Application of skeletonized bilateral internal mammary artery to coronary artery bypass grafting / 中国胸心血管外科临床杂志

@#Objective    To evaluate short-term clinical outcomes of skeletonized bilateral internal mammary artery (sBIMA) in coronary artery bypass grafting (CABG). Methods    The clinical data of 62 patients (54 males and 8 females with an average age of 56.8±6.0 years) undergoing isolated CABG using sBIMA in our hospital from October 2016 to May 2017 were retrospectively analyzed. The coronary graft flow, perioperative clinical outcomes and CT results were reviewed. Results    All the operations were carried out under extracorporeal circulation. Anastomosis of 124 internal mammary arteries was performed and 116 great saphenous veins were used simultaneously with an average anastomosis site of 4.5±0.8 for each patient. The cardiopulmonary bypass time was 116.4±22.9 min, aortic clamping time was 83.0±18.3 min, mechanical ventilation time was 20.8±21.3 h and ICU stay was 2.7±1.7 d. The graft flow of left internal mammary artery (LIMA), right internal mammary artery (RIMA) and great saphenous vein were 28.8±12.4 mL/min, 32.8±13.8 mL/min and 41.5±21.5 mL/min, respectively. There was no significant difference in the graft flow between LIMA and RIMA (P=0.112). There was no perioperative mortality, myocardial infarction or cerebrovascular accident. Only one male patient suffered sternal complication and poor wound healing and then received debridement as well as suturing. Coronary CT angiography showed that distal anastomosis of 7 vein grafts and 5 artery grafts was demonstrated shallow and 1 vein graft was undemonstrated, suggesting occlusion. Conclusion    CABG with sBIMA is a safe and reliable technique with excellent early results.

Outcome of video-assisted thoracoscopic bipolar epicardial radiofrequency ablation for paroxysmal atrial fibrillation / 中华胸心血管外科杂志

Objective This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic bipolar radio-frequency ablation in the treatment of isolated paroxysmal atrial fibrillation.Methods From September 2010 to December 2016,Seventy-two consecutive patients with paroxysmal atrial fibrillation underwent video-assisted thoracoscopic bipolar radio-frequency ablation at Fuwai Hospital.There were 50 males and 22 females with an average age of(56.5 ± 10.5) years and duration of atrial fibrillation with (6.5 ± 4.8) years.45 patients had previous catheter ablation.The patients were followed up at postoperative 3 months,6 months,1 year and annually.Success of ablation was defined as sinus rhythm and no duration of ≥30 s for rapid atrial arrhythmias,including atrial fibrillation,atrial flutter or atrial tachycardia in 24 h Holter examination.Univariate and multivariate logistic regression models were used to analyze the risk factors for atrial fibrillation recurrence.Results One patient converted to sternotomy due to bleeding on operation.All patients were successfully discharged.69 patients completed follow-up,with an average follow-up of(28 ± 18)months(3-60 months).The overall success rate was 73.9％,and the success rate without antiarrhythmic drug was 62.3％.Subgroup analysis showed that the success rate was 80％ when left atrial anterior and posterior diameter(LAD) ≤40 mm,and 57.9％ when LAD ＞ 40 mm (P =0.035).Multivariate logistic regression analysis showed that LAD ＞40 mm was an independent risk factor for postoperative recurrence of atrial fibrillation.Conclusion Video-assisted thoracoscopic bipolar radiofrequency ablation is a safe and effective method for the treatment of paroxysmal atrial fibrillation,especially in patients with LAD≤40 mm.

Effect of CTP guided thrombolytic therapy in the treatment of acute cerebral infarction / 天津医药

Objective To investigate the effect of CT perfusion (CTP) imaging guidance in the treatment of acute cere?bral infarction. Methods Patients (n=200) with acute cerebral infarction who visited our clinic within 6 hours underwent CTP examination and were divided into two groups:penumbra group and non-penumbra group according to their CTP imag?ing (presence of penumbra or not). Recombinant tissue plasminogen activator (rt- PA) was administrated for intravenous thrombolysis in both groups. NIHSS (The NIH Stroke Scale), BI (Barthel Index), mRS (modified Rankin Scores) and hemor?rhagic transformation events of two groups were determined before and after thrombolysis to evaluate its effect and prognosis in these two group. Results Compared with non penumbra group, NIHSS was reduced in penumbra group from 7 days after rt-PA (6.67±3.46 vs 4.76±2.04), and this decrease became obvious at 4 weeks after rt-PA (6.67±3.46 vs 3.68±1.93). Effi?ciency rate at 4 week (60.3%) and good prognosis rate at 3 months(71.7%)were both significantly improved in penumbra group than those in non penumbra group(34.7%,56.8%). Conclusion rt-PA under CTP guidance is effective and safe in the treatment of acute cerebral infarction. The thrombolytic therapy window can be enlarged according to the presence of pen?umbra or not and the bleeding conversion rate remains at low level.

MR diffusion tensor imaging of optic nerve in patients with primary chronic angle-closure glaucoma / 中华放射学杂志

ObjectiveTo investigate the value of MR diffusion tensor imaging (DTI) of optic nerve in the estimation of optic nerve changes of primary chronic angle-closure glaucoma (PCACG).Methods Twenty-five patients with PCACG including monocular involvement in 4 patients and binocular involvement in 21 patients and involving 46 eyes in which 24 right eyes and 22 1eft eyes,and 20 normal volunteers were enrolled.Conventional MRI and DTI were performed on all subjects using Magnetom Tim 3.0 T MRI.Fractional anisotropy( FA),mean diffusivity ( MD),axial diffusivities ( λ ∥ ) and radial diffusivities ( λ ⊥ )were measured and then compared between patients group and control group and between left eyes and right eyes.Two independent samples t-test and paired t-test were used.ResultsOn conventional MRI,thinner optic nerve with vaginal cavity widened slightly was found in 8 optic nerves of 6 patients.The value of FA,λ∥,λ⊥ and MD of 24 right optic nerves in patient group was(0.27 ± 0.09) × 10-3,(2.30 ±0.26) × 10 - 3,( 1.55 ± 0.35 ) × 10 - 3,and ( 1.80 ± 0.31 ) × 10 - 3 mm2/s respectively and that of 22 left optic nerves was (0.24 ± 0.09) × 10-3,(2.25 ± 0.41) × 10-3,(1.61 ± 0.46) × 10-3,and (1.82 ±0.47) × 10-3mm2/s respectively.The FA of optic nerve in patient group was lower than that of control group (P ＜0.05 ),while the meanλ∥,λ ⊥ and MD values was obviously higher than control group (P ＜ 0.05).There was no significant difference between right and left optic nerves in patient gro up ( P ＞0.05).ConclusionsDTI could detect abnormality and provide information about the pathological process of optic nerve in patients with PCACG.

Comparative Study on the Changes of DTI and DTT of Optic Radiation and the Defect of Visual Field / 实用放射学杂志

Objective To study the relationship between the changes of diffusion tensor imaging(DTI)and diffusion tensor tractography(DTT)of optic radiation and the defect of visual field.Methods DTI and DTT were performed in 37 patients with invasion of the optic radiation by intracranial lesions and in 20 normal control group at 3.0T MR scanner,the visual fields of all cases were examined.The relativity between FA values,ADC values and mean sensitivity(MS)values,mean defect(MD)values of visual field and the relativity between the morphological change of optic radiation and the defect of visual field were analysed.Results In comparison with control group,FA values decreased and ADC values increased in subject group,there were statistically significant differences(P＜0.001)between them.In disordered group,FA values were positive correlation with MS values(r=0.718)and negative correlation with MD values(r=-0.694);ADC values were negative correlation with MS values(r=-0.625)and positive correlation with MD values(r=0.538).DTT showed that the ventral tracts of optic radiation were damaged which oppeared as the defect of ditto quadrant of bilateral field vision in 9 cases,the dorsal tracts and the lateral tracts of optic radiation were damaged which appeared as the defect of inferior quadrant of bilateral field vision in 7 cases,the optic radiations were damaged extensively that caused symmetric or asymmetric congruous hemianopia of bilateral field vision in 21 cases.Conclusion DTI and DTT of optic radiation are intimately correlated with the examined results of visual field,it will be a objective index to extimate the function and the morphological changes of optic radiation.

Complete transposition of the great arteries with severe pulmonary hypertension increses late mortality after artery switch operation / 中华胸心血管外科杂志

Objective The postoperative outcomes of transposition of the great arteries with severe pulmonary hypertension (PH) are still controversial. Based on relative large data, we evaluated the relationship between preoperative pulmonary hypertension and postoperative early and midterm clinical outcomes. Methods In this retrospective study, a cohort of consecutive patients with TGA was studied. One hundred and one patients underwent artery switch operation between February 2004 and October 2007. Preoperative medical records were reviewed. The mean follow-up period was 22.6 months. All artery switch operations were performed through a median sternotomy utilizing extracorporeal circulation. Deep hypothermia and circulatory arrest were used in 6 patients. After sternotomy, pulmonary arterial pressure was measured directly. According preoperative mean pulmonary pressure ( mPAP), patients were divided into three groups: normal group ( mPAP ＜25mmHg, n =43), moderate PH group ( mPAP between 25 to 50mmHg, n = 47) and severe PH group ( mPAP ≥50mmHg, n = 11 ). The methods of coronary anastomosis were "open trap door" ( 39 cases), "bay window" (61 cases) and "pulmonary artery tunnel" ( 1 case)techniques. Besides repairing of atrial septal defect and ventricular septal defect, ligation of patent ductus arteriosus, concomitsnt operations also involved mitral valvuloplasty (5 patients), tricuspid valvuloplasty (2 patients), pulmonary valvuloplasty (5 patients), pulmonary artery transplantation ( 1 patient ), subvalvular membrane resection ( 2 patients), widening of the right ventricular outflow tract ( 1 patient ) and collateral circulation occlusion ( 1 patient). The early and late postoperative results were compared among different groups. Results After operation, mPAP in severe PH group decreased from (61.2 ± 8.6 ) mmHg to ( 34.6 ± 13.6 ) mmHg( P ＜ 0.01 ). In moderate PH group it decreased from ( 34.5 ± 6.7 ) mmHg to ( 21.3 ± 5.6) mmHg( P ＜ 0.0l ). mPAP was not significantly changed in the control group. Operative mortality was 7.9% ( 8 patients ).The causes of early death were low output syndrome in 3 patients, septicemia in 4, central nervous system complications in 1.There was no difference in the postoperative complication rates among three groups. Also, no significant differences were found between groups regarding the early operative mortality (control group: 7.0%, moderate PH group: 8.5%, severe PH group:9.1%, P = 0.953 ). Combined abnormity contributed to postoperative death. Patients with ventricular septal defect and patent ductus arteriosus had a higher mortality rate. During follow-up 8 patients died: 5 in control group ( 11.6% ), 5 in moderate PH group ( 10.6% ) and 6 in severe PH group (54.5% ), P ＜ 0.01. Causes of midterm death were sudden death in 10, progressive heart failure in 4, pneumonia in 2. The rates of midterm mortality of the three groups were significantly different ( 11.6%,10.6% and 54.5% for control, moderate PH and severe PH group, respectively, P = 0.001 ). Kaplan-Meier survival analysis for patients with different age groups showed that survival rate in group with age older than 1 year was lower ( P = 0.029 ).Conclusion In TGA/PH patients, mPAP lower than 50 mmHg is suitable for artery switch operation and can get satisfying postoperative outcomes. If mPAP higher than 50 mmHg, even though the operation may decrease the pulmonary pressure, radical artery switch operation should not be recommended because of higher late mortality.

Matrix Metalloproteinases and Hemorrhagic Transformation / 国际脑血管病杂志

Thrombolysis can effectively treat ischemic stroke, but it has the risk of resulting in hemorrhagic transformation. A number of studies have suggested that hemorrhagic transforma-tion is closely correlated with matrix metalloproteinase mediated disruption of blood-brain barrier and the increase of vasopermeability. The increase plasma matrix metalloproteinase(MMP) -9 can be used as an independent predictor of hemorrhagic transformation. Using MMP inhibitors during the early cerebral ischemia may reduce the incidence and severity of hemor-rhagic transformation, however, it needs to be further validated.

TNEAK-Fn14 Pathway and Central Nervous System / 国际脑血管病杂志

Tumor necrosis factor-like weak inducer of apoptosis(TWEAK)is a new member of the tumor necrosis factor family.After TWEAK binding to its receptor Fn14.it induces extensive biological activities.TWEAK-Fn14 pathway participates in pathophysiological mechanisms of cell apoptosis,regulation of the blood-brain barrier permeability and inflammation in central nervous system,and it is closely correlated with the diseases such as ischernic stroke.multiple sclerosis and gliocytoma.

The Roles of Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand and Its Receptors in Central Nervous System Diseases / 国际脑血管病杂志

Tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)is the third member of the tumor necrosis factor(TNF)superfamily.It has received much concern because of its selective killing effect on tumor cells and virus infected cells.However,the subsequent studies have suggested that TRAIL also induces normal cells,such as the death of neurons and oligodendrocytes.TRAIL is associated with a variety of central nervous system diseases including primary brain tumor,multipie sclerosis and ischemic stroke.