Initial clinical experience of left bundle branch pacing after transcatheter aortic valve implantation / 中华心血管病杂志

Objective: To investigate the efficacy and safety of left bundle branch pacing(LBBP) in patients after transcatheter aortic valve implantation (TAVI). Methods: This is a retrospective study. A total of 35 patients underwent TAVI and received pacemaker implantation from January 2018 to December 2020 in Beijing Fuwai Hospital were enrolled. Patients were divided into LBBP group (n=12) and right ventricular apex pacing (RVAP) group (n=23) according to the pacing position. The success rate of operation in LBBP group was calculated, and the occurrence of complications were observed, and the parameters of pacemaker were measured on the 3rd day and 1, 3 and 6 months after operation. The N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiographic and ECG indexes were compared between the two groups on the 3rd day and 1, 3, and 6 months after pacemaker implantation. Result: A total of 35 patients were included, The age was (76.4±7.7) years, including 19 males (54.3%). The procedure time ((86.58±17.10)min vs. (68.74±9.18)min, P<0.001) and fluoroscopy duration ((20.08±4.44)min vs. (17.00±2.26)min, P<0.001) were significantly longer in LBBP group compared with RVAP group. The operation success rate of LBBP group was 11/12. There was no serious operation related complications such as pneumothorax, hemothorax, electrode dislocation, infection, and lower limb bleeding. The patients were followed up for 7.43 (5.21, 9.84) months. The programmed parameters of pacemaker were in the ideal range and stable during follow-up. At 3 and 6 months after operation, the left ventricular ejection fraction in LBBP group was higher than that in RVAP Group (at 3 months: (60.75±2.89)% vs. (57.35±3.33)%, P=0.004; at 6 months: (63.17±3.33)% vs. (56.17±3.97)%, P<0.001), NT-proBNP values was lower in LBBP group than that in RVAP Group (at 3 months: 822 (607, 1 150)ng/L vs. 1 052 (902, 1 536)ng/L, P=0.006; at 6 months: 440 (330,679)ng/L vs. 783 (588, 1 023)ng/L, P=0.001). At 1, 3 and 6 months after operation, the QRS duration was shorter in LBBP group than that in RVAP group (1 month: 99 (97, 107)ms vs. 126(124, 130)ms, P<0.001; 3 months: 98(96, 105)ms vs. 129(128, 133)ms, P<0.001; 6 months: 96(94, 104)ms vs. 130(128, 132)ms, P<0.001). Conclusions: For patients with permanent pacemaker indications after TAVI, LBBP is feasible, safe and reliable. It could improve the cardiac function in the short term, the long-term effect of LBBP needs to be further observed.

Chinese expert consensus on diagnosis, treatment and prevention of venous thrombus embolism associated with chest trauma (2022 version) / 中华创伤杂志

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Esophageal cancer combined with gastric cancer residual esophageal surgery / 中华胸心血管外科杂志

Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.

Esophageal cancer combined with gastric cancer residual esophageal surgery / 中华胸心血管外科杂志

Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.

Long-term clinical outcomes of patients with unprotected left main bifurcation lesions treated with 2-stent techniques / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Currently available evidence suggests that outcomes are less favorable when left main (LM) bifurcation lesions are treated with 2-stent techniques compared with a single-stent technique. We aimed to evaluate the long-term outcomes of the 2-stent techniques for treating unprotected LM bifurcation lesions in Chinese patients.</p><p><b>METHODS</b>We enrolled 301 consecutive patients treated with drug-eluting stents (DES) implantation using 2-stent techniques for unprotected LM bifurcation lesions (MEDINA 1, 1, 1, 70.5%). The 2-stent techniques included crush technique, V stenting, T stenting, and Culottes stenting. After stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB). Clinical and angiographic data were analyzed. The primary endpoints were major adverse cardiac events (MACE), which included death, myocardial infarction, and target lesion revascularization.</p><p><b>RESULTS</b>Immediate procedural success was obtained in all cases with a FKB success rate of 95.3%. Follow-up data were available for all patients. The overall incidence of angiographic in-stent restenosis (ISR) rate was 20.3% and most ISRs were of the focal type. During long-term follow-up (mean duration, (54 ± 22) months), the cumulative incidence of MACE was 11.0%, with 8 (2.7%) deaths, 7 (2.3%) myocardial infarctions, and 18 (6.0%) repeated lesion revascularization. MACEs in high SYNTAX score terciles were significantly higher compared with those in low and intermediate SYNTAX score terciles (P = 0.001).</p><p><b>CONCLUSIONS</b>Although percutaneous coronary intervention (PCI) with 2-stent technique for unprotected LM bifurcation lesions was accompanied with a slightly high incidence of ISR, the long-term clinical follow-up is acceptable. Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with LM bifurcation disease treated by PCI.</p>

Clinical outcome of patients undergoing emergent coronary artery bypass grafting following failed percutaneous coronary intervention in stent era / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore clinical outcomes of patients undergoing emergent coronary artery bypass grafting (CABG) following failed percutaneous coronary intervention (PCI) in the stent era.</p><p><b>METHODS</b>Eleven patients who underwent emergent CABG following failed PCI from January, 2002 to December 2010 were enrolled. The in-hospital follow-up included cardiac deaths, Q-wave myocardial infarction, kidney failure, and cerebrovascular events. The clinical end-point of out-hospital follow-up was the major adverse cardiac events including death, myocardial infarction, and target lesion revascularization.</p><p><b>RESULTS</b>The patients were (61 ± 5) years old. Coronary angiography showed 5 patients had triple vessel lesions. There were 9 target lesions on left anterior descending artery. There were 3 (27.3%) severe calcified, 4 (36.4%) chronic total occlusion, and 4 (36.4%) diffused long lesions. Reasons for emergent CABG were dissection (n = 5, 45.5%), perforation (n = 3, 27.3%), failure to sufficient predilation (n = 1, 9.1%), acute closure (n = 1, 9.1%) and stent loss (n = 1, 9.1%). The average duration of follow-up was (47 ± 33) months. During in-hospital follow-up, there were 1 (9.1%) cardiac death and 2 (18.2%) Q wave myocardial infarction. During follow-up after hospital discharge, 1 patient (9.1%) died of kidney failure, and there was no rehospitalization due to cardiac events.</p><p><b>CONCLUSIONS</b>Emergent CABG after failed PCI often happened in patients with complex coronary lesions. The long term outcome of patients requiring emergent CABG after failed PCI was favorable in this cohort.</p>

Study on activities and protein and gene expression of renal H(+)-K(+)-ATPase in rats subchronic exposed to trimethyltin chloride / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the activity, protein and gene expression of renal HK-ATPase (HKA) in rats subchronic exposed to trimethyltin chloride (TMT).</p><p><b>METHODS</b>In subchronic toxic test (14-week), 55 female SD rats (age, 6 weeks) were divided randomly into 5 groups: control, low, medium, high and super high dosage, respectively, which drank water with TMT of 0, 8.20, 32.81, 131.25 and 262.50 microg x kg(-1) x d(-1) for 14 weeks. Then serum K+ levels were measured; the activities of HK-ATPase (HKA) in kidneys were detected by the method of determinated phosphorus content; Western Blot assay and real-time PCR were used to exam the protein and mRNA expression levels of HKA in kidneys, respectively.</p><p><b>RESULTS</b>The serum K+ level in super-high dosage group was (5.6 +/- 0.4) mmol/L, which was significantly lower than that [(6.9 +/- 0.3) mmol/L] in control group (P < 0.01). The HKA enzymatic activity of kidneys in low and super high dosage groups was 4.50 +/- 1.45 and 4.55 +/- 0.72 micromolPi x mg prot(-1)h(-1), respectively, which were significantly lower than that (6.55 +/- 0.77 micromol Pi x mg prot(-1) h(-1)) in control group (P < 0.05).</p><p><b>CONCLUSION</b>When rats were exposed subchronic to TMT, the renal HKA activity could reduce, but the expression levels of HKA protein and mRNA did not decrease.</p>

Effect of Rhodiola Crenulate oral liquid on reproduction function in male rats / 国际中医中药杂志

Objective To observe the action of Rhodiola Crenulate(RC) oral liquid reproduction function for the male rats. Methods 100 SD rats were randomly divided into 5 groups with equal gender number respectively. The male rats were given RC oral liquid (0, 2.48 g/kg, 7.48 g/kg, 24.80 g/kg) and Nanbao (2.00 g/kg)by oral twice a day for 48 d, respectively. Then the male rat was put into the same box in which the female rat whit two-side ovarys were excised for 15 d, respectively. The intercoursing ability,testosterone levels, and the weight of immune organs of the male rats were examined. 40 four-week-old rats were divided into 5 groups. Except for blank control, all rats's testis were excised. The castrated rats were treated with RC oral liquid (2.48 g/kg, 24.8 g/kg)and Methyltestosterone (2.00 mg/kg). The blank control group and model control group were given the same dose NS by oral twice a day for 28 d, respectively. The weight of accessory sex organs in castrated rats was observed. Results The level of testosterone and the organ coefficients of thymus and spleen in RC oral liquid groups were higher than blank control (P<0.05 or P<0.01).The weight of accessory sex organs of castrated rats in RC oral liquid groups were heavier than model control (P<0.05). Conclusion RC oral liquid can improve the reproduction function in male rats.

Inhibitory effect of adenovirus-mediated endostatin gene transfer on transplanted lung carcinoma in mice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the effect of adenovirus-mediated endostatin gene transfer on transplanted lung cancer in mice and its mechanism of action.</p><p><b>METHODS</b>Transplant tumor model was induced by subcutaneous inoculation of 2 x 10(6) Lewis lung cancer (LLC) cells into the back of C57BL/6 mice. The mice were treated by intratumoral injection of 2 x 10(9) pfu Ad-mEndostatin. The expression of endostatin in situ and its maintaining time were detected by immunohistochemistry and Western Blot, respectively. The endostatin level in serum was determined by ELISA . The inhibition of tumor growth and changes of survival were recorded and the microvessel density (MVD) was determined by histochemical stainingwith CD31 and CD105 antibodies. The tumor apoptosis was observed by electron microscopy.</p><p><b>RESULTS</b>In comparison with controls, intratumoral injection of Ad-mEndostatin significantly inhibited the tumor growth and metastasis, and prolonged the survival rate of mice (P < 0.05). Strong positive expression of mEndostatin was seen in the tumor tissue after injection of Ad-mEndostatin, immunhistochemically ostained by mouse endostatin monoclonal antibody, while the control groups showed only very low expression or absence. Serum endostatin concentration was 1540 +/- 560 ng/ml at the second week of administration, the expression of endostatin diminished a month later. The microvessel density (MVD)) decreased from 42.4 +/- 4.8 to 10.5 +/- 3.2 per x 200 magnificetion microscopic field by CD10 staining and from 68.5 +/- 4.5 to 37.5 +/- 4.6 by CD31 staining, respectively (P < 0.05). More apoptotic tumor cells were seen under the transmission electron microscope.</p><p><b>CONCLUSION</b>Endostatin gene therapy mediated by adenoviral vector efficiently induces expression of endostatin in vivo, and inhibits the growth and metastasis of tumor. It is concluded that its action is targeted to tumor neovasculature and the mechanism is inhibition of tumor angiogenesis.</p>

Clinical application progress of video mediastinoscopy / 国际肿瘤学杂志

Modiastinoscopy is an invasive method with very high sensitivity and specificity, which has an unreplaceble role in diagnosis of indeterminate mediastinal masses and staging of lung neoplasms. Video me-diastinoscopy provides optimal visualization of mediasfinal structure and the possibility for the surgeon to operatewith both hands. And more operation can be performed by video mediastinoscopy. Now video mediastinoscopy has been replacing traditional mediastinoscopy gradually.