Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases / 中华外科杂志

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ2=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

Artificial radial head replacement for the treatment of comminuted fractures of the radial head / 中国骨伤

<p><b>OBJECTIVE</b>To assess the clinical effects of artificial radial head prosthesis replacement for the treatment of comminuted fracture of the radial head.</p><p><b>METHODS</b>From June 2011 to June 2015, 25 patients with radial head comminuted fracture were treated with artificial radial head replacement, including 10 males and 15 females, ranging in age form 24 to 61 years old(mean, 40 years old). The functional recovery of the patients suffering from limb and elbow in different periods, the activity degree of the elbow joint and the function of the elbow in the latest follow-up were compared.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 48 months, averaged 26 months. There were no complications such as infection, elbow instability, subluxation of the distal radioulnar joint, and myositis ossificans. The VAS, Broberg and Morrey elbow function score were improved 6, 9 months after operation compared with that 3 months after operation(<0.05). There were significant differences in elbow flexion and extension, rotation activity between injured side and healthy side 3, 6, 9 months after operation(<0.01), but no significant differences between injured side and healthy side at the latest follow-up(>0.05). At the latest follow-up, according to Broberg and Morrey elbow function evaluation criteria, 16 cases got an excellent result, 7 good and 2 poor.</p><p><b>CONCLUSIONS</b>It can maximize the recovery of elbow joint stability and quicken early functional exercise, prevent and reduce the occurrence of complications by using the artificial radial head replacement therapy to repair comminuted fracture of the radial head. The short-term curative effect is satisfactory, but the long-term effect needs further observation.</p>

Down-regulation of fecal miR-143 and miR-145 as potential markers for colorectal cancer

To detect 4 MicroRNA [miRNA] in the stool samples of colorectal cancer [CRC] patients to determine whether these miRNAs could be biomarkers in CRC screening or treatment. A retrospective comparison study was carried out in the Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China from September 2009 to March 2011. We detected 4 miRNAs [miR-143, miR-145, miR-21, and miR-106a] in the stool samples of 38 CRC patients and 13 healthy individuals. Total RNA from the stool samples was extracted using the EZNA TM stool RNA kit R6828-01. The miRNA quantification was carried out using TaqMan miRNA assays and the TaqMan Gene Expression Master Mix. The expression levels of miR-143 and miR-145 in the stool of the CRC patients were lower than in those of the healthy persons [p<0.005, median of 2[-Ct]]. No statistically significant difference was found in the expression levels of both miR-21 and miR-106a between the stool of CRC patients and those of the healthy persons [p>0.05]. The detection of fecal miRNAs is a potential method for CRC diagnosis or screening. Particularly, the down-regulation of fecal miR-143 and miR-145 could be a potential marker for CRC

Hand-assisted laparoscopic versus laparotomy in total proctocolectomy with ileal pouch-anal anastomosis: a clinical controlled study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the outcomes of total proctocolectomy with ileal pouch-anal anastomosis performed by hand-assisted laparoscopic(HALS) and laparotomy.</p><p><b>METHODS</b>Clinical data of 78 patients undergoing HALS(n=36) or laparotomy(n=42) from January 2009 to June 2011 were retrospectively studied. All the operations were performed by the same surgical group. Patients safety, postoperative recovery, complications were compared between the two groups.</p><p><b>RESULTS</b>As compared to laparotomy group, HALS group had longer operative time[(300.3±56.4) min vs. (227.2±34.0) min, P=0.001], less intraoperative bleeding[(150.2±42.2) ml vs. (213.5±61.0) ml, P=0.043], shorter interval to first flatus[(2.4±0.9) d vs. (3.1±1.2) d, P=0.026], and shorter hospital stay[(9.3±2.6) d vs. (11.6±3.4) d, P=0.039]. There were no significant differences in the incidence of complications such as anastomotic separation, hemorrhage, wound infection, pelvic sepsis, and intestinal obstruction between the two groups(P>0.05).</p><p><b>CONCLUSIONS</b>HALS is as safe as open approach for total proctocolectomy with ileal pouch-anal anastomosis, and short-term outcomes are better than laparotomy.</p>

Percutaneous vertebroplasty and kyphoplasty for the treatment of thoracolumbar fractures in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects of percutaneous vertebroplasty and kyphoplasty in the treatment of fresh thoracolumbar fractures in the elderly.</p><p><b>METHODS</b>From May 2004 to March 2009, among 29 patients (32 vertebras) with thoracolumbar fractures, 18 patients (21 vertebras) were treated with percutaneous vertebroplasty (PVP) and 11 patients (11 vertebras) were treated with percutaneous kyphoplasty (PKP). The visual analogue scale (VAS) and mobility were evaluated 3 days before and after operation. During follow-up period, patients were observed and evaluated in terms of relief of back pain and regaining of living ability. Complications such as bone cement leakage were analyzed.</p><p><b>RESULTS</b>All the patients got successful operation. The average operation time was 38.6 minutes for the 18 patients (21 vertebras) with PVP performed, and 3.2 ml (2-5 ml) bone cement was injected. For the 11 patients (11 vertebras) with PKP performed, the average operation time was 43 minutes, and an average of 3.8 ml (2-6 ml) bone cement was injected. The VAS decreased from preoperative (7.5 +/- 0.7) to (2.2 +/- 0.5) at the 3rd day after operation; the mobility scores of the patients decreased from preoperative (2.4 +/- 0.6) to (1.2 +/- 0.3) at the 3rd day after operation; the vertebral height increased from an average of (52.4 +/- 9.7)% pre-operation to (85.2 +/- 10.6)% after operation; and the average kyphosis correction of Cobb angle was 11.2 degrees. During an average of 12.6 months follow-up, no patients reported vertebral pain. Review of X-ray films showed no significant loss of vertebral height. One patient died from complications of heart disease 5 months being discharged from hospital. Another patient died from the same cause at 6 months after opertaion. Paravertebral leakage of bone cement was also found in 2 patients. No serious complications occurred and patients were satisfied with the treatment.</p><p><b>CONCLUSION</b>PVP, PKP can be used to instantly reinforce vertebral injury, relieve pain, and improve the patient's mobility. For elder people with fresh thoracolumbar fractures, when health conditions are allowed, PVP or PKP surgery is the right treatment.</p>