Short-term clinical and echocardiographic outcomes of the novel domestic transcatheter edge-to-edge repair Neonova? system in patients with mitral regurgitation / 中华超声影像学杂志

Objective:To investigate short-term safety, efficacy and the learning curve of this self-developed novel transcatheter valve repair system (Neonova?) in patients with mitral regurgitation, and explore the role of perioperative echocardiography.Methods:Ten patients who visited the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2021 to March 2022 and met the inclusive criteria were prospectively enrolled. All the patients were at high risk of surgery with moderate to severe or severe mitral regurgitation (MR). Clamps of Neonova? were implanted under guidance of transesophageal echocardiography and digital subtraction angiography. Clinical outcomes, echocardiography indexes and learning curves of this technique were evaluated immediately after intervention, 7 d, 1 month and 3 months post-intervention.Results:The technical success rate was 100% with MR relieved in all patients immediately after intervention. The device and procedural success rates were both 90.0% with 1 patient received surgical replacement at 37 days post-intervention while the others′ reduced to mild (8/9) and moderate (1/9) MR. New York Heart Association class and the Kansas City Cardiomyopathy Questionnaire improved significantly (all P<0.001). Mean mitral valve pressure gradient didn′t increase significantly after intervention when compared with that before intervention( P=0.324), and no mitral stenosis was observed. Left ventricular end-diastolic diameter decreased significantly ( P=0.008) during follow up.Procedure duration ranged from 60 to 300 (175.8±75.2)minutes. The simple linear regression model between procedure volume and duration showed that procedure duration decreased significantly with the increase of procedure volume ( F=15.857, P=0.004). Conclusions:Neonova? implantation can improve MR severity and clinical symptoms safely and effectively. Transthoracic echocardiography and transesophageal echocardiography are essential for perioperative management of transcatheter mitral valve repair.

Echocardiographic evaluation of the domestic D-Shant device for treatment of patients with chronic heart failure / 中华超声影像学杂志

Objective:To evaluate the efficacy of the domestic D-Shant device for the treatment of patients with chronic heart failure (CHF) using echocardiography.Methods:Twenty-four CHF patients who were treated with domestic D-Shant device in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2020 to December 2021 were enrolled in the study. Pulmonary capillary wedge pressure (PCWP)/ left atrial pressure (LAP), right atrial pressure (RAP), pulmonary artery pressure, interatrial septal gradient pressure, cardiac index and pulmonary/systemic blood flow ratio (Qp/Qs) were measured before and after implantation using right heart catheterization.Left atrial end-diastolic area index (LAEDAI), left atrial end-diastolic volume index (LAEDVI), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), right atrial end-diastolic diameter, right ventricular end-diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), right ventricular tractional area change (RVFAC), device shunt aperture, velocity and pressure, together with mitral and tricuspid regurgitation severity were measured using echocardiography before, and 1 month as well as 3 months after D-Shant device implantation. Clinical data were collected and analyzed including 6-minute walking test (6MWT), New York Heart Association (NYHA) classification and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Spearman correlation analysis was used to determine the relation between the changes in PCWP/LAP as well as echocardiographic parameters before and 3 months after implantation and NYHA classification. Binary Logistic regression analysis was performed to determine the predictive factors of NYHA classification improvement at 3-month follow-up after D-Shant device implantation.Results:①D-Shant devices were successfully implanted in all patients. ②Compared with preoperative values, invasive PCWP/LAP systolic, diastolic and mean pressures, transatrial septal gradient, and pulmonary systolic, diastolic and mean pressures decreased significantly after implantation(all P<0.001); Qp/Qs increased significantly after implantation( P<0.001). ③Compared with preoperative values, TAPSE, RVFAC and pulmonary artery flow velocity increased at 1 month after implantation(all P<0.05), whereas a significant reduction in mitral regurgitation grade, and an increase in LVEF and pulmonary artery flow velocity at 3 months after implantation(all P<0.05). Right atrial end-diastolic diameter, right ventricular end-diastolic diameter, LAEDAI, LAEDVI, LVEDVI, LVESVI, ratio of early to late diastolic peak velocities of mitral inflow(E/A), systolic peak velocity of mitral annulus at septal site(S′), ratio of early diastolic peak velocity of mitral inflow to diastolic peak velocity of mitral annulus(E/e′), pulmonary artery diameter, inferior vena cava diameter and degree of tricuspid regurgitation did not change among before, and 1 month as well as 3 months after implantation. There were no significant changes in the device shunt aperture, velocity and pressure between 1 month and 3 months after implantation(all P>0.05). ④The significant improvements in NYHA classification, KCCQ scores and 6MWT were observed at 1 and 3 months after implantation compared with preoperative values (all P<0.01). ⑤NYHA classification at 3 months after implantation was correlated with LVEF pre-post, PCWP/LAP pre-post, TAPSE pre-post and RVFAC pre-post ( rs=0.738, -0.730, 0.738, 0.723; all P<0.001). Logistic regression analysis showed that LVEF pre-post was an independent predictor for NYHA classification improvement at 3 months after implantation ( OR=0.687, 95% CI=0.475-0.992, P=0.045) . Conclusions:Domestic D-Shant device can effectively improve the cardiac function and clinical symptoms in patients with CHF. Echocardiography is a feasible and effective method to evaluate the benefits of domestic D-Shant device for the treatment of CHF.

Efficacy of sertraline combined with low-dose olanzapine in patients with depression and anxiety comorbidity / 四川精神卫生

ObjectiveTo observe the efficacy and safety of sertraline combined with low-dose olanzapine in the treatment of depression and anxiety comorbidity and its effect on sleep quality， so as to provide references for the related clinical treatment. MethodsA total of 121 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for depressive episode and generalized anxiety disorder in The Third People's Hospital of Tianshui and the Sanatorium for Mental Illness of Veterans in Tianshui from October 2019 to August 2020 were enrolled， and they were divided into two groups according to the random number table method. Study group （n=61） received sertraline combined with low-dose olanzapine， while control group （n=60） received sertraline only. Then the disease severity degree， sleep quality and adverse reactions were assessed using Hamilton Depression Scale - 17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pittsburgh Sleep Quality Index （PSQI） and Treatment Emergent Symptom Scale （TESS） at the baseline， 1st， 2nd， 4th， 6th and 8th weekend， respectively. ResultsPost-treatment HAMD-17， HAMA and PSQI scores in both groups were lower than those before treatment （P<0.05）. At each time point after treatment， HAMD-17， HAMA and PSQI scores of study group were lower than those of control group， with statistical significance （P<0.05）. ConclusionSertraline alone and its combination with low-dose olanzapine are both effective in the treatment of depression and anxiety comorbidity， while the combination therapy achieves better efficacy and higher safety in alleviating anxiety and insomnia symptoms.

Clinical study of Sini-Jia-Huanglian Decoction combined with conventional western medicine therapy in the treatment of chronic heart failure with qi deficiency and blood stasis syndrome / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of Sini-Jia-Huanglian Decoction on chronic heart failure (CHF) with qi deficiency and blood stasis syndrome. Methods:A total of 100 patients with CHF and qi deficiency and blood stasis syndrome in Handan Mingren hospital from January 2018 to June 2019 who met the inclusion criteria were divided into two groups according to the random number table method, 50 cases in each group. The control group was treated with conventional western medicine therapy, and the treatment group was treated with Sini-Jia-Huanglian Decoction on the basis of the control group. Both groups were treated for 30 days. TCM syndrome score was performed before and after treatment. The level of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) was detected by radioimmunoassay. The levels of peptide and galectin 3 (Gal-3) were detected by ELISA. The exercise tolerance was measured by 6-minute walking test, the clinical efficacy was tevaluated. Results:The total effective rate of the treatment group was 92.0% (46/50), and the control group was 76.0% (38/50), there was significant difference between the two groups ( χ2=4.762, P=0.029). After treatment, the scores of shortness of breath, palpitation, dyspnea, dizziness, chest pain and total scores in the treatment group were significantly lower than those in the control group ( t values were 4.257, 8.493, 8.211, 4.481, 5.500, 6.977, respectively, all Ps<0.01). After treatment, the levels of NT-proBNP (2 349.61 ± 683.50 ng/L vs. 3 026.27 ± 714.35 ng/L, t=4.840), and peptide (12.16 ± 3.43 ng/L vs. 17.52 ± 3.98 ng/L, t=7.214) and Gal-3 (3.01 ± 0.82 μg/L vs. 3.94 ± 0.93 μg/L, t=5.304) in the treatment group were significantly lower than those in the control group ( P<0.01), and the walking distance of 6 minutes (450.66 ± 79.25 m vs. 384.49 ± 70.16 m, t=4.421) was significantly longer than that of the control group ( P<0.01). Conclusions:The Sini-Jia-Huanglian Decoction can improve the heart function and clinical symptoms of CHF patients with qi deficiency and blood stasis syndrome, and improve the clinical efficacy.

Results of surgical treatment for moderate or severe slipped capital femoral epiphysis through the approach of surgical hip dislocation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of surgical treatment for moderate or severe slipped capital femoral epiphysis (SCFE) using modified Dunn procedure through the approach of surgical hip dislocation at the interval of minimum 12 months follow-up.</p><p><b>METHODS</b>From November 2011 to June 2013, 6 patients (7 hips) with SCFE were treated in department of pediatric orthopedics, Hospital Affiliated to Shanghai Jiaotong University School of Medicine, they all had trauma history. The patients were aged from 10-15 years, mean 13.6 years. The duration of symptoms ranged from 4 to 35 days, average 14.2 days. The degree of slip was averagely 45% (25%-55%). In 6 patients (except right side of 1 case was treated in situ with cannulated screws) were surgically treated using modified Dunn procedure through the approach of surgical hip dislocation. Postoperatively the brace was used for immobilizing the hip for 4 weeks, then 4 weeks of bed traction combined with rehabilitation program of hip joint activity. Eight weeks later, the gradual touchdown weight bearing was being allowed.</p><p><b>RESULTS</b>The follow-up time ranged from 12 to 30 months, average 23.8 months. Six patients have been able to walk without crutches, no obvious limp. X-ray film showed femoral epiphysis line on the bit of good recovery, no appearance of avascular necrosis of the femoral head, joint space was normal. The Harris score of hip evaluation was 94.7 averagely, ranging 85-100, at the time of last follow-up.</p><p><b>CONCLUSIONS</b>Application of surgical treatment for moderate or severe SCFE with open reduction through the approach of surgical hip dislocation is a valid alternative method. The femoral head epiphysis can be capable of restoring anatomy, at present no case occurred avascular necrosis, and patients are satisfied with the function of the hip joint.</p>

Evaluation of structural and elastic changes of arteries in patients with chronic kidney disease by ultrasonography / 中华超声影像学杂志

Objective To evaluate the structural and elastic changes of the arteries of chronic kidney disease (CKD) patients before dialysis by echo-tracking technique.Methods Thirty-nine CKD patients were enrolled in the study before dialysis and subdivided into CKD stage 2-3 group (n =19) and CKD stage 4-5 group (n =20).Forty age matched healthy subjects were selected as the control group.The parameters of arterial structural and stiffness such as intima-media thickness (IMT),stiffness parameter (β),pressure strain elastic modulus(Ep),arterial compliance(AC),augmentation index(AI),carotid pulse wave velocity (PWVβ),carotid-femoral pulse-wave velocity (PWVcf),carotid diameter (D) were measured by echotracking technique and compared among groups.Stepwise multiple linear regression analysis was performed to identify the associated factors of arterial stiffness.Results Compared with healthy group,PWVcf and Dwere significantly increased in CKD stage 2-3 group (P ＜0.05,P ＜0.001),PWVβ significantly increased in CKD stage 4-5 group(P ＜0.05) ;when compared CKD4-5 group with CKD2-3 group,PWVcf and D were significantly increase in CKD stage 4-5 group(P ＜0.05,P ＜ 0.001).The results of stepwise multiple regression analysis demonstrated that the age and estimated glomerular filtration rate (eGFR) were independent impact factors of PWVcf.Conclusions Echo-tracking technique can assess the structural and stiffness changes of arteries in patients with CKD in the early stage and provide valuable information for clinical management.

Quality of life for Chinese patients with adolescent idiopathic scoliosis: evaluation of the Chinese version of the Scoliosis Research Society's outcomes instrument 22 / 中华物理医学与康复杂志

Objective To evaluate the health-related quality of life ( HRQL) of patients with adolescent idiopathic scoliosis ( AIS) before treatment. Methods Sixty-two female patients with AIS were evaluated using the Chinese version of Scoliosis Research Society's outcomes instrument 22 ( SRS-22) HRQL questionnaire before treatment. The patients were categorized into thFee groups: a mild deformity group with a major curve Cobb angle less than 30° ( n =14),a moderate deformity group with Cobb angles of 30° to 50° ( n =42), and a severe deformity group with Cobb angles more than 50° ( n =6). Results The severe deformity group scored lowest in the self-image domain.There was,however,no significant difference in the functional activity,pain or mental health domain scores between the three groups. Conclusions The Chinese version of the SRS-22 HRQL questionnaire can be used to assess the HRQL of Chinese AIS patients.AIS patients with a major curve Cobb angle more than 50° have relatively low self-image scores.

Modified rectangle cross-finger flap to repair degloved avulsion of fingertip / 中华骨科杂志

Objective To investigate the operative procedure and the clinical result of the modified rectangle cross-finger flap based on the dorsal branches in the middle phalange to repair degloved avulsion of fingertip.Methods From January 2006 to March 2010,26 patients with the avulsions of fingertip were treated by the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange of adjacent finger.There were 21 men and 5 women,with an average age of 31.6 years(range,17-56 years).Fourteen cases were crushed by machine,8 cases were pressed and 4 cases were tied.There were 8 index fingers,9 long fingers,4 ring fingers and 5 little fingers.The length of the avulsion was 1.1-2.6 cm.The flap was harvested from the dorsal of contiguous digital of their middle and proximal segment.The both dorsal branches of the both proper palmar digital nerves were cut off and were anatomized with the nerve end of the injured digit.The area of flaps ranged from 3.6 cm×2.3 cm-6.5 cm×3.2 cm.The donors were closed by skin graft.Results The pedicels were cut when 13-23 d after operation.Twenty-five patients were followed up for 6-28 months(mean,16.3 months).All flaps survived with satisfactory appearance,sensation and function.All flaps and donors were primary healing.Two point discrimination was 6-9 mm with an average of 7.8 mm.The postoperative outcomes were evaluated by the total active movement.The results were excellent in 17fingers,good in 7,and fair in 1.The rate of excellent and good was 96%.Conclusion The treatment of degloved avulsion of fingertip with the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange is recommendable.The operative procedure of harvesting the flap is simple.There is enough blood to supply the flap and the surviving rate is high.The postoperative function of the injured hand can be recovered satisfactorily.The figure of flap is well and the sense of flap is sensitive.The technique can be operated in the last 4 fingers without thumb.

Regulative role of progesterone in inflammatory reaction after traumatic brain injury in rats / 中华创伤杂志

Objective To investigate the effect of progesterone on the expressions of inflammation-related factors of cortical cyclooxygenase-2 ( COX-2 ),prostaglandin E2 ( PGE2 ),inducible nitric oxide synthase (iNOS) and NF-κB in the cortex after traumatic brain injury (TBI) in rats so as to study the possible molecular mechanism of neuroprotective effect of progesterone on TBI.Methods Fortyfive male Spraque-Dawley rats were enrolled in the study and randomly divided into three groups,ie,sham operation group (n =15),TBI group (n =15) and progesterone treatment group (n =15).The rat model of TBI was duplicated with the improved Feeney' s method.The PROG treatment group was given i.p.injections of progesterone ( 16 mg/kg) at 1 and 6 hours after injury.The rats were sacrificed in three groups at 24 hours after injury and the specimens were removed.The changes of the positive cell numbers and protein level of COX-2,PGE2,iNOS and NF-κB in the cortex were examined by immunohistochemistry and Western blot.Results The positive cell numbers and protein levels of COX-2,PGE2,iNOS and NF-κB in the cortex of the TBI group were distinctly higher than those of the sham operation group (P＜O.05).While the positive cell numbers and protein levels of COX-2,PGE2,iNOS and NF-κB in the cortex of the progesterone treatment group were distinctly lower than those of the TBI group ( P ＜O.05).Conclusions Progesterone may exert protective effect on TBI through inhibiting NF-κB activity,blocking the inflammation response course of NF - κB and iNOS and decreasing the expressions of COX-2 and PGE2.

Anatomy of the optic chiasma and its surrounding structures in saddle area operation / 中国综合临床

Objective To provide morphological evidences for visual field defect caused by the compression of the saddle area tumors.Methods The shape and position of the optic chiasma and its surrounding saddle diaphragm,pituitary,internal carotid artery,and perforating arteries of optic chiasma were studied from 80 adult.Results Its maximum angle was 100° in anterior horn with prechiasmatic space, and minimum angle was 40° with postfixed optic chiasma.The area of optic chiasma averaged(1.32±0.04)cm2,the thickness of saddle diaphragm was 0.58 mm,and about 5% of saddie diaphragm did not exist.The foramen of saddle diaphragm pushed into the opposite side was 52.5%,and the maximum diameter was 7.8 mm×9.8 mm.The pituitary was found inferior to the saddle diaphragm foramen in 78%(62/80).In 76.3%(61/80) brains,the carotid artery touched chiasm opticum.Conclusions Visual field defect caused by compression from pituitary tumor and craniopharyngioma is directly related with the shape of the optic chiasma and its surrounding structures.

Overexpression of ?-synuclein in SH-SY5Y cells in vitro leads to oxidative stress / 中国病理生理杂志

AIM: To observe the influence of overexpression of ?-synuclein on the cultured SH-SY5Y cells. METHODS: The plasmid of ?-synuclein-pcDNA_3 was transfected into SH-SY5Y cells with LipofectAMINE. The expression of ?-synuclein was determined by anti-?-synuclein immunocytochemistry. The intracellular reactive oxygen species was determined with 2', 7'-dichlorofluorescein diacetate (DCF-DA) by using a FACSCAN flow cytometer and fluorescent microscope. The intracellular content of reduced GSH was detected with glutathione assay kit by spectrophotometer. RESULTS: The ?-synuclein was expressed in cultured SH-SY5Y cells transfected with the plasmid of ?-synuclein-pcDNA_3. The DCF loading analysis and the intracellular level of reduced GSH suggested that the transfected cells were under oxidative stress. CONCLUSION: Overexpression and accumulation of ?-synuclein in SH-SY5Y cells increase intracellular reactive oxygen species levels, it is suggested therefore that the ?-synuclein does play an important role in the pathogenesis of Parkinson's disease.

Progesterone regulates COX-2 and Caspase-3 expressions in hippocampal neurons in rats after traumatic brain injury by NF-?B signaling pathway / 第三军医大学学报

Objective To investigate the effect of nuclear factor-?B(NF-?B) on the regulation of cyclooxygenase-2(COX-2) and Caspase-3 in hippocampal neurons after traumatic brain injury(TBI) in rats,and explore the neuroprotective effect and the possible mechanism of progesterone(PROG) in hippocampal neurons after TBI.Methods Forty-five male Spraque-Dawley rats were randomly divided into 3 groups: sham-operated group(n=15),TBI group(n=15) and PROG-treated group(n=15,intraperitoneal injection of PROG 16 mg/kg in 1 and 6 h after injury).The rat model of TBI was duplicated with the improved Feeney's method.The rats were sacrificed in 24 h after injury and their brain was resected.Nissl staining,immunohistochemical staining and Western blot assay for NF-?B,COX-2 and Caspase-3 was used to observe the changes of positive cell numbers and protein levels in the hippocampal neurons.Results The numbers of immunoreactive neurons to NF-?B(24.0?2.5),COX-2(35.9?2.7) and Caspase-3(25.1?2.7) were significantly increased in the hippocampus at 24 h after TBI when compared with the positive neuron numbers of NF-?B(1.9?0.9),COX-2(1.5?0.7) and Caspase-3(1.8?0.8) in sham group.After the treatment of PROG,the positive cell number of NF-?B(14.2?1.8),COX-2(16.6?2.7),Caspase-3(11.2?2.4) was reduced obviously as compared with the TBI group(P