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Objective To summarize seven-year experience in therapy for acute aortic syndrome.Methods Between May 2009 and June 2016,103 patients(75 males and 28 females)diagnosed as acute aortic syndrome underwent operation. The mean age was(43.13 ±15.07)years(20 -79 years).We applied hypothermic circulatory arrest and selective antegrade cerebral perfusion to achieve organic protection.92 patients underwent Sun's procedure.Bentall procedure was performed on 63 patients.9 patients accepted aortic valve repair or root plasty.Mitral valve was replaced in 5 patients.Right coronary artery bypass grafting was carried out on 3 patients.Results Mean cardiopulmonary bypass time was(231.7 ±55.9)min, and cross-clamp time was(138.1 ±31.3)min.Selective cerebral perfusion time was(31.0 ±6.8)min.9 patients died within postoperative 30-days.Conclusion Despite of progression of treatment on acute aortic syndrome, further researches are still required for severe complications and strategies of therapy.
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Objective: To analyze the risk factors of acute kidney injury (AKI) after isolated heart valve prosthesis implantation (HVPI) in relevant patients. Methods: We retrospectively studied 400 patients who received isolated HVPI in our hospital. The demographic characteristics and pre-, intra-, post-operative information were collected to conduct uni- and multi-variantanalysis. Results: The pre-operative serum creatinine level in 400 patients was 85.0 (72.0, 98.0) μmol/L and post-operative level was 104.5 (80.0, 146.3) μmol/L, the elevation was 20.9% (1.6%, 57.9%),P50years (OR=2.12, 95% CI 1.13-3.95),hypertension history (OR=4.07, 95% CI1.23-13.47), cardiopulmonary bypass time>180 minutes (OR=5.38, 95% CI 1.63-17.77), post-operative hemoglobin100 u/L (OR=12.10, 95% CI 2.28-64.23), pleural fluid drainage at the day of operation> 500 ml (OR=2.12, 95% CI 1.13-3.95), extubation after 24 hours of operation (OR=3.94, 95% CI 2.07-7.52), combining low cardiac output syndrome (OR=4.64, 95% CI 1.06-20.29) were the independent risk factors for AKI occurrence in patients after HVPI, allP<0.05. Conclusion: Post-HVPI AKI was associated with many factors. At prior operation, it was mainly related to the age and hypertension; during theoperation, it was mainly related to cardiopulmonary bypass time; at post-operation, it was mainly related to delayed extubation, low cardiac outputsyndrome, anemia, increased pleural lfuid drainage and serum glutamic-pyruvic transaminase.
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Objective To observe the expression of Caspase-12 and GRP78 of endoplasmic reticulum stress (ERS) in cardiac arrest and beating heart mitral valve replacement Methods Thirty patients with rheumatic heart disease mitral stenosis were randomly divided into beating heart group (BH,n=15) and cardiac arrest group(CA, n = 15). Both groups accepted MVR by beating heart surgery and cardiac arrest surgery under cardiopulmonary bypass (CPB) respectively. Right atrial myocardial tissues were collected at prior the start of CPB (T0), after aortic cross-clamping 30 minutes (BH group 30 minutes after CPB, T1) and stitched right atrium (T2) respectively. The method of reverse transcriptase polymerase chain reaction (RT-PCR) was applied to detect the expression level of Caspase-12 and GRP78 in two groups and positive staining of Caspase-12 and GRP78 of myocardial tissue slices in both groups was observed by immunohistochemical method. Results The expression of Caspase-12 in CA group heightened at T1and significantly increased at T2 (P < 0.05) but the expression of Caspase-12 in BH group had increased in T2 only (P < 0.05). Caspase-12 in CA group expressed higher than that in BH group at T1 and T2. The expression of GRP78 had increased at T1 in two groups but it in CA group expressed higher than that inBH group at T2. The number of positive staining of Caspase-12 and GRP78 in CA group was higher than that in BH group at T2. Conclusion MVR of beating heart can reduce the reaction of ERS to enhance the myocardial protection under CPB.
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Objective To investigate the effect of L-carnitine (LCN) on heart function following myocardial contusion in mongrel dogs.Methods Twenty-four male mongrel dogs were randomly divided into myocardial contusion group,low dose LCN group (LCN1 group),and high dose LCN group (LCN2 group) with 8 dogs per group,according to the random number table.The model of myocardial contusion was established in all groups.LCN1 and LCN2 groups were respectively treated with 100 mg/kg and 200 mg/kg LCN for three consecutive days before the injury and afterward.Left ventricular systolic pressure (LVSP),left ventricular end diastolic pressure (LVEDP),left ventricular ± dp/dt were recorded 30 min before injury,and 30 min,1 h,2 h,4 h as well as 6 h after injury.Blood samples were withdrawn from femoral vein to detect the levels of creatine kinase isozyme (CK-MB),cardiac troponin I (cTnI),and malondialdehyde (MDA).Wall motion score index (WMSI) was observed using the ultrasound examination 1 day before and 5 hours after injury.Myocardial tissue was available at 6 hours after injury for the examination of content of adenosine triphosphate (ATP).Results LVSP and ± dp/dtmax appeared a downward trend after injury,while a gradual increase in LVEDP.And the changes were relatively smaller with LCN intervention,especially in LCN2 group.Levels of CK-MB,cTnI and MDA increased after injury,but the same time point showed lower levels in LCN groups (especially in LCN2 group) as compared to myocardial contusion group (P ＜ 0.05).WMSI increased 5 hours after the injury,but the increase was higher in myocardial contusion group (2.46 ±0.31) than that in LCN1 group (1.91 ± 0.23) and LCN2 group (1.85 ± 0.25) (P ＜ 0.05).There was no significant difference in WMSI between the two LCN groups (P ＞ 0.05).Level of ATP in myocardial contusion group was (11.3 ± 1.6) μg/g,which was improved after LCN intervention (P ＜ 0.05),and the improvement was much higherin LCN2 group than in LCN1 group[(21.3±3.9) ug/g vs (15.7±2.8)ug/g] (P＜0.05).Conclusion LCN can alleviate the adverse effect of myocardial contusion on cardiac function in mongrel dogs,which may be associated with the reduced energy imbalance induced by LCN.
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BACKGROUND:Changes in the parameters of lumbar spine bone structure are direct reaction of morphological changes in lower lumbar spine bone structure. These changes possibly result from normal structure strain of the spine affected by long-term external or internal factors. Whether the conditions reflected by different parameters are identical, and whether corresponding clinical symptoms are correlative stil deserves further exploration. OBJECTIVE:To measure and compare the construction parameters of lumbar spine bone structure in lower lumbar disc herniation patients, and to investigate whether abnormalities of lumbar bony structure could lead to lower lumbar disc herniation and to evaluate the significance in degenerative lumbar disc. METHODS:From March 2008 to March 2010, 207 cases of lower lumbar disc herniation were randomly selected from the Department of Orthopedics, First Affiliated Hospital, Fuzhou General Hospital, Nanjing Military Area Command of Chinese PLA. They received CT examination at the Department of Radiology at the same period, and results revealed that 143 cases of lower lumbar disc non-herniation served as control group. According to gender, they were divided into male and female groups. According to ages, they were divided into 25-34 group, 35-44 group, 45-54 group and 55-65 group. They were studied by measuring spinous process deflection angle, facet joint angle, lumbar vertebrae curvature, angle of lumbar vertebrae curvature, lumbosacral angle. RESULTS AND CONCLUSION:Process deflection angle at L 4 and L 5 levels had a significant statistical difference between the lower lumbar disc herniation group and the control group. The date did not show normal distribution. Using Rank sum test, it had a significant statistical difference (Z=-10.609,-12.074, P0.05). There only was significant difference on lumbosacral angle between male group and female group (P=0.007<0.01). There was significant difference on the facet asymmetry, lumbar vertebrae curvature, angle of lumbar vertebrae curvature and lumbosacral angle between 55-65 age group and 25-34 age group or 35-44 age group (P<0.01), and there was significant difference between 45-54 age group and 25-34 age group (P<0.01). These data suggested that the abnormalities of lumbar bony structure could not directly lead to the lumbar disc herniation, but the abnormalities of lumbar bony structure aggravate the lumbar intervertebral disc degeneration.
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BACKGROUND:Primary dislocation after total hip arthroplasty is a major complication, besides prosthesis loosening. It is controversial whether joint capsule and external rotators should be repaired during total hip arthroplasty through posterolateral approach. OBJECTIVE:To explore the clinical significance of joint capsule and external rotator repair on preventing hip dislocation after primary total hip arthroplasty through posterolateral approach. METHODClinical data of patients with primary or secondary hip osteoarthritis after primary total hip arthroplasty through posterolateral approach were retrospectively analyzed. They were assigned to two groups according to different strategies of soft tissue repair. Control group did not receive posterior soft tissue repair. Combined repair group received the repair of joint capsule and short external rotators. Al patients were fol owed up for more than 1 year. Early dislocation was defined as the dislocation occurred within 1 year after operation. The effects of different repair methods on early dislocation rate were compared. RESULTS AND CONCLUSION:There were 362 patients. Total y 390 case-times of primary total hip arthroplasty were included. Early dislocation occurred in 7 cases, of which 6 case-times in the control group (2.2%, 6/268), and 1 case-time in the repair group (0.8%, 1/122). There were significant differences in the incidence rate of early dislocation between the repair group and control group (P=0.012). These findings confirmed that the combined repair of posterior joint capsule and short external rotators could decrease the rate of early dislocation after primary total hip arthroplasty through posterolateral approach.
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OBJECTIVE@#To explore the clinicopathologic and molecular characteristics of hereditary nonpolyposis colorectal cancer (HNPCC), and to improve the level of diagnosis and treatments of HNPCC.@*METHODS@#Thirty HNPCC patients (HNPCC group) who were treated in Xiangya Hospital were retrospectively analyzed, and 25 patients with sporadic colorectal cancer in the same duration were randomly chosen as a control group. The onset of age, location of tumor, pathological type, treatment method, and prognosis were compared in the 2 groups. The expression loss rate of mismatch repair gene (MMR) MLH1 and MSH2 in the 2 groups was detected by immunohistochemistry.@*RESULTS@#The onset age in the HNPCC group was earlier than that in the control group (P0.05).@*CONCLUSION@#HNPCC patients are characterized with early onset associating with multiple tumors. The accuracy of diagnosis can be improved by combining the detection of MMR gene. Optimal surgical treatment and close follow-up may bring good result to HNPCC patients.
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Aged , Female , Humans , Male , Middle Aged , Adaptor Proteins, Signal Transducing , Genetics , Metabolism , Adenocarcinoma , Diagnosis , Genetics , Pathology , General Surgery , Case-Control Studies , Colorectal Neoplasms, Hereditary Nonpolyposis , Diagnosis , Genetics , Pathology , General Surgery , Endometrial Neoplasms , Pathology , MutL Protein Homolog 1 , MutS Homolog 2 Protein , Genetics , Metabolism , Mutation , Neoplasms, Second Primary , Pathology , Nuclear Proteins , Genetics , Metabolism , Retrospective StudiesABSTRACT
[Objective]To provide microsurgery anatomical data for the surgical operation in treating of extreme lateral lumbar dsic herniation through the observations of the regional anatomic structure about the post-median approach tolateral vetebral lamina(PMALVL).[Method]Thicknesses of intertransverse ligament,the distribution of anterior branches of lumbar nerve and vessel were measured at the adult cadavas specimens.Retrospectively analyzed with 12 cases of extreme lateral lumbar disc herniation from January 2004 to January 2006,including 7 cases were treated by the lateral approach to the vertebral lamina,5 cases treated by PMALVL.[Result]The thickness of intertransverse lingament is 0.6~1.3 mm.More than 90 percent of anterior branches of lumbar segmental arteries and the accompanying veins from L_3 to S_1 were located ventrally in the superior portion of the intertransverse ligament.A branch from Lumbar artery permanently locates in the hfiddle of post-lateral intertransverse ligament.The angle between the anterior branch of Lumbar nerve root and midline sagittal plane is 18.9?~39.2?.The distance from the root of the tranverse to the anterior branch of lumbar nerve root and from the lateral margin of the pars interarticul aris to the anterior branch of lumbar nerve root(5.6~8.0)mm and(1.7~3.6)mm respectively.The period of follow up in 12 cases was from 3 months to 24 months,with an average of 10 months.The resultwas excellentin 8 cases,good in 3 cases,total fine rate according the classification of Nakal was 91.67%.[Conclusion]Intertransvarse ligament is a reliable landmark for PMALVL and treating extreme lateral lumbar disc herniation through PMALVL may get microtraumatic and excellent effect.