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Objective: To evaluate the long-term efficacy and safety of the implantable ventricular assist system EVAHEART I in clinical use. Methods: Fifteen consecutive patients with end-stage heart failure who received left ventricular assist device therapy in Fuwai Hospital from January 2018 to December 2021 were enrolled in this study, their clinical data were retrospectively analyzed. Cardiac function, liver and kidney function, New York Heart Association (NYHA) classification, 6-minute walk distance and quality of life were evaluated before implantation and at 1, 6, 12, 24 and 36 months after device implantation. Drive cable infection, hemolysis, cerebrovascular events, mechanical failure, abnormally high-power consumption and abnormal pump flow were recorded during follow up. Results: All 15 patients were male, mean average age was (43.0±7.5) years, including 11 cases of dilated cardiomyopathy, 2 cases of ischemic cardiomyopathy, and 2 cases of valvular heart disease. All patients were hemodynamically stable on more than one intravenous vasoactive drugs, and 3 patients were supported by preoperative intra aortic balloon pump (IABP). Compared with before device implantation, left ventricular end-diastolic dimension (LVEDD) was significantly decreased ((80.93±6.69) mm vs. (63.73±6.31) mm, P<0.05), brain natriuretic peptide (BNP), total bilirubin and creatinine were also significantly decreased ((3 544.85±1 723.77) ng/L vs. (770.80±406.39) ng/L; (21.28±10.51) μmol/L vs. (17.39±7.68) μmol/L; (95.82±34.88) μmol/L vs. (77.32±43.81) μmol/L; P<0.05) at 1 week after device implantation. All patients in this group were in NYHA class Ⅳ before implantation, and 9 patients could recover to NYHA class Ⅲ, 3 to class Ⅱ, and 3 to class Ⅰ at 1 month after operation. All patients recovered to class Ⅰ-Ⅱ at 6 months after operation. The 6-minute walk distance, total quality of life and visual analogue scale were significantly increased and improved at 1 month after implantation compared with those before operation (P<0.05). All patients were implanted with EVAHEART I at speeds between 1 700-1 950 rpm, flow rates between 3.2-4.5 L/min, power consumption of 3-9 W. The 1-year, 2-year, and 3-year survival rates were 100%, 87%, and 80%, respectively. Three patients died of multiple organ failure at 412, 610, and 872 d after surgery, respectively. During long-term device carrying, 3 patients developed drive cable infection on 170, 220, and 475 d after surgery, respectively, and were cured by dressing change. One patient underwent heart transplantation at 155 d after surgery due to bacteremia. Three patients developed transient ischemic attack and 1 patient developed hemorrhagic stroke events, all cured without sequelae. Conclusion: EVAHEART I implantable left heart assist system can effectively treat critically ill patients with end-stage heart failure, can be carried for long-term life and significantly improve the survival rate, with clear clinical efficacy.
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Humans , Male , Adult , Middle Aged , Female , Heart Failure/complications , Follow-Up Studies , Retrospective Studies , Heart-Assist Devices , Quality of LifeABSTRACT
The twenty-first century has already recorded more than ten major epidemics or pandemics of viral disease, including the devastating COVID-19. Novel effective antivirals with broad-spectrum coverage are urgently needed. Herein, we reported a novel broad-spectrum antiviral compound PAC5. Oral administration of PAC5 eliminated HBV cccDNA and reduced the large antigen load in distinct mouse models of HBV infection. Strikingly, oral administration of PAC5 in a hamster model of SARS-CoV-2 omicron (BA.1) infection significantly decreases viral loads and attenuates lung inflammation. Mechanistically, PAC5 binds to a pocket near Asp49 in the RNA recognition motif of hnRNPA2B1. PAC5-bound hnRNPA2B1 is extensively activated and translocated to the cytoplasm where it initiates the TBK1-IRF3 pathway, leading to the production of type I IFNs with antiviral activity. Our results indicate that PAC5 is a novel small-molecule agonist of hnRNPA2B1, which may have a role in dealing with emerging infectious diseases now and in the future.
Subject(s)
Animals , Mice , Antiviral Agents/pharmacology , COVID-19 , Hepatitis B virus , Interferon Type I/metabolism , SARS-CoV-2/drug effects , Heterogeneous-Nuclear Ribonucleoprotein Group A-B/antagonists & inhibitorsABSTRACT
Autoimmune disease is a disease caused by the body's immune system being misdirected to attack the host itself. Patients with this type of diseases are in poor general condition, and are affected by vascular and skin tissue lesions, and therapeutic drugs. Once the skin is broken, chronic wounds that do not heal could easily develop. This type of wounds is difficult to treat and requires joint diagnosis and treatment of multidisciplinary physicians. Therefore, this article reviews the advances on research and treatment of autoimmune disease-related chronic wounds in order to provide reference for their clinical treatment.
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Humans , Autoimmune Diseases/therapy , Skin , Skin Diseases/therapy , Wound HealingABSTRACT
Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.
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Objective To evaluate the application value of abbreviated comprehensive geriatric assessment(aCGA)in elderly female breast cancer patients. Methods Eight aspects of the traditional CGA were simplified to form the aCGA assessment table,based on which the patients were classified into three grades of A,B and C according to the total scores.This study enrolled the elderly female patients with breast cancer aged 70 years and above who were treated in PUMC Hospital from June 2018 to January 2020.Eastern Cooperative Oncology Group(ECOG)scoring and aCGA grading were performed respectively,and the results of the two methods were compared. Results Of the 162 patients,111(68.5%)were classified by the aGGA method as grade A,43(26.5%)as grade B,and 8(5.0%)as grade C;131(80.9%)cases have concurrent diseases,and the most common complications were hypertension(
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Aged , Female , Humans , Breast Neoplasms , Geriatric AssessmentABSTRACT
OBJECTIVE: To investigate the feasibility of abdominal surgical resection of intracardiac leiomyomatosis.METHODS: The clinical data of 4 cases of intracardiac leiomyomatosis performed in zhongshan Hospital,Fudan University from December 2015 to August 2017 were analyzed retrospectively. RESULTS: Four patients underwent onestage surgery through an abdominal approach,without death. The operative time was 185-420(315.3 ± 86.4) min.Extracorporeal circulation time was 22-175(71.8±60.4)min and blood loss was 600-3000(1475.0±941.7)mL. Acute renal failure occurred in one of the patients after operation,the rest had no surgical complications. After 8-26 months of follow-up,there was no sign of recurrence and metastasis. CONCLUSION: One-stage surgery of intracardiac leiomyomatosis through an abdominal approach is feasible. But,how to determine the indications of surgery remains to be further explored and studied.
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Objective · To investigate the effect of hyperthermic intraperitoneal chemotherapy on postoperative gastrointestinal function recovery in patients with gastrointestinal cancer. Methods · Sixty-two cases of gastrointestinal cancer patients were enrolled who accepted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, from July 2014 to June 2017. The gastrointestinal function of patients were evaluated according to the I-FEED scoring system. The patients were divided into normal recovery group (I-FEED score＜6, n=38) and delayed recovery group (I-FEED score ≥ 6, n=24). Univariate and multivariate Logistic analyses were performed on characteristic factors that may affect the recovery of postoperative gastrointestinal function including gender, age, presence of diabetes, preoperative albumin, and so on. Results · There were significantly differences in the preoperative serum albumin level (P=0.040), intraoperative bleeding (P=0.044), the time of extraction of the peritoneal cavity drainage tube (P=0.026), the time of urethral tube extraction (P=0.021) and the time of hospitalization (P=0.017) in the two groups of patients with normal or delayed gastrointestinal function recovery. Multivariate Logistic regression results suggested that preoperative serum albumin level may be beneficial for the recovery of postoperative gastrointestinal function (OR=0.84, 95％ CI 0.17-4.27, P=0.041).Conclusion · The preoperative serum albumin level can be used as an independent predictor of postoperative gastrointestinal functional recovery in patients with gastrointestinal cancer after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.
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@#AIM:To analyze and compare the influence of different injury sites and injury types on surgical repair of canalicular laceration.<p>METHODS: A retrospective study was conducted on 87 cases(87 eyes)of traumatic canalicular laceration from January 2016 to August 2017, who were treated with silicone lacrimal drainage tube implantation. Lacrimal irrigation were performed 3mo and 6mo after surgery, and their respective operation results were evaluated. 3mo after surgery, lacrimal drainage tube were removed. Statisical analysis was proceeded on injury types, distances as well as the success rate of lacrimal passage irrigation.<p>RESULTS: Among the 87 cases of canalicular laceration, 29 eyes(33%)were in the PCL(proximal canalicular laceration)group, 41 eyes(47%)were in the MCL(medial canalicular laceration)group, and 17 eyes(20%)were in the DCL(distal canalicular laceration)group. There were 22 eyes(25%)of lacrimal canaliculi fracture caused by sharp instrument injury, including 18 eyes in the PCL group, 2 eyes in the MCL group and 2 eyes in the DCL group. There were 65 eyes(75%)of lacrimal canaliculi fracture caused by blunt trauma or collision, including 11 eyes in the PCL group, 39 eyes in the MCL group and 15 eyes in the DCL group. Six months after surgery, 72 eyes of lacrimal passage irrigation were successful, including 20 eyes in the PCL group, 36 eyes in the MCL group, and 16 eyes in the DCL group. The success rate of postoperative anatomic reduction in the three groups was 69%、88%、94%, respectively(<i>P</i>=0.047). There were 19 eyes of acute injury and 53 eyes of blunt injury with successful lacrimal duct irrigation respectively. The success rate of anatomical reduction was 86%、82%(<i>P</i>=0.605), respectively.<p>CONCLUSION: The canalicular laceration closed to lacrimal punctum is more vulnerable to cutting injury, while the canalicular laceration, which is near the lacrimal sac or between the lacrimal sac and center part of lacrimal punctum, can be more likely caused by lacerated wound. The success rate after operation is higher for patients with distal or medial canalicular laceration, and lower for those who with blunt wound location near the lacrimal punctum.
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AIM To observe the endometrium receptivity of polycystic ovary syndrome patients and research advance of expression of HOXA10 in endometrium.METHODS Eighty PCOS patients were divided into treatment group and control group,40 persons in each group randomly.The control group was treated with clomiphene (CC) + human menopausal gonadotropin (HMG) + human chorionic gonadotropin (HCG),and the treatment group was treated with CC + HMG + HCG + Yin-Nourishing Yang-Supplementing.After 3 periods,take a record for below:endometrial thickness (Em) in the middle,advanced stage and mid-secretory phase of hyperplasia endometrii,the levels of spiral artery PI/RI in midluteum endometrium,the levels in serum of E2 and P in midluteum endometrium,the expression of HOXA10 mRNA from both groups,clinical pregnancy rate and abortion rate for each group.RESULTS Compared with the control group,endometrial thickness in the treatment group was increased and there is statistical difference in the middle and late follicle phases (P ＜ 0.05),but there was no statistical difference in midluteum endometrium (P ＞ 0.05);the level of E2 and P in the treatment group were raised (P ＜0.05) with statistical significance;PI and RI were obviously contracted (P ＜ 0.01).Expression of HOXA10 mRNA was increased (P ＜ 0.01).Compared with the control group,the treatment group had a significant difference in pregnancy rate (P ＜ 0.05).The abortion rate was lower,but there was no statistical significance (P ＞ 0.05).CONCLUSION Yin-Nourishing Yang-Supplementing Treatment can obtain higher pregnancy rate and lower abortion rate of PCOS patients and the mechanism might be associated with raising the expression of HOXA10 mRNA and reducing spiral artery PI/RI,also improving the function of corpus luteum treatment,then to improve the receptivity of endometrium.Yin-Nourishing Yang-Supplementing Treatment is well worth popularizing in further clinical application.
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<p><b>OBJECTIVE</b>To study the effects of soybean products consumption on the risk of gastric cancer.</p><p><b>METHODS</b>Literatures published in English and Chinese reporting the relationship between soybean product consumption and gastric cancer from 1988 to 2008 were searched in this study. Fifty-three relevant articles were selected and 28 of them met the criteria. Meta-analysis was applied to estimate the combined odds ratio (OR) and 95% confidence interval (95%CI) between soybean product consumption and gastric cancer.</p><p><b>RESULTS</b>A total of 28 independent studies were selected including 16 case-control studies, 10 cohort studies and 2 cross sectional studies. The random-effect model was used due to the heterogeneity among these studies. The overall ORs (95%CI) of Meta-analysis on subjects who consumed soybean products, tofu and miso were 0.58 (0.52 - 0.65), 0.90 (0.80 - 1.00) and 1.18 (1.09 - 1.28), respectively.</p><p><b>CONCLUSION</b>Consumption of soybean products and tofu was inversely associated with gastric cancer, while miso consumption could increase the risk to gastric cancer.</p>