Reconstruction and analysis of K-Clip surgery process based on finite element method / 中国胸心血管外科临床杂志

@#Objective     To investigate the effects of different types of tricuspid regurgitation, implantation positions, and device models on the treatment outcomes of K-Clip for tricuspid regurgitation using numerical simulations. Methods     Three-dimensional reconstruction of the heart model was performed based on CT images. Two different regurgitation orifices were obtained by modifying the standard parameterized tricuspid valve leaflets and chordae tendineae. The effects of different K-Clip models at different implantation positions (posterior leaflet midpoint, anterior-posterior commissure, anterior leaflet midpoint, posterior septal commissure) were simulated using commercial explicit dynamics software Ls-Dyna. Conclusion     For the two types of regurgitation in this study, clipping at the posterior leaflet midpoint resulted in a better reduction of the regurgitation orifice (up to 75% reduction in area). Higher clamping forces were required for implantation at the anterior leaflet midpoint and posterior septal commissure, which was unfavorable for the smooth closure of the clipping components. There was no statistical difference in the treatment outcomes between the 18T and 16T K-Clip components, and the 16T component required less clamping force. Therefore, the use of the 16T K-Clip component is recommended.

Real-time monitoring and step-by-step guidance for transcatheter tricuspid annuloplasty using transesophageal echocardiography / 中华超声影像学杂志

Tricuspid regurgitation (TR) interventions are under rapid development. The K-Clip? system is the first domestic transcatheter tricuspid annuloplasty system with unique clamping procedure to achieve annular reduction.Intraoperative echocardiographic monitoring procedures for transcatheter tricuspid annuloplasty have not been reported yet in China. Thus, this review aimed to propose the standard two-dimensional and three-dimensional transesophageal echocardiographic workplanes and procedures to guide and monitor the implantation of K-Clip system based on our experience in Zhongshan Hospital, Fudan University to provide a reference point for the intraoperative echocardiographic monitoring of future transcatheter tricuspid annuloplasty devices in China.

Quantitative evaluation of the dynamic changes of mitral annulus in patients with degenerative mitral regurgitation by three-dimensional echocardiography / 中华超声影像学杂志

Objective:To quantitatively analyze the static geometric structure and dynamic changes of the mitral annulus(MA) in patients with degenerative mitral regurgitation (DMR) by three-dimensional transthoracic echocardiography.Methods:Thirty-five patients with DMR (both mitral valve prolapse and Barlow) were collected as DMR group in Yunnan Fuwai Cardiovascular Disease Hospital from August 2019 to March 2021, and 42 healthy volunteers were selected as control group during the same period. The mitral annulus area (MAA), mitral annulus perimeter (MAP), mitral annulus anterolateral-posteromedial diameter (DALPM), anteroposterior diameter (DAP), non-planar angle (NPA), mitral annulus height (AH), and the ratio of height to intercommissural diameter (AHCWR) were measured during the late-diastole, early-systole, mid-systole and late-systole, and the systolic change fractions of the above parameters were calculated. The differences of static structure and dynamic change of MA between the two groups were compared, and the characteristics of dynamic change of MA in the whole cardiac cycle were analyzed.Results:Static structure: MAA, MAP, DAP and DALPM in DMR group were higher than those in control group during the whole cardiac cycle, and the differences were statistically significant (all P<0.05). Compared with the control group, the saddle structure in DMR group were flattened in the middle and late contraction stages (AHCWR: 0.17±0.01 vs 0.21±0.01 and 0.15±0.01 vs 0.23±0.01, both P<0.05), while the saddle structure was relatively preserved in the rest of the contraction stage. Dynamic changes: Presystole contraction (MAA, MAP, DAP, DALPM decreased, all P<0.05) were appeared durng the late-diastole and early-systole in the control group, and saddle shape deepened (NPA decreased, AH and AHCWR increased, all P<0.05). Compared with the control group, presystole MA contraction and saddle deepening disappeared in DMR group (there were no significant differences in all MA parameters between late-diastole and early-systole, all P>0.05). The systolic dynamic changes were weaker and impaired when compared with the control group, which showed that the systolic change scores of DALPM, NPA and AHCWR were lower than those of the control group (all P<0.05). There were no statistical differences in the 4 time phases of MA parameters except DAP (all P>0.05). Conclusions:The saddle-shape structure of MA in normal subjects is obvious, and the dynamic change of MA in the cardiac cycle is significant, with obvious contraction before contraction and saddle-shape deepening. The saddle structure of DMR patient is flattened in the middle and late systolic period, and the MA kinetic energy of DMR patient is weakened throughout the cardiac cycle, the contraction phenomenon disappeared before contraction, and the dynamic change of systolic period is impaired to varying degrees.

Value of pulmonary annulus index in predicting transannular patch in tetralogy of Fallot repair / 中华胸心血管外科杂志

Objective:Pulmonary annulus index is used to predict the application value of transannular patch in children with tetralogy of Fallot.Methods:A retrospective analysis of 130 patients with pediatric heart disease diagnosis of TOF and undergoing TOF repair in Beijing Anzhen Hospital affiliated to Capital Medical University from December 2018 to December 2019, 112 cases were included in this study, 18 cases were excluded. They were divided into TAP group and no TAP group, related values of pulmonary annulus and aortic annulus were measured. The pulmonary annulus index, the pulmonary annulus Z-score and main pulmonary artery Z-score were calculated to do statistically analyze.Results:A total of 112 patients, average age(22.87±12.21) months; 66 males and 46 females; weight( 9.94±4.08)kg; 3 cases died, 1 case died of sepsis caused by pulmonary infection, 1 case died of low cardiac output syndrome, and 1 case died of multiple organ failure. 62 cases(55.8%) did not transannular patch, 50 cases(44.2%) transannular patch. The pulmonary annulus Z-score, main pulmonary artery Z-score and PAI in TAP group were smaller than those in no TAP group( P<0.05). Receiver operator curves( ROC) analysis showed that the cut-off value of PAI at 0.53 AUC was 0.85, the sensitivity was 75%, the specificity was 80%; the cutoff value of pulmonary annulus at -1.98 AUC was 0.88, the sensitivity was 80%, the specificity was 71%; the cutoff value of main pulmonary artery at -2.12 AUC was 0.87, the sensitivity was 77%, and the specificity was 87%. When the critical value of PAI(>0.53) and main pulmonary artery Z-score(>2.12), 88.2% of the children could avoid TAP, and 94% of the children could avoid TAP when the critical value of pulmonary annulus Z-score(> -1.91) and main pulmonary artery Z-score(>-2.12) were combined. Conclusion:The predictive effect of pulmonary annulus index as a simple and effective predictor of TAP in TOF radical operation is the same as that of pulmonary annulus Z-score. Combining either with main pulmonary artery Z-score was the most accurate method of prediction.

Clinical study of mitral annulus displacement measured by two-dimensional speckle tracking imaging to assess the left ventricular systolic function in Kawasaki disease / 中华超声影像学杂志

Objective:To evaluate the value of mitral annulus displacement(TMAD) measured by two-dimensional speckle tracking imaging in evaluating left ventricular(LV) systolic function before and after immunoglobulin(IVIG) treatment in children with Kawasaki disease(KD).Methods:Thirty-five hospitalized children with acute KD(KD group) and 40 healthy volunteers(control group)were enrolled from September 2020 to March 2021 in the Third Affiliated Hospital of Zhengzhou University. All participants underwent echocardiography.Left ventricular ejection fraction(LVEF) and left ventricular short axis shortening(LVFS) were calculated from M-mode echocardiography. All children had their apical four-chamber and two-chamber view recorded and stored in real time, and the images of the KD group were recorded in the acute, subacute and convalescent stages, respectively. The data was analyzed by QLab 13.0 offline quantitative analysis software. The TMAD parameters between the KD group and the control group were compared. And the TMAD parameters at different periods in the KD group were compared. Pearson correlation analysis was conducted to evaluate associations between TMAD parameters and LVEF and N-terminal B-type natriuretic peptide(NT-proBNP) in children with acute KD.Results:①The parameters of TMAD AP4 MV1, TMAD AP4 MV2, TMAD AP2 MV1, TMAD AP2 MV2, TMAD AP4 Midpt, TMAD AP4 Midpt%, TMAD AP2 Midpt and TMAD AP2 Midpt% were decreased in patients with KD at different periods than those of the control group(all P<0.05), while there was no significant difference in LVEF between the two groups( P>0.05). ②After IVIG treatment, the values of TMAD AP4 MV1, TMAD AP4 MV2, TMAD AP2 MV1, TMAD AP2 MV2, TMAD AP4 Midpt, TMAD AP4 Midpt%, TMAD AP2 Midpt and TMAD AP2 Midpt% in subacute stage of KD were higher than those in acute stage(all P<0.05), the values of TMAD AP4 Midpt% and TMAD AP2 Midpt% in the convalescent stage of KD were higher than those in the subacute stage(all P<0.05). ③The parameters of TMAD were positively correlated with LVEF( r=0.36, 0.40, 0.32, 0.28, 0.42, 0.46, 0.35, 0.37; all P<0.05) and negatively correlated with NT-proBNP( r=-0.61, -0.57, -0.40, -0.60, -0.63, -0.47, -0.61, -0.36; all P<0.05). Conclusions:TMAD measured by two-dimensional speckle tracking imaging can quickly and accurately evaluate left ventricular systolic function in children with KD before and after IVIG treatment, and TMAD combined with NT-proBNP can provide a new method for clinical management of KD.

Intervertebral disc tissue engineering based on polymer materials: Research focus and hot spots / 中国组织工程研究

BACKGROUND: In recent years, the rapid development of tissue engineering technology provides a new idea for the treatment of intervertebral disc degeneration; that is, biomaterials are used to reconstruct the damaged intervertebral disc structure. OBJECTIVE: To summarize polymer materials which are applicable for intervertebraltissue engineering construction, and overview the advantages, disadvantages and application progress of each material. METHODS: We searched related articles from inception to February 2020 in PubMed, Web of Science and CNKI databases with “polymer, intervertebral disc, tissue engineering, nucleus pulposus, annulus fibrosus” as English and Chinese key words. Initially 189 related articles were searched, and 109 eligible articles were included in final analysis according to inclusion and exclusion criteria. RESULTS AND CONCLUSION: Intervertebral disc is composed of inner soft nucleus pulposus and outer stiff annulus fibrosus. Accordingly, it requires two components with different structures and functions to reconstruct a complete intervertebral disc with tissue engineering method. Chitosan, alginate and hyaluronic acid are considered as optimal materials for nucleus pulposus construction because of their appropriate swelling character and ability of inducing cells to secrete nucleus pulposus matrix. Silk fibroin, collagen, polyethylene glycol, polylactic acid, polyglycolic acid and polycaprolactone with high mechanical strength are suitable for annulus fibrosus construction to bear high loading burden. By further surface modification, these synthesis scaffolds wound show a better cellular compatibility and promote tissue integrity after in vivo implantation.

Biomechanical characteristics of the lumbar disc after fatigue injury / 中国组织工程研究

BACKGROUND: Lumbar disc herniation is a common clinical disease, and its pathological basis is disc degeneration. Long-term mechanical load is considered to be an important cause of lumbar disc degeneration. Because the occurrence of lumbar disc herniation is strongly associated with its mechanical state, it is necessary to further study the stress/strain behavior in the lumbar disc to provide inspiration for preventing lumbar disc herniation. OBJECTIVE: To analyze the effect of fatigue loading on mechanical properties of the whole and different regions of the intervertebral disc. METHODS: The freshly slaughtered sheep lumbar intervertebral discs L1-L2, L3-L4, and L5-L6 were obtained and made into experimental samples. The experimental samples were fixed on the experimental platform through the upper and lower vertebrae, and a quasi-static compression-cyclic loading compression-quasi-static compression experiment was performed. The L3-L4 motion segment was cut parallel to the sagittal plane, and the non-contact digital image correlation technique was used to record the internal deformation of the lumbar disc during compression. RESULTS AND CONCLUSION: (1) The results showed that all lumbar intervertebral discs exhibited non-linear load-displacement and stress-strain characteristics. (2) Effect of fatigue loading: The Young’s modulus of the lumbar intervertebral disc increased significantly after fatigue loading. (3) Impact of segment changes: The Young’s modulus changed with segment changes as follows: L5-L6 segments < L3-L4 segments < L1-L2 segments. (3) Effect of loading rate: Comparing the mechanical properties under the compression rate of 0.01 mm/s and 0.1 mm/s, it could be seen that with the increase of the compression rate, the Young’s modulus of the intervertebral disc increased significantly. (5) Internal displacement distribution: Fatigue loading had a significant effect on the internal displacement distribution of the lumbar disc under compression. Before fatigue loading, the axial displacement in upper afferent fiber was largest, and the radial displacement in inner afferent fiber was slightly smaller than that in outer afferent fiber. After fatigue loading, the axial displacement in upper afferent fiber was smallest, and the radial displacement in inner afferent fiber was significantly smaller than in outer afferent fiber. (6) The research work in this article has important theoretical guiding significance for preventing lumbar disc herniation in daily life.

P38/akt pathway regulates the oriented differentiation of bone marrow mesenchymal stem cells in nanofiber annulus fibrosus scaffolds with different spatial structures / 中国组织工程研究

BACKGROUND: Previous studies have shown that a variety of materials can be used for the construction of tissue engineering scaffolds. The topological structure of the scaffold surface has a regulatory effect on the biological behaviors such as stem cell proliferation and differentiation, but the specific mechanism is still unclear. OBJECTIVE: To investigate the role of P38 and Akt pathways in the oriented differentiation of bone marrow mesenchymal stem cells in nanofiber scaffolds. METHODS: Three kinds of nanofiber scaffolds (AFS, AYS, 3-DPS) with different structures were constructed. Rat bone marrow mesenchymal stem cells were inoculated on the surface of three kinds of nanofiber scaffolds. After osteogenic induction, cell morphology, adhesion and proliferation were detected. mRNA expression levels of key phenotype molecules (COLIα1, COLIIα1, Aggrecan, Sox-9) were measured using qRT-PCR. Intracellular P38, AKT, ERK1/2 and JNK expression was detected by western blot assay. RESULTS AND CONCLUSION: After 4 and 8 hours of culture, cell adhesion rate of the 13-DPS scaffold group was higher than that of the AFS and AYS scaffold groups (P<0.05). After 7 days of culture, cells of the 13-DPS scaffold group proliferated faster than those of AFS and AYS scaffold groups (P<0.05). Bone marrow mesenchymal stem cells adhered firmly and grew well on three kinds of scaffolds. Fibroblast-like growth was observed on the AFS and AYS scaffolds and chondrocyte-like growth was observed on the 3-DPS scaffold. After 3 weeks of cartilage induction, mRNA expression of COLIIα1, Aggrecan and Sox-9 was higher, and the mRNA expression of COLIα1 was lower, in the 3-DPS scaffold group compared with the other two groups (both P<0.05). After 3 weeks of cartilage induction, relative expression level of p-AKT and p-P38 in the 3-DPS scaffold group was significantly higher than that in the other two groups (both P<0.05). There were no significant differences in AKT total protein and ERK1/2, JNK, P38, p-ERK1/2, p-JNK and p-P38 protein expression levels among three groups. These findings suggest that nanofiber annulus fibrosus scaffolds with different spatial structures can induce the oriented differentiation of bone marrow mesenchymal stem cells through the P38 and AKT pathway, which were the downstream of the Integrin-FAK signaling pathway.

Research progress of intervertebral disc repair with decellularized matrix materials / 中国组织工程研究

BACKGROUND: With the development of tissue engineering, the repair and regeneration of disc becomes possible. Decellularized extracellular matrix is an important means for disc regeneration. OBJECTIVE: To review and summarize the processing, quality control and application of decellularized matrix materials applied in intervertebral disc regeneration in recent years and put forward the prospect. METHODS: PubMed, Web of Science and CNKI databases were searched for the articles concerning decellularized methods and decellularized matrix repairing intervertebral disc with the search terms of “intervertebral disc, decellularization, extracellular matrix, scaffold material, tissue engineering” in English and Chinese, respectively. After screening based on the inclusion and exclusion criteria, the articles with high relevance were included for review. RESULTS AND CONCLUSION: The decellularized tissue-engineered intervertebral disc aims to maintain the physiologically relevant bioactivators to a great extent, improve mechanical properties and biocompatibility, and reduce immunogenicity. The decellularized matrix material can simulate the microenvironment of the extracellular matrix in the intervertebral disc. As a cell carrier, it can well induce the differentiation of seed cells, which has achieved certain progress in the repair of intervertebral discs. However, further studies need to address the following issues: proper porosity of decellularized matrix materials, immunological rejection, implant ways in vivo and repair effect.

The Anatomical Study Of Mitral Valve Annulus In The Human Cadaveric Hearts For Bioprosthesis

Introduction: The unimpeded forward flow of blood across the mitral orifice depends upon a coordinatedinteraction between the mitral annulus, leaflets, chordae tendinae & papillary muscle. Knowledge about thenormal anatomy of mitral valve annular morphometry is important for assessing the valve pathologies and alsoin valve replacement surgery for a deceased valveMaterials and methods: 50 heart of embalmed adult human cadaver of both sex aged between 20-70 years weretaken from the department of anatomy, VIMS & RC. Parameters measured were annular diameter, circumference,area of mitral valve by using vernier caliper, measuring scale, cotton thread & magnifying lens.Results: In the present study mean value of mitral valve were, circumference of mitral valve was 8.19±1.01cm inmales, 7.76±0.99 cms in females, diameter was 3.10±0.40 cm in males & 3.26±0.48 cm in females, area of mitralvalve was 5.45±1.34 cm2in males & 4.89±1.20 cm2 in females. All the parameters of mitral valve annulus likecircumference, diameter & area of valve was more in males except in females the diameter was more. There wasno significant difference between male & female values of mitral valve annulus.Conclusion: Knowledge of normal measurements of the component parts of the mitral valve is essential for thesurgeon during operation to assess the exact mechanical reason for valve insufficiency & in development &manufacture of prostheses for valvuloplasty

Proportion of pulmonary valve annulus: A new predictive index for transannular patch in repair of tetralogy of Fallot / 中国胸心血管外科临床杂志

@#Objective To investigate if the ratio of pulmonary valve annulus, which is the proportion of pulmonary valvular annulus size to total size of aortic valvular annulus and pulmonary valvular annulus, can better guide the choice of surgical approach than the value of z. Methods A retrospective analysis was made for 254 patients who underwent total correction of tetralogy of Fallot in Guangdong General Hospital between January 2016 and January 2018. There were 154 males and 100 females with an average age of 14.60±18.76 years. The patients were categorized into two groups, a transannular patch group (TAP, n=164) and a non-TAP group (n=90). The sizes of pulmonary and aortic valvular annulus were evaluated in each group, and the cutoff value of proportion of pulmonary valvular annulus for TAP was calculated. Results Both proportion of pulmonary valvular annulus and z-scores were smaller in the TAP group than those in the non-TAP group (0.29±0.06 vs. 0.36±0.06, P<0.001; –4.04±2.13 vs. –2.06±1.84, P<0.001, respectively). In receiver operating characteristics analyses, proportion of pulmonary valvular annulus and the z-score cutoff values were 0.353 (area under the curve 0.781, 95%CI 0.725–0.831) and –2.13 (area under the curve 0.766, 95%CI 0.709–0.817), respectively, demonstrating that the proportion of pulmonary valvular annulus was a more powerful diagnostic tool as a predictor of TAP. Conclusion Our results suggest that the proportion of pulmonary valvular annulus is an effective predictor for TAP and can be easily applied to clinical practice.

Echocardiography diagnosis and surgical outcome of rheumatic tricuspid valve disease / 中华超声影像学杂志

Objective To review the patients with rheumatic tricuspid valve disease ( RTVD) who were confirmed in cardiac operation and underwent tricuspid valve repair ,and summarize two and three-dimensional echocardiography ( 2D-STE ,3D-STE) characteristics of RTVD ,and evaluate the surgical procedures and outcomes of RTVD . Methods Between December 2009 and December 2017 ,359 patients with rheumatic heart disease ( RHD) underwent left-sided valvular replacement were enrolled . During the operation , 56 patients with RTVD were confirmed . All patients underwent 2D-STE and 3D-STE preoperatively . The preoperative echo characteristics of RTVD and the procedure of tricuspid valvular repair were reviewed . The morphology and function of tricuspid valve were followed after operation . Results Fifteen patients with RTVD were diagnosed by transthoracic echocardiography( TTE) preoperatively .Eight patients were presented tricuspid stenosis . Tricuspid annulus diameter [ ( 40 .3 ± 5 .6 ) mm ] , tethering distance[(5.9±2.2)mm] ,andpulmonaryarterysystolicpressure[(46.3±15.9)mmHg(1mmHg=0.133 kPa) ] were measured by echocardiography ,preoperatively . Moderate and severe tricuspid regurgitation were presented in 32 patients( 57 .1％ ) . All patients underwent tricuspid valvular repair . During the mean follow-up (78 .9 months) ,tricuspid annulus diameter was reduced and tricuspid regurgitation was relieved . Recurrent tricuspid regurgitation occurred in 8 patients(14 .3％ ) . Conclusions Preoperatively 2D-STE and 3D-STE need to evaluate tricuspid valve very carefully . Compared with functional tricuspid regurgitation , RTVD has some characteristics ,including more serious tricuspid reflux grade ,higher tethering distance ,the mismatch between tricuspid reflux degree and tricuspid anmular diameter or pulmonary artery pressure . Tricuspid valve repair shows better early and mid-term outcomes .

Treatment of Isolated Type Ic Lesion-Induced Aortic Regurgitation by External Suture Annuloplasty Alone / 日本心臓血管外科学会雑誌

A diagnosis of active aortic valve endocarditis was made in a 52-year-old man who presented with fever and edema. Blood cultures were positive for Streptococcus gallolyticus subsp. pasteurianus. The infection was treated successfully using antibiotics and dental care, but a mobile vegetation-like structure on the aortic valve and severe aortic regurgitation, mainly due to aortic annulus dilatation, remained and required surgery. During the surgical procedure, the aortic valve leaflets were seen to be almost normal, and the regurgitation was found to be mainly due to aortic annulus dilation. Regurgitation could be managed with external suture annuloplasty alone, although a second session was necessary to reduce the annular size by one size. The annular size has been stable for over 1 year after surgery without re-operation of the aortic valve. This procedure not only reduces the operation time but also decreases the surgical stress and avoids the need for prosthetic valve replacement.

Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain

BACKGROUND: Discogenic pain is a common cause of disability and is assumed to be a major cause of non-specific low back pain. Various treatment methods have been used for the treatment of discogenic pain. This study was conducted to compare the therapeutic success of radiofrequency (an intradiscal procedure) and laser annuloplasty (both an intradiscal and extradiscal procedure). METHODS: This single-center study included 80 patients and followed them for 6 months. Transforaminal laser annuloplasty (TFLA, 37 patients) or intradiscal radiofrequency annuloplasty (IDRA, 43 patients) was performed. The main outcomes included pain scores, determined by the numeric rating scale (NRS), and Oswestry disability index (ODI), at pre-treatment and at post-treatment months 1 and 6. RESULTS: The patients were grouped according to procedure. In all procedures, NRS and ODI scores were significantly decreased over time. Mean post-treatment pain scores at months 1 and 6 were significantly lower (P 40%. CONCLUSIONS: Our results indicate that annuloplasty is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin, and TFLA might be superior to IDRA in patients with discogenic low back pain.

Quantitative Predictive Imaging Biomarkers of Lumbar Intervertebral Disc Degeneration

STUDY DESIGN: Observational comparative study. PURPOSE: To compare fractional anisotropy (FA) maps with T2 values of the nucleus pulposus (NP) and annulus fibrosus (AF) of intervertebral discs in healthy volunteers and patients to develop a predictive disc health scale. OVERVIEW OF LITERATURE: T2-weighted magnetic resonance imaging (MRI) is not sensitive to early morphological changes and provides no quantitative biomarker profile for early degeneration. METHODS: We examined 59 healthy controls and 59 patients with back pain by MRI using T2 relaxometry and diffusion tensor imaging (DTI). Each group was divided into three age subgroups: A (50 years, n=21). We obtained FA values for AF and NP and T2 values for NP for each intervertebral disc. Furthermore, we calculated the FA (AF/NP) ratios. RESULTS: We categorized 590 intervertebral discs from 118 participants, 566 of which were analyzed with T2 relaxometry and DTI. The T2 values were as follows: subgroup A, 55.8±4.4 ms; B, 48.5±6.9 ms; C, 45.8±8.7 ms (p120 ms, 90–100 ms, and 70 ms, respectively (p<0.001). Control subgroup A had higher T2 values and AF/NP ratios than subgroups B and C; the AF values were not significantly different. Control subgroup B had higher T2 values and AF/NP ratios than subgroup C but lower FA (NP). CONCLUSIONS: FA maps of the AF/NP ratio and T2 values of NP are potential microstructure biomarkers of normal and degenerating discs and can help detect early degeneration using a predictive disc health score on a continuous scale.

Study on radiofrequency catheter ablation below tricuspid valve in premature ventricular contraction originating from tricuspid annulus under Carto3 guidance / 中国医师进修杂志

Objective To evaluate the safety and clinical effect of radiofrequency catheter ablation below tricuspid valve using Carto3 system combined with SmartTouch contact force catheter in premature ventricular contraction (PVC) originating from tricuspid annulus. Methods The clinical data of 21 patients with PVC originating from tricuspid annulus from September 2016 to September 2018 were retrospectively analyzed. Radiofrequency catheter ablation below tricuspid valve was performed using Carto3 system combined with SmartTouch contact force catheter. Results The result of intraoperative mapping under Carto3 guidance showed that premature ventricular contraction in 12 cases originated from septal portion of the tricuspid annulus and in 9 cases originated from free wall of the tricuspid annulus. All patients′ ablation were successful, and no operative complications occurred. The patients were followed up for 1 to 23 months, and no recurrence occurred. However, there was 1 patient whose first radiofrequency ablation on the tricuspid valve was immediately successful, and PVC recurred 2 h after operation. Finally, radiofrequency ablation was performed successfully at 12 O′clock below the tricuspid valve 9 months later. Conclusions Radiofrequency catheter ablation below the tricuspid valve using carto3 guidance combined with SmartTouch contact force is safe in PVC originated from tricuspid annulus, and it can improve the success rate.

MSCT evaluation on dynamic changes of aortic annulus during cardiac cycle / 中国介入影像与治疗学

Objective: To explore the dynamism of aortic annulus (AA) during cardiac cycle and the correlation with calcification with MSCT. Methods A total of 69 aortic stenosis patients (AS group) and 69 controls (normal control group) underwent MSCT. Dimensions of AA were assessed on both systolic and diastolic phase. For each phase, the long diameter, short diameter, area and perimeter of AA were measured, respectively. The features of annular dimension change and the relationship with calcium score were analyzed. Finally, the differences of dynamic of AA in different calcification grades were compared. Results The mean annular dimensions were significantly larger during systole than diastole (all P0.05). In AS group, the perimeter-derived diameter (DP) of AA was significantly larger than the area-derived diameter (DA) in both systolic and diastolic phase (P<0.001). The change rate of AA area was significantly higher than change rate of perimeter (P<0.001) during cardiac cycle. There were negative correlation between the calcium score of AA and the change of DA and Dp (r=-0.264, -0.302, P<0.05). The dynamic of AA had significant difference among different calcification grades (P<0.05). Conclusion: The morphology and structure of AA significantly changed during cardiac cycle, and the dynamic change of AA with severe calcification significantly reduced. Systolic multiparameter measurement might provide accurate anatomical data for transcatheter aortic valve replacement.

A Study Of The Dimensions Of The Human Tricuspid Valve

Background: With the advent of the prosthetic valves, which are being used by the cardiac surgeons to replacediseased or damaged valves, an accurate knowledge of the dimensions and size of the tricuspid valve will be ofimmense help. Surgical correction on the heart valves has given a new lease of life to patients. This study, so farhas been done mostly on the American and European races. Studies in the Indians, particularly South Indianshas been rare. Hence the present study.Materials and Methods: 96 hearts were studied which were collected from cadavers allotted to undergraduatestudents for dissection, over a period of time. Hearts were removed by dissection method. The circumference ofthe tricuspid valve was measured & the diameters of the tricuspid valve are measured in two separate dimensionsin two separate perpendicularly oriented planes at the maximally separated points which is described undermaterials & methods.Results: The results of the study are as follows: The dimensions of the tricuspid valve annulus range from 5.7 cm– 14.8 cm. No accessory leaflets were foundConclusions: The study of the dimensions of the tricuspid valve annulus dimensions is important for variouscardiac procedures. The knowledge of the annulus of the tricuspid valve is important for the cardiac surgeon intricuspid valve diseases like stenosis and regurgitation as it will help him plan palliative or corrective surgeryin the congenital or acquired heart diseases.

Energy supply and demand in the intervertebral disc / Fornecimento e demanda de energia no disco intervertebral / Suministro de energía y demanda en el disco intervertebral

ABSTRACT The intervertebral disc (IVD) is one of the parts of the body most commonly affected by disease, and it is only recently that we have come closer to understanding the reasons for its degeneration, in which nutrient supply plays a crucial role. In this literature review, we discuss the basic principles and characteristics of energy supply and demand to the IVD. Specifically, we review how different metabolites influence IVD cell activity, the effects of mechanical loading on IVD cell metabolism, and differences in energy metabolism of the annulus fibrous and nucleus pulposus cell phenotypes. Determining the factors that influence nutrient supply and demand in the IVD will enhance our understanding of the IVD pathology, and help to elucidate new therapeutic targets for IVD degeneration treatment.

RESUMO O disco intervertebral (IVD) é uma das partes mais comuns do corpo e apenas recentemente nos aproximamos de compreender as razões da sua degeneração, em que o suprimento de nutrientes desempenha um papel crucial. Nesta revisão da literatura, discutimos os princípios básicos e as nuances do fornecimento e da demanda de energia para o IVD. Específicamente, analisamos como os diferentes metabólitos influenciam na atividade das células IVD, os efeitos da carga mecânica no metabolismo das células IVD, a diferença no metabolismo energético dos fenótipos das células fibrosas e do núcleo do pulposus anelar. A determinação de fatores que influenciam o suprimento e a demanda de nutrientes no IVD aumentará nossa compreensão da patologia IVD e ajudará a elucidar novos alvos terapêuticos para o tratamento da degeneração IVD.

RESUMEN El disco intervertebral (IVD, por sus siglas en inglés) es una de las partes más comúnmente enfermas del cuerpo y solo recientemente nos acercamos a la comprensión de los motivos de su degeneración, de los cuales el suministro de nutrientes juega un papel crucial. En esta revisión de la literatura discutimos los principios básicos y los matices de la oferta y demanda de energía para el IVD. Específicamente, revisamos cómo los diferentes metabolitos influyen en la actividad de las células IVD, los efectos de la carga mecánica sobre el metabolismo de las células IVD y las diferencias en el metabolismo energético de los fenotipos de las células del anillo fibroso y el núcleo pulposo. La determinación de los factores que influyen en la oferta y demanda de nutrientes en el IVD mejorará nuestra comprensión de la patología IVD y ayudará a dilucidar nuevos objetivos terapéuticos para el tratamiento de la degeneración IVD.

Outcomes of surgical treatment of lumbar disk herniation using an annular closure device / Desfechos do tratamento cirúrgico da hérnia de disco lombar com aparelho de fechamento anular / Resultados del tratamiento quirúrgico de la hernia de disco lumbar utilizando un dispositivo de cierre anular

ABSTRACT Objective: The aim of the study was to investigate the clinical and radiological results of using the annular closure device in patients with lumbar disc herniation (LDH). Methods: The study involved 120 patients with LDH operated on by limited discectomy and annular closure using the Barricaid device. A literature review was conducted to evaluate the effectiveness of the annuloplasty. Results: All patients showed postoperative regression of the radicular pain syndrome and were mobilized on the day of surgery. The correlation between the removed nucleus pulposus and changes in DHI was studied by linear regression. The results revealed that disc height loss is directly correlated with the volume of removed nucleus pulposus (p <0.05). Modic changes were present in 22 (22%) patients. Endplate changes (resorption and erosion) were present in 25 patients (20.7%). We found that these changes in MR and CT images have no effect on the clinical presentation of the disease. No intraoperative complications, such as severe hemorrhage requiring blood transfusion, or injury to the dura mater or nerve roots, were observed in our case series. Postoperative complications occurred in 3 (2.5%) patients. The reoperation rate was 4.2%. Conclusions: The use of the Barricaid annular closure device in 120 patients with lumbar disc herniation and high risk of recurrent herniation showed good clinical and radiographic outcomes. The reoperation rate in our study was 2.5%; disc reherniation at the operated level was observed in 1.7% of patients. This is a good outcome compared to the data reported for patients having a high risk of disc reherniation. Level of Evidence IV; Case series.

RESUMO Objetivo: O objetivo do estudo foi estudar os resultados clínicos e radiológicos do uso do dispositivo de fechamento anular em pacientes com hérnia discal lombar (HDL). Métodos: O estudo envolveu 120 pacientes com LDH operados por discectomia limitada e fechamento anular usando o dispositivo Barricaid. Uma revisão da literatura foi realizada para avaliar a eficácia da anuloplastia. Resultados: Todos os pacientes apresentaram regressão pós-operatória da síndrome da dor radicular e foram mobilizados no dia da cirurgia. A correlação entre o núcleo pulposo removido e as alterações no DHI foi estudada por regressão linear. Revelou-se que a perda de altura discal está diretamente correlacionada com o volume do núcleo pulposo removido (p <0,05). Alterações modicadas reveladas em 22 (22%) pacientes. As alterações no endplate foram reveladas em 25 pacientes (20,7%). Descobrimos que essas mudanças nas imagens de RM e TC não têm efeito sobre a apresentação clínica da doença. Não foram observadas complicações intraoperatórias, como hemorragia grave que necessitou de transfusão sanguínea, lesão da dura-máter ou raízes nervosas, em nossa casuística. Complicações pós-operatórias foram reveladas em 3 (2,5%) pacientes. A taxa de reoperação foi de 4,2%. Conclusão: O uso do dispositivo de fechamento anular Barricaid em 120 pacientes com hérnia discal lombar e alto risco de hérnia recorrente mostrou bons resultados clínicos e radiográficos. A taxa de reoperação em nosso estudo foi de 2,5%; reinteriato discal no nível operado foi observado em 1,7% dos pacientes. É um bom resultado comparado aos dados relatados para pacientes com alto risco de reintervenção com disco. Nível de evidência IV; Série de casos.

RESUMEN Objetivo: El objetivo del estudio fue estudiar los resultados clínicos y radiológicos del uso del dispositivo de cierre anular en pacientes con hernia de disco lumbar (LDH). Métodos: El estudio involucró a 120 pacientes con LDH operados por discectomía limitada y cierre anular usando el dispositivo Barricaid. Se realizó una revisión de la literatura para evaluar la efectividad de la anuloplastia. Resultados: Todos los pacientes mostraron regresión postoperatoria del síndrome de dolor radicular y se movilizaron el día de la cirugía. La correlación entre el núcleo pulposo retirado y los cambios en DHI se estudiaron mediante regresión lineal. Los resultados revelaron que la pérdida de altura del disco se correlaciona directamente con el volumen del núcleo pulposo retirado (p <0,05). Cambios módicos revelados en 22 (22%) pacientes. Los cambios de placa terminal (resorción y erosión) se revelaron en 25 pacientes (20,7%). Descubrimos que estos cambios en las imágenes de RM y TC no tienen ningún efecto sobre la presentación clínica de la enfermedad. En nuestra serie de casos no se observaron complicaciones intraoperatorias, como hemorragia severa que requiriera transfusión de sangre, lesión de la duramadre o raíces nerviosas. Las complicaciones postoperatorias se revelaron en 3 (2,5%) pacientes. La tasa de reoperación fue del 4,2%. Conclusiones: El uso del dispositivo de cierre anular Barricaid en 120 pacientes con hernia de disco lumbar y alto riesgo de hernia recurrente mostró buenos resultados clínicos y radiográficos. La tasa de reoperación en nuestro estudio fue del 2.5%; la hernia recurrente del disco en el nivel operado se observó en el 1,7% de pacientes. Es un buen resultado en comparación con los datos informados para pacientes que tienen un alto riesgo de hernia recurrente del disco. Nivel de evidencia IV; Serie de casos.