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The overall efficacy of neoadjuvant chemotherapy for locally advanced gastric cancer has been recognized. However, neoadjuvant chemotherapy is ineffective in a subset of patients due to tumor heterogeneity. The tumor regression grade (TRG) has unique advantages in assessing the efficacy of neoadjuvant chemotherapy for gastric cancer. Nonetheless, since TRG is dependent on postoperative pathology, it becomes a significant topic today to mine TRG predictors to more accurately select appropriate patients for neoadjuvant chemotherapy. Therefore, to understand the relevant research progress and current research challenges of TRG predictors after neoadjuvant chemotherapy for gastric cancer from the aspects of biomarkers, immunity, inflammatory indicators, body composition, imaging indicators, etc., is conducive to further clinical research and practice.
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BACKGROUND@#Liver biopsy for the diagnosis of non-alcoholic steatohepatitis (NASH) is limited by its inherent invasiveness and possible sampling errors. Some studies have shown that cytokeratin-18 (CK-18) concentrations may be useful in diagnosing NASH, but results across studies have been inconsistent. We aimed to identify the utility of CK-18 M30 concentrations as an alternative to liver biopsy for non-invasive identification of NASH.@*METHODS@#Individual data were collected from 14 registry centers on patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD), and in all patients, circulating CK-18 M30 levels were measured. Individuals with a NAFLD activity score (NAS) ≥5 with a score of ≥1 for each of steatosis, ballooning, and lobular inflammation were diagnosed as having definite NASH; individuals with a NAS ≤2 and no fibrosis were diagnosed as having non-alcoholic fatty liver (NAFL).@*RESULTS@#A total of 2571 participants were screened, and 1008 (153 with NAFL and 855 with NASH) were finally enrolled. Median CK-18 M30 levels were higher in patients with NASH than in those with NAFL (mean difference 177 U/L; standardized mean difference [SMD]: 0.87 [0.69-1.04]). There was an interaction between CK-18 M30 levels and serum alanine aminotransferase, body mass index (BMI), and hypertension ( P < 0.001, P = 0.026 and P = 0.049, respectively). CK-18 M30 levels were positively associated with histological NAS in most centers. The area under the receiver operating characteristics (AUROC) for NASH was 0.750 (95% confidence intervals: 0.714-0.787), and CK-18 M30 at Youden's index maximum was 275.7 U/L. Both sensitivity (55% [52%-59%]) and positive predictive value (59%) were not ideal.@*CONCLUSION@#This large multicenter registry study shows that CK-18 M30 measurement in isolation is of limited value for non-invasively diagnosing NASH.
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Humans , Non-alcoholic Fatty Liver Disease/diagnosis , Keratin-18 , Biomarkers , Biopsy , Hepatocytes/pathology , Apoptosis , Liver/pathologyABSTRACT
Objective:To investigate the inhibitory effect and mechanism of heme oxygenase-1 (HO-1) on the inflammatory response of macrophages.Methods:Mouse macrophage strain RAW264.7 was cultured in vitro, and the cells in the logarithmic growth phase were used for the experiment. The RAW264.7 cells were divided into four groups. In blank control group, the cells were continuously incubated and received no treatment (cultured at 37 ℃, 95% air, 5% CO 2). In lipopolysaccharide (LPS) model group, 1 mg/L LPS was added to the medium to prepare LPS challenge model. In HO-1 inducer group, the cells were incubated with 30 μmol/L HO-1 inducer hemin for 1 hour, and then 1 mg/L LPS was added for incubation. In HO-1 inhibition group, the cells were incubated with 5 μmol/L HO-1 specific antagonist Zinc protoporphyrin Ⅸ (ZnPPⅨ) for 0.5 hour, and then 1 mg/L LPS was added for incubation. After 48 hours of incubation with LPS, the supernatant of each group was taken, and the protein expressions of HO-1, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), thioredoxin interacting protein (TXNIP), NOD-like receptor protein 3 (NLRP3) and mitochondrial autophagy marker microtubule-associated protein 1 light chain 3B (LC-3B) were detected by Western blotting. The expression of reactive oxygen species (ROS) was detected by immunofluorescence staining. Results:Compared with the blank control group, the cells in the LPS model group had a certain stress response, and autophagy occurred in mitochondria, but the expression of some inflammatory factors was restricted, which was related to the impairment of cell function. The protein expressions of HO-1, IL-1β, LC-3B, ROS were significantly increased, the protein expressions of TNF-α, TXNIP, and NLRP3 were decreased significantly, indicating that the cells were seriously injured after LPS challenge, and the model was successfully established. Compared with the LPS model group, HO-1 protein expression in the HO-1 inducer group was significantly increased (HO-1/GAPDH: 0.31±0.03 vs. 0.22±0.03, P < 0.05), the protein expressions of TNF-α, IL-1β, TXNIP, NLRP3, LC-3B and ROS were significantly inhibited [TNF-α protein (TNF-α/GAPDH): 0.08±0.01 vs. 0.45±0.05, IL-1β protein (IL-1β/GAPDH): 0.50±0.01 vs. 0.82±0.03, TXNIP protein (TXNIP/GAPDH): 0.21±0.02 vs. 0.28±0.02, NLRP3 protein (NLRP3/GAPDH): 0.11±0.01 vs. 0.17±0.02, LC-3B protein (LC-3B/GAPDH): 0.67±0.04 vs. 0.92±0.12, ROS (fluorescence intensity): 80.9±12.5 vs. 94.1±19.5, all P < 0.05], indicating that HO-1 could inhibit inflammatory response and oxidative stress, and reduce mitochondrial autophagy. Antagonizing HO-1 could increase inflammatory response, oxidative stress and mitochondrial autophagy, the inhibitory degree of TNF-α and IL-1β expression was significantly reduced as compared with the HO-1 inducer group [TNF-α protein (TNF-α/GAPDH): 0.26±0.02 vs. 0.08±0.01, IL-1β protein (IL-1β/GAPDH): 0.76±0.01 vs. 0.50±0.01, both P < 0.05], the protein expressions of TXNIP, NLRP3, LC-3B and ROS were significantly increased as compared with the LPS model group [TXNIP protein (TXNIP/GAPDH): 0.43±0.02 vs. 0.28±0.02, NLRP3 protein (NLRP3/GAPDH): 0.24±0.02 vs. 0.17±0.02, LC-3B protein (LC-3B/GAPDH): 1.12±0.07 vs. 0.92±0.12, ROS (fluorescence intensity): 112.0±17.0 vs. 94.1±19.5, all P < 0.05]. Conclusion:HO-1 can reduce the inflammatory response by inhibiting the activation of TXNIP/NLRP3 inflammasome and reducing the release of inflammatory mediators.
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Objective:To evaluate the effect of experiential health education on patients discharged from hospital with the tube after pancreaticoduodenectomy.Methods:A total of 65 patients admitted to the General Surgery Department of Peking University Third Hospital for pancreaticoduodenectomy from September 2020 to August 2021 were selected as the study objects by convenience sampling method. The 31 patients with pancreaticoduodenectomy who received routine education about drainage tube from September 2020 to February 2021 were selected as the control group, and 34 patients with pancreaticoduodenectomy who received experiential health education about drainage tube from March 2021 to August 2021 were selected as the study group. The self-nursing ability and self-management of drainage tube of the patients in both groups were observed.Results:The total score of drainage tube self-care ability, drainage bag fixation score, drainage bag replacement score, drainage fluid dumping score, anti-drainage tube pull score, drainage tube extrusion method score were 10.00(10.00, 10.00), 2.00(2.00, 2.00), 2.00(2.00, 2.00), 2.00(2.00, 2.00), 2.00(2.00, 2.00), 2.00(2.00, 2.00) points, Higher than the control group 5.00(4.00, 5.00), 1.00 (1.00, 1.00) and 1.00 (0.00, 1.00), 1.00 (1.00, 1.00) and 1.00 (1.00, 2.00), 1.00 (1.00, 1.00) points, the differences were statistically significant ( Z values were -7.31--5.78, all P<0.05).In the self-management of drainage tubes in the study group, the drainage tube pulling rate, the incidence of exudation around drainage tubes, and the rate of leakage of drainage fluid registration were 8.82% (3/34), 14.7% (5/34), and 5.88% (2/34), respectively, lower than 61.29% (19/31), 41.94% (13/31), and 87.10% (27/31) in the control group, with statistically significant differences ( χ2=19.94, 6.00, 43.28, all P<0.05). Conclusions:Experiential health education can effectively improve drainage tube self-care ability of patients after pancreaticoduodenectomy, promoting postoperative rehabilitation of patients.
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Objective:To construct a service index system suitable for palliative care institutions at all levels, and provide reference for medical institutions to carry out programmed palliative care services.Methods:From April 2020 to June 2021, using expert focus group method, combined with domestic and foreign literature review and pilot work experience, the flow chart of hospice care service was preliminarily drawn, and the service indicators were formulated. Delphi expert letter consultation method was used to conduct two rounds of consultation among 16 experts, and finally the palliative care service index system was formed.Results:The positive coefficient of experts in the two rounds of Delphi expert letter consultation were 16/20 and 16/16, the authority coefficient was 0.828, 0.831, and the Kendall harmony coefficient was 0.236, 0.389, respectively. Finally, the palliative care service index system consisted of 8 indicators for primary level, 18 indicators for secondary level and 40 indicators for tertiary level.Conclusions:The established palliative care service index system is scientific and reliable, which can provide reference for all levels of hospice care institutions to carry out programmed services.
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Objective:To explore the effects of myosteatosis and blood glucose (BG) on postoperative complications in non-diabetic gastric cancer patients receiving supplemental parenteral nutrition (SPN) after gastrectomy.Methods:Patients who underwent radical gastrectomy between March 2017 and June 2021 in the Department of Surgical Oncology, the First Hospital of Lanzhou University were included in this study. Various preoperative inflammatory and nutritional indicators, including skeletal muscle metrics at the third lumbar level on CT, were collected retrospectively. Postoperative BG within 3 days and complications within 30 days were monitored. Patients were divided into two groups according to the presence or absence of myosteatosis (assessed via skeletal muscle density [SMD]) and the differences in postoperative BG and complication incidence were compared. Mediation model was used to analyze the mediating effect of BG in the association between SMD and postoperative complications.Results:A total of 357 patients were included in the study. Compared with the 299(83.8%) patients without myosteatosis , the incidence of hyperglycemia, mean BG, maximal BG, and BG fluctuation while on SPN in the 58(16.2%) patients with myosteatosis were higher, and the comprehensive complication index (CCI) and the incidence of complication were higher ( P<0.05). More importantly, BG showed the mediation effect of -0.0892 in the effect of SMD on CCI ( P<0.05), with the effect size of 19.3％. Conclusion:Myosteatosis and postoperative hyperglycemia are associated with higher incidence of complications, and BG plays an intermediary role in the association between myosteatosis and CCI.
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Objective:To compare the safety and effectiveness of direct stenting versus deferred stenting for the treatment of acute ST segment elevation myocardial infarction(STEMI)with a high thrombus load in patients aged 60 years and above.Methods:In this study, we analyzed 252 elderly STEMI patients with a high thrombus load(thrombus score ≥ 4 points)who received percutaneous coronary intervention(PCI)at Beijing Anzhen Hospital Affiliated or at the Affiliated Hospital of Beihua University from January 2015 to December 2018.They were divided into the direct stent group(n = 126)and the deferred stent group(n = 126)according to whether the stent was inserted immediately or not.Baseline information, surgical information, clinical outcomes and major adverse cardiac events were compared between the two groups at 1 year follow-up.Cox regression analysis was used to determine whether deferred stent implantation was a prognostic factor.Results:There were no significant differences in the distribution of infarct-related arteries, time from onset to balloon dilatation, thrombus load scores and the number of stents between the two groups(all P> 0.05). The diameter and length of the stent were(3.20 ± 0.47)mm and(18.33 ± 5.06)mm in the deferred stent group and(3.03 ± 0.50)mm and(22.60 ± 5.08)mm in the direct stent group, respectively, with a significant difference between the two groups( t=2.926, 6.678, P=0.004, 0.000). The incidences of slow blood flow, distal embolism and low myocardial perfusion staining in the deferred stent group were 2.38%(3/126), 3.17%(4/126)and 2.38%(3/126), respectively, significantly lower than those in the direct stent group, which were 15.87%(20/126), 24.60%(31/126)and 20.63%(26/126), respectively( χ2=13.827, 24.188, 20.614, all P=0.000). The left ventricular ejection fraction(LVEF)at 1 year in the deferred stent group was (0.60±0.05)%, significantly higher than that in the direct stent group(0.57±0.05)%( t=3.859, P=0.000). There was no significant difference in major adverse cardiac events between the two groups at 1 year follow-up( P> 0.05). Cox regression analysis results showed that deferred stent implantation was not a factor affecting the clinical outcome( HR=0.827, 95% CI: 0.288~2.372, P=0.724). Conclusions:Deferred stent implantation and direct stent intervention are equally safe and effective for STEMI patients aged over 60 with a high thrombus load if admitted to the hospital within 12 hours after onset.Deferred stent implantation can significantly improve the infarct-related artery blood flow classification, reduce the distal embolism rate, increase the grade 3 rate of myocardial perfusion staining, increase the diameter of the stent, reduce the length of the stent and improve left ventricular ejection fraction.
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As a kind of skills clinical medical students must master, the basic teaching of operative surgery is relatively backward in teaching mode and means, thus negatively affecting the teaching effect. The virtual reality is applied to the basic teaching of operative surgery, and the pre-designed course contents are presented in a situational way, so that students can experience the immersive learning style. It changes the classroom roles, gives full play to the advantages of virtual reality, and makes up the disadvantage of traditional education mode, finally improving the training effect.
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Objective:To investigate the risk factors for overall survival in operable hepatocellular carcinoma with portal vein tumor thrombus (PVTT-HCC) patients and establish a scoring system.Methods:Survival data in 253 PVTT-HCC patients were retrospectively analyzed in Guangxi Medical University Affiliated Tumor Hospital. Survival curves were analyzed using the Kaplan-Meier method and log-rank test. Cox stepwise regression analysis was used to identify independent preoperative risk factors affecting overall survival. A prognostic scoring system based on independent risk factors and their relative coefficients was established to screen patients with greater hepatic resection benefits, and the identification ability of the model was based on ROC.Results:A total of 253 patients with PVTT-HCC were enrolled in this study, there were 222 males and 31 females, with a median age 44 years. The median survival time in all patients was (13.00±2.15) months. Rate of overall survival was 51.8% at 1 year, 25.0% at 3 years and 17.7% at 5 years. Multivariable Cox regression analyses showed four risk factors including: AST≥40 U/L, ALP (≥80 U/L), tumor number (>1), and incomplete tumor capsule. A prognostic scoring system was established based on these variables. The area under curve of the scoring system was 0.780 (95% CI: 0.715-0.845). Patients were classified as low- or high-risk group for hepatic resection depending on whether their score was <3 ( n=77) or ≥3 ( n=176), respectively. High-risk patients had a median survival of 10 months, compared to 29 months in low-risk patients. Low-risk patients also had better survival rates at 1 year (75.3% vs 41.5%), 3 years (47.6% vs 15.2%), and 5 years (34.7% vs 10.5%), P<0.05. Conclusion:A prognostic scoring system for hepatic resection in PVTT-HCC patients has been developed based entirely on preoperative variables. Using this system, patients belong to the low risk group have better prognosis after surgery, which can provide a basis for surgical treatment of PVTT-HCC patients.
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Metal-organic frameworks (MOFs) are formed by self-assembly of metal ions or clusters with organic ligands, and are widely used in the fields of catalysis, sensing, energy and biomedicine. Recently, biological composites based on MOFs have attracted increasing attention. MOFs can be used as a platform for encapsulating bioactive substances due to the advantages such as large pore capacity, large specific surface area and diverse structure composition. These features can protect bioactive substances from adverse conditions, e.g. high temperature, high pressure, and organic solvents, thus improving the anti-adversity of bioactive substances. This review summarizes the advances of using MOFs as protective coatings to improve the anti-adversity of different bioactive substances, and introduces the synthesis strategy of MOFs-based biological composites, with the aim to promote the practical application of MOFs-based biological composites.
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Catalysis , Ions , Metal-Organic Frameworks , MetalsABSTRACT
Interstitial lung disease (ILD) is a risk factor for lung cancer. Patients with lung cancer associated with ILD (LC-ILD) often appear clinically. During the treatment of LC-ILD, there is a risk of causing acute exacerbation or even death in the treatment of lung cancer. At the same time, combining ILD has become the exclusion criteria for prospective clinical trials of most lung cancers. Therefore, when lung cancer is combined with ILD, it often becomes a difficult point for the treatment of lung cancer. Because LC-ILD patients have a certain proportion in the clinic, it is necessary to explore the best treatment options. Here we review the results of existing clinical studies for reference.
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Objective:By comparing the clinical data and follow-up data of patients with coronary heart disease combined with chronic kidney disease who choose different ways of revascularization for the first time when do PCI revascularization therapy again. To investigate the effect of coronary artery bypass grafting on revascularization for the first time in patients.Methods:A retrospective analysis of clinical data of 358 patients with coronary heart disease combined with chronic kidney disease who received revascularization PCI from January 2008 to December 2017 was made. All the patients were divided into CABG group(75 cases) and PCI group(283 cases) for clinical characteristics and prognosis comparison. According to the occurrence of major adverse cardiovascular events, Cox regression was carried out to establish a risk prediction model. Results:Compared with the patients in the two groups, the ratio of current smoking(17.33% vs. 33.57%, P=0.006) and hospitalized patients with recurrent acute myocardial infarction(28.00% vs. 40.64%, P=0.045) were decreased in CABG group, the ratio of triple-vessel disease(82.67% vs. 55.12%, P<0.001) and road via femoral artery(49.33% vs. 24.03%, P<0.001) were significantly increased in the CABG group, the Gensini score[136.00(100.75, 164.00) vs. 53.00(39.00, 74.00), P<0.001] and contrast agent dosage [300(200, 400)ml vs. 200(200, 300)ml, P<0.001] were significantly higher in CABG group, but the incidence of MACCE was significantly lower in CABG group than in PCI group (40.00% vs. 57.60%, χ2=7.571, P=0.0059). According to the Cox regression of MACCE events, it was found that CABG ( RR=0.586, 95% CI: 0.396-0.867, P=0.007) and higher glomerular filtration rate( RR=0.988, 95% CI: 0.980-0.997, P=0.007) were the protective factors, white blood cell elevation( RR=1.100, 95% CI: 1.020-1.187, P=0.013) and the application of renin-angiotensin-aldosterone system inhibitor( RR=1.380, 95% CI: 1.016-1.875, P=0.039) were independent risk factors. Conclusion:Patients with coronary heart disease combined with chronic kidney disease can benefit from CABG for the first time in revascularization, when they were confronted with PCI revascularization again.
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@#Objective To summarize and analyze the risk factors and management of artificial valve slippage in transcatheter aortic valve implantation (TAVI). Methods We retrospectively analyzed the clinical data of 131 patients undergoing TAVI surgery in our center from September 2017 to May 2019, including 62 patients through transapical approach and 69 patients through transfemoral artery approach. Results A total of 131 patients received TAVI surgery, among whom 4 patients had slipped during the operation, 2 patients via transfemoral artery approach, and another 2 patients via transapical. The average age was 77±9 years with one female (25%). Preoperative evaluation, higher position and poor coaxial were main risk factors for valve slip in TAVI. Conclusion Valve slippage is also a serious complication in TAVI surgery. Reasonable and effective treatment can avoid thoracotomy.
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This study aims to establish a information training and evaluation system from the perspective of training clinical skills of medical students, and investigate the effectiveness of the new training system and information platform through case analysis and comparative study. Results of data analysis showed that hybrid training mode integrating online and offline teaching can significantly improve the clinical skill training effect when compared with the traditional teaching mode. At the same time, it puts forward higher requirements for information environment and design of each teaching part.
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This study aims to establish a information training and evaluation system from the perspective of training clinical skills of medical students, and investigate the effectiveness of the new training system and information platform through case analysis and comparative study. Results of data analysis showed that hybrid training mode integrating online and offline teaching can significantly improve the clinical skill training effect when compared with the traditional teaching mode. At the same time, it puts forward higher requirements for information environment and design of each teaching part.
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Objective@#To compare the efficacy and safety of active transfer of plaque (ATP) versus provisional stenting (PS) with drug-eluting stents (DES) for the treatment of coronary bifurcation lesions.@*Methods@#A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial, patients were divided into either ATP (n=560) or PS group (n=576) accordingly. The primary endpoint was target lesion revascularization within 1 year, and the second endpoints were all-cause death, cardiogenic death, myocardial infarction, stent thrombosis, stroke, recurrent angina within 1 year.@*Results@#There were no significant differences in age, sex, hypertension, diabetes, hyperlipidemia and smoking history between the two groups (P>0.05). The incidence of TIMI blood flow <3 grade in the side branch (1.6%(9/560) vs. 7.5% (43/576), P<0.01), acute occlusion of the side branch (1.3%(7/560) vs. 7.1%(41/576), P<0.01) and implanted stents of side branch (1.8%(10/560) vs. 7.8% (45/576), P<0.01) were significantly lower in the ATP group than those in the PS group. During the one year follow up, the rate of target lesion revascularization was similar between ATP group and PS group (4.6%(26/560) vs. 4.0%(23/576), P=0.66).@*Conclusions@#The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique. However, ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.
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Objective@#To analyze the trends on constituent ratio of non-ST-segment-elevation (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) and related in-hospital mortality in acute myocardial infarction (AMI) patients hospitalized in Beijing Anzhen Hospital from 2004 to 2014.@*Methods@#This is a single-center, retrospective study. We reviewed all patients hospitalized for AMI in Beijing Anzhen Hospital from January 1 2004 to December 31 2014, and collected all related information including hospitalization stay, the type of AMI, revascularization and in-hospital mortality. We analyzed the trends of constituent ratio of NSTEMI and STEMI, and their in-hospital mortalities during the 11 years.@*Results@#Data from a total of 23 864 patients with AMI, including 5 539 STEMI and 18 325 NSTEMI, were analyzed. Compared with STEMI patients, NSTEMI patients were older, less likely to be male (P<0.001), had higher prevalence of hypertension, hyperlipidemia, diabetes (P<0.001), and lower prevalence of smoking (P<0.001). Additionally, patients with NSTEMI were more likely to have prior history of MI (12.6% (695/5 539) vs. 7.4% (1 354/18 325), P<0.001) and coronary artery bypass graft surgery (2.7% (152/5 539) vs. 0.7% (124/18 325), P<0.001). The constituent ratio of NSTEMI was significantly increased during the observation period, rising from 15.8% (107/802) in 2004 to 35.7% (1 273/3 583) in 2014 (P value for trend <0.001). The in-hospital mortality of NSTEMI patients was significantly lower compared with those with STEMI (1.84% (102 cases) vs. 2.74% (502 cases), P<0.001). The mortality of both STEMI and NSTEMI were significantly decreased during the 11 years (both P value for χ2 trend test <0.001). After adjusting for other risk factors, NSTEMI was independently associated with lower in-hospital mortality (OR=0.50, 95%CI 0.40-0.63, P<0.001).@*Conclusions@#In patients with AMI, the constituent ratio of NSTEMI versus STEMI is increased during the 11 years. The in-hospital mortality is decreased for both STEMI and NSTEMI patients in the past 11 years, and the in-hospital mortality rate of NSTEMI patients is lower than STEMI patients in this patient cohort during the observation period.
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Plant sterols are a class of compounds naturally produced by plants and structurally similar to cholesterol. For human, plant sterols can only be obtained from food and cannot be utilized directly. With the development of gas chromatography technology and in-depth research on the molecular mechanisms of rare diseases, plant sterols have been found to play important roles in atherosclerotic cardiovascular disease (ASCVD)and become a residual risk factor after statin therapy. As a novel metabolic marker, plant sterols can reflect steady state the imbalance of the cholesterol and the increase of the cholesterol absorption within the human body, and is expected to become a new risk factor for ASCVD residual risk assessment.
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Objective To explore the clinic results of our new designed transcatheter valve in valve for the mitral biopro-thesis deterioration.Methods Mitral bioprothesis deterioration patients with high risk for the routine bypass surgery got con-sent.After general anesthesia in the hybrid operation the left ventricle apical puncture was performed with guidance of 3D echo and X-ray.The retro-preset J Valve system was guided into the left atrium and the mitral bioprothesis with the beating heart . Results There were total 9 cases between Jan 2019 to Mar 2019 which had STS score above 6-8.The mitral bioprothesis in-cluded Hancock valve 3 cases, Perimount valve 3 cases, Epic valve 2 cases, Baxiter valve 1 case.The mitral bioprosthesis size included 27 for 6 cases and 25 for 3 cases.The successful implant rate was 100％, mortality rate 0, and all the patients recov-ered well without any main complications.The mean tran-valular pressure was only(8 ±2) mmHg (1 mmHg=0.133 kPa). Conclusion This innovative mitral valve in valve technique with retro-preset J Valve system got very good clinic results and worthy of deep research.
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Objective To analyze the correlation between calcification factors and fractional flow reserve derived from CT (CT?FFR). And to evaluate the diagnostic efficacy of CT?FFR in coronary artery lesions with calcification compared with that of invasive FFR. Methods Sixty?five patients (74 coronary artery vessels) who were admitted to Beijing Anzhen Hospital from July 2014 to December 2016 were included in this study retrospectively. All patients had completed CCTA (coronary CT angiography), coronary angiography and invasive FFR measurements, and had coronary lesions contain calcifications. The evaluation of CCTA data included quantitative analyses of plaque components, coronary artery stenosis, and CT?FFR measurements. The patients′basic data were grouped and compared according to the FFR values. The measurement data was tested by independent?samples t tests, and the categorical data were analyzed by χ2 tests. Quantitative measurements of plaques were compared between groups using independent?sample t tests or rank sum tests based on FFR and CT?FFR values. The reproducibility of CT?FFR measurement software was evaluated by inter?class correlation coefficient (ICC) and the Youden index was calculated to determine the threshold for CT?FFR diagnosis of ischemia. Pearson or Spearman correlation analyses were used to assess the correlations between CT plaque quantitative indicators, CT?FFR and invasive FFR. Multivariate logistic regression analysis was used to analyze the predictors of ischemia by FFR and CT?FFR. In contrast to invasive FFR results, the sensitivity, specificity, negative predictive value, positive predictive value (PPV) of CT?FFR in the diagnosis of coronary ischemic lesions were evaluated, and the diagnostic consistency was evaluated by the Bland?Altman method. Results Compared with invasive FFR, CT?FFR had a more significant correlation with calcification volume and ratio of calcification in plaques (r=-0.519 and－0.547, respectively, both P=0.001). Multivariate logistic regression analysis showed that plaque length was a predictor of invasive FFR in the diagnosis of pathological ischemia ( OR=1.13, 95%CI : 1.05—1.23, P=0.002), and was associated with CT?FFR to determine pathological ischemia. In addition to plaque length ( OR=1.10, 95%CI : 1.02—1.18, P=0.010), the predictor also included ratio of calcification in plaque ( OR=1.09, 95%CI: 1.03—1.15, P=0.003). Compared with invasive FFR results, the diagnostic sensitivity of CT?FFR was 79.1%, the specificity was 80.6%, the PPV was 85.0%, and the area under the ROC curve was 0.78. The result for the diagnosis of ischemia lesion by using CT?FFR had significant statistical differences with the results by according coronary artery stenosis (χ2=10.05, P=0.002; χ2=34.71, P=0.001; χ2=7.65, P=0.006; Z=2.10, P=0.029). The Bland?Altman analysis showed a mean difference of －0.01 (-0.26—0.25) between the CT?FFR and the invasive FFR. Conclusions There is no significant correlation between the proportion of calcification components of coronary plaque and the presence or absence of myocardial ischemia, but the proportion of calcification in plaque will affect the result that is evaluated by CT?FFR. However, compared with CT?based stenosis evaluation, CT?FFR can still significantly improve the ability of CCTA to diagnose ischemia lesion with calcification.