selective intra-arterial infusion of verapamil for the treatment of cerebral vasospasm after subarachnoid hemorrhage:an efficacy analysis / 中国脑血管病杂志

Objective To investigate the efficacy of super selective intra-arterial infusion of verapamil for the treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH).Methods From January 2013 to February 2016,the clinical data of 15 patients with subarachnoid hemorrhage (SAH) who had CVS after intracranial aneurysm clipping (n=8) or endovascular treatment (n=7) were analyzed retrospectively.All patients received whole brain digital subtraction angiography (DSA).Microcatheter super selection to spastic arteries was used and verapamil (11.1±3.4 mg) was infused.The findings of whole brain DSA before and after treatments were compared.The blood pressure and heart rate were collected during the treatment and the findings of transcranial Doppler ultrasonography were recorded.The patients were followed up for 6 months and the Glasgow outcome scale (GCS) scores were obtained.Results (1) A total of 20 intra-arterial infusion treatments were performed in 15 cases.They were compared before and after perfusion.CVS was improved on DSA in 14 cases,there was no significant change in on cases.(2) Transcranial Doppler ultrasonography showed that the mean blood flow velocity (mBFV) of the middle cerebral artery was decreased from 181±4 cm/s before the super selective intra-arterial infusion to 126±4 cm/s within 1 hour after treatment.There was significant difference (t=42.46,P0.05).(4) All patients were followed up for 6 months.The GOS score at 6 months:good recovery in 9 cases,moderate disability but could take care of themselves in 3 cases,severe disability and could not take care of themselves in 3 cases,no persistent vegetative state or death.Conclusion Super selective intra-arterial infusion of verapamil can effectively improve the treatment of aneurysmal SAH caused CVS.At the same time,it has no obvious effect on blood pressure and heart rate.

Disease assessment and prognosis of liver failure / 临床肝胆病杂志

Liver failure has a high fatality rate and greatly threatens human health. Liver transplantation can effectively reduce the fatality rate. However, the problems such as donor shortage and allograft rejection limit the wide application of liver transplantation. An accurate early assessment helps to evaluate patients′ condition and optimize therapeutic strategies. At present, commonly used systems for prognostic evaluation include the King′s College Hospital, MELD, integrated MELD, Child-Pugh score, CLIF-SOFA, CLIF-C ACLFS, and D-MELD, and each system has its own advantages and disadvantages. Among these systems, the MELD scoring system is the most commonly used one, and the D-MELD scoring system is the most innovative one, which can be used for patients on the waiting list for liver transplantation. This article elaborates on the characteristics and predictive value of each scoring system in clinical practice.

Diagnostic experience in 3 cases of cardiac occupying lesion / 中南大学学报(医学版)

The clinic symptoms of cardiac occupying lesions are complex and difficult to diagnose currently. In this study, three cases of atrial angiosarcoma, left ventricular aneurysm and left ventricular diverticulum were selected, respectively. The clinical characteristics, imaging features (echocardiogram, cardiac CT and MRI) and the postoperative and pathological results for patients were studied. We compared the differences in clinical symptoms, morphology, histology and haemodynamics among the three patients. The diagnosis were confirmed by intraoperative and postoperative pathological examination. We conclude that proper imaging approaches would be beneficial to diagnose the cardiac occupying lesions. Accurate preoperative diagnosis is beneficial to preoperative preparation as well as the decrease in operative risks.

Management strategy and prognosis analysis for poor -grade aneurysmal subarachnoid hemorrhage / 中国基层医药

Objective To investigate the efficacy of microsurgery and predictors of outcome for poor -grade aneurysmal subarachnoid hemorrhage(aSAH).Methods Clinical data of 43 patients of poor -grade aSAH who per-formed microsurgery were retrospectively analyzed.There were 30 patients with Hunt -Hess grade IV and 1 3 patients with grade V.24 patients received emergency operation(within 6hours after onset),1 6 patients received ultra -early operation(within first 24hours after onset).Outcome was assessed by Glascow Outcome Scale(GOS).Results Of 43 patients who received microsurgery,favorable outcome was achieved by 1 9 cases of 43 cases (44.2%),poor outcome was achieved by 1 6 cases of 43 cases (37.2%),the overall outcome of patients with Hunt -Hess grade IV was better than that with grade V(Z =-2.486,P =0.01 6).1 8 patients with intracerebral hematoma received ultra -early or emergency operation,effective surgical intervention(GOS≥3)achieved in 1 2 patients,there was no signifi-cant difference in prognosis between the patients and the others who without intracerebral hematomas(χ2 =0.1 03,P =1 .000).Conclusion The ultra -early or emergency surgery could avoid the risk of aneurysmal re -rupture,relieve malignant intracranial hypertension as soon as possible and decrease the mortality of poor -grade aSAH patients.

Outcome of microsurgical treatment and its influencing factors in patients with aneurysmal subarachnoid hemorrhage / 国际脑血管病杂志

Objective To investigate the outcome of microsurgical treatment and its influencing factors in patients with aneurysmal subarachnoid hemorrhage.Methods The consecutive patients with aneurysmal subarachnoid hemorrhage treated with the early or ultra-early microsurgery were enrolled retrospectively.The Glasgow outcome scale (GOS) was used to assess the outcomes of patients at discharge.GOS 4-5 was defined as good outcome,and GOS 1-3 was defined as poor outcome.Results A total of 147 patients with aneurysmal subaraclnoid hemorrhage were enrolled.One hundred and twelve patients (76.2％) had good outcomes.There were significant differences in the proportions of preoperative Glasgow Coma Scale (GCS) scores (12.8 ± 2.8 vs.7.5 ± 3.8;t =7.525,P ＜0.001),low Hunt-Hess grade (83.0％ vs.31.4％;x2 =34.318,P ＜ 0.001),size of aneurysm (x2 =9.531,P =0.009),preoperative rebleeding (6.3％ vs.25.7％;x2 =8.506,P =0.003),preoperative brain herniation (4.5％ vs.40.0％;x2 =26.846,P ＜ 0.001),initial CT scan showing intracerebral hemorrhage (19.6％ vs.48.6％;x2 =11.449,P =0.002),and intraventricular hemorrhage (8.9％ vs.40.0％;x2 =18.846,P ＜0.001) between the good outcome group and the poor outcome group.Multivariate logistic regression analysis showed that the larger aneurysm (odds ratio [OR] 3.194,95％ confidence interval [CI] 1.458-6.999;P =0.004),older age (OR 1.054,95％ CI 1.013-1.097;P=0.010),lower preoperative GCS score (OR 0.539,95％ CI 0.410-0.724;P ＜ 0.001),and preoperative brain herniation (OR 3.633,95％ CI 1.039-12.700;P =0.043) were the independent risk factors for poor outcomes.Conclusions After active surgical treatment,most of the patients with aneurysmal subarachnoid hemorrhage have good outcomes,however,patients with older age,larger aneurysms,lower preoperative GCS scores,and preoperative brain herniation usually have poor outcomes.

Impact of the different rupture points on the prognosis of patients in anterior circulation aneurysm clipping / 中国脑血管病杂志

Objective Toinvestigatetheimpactofthedifferentrupturepoints(sac,neck,andtop) of intraoperative aneurysm rupture (IAR)on the prognosis of patients in anterior circulation aneurysm clipping.Methods Theclinicaldataof135consecutivepatients(148aneurysms)acceptedmicrosurgical aneurysm clipping from May 2009 to March 2012 were analyzed retrospectively. The prognostic evaluation of the patients after procedure was assessed by using the Glasgow outcome scale (GOS). The different aneurysm rupture points of IAR were used as influencing factors,and the relationship between the different rupture pointsandtheprognosisofpatientswasanalyzed.Results Duringclippingof148aneurysmsin 135 patients,31 aneurysms in 30 patients had intraoperative rupture (20. 9% of the aneurysms, 22.2% of the patients). Nine rupture points occurred on the top of aneurysms,17 occurred on the sac,and 5 occurred on neck. The Glasgow outcome scale (GOS)scores 5,4,3,2 and 1 were in 17,8,2,1 and 2 patients,respectively. A total of 25 patients had good prognosis and 5 cases had poor prognosis. There were no significant differences in the impact of different rupture points of IAR on the prognosis in patients of IAR (OR,100. 00,95% confidence interval 6. 764-18. 344,P=0. 006). Of the 25 patients with aneurysm sac or top rupture,1 case had poor prognosis. Of the 5 patients with aneurysm neck rupture, 4caseshadpoorprognosis.Conclusion Inanteriorcirculationaneurysmclipping,thedifferent aneurysm rupture points may have significant impact on the prognosis of patients,the aneurysm neck rupture is a main factor for resulting in the poor prognosis of patients.

8.5 year-follow-up of combined heart-lung transplantation in a patient / 中南大学学报(医学版)

To summarize the case of combined heart-lung transplantation for a patient who survived for 8.5 years. On September 20, 2003, at Second Xiangya Hospital of Central South University, homologous heartlung transplantation was performed on a male patient who was diagnosed with cardiopulmonary failure secondary to congenital ventricular septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1500 mL modified St.Thomas solution and 3000 mL modified LPD solution. Postoperative immunosuppressive therapies included: methylprednisolone and human anti-lymphocyte globulin protein in the induction period; and combination of ciclosporin A, CellCept and prednisolone in the stable period. In 2007, the treatment was changed to CellCept mg, twice a day+FK506 4 mg, twice a day. The patient lived 8.5 years of normal life with cardiac function of NYHA I-II. Echocardiogram showed left ventricular ejection fraction of 61% to 74%. Heart-lung transplantation proved reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation and proper perioperative treatment are key factors for long-term survival after heart-lung transplantation.

Diagnosis and treatment of warfarin resistance / 中南大学学报(医学版)

Warfarin resistance is a phenomenon that patients need to take much higher than normally prescribed dosage of warfarin to maintain the target therapeutic international normalized ratio (INR) range, or even fail to reach the target INR. Warfarin resistance can be categorized in etiologic terms as hereditary vs acquired, or in pharmacologic terms as pharmacokinetic vs pharmacodynamic. Once warfarin resistance is diagnosed, the type of resistance should be determined as soon as possible so that treatment could be oriented toward the causes. Poor compliance, genetic mutations, concurrent medications that could decrease the absorption or increase the clearance of warfarin, and consumption of diet rich in vitamin K are the major reasons for warfarin resistance. Educating patients, increasing warfarin dosage and switching to other anticoagulants would be effective for warfarin resistance.

Performance effect of rabbit carotid artery treated with decellularization and photo-oxidation / 中南大学学报(医学版)

OBJECTIVE@#To analyze and discuss the feasibility of rabbit carotid artery treated with decellularization and photo-oxidation.@*METHODS@#Sixty vascular slices of rabbit carotid artery were divided into a fresh group, a cryopreservation group, a glutaraldehyde group, and a decellularization plus photo-oxidation group 15 in each group. To evaluate the physical properties of all the rabbit carotid arteries by testing heat-shrinking temperature, tensile stress and the max elongation of each group. Then by buliding subcutaneous embedding model in SD rats we evaluated the biological stability and the anti-calcification function property of the above rabbit carotid arteries, and the detection means included HE stain, atomic absorption spectrometry and Von-Kossa calcium salt stain.@*RESULTS@#The heat-shrinking temperature, tensile stress and the max elongation in the cryopreservation group were lower or shorter than those of the other groups and the difference had statistical significance (P<0.05). Although the heat-shrinking temperature and the tensile stress in the decellularization plus photo-oxidation group were lower or shorter than those in the glutaraldehyde group (P<0.05), the max elongation in the decellularization plus photo-oxidation group was much longer than that in the glutaraldehyde group (P<0.05). The rabbit carotid artery treated with decellularization plus photo-oxidation showed lower immunogenicity and better biological stability and better anti-calcification property compared with the other groups.@*CONCLUSION@#Decellularization associated with photo-oxidation is a suitable and novel protocol for small caliber artery allograft with a diameter of less than 6 mm which is unbreakable to mechanical properties and conducive to biological stability, which has a broad prospect.

In vitro establishment of a three-dimensional hepatocyte culture system using collagen hydrogel as scaffolds / 中国组织工程研究

BACKGROUND:Rapid loss of liver-specific functions of the cultured hepatocytes limits the development of hepatocyte-based therapies. OBJECTIVE:To establish a three-dimensional culture system based on col agen hydrogel that enables to enhance liver-specific functions for a long period during culture of hepatocytes. METHODS:Hepatocytes were isolated from Sprague-Dawley rats and then encapsulated into liquid type Ⅰcol agen solution that was premixed with hepatocyte growth factor and Dulbecco's modified Eagle’s medium to create hepatocyte/col agen hydrogel compounds. The compounds were inoculated into a 96-wel plate. After gelation, culture medium was added. Light microscope, hematoxylin-eosin staining and transmission electron microscopy were used to examine the morphological characteristics and ultrastructure of the cultured hepatocytes. The cellsupernatant was col ected and tested for albumin secretion and urea synthesis. Periodic acid-schiff staining, immunofluorescence staining and quantitative real-time PCR were also used to further clarify liver-specific phenotype or function of the hepatocytes.RESULTS AND CONCLUSION:(1) Light microscope revealed that hepatocytes were round shape and distributed uniformly in col agen hydrogel. The three-dimensional hepatocyte culture system exhibited similarities to liver-like structure and tight junction were formed between hepatocytes after 14 days of culture. (2) Within the three-dimensional culture system, hepatocytes remained positive for periodic acid-schiff staining, albumin and hepatocyte nuclear factor-4αpositive after 14-day culture, which provided the convincing evidence of highly differentiated primary hepatocytes with functions of glycogen and albumin synthesis. (3) The albumin and urea productions in the three-dimensional culture system had a significantly higher level than in the two-dimensional culture, and could remain at a high level at least for 15 days. (4) The expression levels of hepatocyte-specific genes including Albumin, HNF-4α, Claudin-3, CYP1A1, CYP3A1 and G6P were significantly improved in the three-dimensional culture as compared with the two-dimensional culture. The col agen hydrogel based three-dimensional culture system provides a valuable model to enhance the hepatocyte functional maintenance and lay the foundation for the development of hepatocyte-based therapy for liver disease.

Reparation of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the effect of mitral annuloplasty of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring.@*METHODS@#From March 2009 to December 2011, 32 patients having anterior mitral valve prolapse received mitral annuloplasty with artificial chord and mitral annuloplasty ring in our department, among which 27 simple anterior mitral valve plasty and 5 combine anterior-posterior mitral valve plasty were completed.@*RESULTS@#All patients survived. Postoperative echocardiography showed no or trivial mitral regurgitation in 28 patients and mild mitral regurgitation in the other 4 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) obviously decreased after the operation. During the follow up of 3 months to 3 years, the cardiac function of the patients improved at different degrees.@*CONCLUSION@#Reparation of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring is simple, reliable and effective, and its early to midterm result after the operation proves good.

A new triple-branched aortic arch covered stent graft in DeBakey Type I aortic dissection / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of a new triple-branched aortic arch covered stent graft on DeBakey Type I aortic dissection, and to assess its efficacy in comparison with traditional surgery.@*METHODS@#From January 2010 to November 2010, 38 patients of DeBakey Type I aortic dissection were treated surgically in the Second Xiangya Hospital of Central South University, in which 16 operations used triple-branched aortic arch covered stent grafts (stent graft group, SG group), 22 operations used traditional 4 sides branches aortic arch grafts (arch graft group, AG group).@*RESULTS@#Compared with AG group, the cardiopulmonary bypass time[(138.1± 56.42) vs (179.21± 67.64) min], the clamp time [(98.56±28.08) vs (134.36±46.46) min] and the selective cerebral perfusion time[(27.3±14.76) vs (48.74±18.22) min] in SG group were obviously shortened(P<0.05). The volume of drainage 24 hours after operation in SG group also reduced[(608.93±308.15) vs (899.04±437.79) mL](P<0.05). The SG group had a lower rate of recurrent laryngeal nerve injury (6.25% vs 27.3%) and duration of hospitalization[(16.15±6.68) vs (21.18±12.69) d](P<0.05). During a following-up period of 14 to 24 months,reexamination of aortic CT angiography showed that the triple-branched aortic arch covered stent graft expanded well, and attached to the wall satisfactorily, while the corresponding false lumen of the aortic artery disappeared and the distal false lumen was filled with thrombus. The life quality of patients were good.@*CONCLUSION@#The new triple-branched aortic arch covered stent graft is appropriated for most patients with DeBakey Type I aortic dissection. Its use can simplify the aortic arch procedure,decrease the operation risk and has satisfactory results in early and middle stage after operation.

Reoperative valve surgery after open-heart valve surgery: a report of 155 cases / 中南大学学报(医学版)

OBJECTIVE@#To summarize the characteristics of reoperative valve surgery after previous open-heart valve surgery.@*METHODS@#From 1996 to 2010, 155 patients who underwent reoperative valve surgery, either valve replacement or tricuspid annuloplasty or the repair of perivalvular leakage were included in the study. The reoperative interval was 1-266 (94.82 ± 85.37) months. All surgeries were carried out with extracorporeal circulation under moderated hypothermia. The cardioplegic solution in cold crystal or blood was used if heart beating was stopped during the surgery.@*RESULTS@#The total in-hospital mortality was 5.81%, while it was 2.75% from 2005 to 2010. The end-diastolic dimension, size of atrium and ventricles were reduced after the reoperation. Ventricular arrhythmia and low cardiac output were the most frequent complications.@*CONCLUSION@#The success rate of reoperative valve surgery can be improved by the distinctive therapeutic strategies based on the clinical characteristics and therapy principles obtained from practice experiences.