Toxicity Management and Efficacy Evaluation of BCMA-CART in the Treatment of Relapsed and Refractory Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the toxicity management and efficacy evaluation of BCMA-chimeric antigen receptor T cells(CART) in the treatment of relapsed and refractory multiple myeloma (MM).@*METHODS@#The efficacy and adverse reactions of 21 patients with MM who received BCMA-CART treatment at the First Affiliated Hospital of Wenzhou Medical University from December 2017 to September 2020 were evaluated, and the efficacy assessment and survival analysis for high-risk patients and non-high-risk patients were evaluated.@*RESULTS@#After infusion of BCMA-CART cells in 21 MM patients, the number of effective cases was 17, of which the complete remission (sCR/CR) was 10, and the partial remission (VGPR/PR) was 7. The median OS time for all patients was 19.4 months, and the median PFS time was 7.9 months. The number of patients with extramedullary disease(EMD), high-risk genetics, and ISS stage Ⅲ were 5, 15 and 8, and the effective number was 3, 11 and 6, respectively. The treatment of 3 patients without high-risk factors was effective. The median OS and median PFS of patients with EMD were 14.2 and 2.5 months, respectively, which were shorter than those of patients without EMD (19.4 months and 8.9 months, respectively). The median OS and median PFS of patients with high-risk cytogenetic factors and ISS Ⅲ were not significantly different from those of non-high-risk patients. Cytokine release syndrane (CRS) occurred in 20 patients, of which 14 cases were Grade 1 CRS, while 6 were Grade 2, no CRS of Grade 3 or above occurred. IL-6 receptor inhibitors were used in 9 patients. All CRS were controlled effectively, and no patients had neurological toxicity.@*CONCLUSION@#BCMA-CART is a certain curative effect in the treatment of relapsed and refractory multiple myeloma, and the adverse reactions can be well controlled through close monitoring and timely treatment.

Pleurodesis with an Autologous Blood Patch in the Treatment of Persistent Air Leak after Lung Resection / 中国医学科学院学报

Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.

Tobacco control intervention on vocational school students based on social cognitive theory / 中国学校卫生

Objective@#This study conducted a tobacco control intervention practice on vocational school students based on social cognitive theory, for exploring the practical and feasible tobacco control strategies among students, so as to reduce adolescents’ smoking behaviors.@*Methods@#Cluster random sampling method was used to select students in four vocational schools in Shanghai, which were randomly divided into the intervention group (2 schools 1 003 students) and the control group (2 schools 1 096 students). The intervention was conducted on the intervention group based on the social cognitive theory and lasted for 6 months. The control group was blank. Descriptive and analytical statistical methods were used to evaluate the effect of intervention.@*Results@#After the intervention, in the intervention group, the current smoking rate (2.77%) and the smoking intention in the next 1 year (8.50%) both decreased, the scores of the cognition of the harm of smoking as well as second hand smoking and the attitudes towards tobacco all increased(39.04%, 32.93%), the self-efficacy of refusing smoking increased (88.93%), the social pressure decreased(12.40%), the exposure rate of secondhand smoke in family decreased(35.45%), and the exposure to tobacco control message on media increased (36.68%). The difference was statistical significant compared to the control group (χ2=8.67，19.32，17.87，8.32，13.51，14.71，17.36，20.09，P<0.01).@*Conclusion@#The tobacco control model based on social cognitive theory could effectively improve adolescents’ self-efficacy, increase their tobacco-related knowledge, and significantly reduce their future smoking intention and behavior.

Arterial switch operation: A double cohort study of 20 years’ outcomes of 571 patients in a single center / 中国胸心血管外科临床杂志

@#Objective    To define the patient characteristics and perioperative management, and to define the mortality and its risk factors after arterial switch operation (ASO). Methods    We conducted a bidirectional cohort study with 571 consecutive patients undergoing ASO from 1997 to 2016 in our hospital. We enrolled patients who underwent ASO before 2012 retrospectively and after 2012 prospectively and followed up all the patients prospectively. Demographic characteristics, clinical information and mortality of these patients were summarized. Joinpoint regression analysis was used to identify the time trend of the overall mortality. Kaplan-Meier survival analysis was used to evaluate the mid- and long-term survival rate after ASO. Cox proportional hazards regression models were used to explore the potential factors associated with mortality. The cumulative incidence of complications after ASO was predicted using competing risk models. Results    Several aspects of patients’ characteristics and perioperative management in our center differed from those in the developed countries. The overall mortality and in-hospital mortality after ASO was 16.3% and 15.1%, respectively. The overall cumulative survival rate at 5, 10 and 15 years after ASO was 83.3%, 82.8% and 82.8%, respectively. A significant decrease of overall mortality from 1997 to 2016 was observed. Independent risk factors of mortality included earlier ASO (1997-2006), single or intramural coronary anatomy and longer cardiopulmonary bypass time. Ten years after ASO, re-intervention, arrhythmia, pulmonary and anastomotic stenosis were the most common complications with a cumulative incidence over 10%. Conclusion    Significant improvements in the results of the ASO were observed and the postoperative mortality rate is close to reports from developed countries. Nonetheless, we have identified the need for further improvement in the early and late postoperative periods after ASO. Pulmonary stenosis, anastomotic stenosis and arrhythmia should be paid attention to during the long-term follow-up after ASO.

Simple pulmonary artery approach in subarterial ventricular septal defect repair in 102 patients: A clinical analysis / 中国胸心血管外科临床杂志

@#Objective    To summarize and analyze the experience of subarterial ventricular septal defect (VSD) repaired with simple pulmonary artery approach. Methods    We retrospectively anlyzed the clinical data of 102 patients with subarterial VSD repaired with simple pulmonary artery approach in our hospital from August 2015 to October 2018. There were 67 males and 35 females at median age of 3 years (ranging 4 months to 49 years). Results    The median operation time was 82 (54-136) min. Median cardiopulmonary bypass time was 36 (21-62) min. The median aortic cross-clamping time was 13 (7-32) min. Thirty two patients of tracheal intubation were removed from the fast-track operating room immediately after surgery. Of the 102 patients, 67 patients underwent a small incision in the lower sternum. The median postoperative ICU stay time was 26 (13-36) h. There was no planned reoperations and no early death. Conclusion    Simple pulmonary artery approach for subarterial ventricular septal defect repair with less intracardiac procedures, short operation time, less trauma, quick postoperative recovery has certain advantages in the application of specific groups.

Awareness and associated factors of tobacco hazards among middle school personnel in Shanghai / 中国学校卫生

Objective@#To understand current situation of the awareness of tobacco hazards among middle school personnel in Shanghai and to explore its influencing factors,and to provide reference for making targeted measures to control tobacco hazards in schools.@*Methods@#A total of 30 middle schools in Shanghai were selected by stratified cluster sampling method. The questionnaires were used to investigate the smoking prevalence and tobacco hazard awareness of 3 007 faculty members.@*Results@#The total smoking rate of school personnel in Shanghai was 8.25%; the complete correct rate on the harm of smoking and second-hand smoke was only 19.72% and 23.74%, respectively. The correct awareness rate of harm caused by tobacco, such as stroke, osteoporosis and heart disease, was less than 50%. Gender, education level, smoking behavior and tobacco control training were related with tobacco hazards perception level.@*Conclusion@#The smoking rate among middle school personnel in Shanghai has been generally improved, but the faculty and staff have an unbalanced understanding of tobacco hazards. The school's tobacco control education should be targeted. Smoking, men and personnel with relatively low education levels are the key groups in school tobacco control education.

Transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia in patients with a history of transrectal prostate biopsy / 中华男科学杂志

Objective@#To evaluate the efficiency and safety of transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of BPH in patients with a history of transrectal prostate biopsy (TRPB).@*METHODS@#We retrospectively analyzed the clinical data on 102 cases of BPH treated by HoLEP in our hospital between November 2015 and May 2017, of which 42 had received TRPB prior to HoLEP (the PB group) but not the other 60 (the non-TRPB ［NPB］ group). We compared the preoperative, perioperative and postoperative follow-up data between the two groups of patients.@*RESULTS@#There were no statistically significant differences in the mean age, prostate volume, and preoperative post-void residual urine volume (PVR), IPSS, quality of life (QOL) score and maximum urinary flow rate (Qmax) between the two groups of patients. The preoperative PSA level was significantly higher in the PB than in the NPB group (［10.30 ± 3.62］ vs ［2.62 ± 1.75］ μg/L, P < 0.01), and the operation time markedly longer in the former than in the latter (［78.00 ± 18.25］ vs ［67.93 ± 15.89］ min, P < 0.01), particularly in the patients with an interval of <2 weeks between HoLEP and TRPB than in those with an interval of ≥2 weeks (［91.17 ± 16.51］ vs ［68.13 ± 12.45］ min, P < 0.01). Statistically significant differences were not found in the postoperative hemoglobin level, continuous bladder irrigation duration, catheter-indwelling time and hospital stay, nor in the incidence rate of transient urinary incontinence between the PB and NPB groups (47.62% vs 45%, P = 0.794). There were no transurethral resection syndrome, bladder or rectal injury, or blood transfusion in either group, nor statistically significant differences in PVR, Qmax, IPSS and QOL score between the two groups of patients at 3, 6 or 12 months after operation.@*CONCLUSIONS@#HoLEP is a safe and effective surgical treatment of BPH for patients with a history of TRPB, which can reduce the time and increase the safety of operation when performed at ≥2 weeks after TRPB.

Clinical Observation of Addition and Subtraction Therapy of Shentong Zhuyutang to Myofascial Pain Syndrome (MPS) with Stagnation of Blood Stasis / 中国实验方剂学杂志

Objective: To observe the short and long term effect of addition and subtraction therapy of Shentong Zhuyutang to myofascial pain syndrome (MPS) with stagnation of blood stasis and to investigate its mechanism of action.Method: One hundred and forty-eight eligible patients were randomly divided into control group (73 cases) and observation group (75 cases) by random number table.Patients in both groups got electroacupuncture treatment.Patients in control group additionally got Yaotong capsules,4 grains/time,3 times/day.Patients in observation group additionally got addition and subtraction therapy of Shentong Zhuyutang,1 dose/day.The treatment was continued for 6 weeks in both groups,and 16 weeks follow-up was recorded.Before treatment,and at the 1st,2nd,3rd,4th,5th,6th week after treatment,scores of visual analogue scale (VAS) was graded.Before and after treatment,scores of JOA,Roland-Morris disability questionnaire (RDQ),body damage index assessment scale (PⅡ scale),stagnation of blood stasis,and Pittsburgh sleep quality index (PSQI) were graded.Levels of thromboxane 2(TXB2),6-ketone-prostaglandin F1α(6-keto-PGF1α) were detected,and TXB2/6-keto-PGF1α was calculated;in addition,the recurrence was recorded and followed up.Result: By rank sum test,the clinical efficacy in observation group was better than that in control group (Z=1.969,Pst,2nd,3rd,4th,5th,6th week in both groups after treatment (Fcontrol=5.801,Fobservation=6.649,Pt-test indicated that scores of VAS in observation group were lower than those in control group at 2nd,3rd,4th,5th,6th week (PP2,and T/K in observation group were lower than those in control group (P1α was higher than that in control group (Pχ2=4.745,PConclusion: Based on acupuncture treatment,addition and subtraction therapy of Shentong Zhuyutang can relieve the pain caused by myofascial pain syndrome (MPS) with stagnation of blood stasis,recover lumbar activity function,reduce rate of recurrence,and ameliorate blood circulation,with anti-inflammatory and analgesia effects.

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.

The application value of virtual reality technology in the surgical treatment of coronary artery fistula and abnormal origin of coronary artery / 中国胸心血管外科临床杂志

@#Objective To evaluate the application value of virtual reality (VR) technology in the surgical treatment of coronary artery fistula (CAF) and abnormal origin of coronary artery (AOOCA). Methods From January 2014 to June 2018, with the assistance of virtual reality technology, 4 patients with CAF and 4 patients with AOOCA in the Department of Cardiac Surgery of our hospital underwent treatment method deciding and operation details planning. In the CAF patients, there was 1 male and 3 females and they were 8 years, 16 years, 62 years, and 65 years, respectively. In the AOOCA patients, there was 1 male and 3 females at age of 4-month, 2 years, 14 years, and 29 years, respectively. Results The virtual heart models in all 8 patients were well matched with the real heart. The spatial structure information of CAF/AOOCA and surroundings can be intuitively and fully shown by virtual reality technology in all patients. All of the 4 CAF patients repaired coronary artery incision, including 2 patients with autologous pericardium patch and 2 patients with direct suture. Of the 4 AOOCA patients, 3 underwent coronary directly transplantation but 1 underwent Takeuchi surgery. And 2 had mitral valve plasty at the same time. All the operations were completed successfully, with good recovery and no serious complications. Among the 4 CAF patients, 3 had no residual fistula, and 1 had minor residual fistula. Coronary arteries were all unobstructed in 4 patients of AOOCA; moderate and severe mitral regurgitation in 2 patients were significantly reduced after surgery. Conclusion VR allows doctors to understand the spatial structure information of CAF/AOOCA and surroundings before the operation, and assists them to make accurate treatment decisions and develop detailed surgical plans before the operation, ensuring its safety. Its clinical application value is significant.

Application and evaluation of modified pericardial oblique sinus approach in total anomalous pulmonary venous connection in neonates / 中国胸心血管外科临床杂志

@#Objective     To analyze the use of modified pericardial oblique sinus approach in surgical repair for total anomalous pulmonary venous connection in neonates. Methods     Between May 2005 and December 2015, 67 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. The patients are divided into three groups according to the different approaches including a sulcus approach group (6 patients), a superior approach group (14 patients), and a modified pericardial oblique sinus approach group (47 patients). There were 53 males and 14 females at median age of 12.5 (7.0, 20.5) d.  Results     The time of cardiopulmonary bypass [88 (80.0, 107.0) min vs. 135 (121.0, 157.0) min, P<0.05] and aortic cross clamping of the modified pericardial oblique sinus approach group was significantly shorter than that of the sulcus approach group [45 (39.0, 53.0) min vs. 80 (73.0, 85.0) min, P<0.05]. Perioperative mortality (2.1% vs. 28.6%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the superior approach group. The long-term mortality (4.3% vs. 60.0%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group or the superior approach group . The rate of pulmonary venous stenosis was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group (2.1% vs. 50.0%, P<0.05) or superior approach group (2.1% vs. 35.7%, P<0.05).  Conclusions     In surgical correction of neonatal supracardiac and infracardiac total anomalous pulmonary venous, compared with the traditional surgical approach, the modified pericardial oblique sinus pathway can provide excellent surgical space and has a good surgical prognosis.

MicroRNA-383-5p inhibits the progression of gastric carcinoma via targeting HDAC9 expression

MicroRNAs (miRNAs), as post-transcriptional regulators, have been reported to be involved in the initiation and progression of various types of cancer, including gastric cancer (GC). The present study aimed to investigate the role of miR-383-5p in gastric carcinogenesis. Cell viability was analyzed using CCK-8 kit. Annexin V-fluorescein isothiocyanate/propidium iodide double staining was used to evaluate cell apoptosis. The expression levels of miR-383-5p and histone deacetylase 9 (HDAC9) mRNA in GC tissues and cell lines were analyzed using RT-qPCR. The protein expression of HDAC9 was detected by western blotting. We found that HDAC9 was up-regulated and miR-383-5p was down-regulated in GC tissues and cell lines. High HDAC9 expression or low miR-383-5p expression was closely related to poor prognosis and metastasis in GC patients. HDAC9 knockout or miR-383-5p mimics led to growth inhibition and increased apoptosis in AGS and SGC-7901 cells. More importantly, we validated that miR-383-5p as a post-transcriptional regulator inhibited HDAC9 expression and was inversely correlated with HDAC9 expression in GC tissues. miR-383-5p had the opposite effects to HDAC9 in gastric carcinogenesis. miR-383-5p played an important role in gastric carcinogenesis, and it is one of the important mechanisms to regulate oncogenic HDAC9 in GC, which might be helpful in the development of novel therapeutic strategies for the treatment of GC.

Application of pulmonary valve reconstruction technology in right ventricular outflow tract reconstruction / 中国胸心血管外科临床杂志

@#Objective To evaluate possibility and reliability of the technique of artificial pulmonary valve reconstruction in right ventricular outflow tract reconstruction. Methods We retrospectively analyzed the clinical data of 35 patients with artificial pulmonary valve reconstruction of right ventricular outflow tract reconstruction surgery in our hospital between February 2012 and December 2016. There were 35 patients with 19 males and 16 females at age of 10 years ranged 5 months to 42 years and body weight of 26 (8–62) kg. There were 21 patients with artificial moncusp valve, 6 patients with bicuspid technology, 8 patients with comprehensive forming method. Results Average extracorporeal circulation time was 75–251 (120±37) min. Aorta blocking time was 32–185 (72±28) min. ICU stay time was 14–225 (59±51) hours. Breathing machine auxiliary time was 6–68 (24±18) hours. There were 3 early postoperative deaths. There was no death during the long term following-up time. Thirty-two patients survived with heart function of class Ⅰ in 20 patients, class Ⅱ in 10 patients, class Ⅲ in 2 patients. Conclusion In right ventricular outflow tract reconstruction using the technique of artificial pulmonary valve reconstruction in the operation, it can reduce early postoperative right ventricular volume load. To smooth out perioperative patients, the surgical technique is simple, cheap, safe, but long-term follow-up still needs further observation.

Clinical efficacy of reimplantation of anomalous origin of the left coronary artery from the pulmonary artery: A case control study / 中国胸心血管外科临床杂志

@#Objective    To analyze the clinical efficacy and mid-term outcomes of reimplantation of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA), and to evaluate whether concomitant management of mitral regurgitation (MR) during ALCAPA repair is needed. Methods    Between March 2005 and March 2015, 52 consecutive patients (20 males and 32 females with a median age of 10 months ranging 2-193 months) underwent reimplantation of ALCAPA at Department of Cardiac Surgery, Guangdong Cardiovascular Institute. There were 14 males and 21 females with a mean age of 35.4±42.8 months not receiving mitral valvuloplasty (a Non-MVP group), and 6 males and 11 females with a mean age of 13.5±11.0 months receiving mitral valvuloplasty (a MVP group). In order to facilitate the analysis, degree of MR was graded by number: 0.0=none, 1.0=trivial, 2.0=mild, 2.5=mild-moderate, 3.0=moderate, 3.5=moderate-severe and 4.0=severe. Results    The left ventricular fractional shortening (LVFS) and left ventricular end diastolic diameter (LVEDD) demonstrated significant improvement between preoperation and discharge (28.6%±9.6% vs.   32.1%±10.1%, P=0.023; 38.4±5.6 mm vs. 30.5±5.7 mm, P<0.001), and there was also significant improvement in the mean MR grade between preoperation and discharge (2.9±1.2, vs. 2.4±1.2, P=0.001). There were 4 in-hospital deaths (7.7%). The median follow-up was 21.0 months (ranging 1.5-111.0 months). Three patients (5.8%) were lost to follow-up, 1 patient required reoperation for mitral valve replacement and there was no death during follow-up. Significant improvement was seen in LVFS between discharge and final follow-up (32.1%±10.1% vs. 38.0%±6.0%, P=0.001); however, there was no significant difference in the degree of MR between discharge and final follow-up (2.4±1.2 vs. 2.3±1.2, P=0.541). There was no significant difference in cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time or hospital stay between the two groups. Conclusion    Creation of a dual coronary system with reimplantation of the left coronary artery results in complete recovery of left ventricular function. However, concomitant management of MR during ALCAPA repair remains controversial. Concomitant mitral valve repair for ALCAPA patients with moderate-severe and severe MR is helpful to early function recovery of mitral valve.

Outcomes of subxiphoid uniportal video-assisted thoracoscopic surgery for bilateral chest diseases / 中国胸心血管外科临床杂志

@#Objective To summarize clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic surgery for bilateral chest diseases simultaneously. Methods The clinical data of 60 patients with bilateral chest diseases treated by uniportal thoracoscopic surgery via subxiphoid approach in the Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College from August 2016 to December 2017 were retrospectively analyzed. There were 35 males and 25 females, aged 25.5±8.8 years ranging from 13 to 51 years. There were 40 patients wtih palmar hyperhidrosis, and 20 patients with bilateral pulmonary bullae and onset of one-side pneumothorax. All patients adopted subxiphoid uniportal video-assisted thoracoscopic surgery. Among them 36 patients with palmar hyperhidrosis underwent resection of R3 bilateral sympathetic nerves, 1 resection of R4 bilateral sympathetic nerves, 3 resection of R3+R4 bilateral sympathetic nerves, and 20 patients with pulmonary bullae underwent bilateral bullectomy and pleurodesis. Results Fifty-five patients cured within 1 to 4 days and discharged after surgery. One patient with incision infection and pulmonary infection after bullectomy, cured and discharged after 3 weeks anti-inflammation and incision dressing change. Four patients with Grade B healing recovered after 1 to 2 weeks dressing change. During the follow-up, no pneumothorax or hand perspiration relapsed. Conclusion Subxiphoid uniportal video-assisted thoracoscopic surgery for simple bilateral chest disease simultaneously is safe and feasible, which not only avoids simultaneous trauma of bilateral punch, but also alleviates the pain of patients.

Outcome assessment of different surgeries for neonates with pulmonary atresia and ventricular septal defect / 中国胸心血管外科临床杂志

@#Objective To explore the feasibility and option of different surgeries for neonates with pulmonary atresia and ventricular septal defect (PA/VSD) through assessing the effect of common surgeries. Methods Fourteen neonates who underwent their first surgery in our center from July 2004 to October 2014 were included. Their basic characteristics, operation and pre- and postoperative clinical information were extracted. Follow up was conducted and the last visit was on October 10, 2016. Short- and midterm survival and total correction rate were compared among different surgeries. Results Among the 14 patients, there were 4 (28.6%) patients, 6 (42.9%) and 4 (28.6%) who underwent one-stage repair, right ventricular outflow tract (RVOT) reconstruction, and systemic to PA shunt operation respectively. The overall in-hospital mortality after the first operation was 28.6% (4/14). At last visit, no death occurred resulting the 5-year survival rate of 71.4% (10/14). The overall total correction rate for all neonates was 64.3% (9/14). Although no statistical difference was found in the mortality among the one-stage repair , RVOT reconstruction and systemic to PA shunt group(50.0% vs. 33.3% vs. 0.0%, P=0.280), the survival and hazard analysis implied better outcomes of the systemic to PA shunt palliation operation. There was no statistical difference in the total correction rate and months from the first palliative operation to correction between those who underwent RVOT reconstruction and systemic to PA shunt (75.0% vs. 50.0%, P=0.470; 32.0 months vs. 18.0 months, P=0.400). Conclusion Performing surgeries for neonates with PA/VSD is still a great challenge. However, the midterm survival rate was optimistic for the early survivors. Systematic to PA shunt seemed to be a better choice with lower mortality for the neonates with PA/VSD who need the surgery to survive.

Application of bidirectional Glenn procedure in adult congenital heart disease / 中国胸心血管外科临床杂志

@#Objective    To analyze the feasibility of bidirectional Glenn procedure (BDG) in treatment of adult congenital heart disease (ACHD). Methods    From December 2004 to December 2015, 42 ACHD patients received BDG in our hospital. There were 23 males and 19 females with a mean age of 24.6±8.5 years (range: 18 to 49 years). There were functional single ventricle (FSV) in 14 patients, Ebstein’s anomaly in 11, corrected transposition of great arteries in 7, transposition of great arteries in 5, double outlet of right ventricle in 3 and tricuspid atresia in 2. Twenty patients suffered moderate or severe atrioventricular valve regurgitation (AVVR). Half of the patients were operated upon with cardiopulmonary bypass (CPB) and the others with off-pump coronary artery bypass grafting (OPCABG). Thirty-four patients underwent unilateral BDG shunt and eight bilateral BDG shunts. Concomitant procedures included correction of Ebstein’s anomaly (7 patients), atrioventricular valve replacement (7), atrial septostomy (3), ligation of patent ductus arteriosus (3), ligation of major aortopulmonary collateral arteries (2), correction of total anomalous pulmonary venous connection (1) and mitral valve repair (1). Results    The early operative mortality was 9.5% (4/42). FSV and moderate or severe AVVR were risk factors for BDG in ACHD. Early postoperative oxygen saturation increased from 78.8%±11.2% to 89.3%±6.6% (P<0.05). The follow-up time was 6-132 (41.4±33.1) months. There was no death. The heart function improved (2.7±0.5 vs. 1.9±0.4, P<0.05). Conclusion    The BDG shunt can be applied to ACHD. Although the early mortality is relatively high, the middle- and long-term results are satisfactory. The oxygen saturation increases and  the heart function improves. The life quality of patients will also improve. FSV and moderate or severe AVVR are risk factors for BDG in ACHD.

Sutureless technique use in the surgery for total anomalous pulmonary venous connection in neonates / 中国胸心血管外科临床杂志

@#Objective    To analyze the sutureless technique use in the surgical repair for total anomalous pulmonary venous connection in neonates. Methods    Between September 2002 and December 2015, 71 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. There were 57 males and 14 females at median age of 8 (1, 29) d. And the median body weight was 3.3 (2.1, 4.7) kg. There were 45 patients (63.4%) with supracardiac, 26 patients (36.6%) with infracardiac. Patients were divided into two groups: a conventional technique group (29 patients) and a sutureless technique group (42 patients). To control for potential differences in the characteristics of patients between the sutureless technique group and the conventional technique group, the method of propensity-score matching was used. Results    Basic characteristics of patients after propensity-score were not different.There were 11 operative deaths (15.5%), 7 late deaths (96.%), total 18 deaths (25.4%). The mortality was 58.6% (17/29) in the conventional technique group, 2.4% (1/42) in the sutureless technique group (P=0.000). Kaplan-Meier survival curve showed a difference in   mortality between the two groups (P=0.005). The patients were followed up for 25.5 (1.0-13.0) months.Postoperative anastomotic or pulmonary vein stenosis occurred in 12 patients, 8 of them died at a higher mortality than that of the patients with smooth anastomosis [66.7% (8/12) vs. 16.9% (10/59), P=0.001]. Conclusion    The patients who have postoperative anastomotic or pulmonary vein stenosis have higher mortality. Compared with conventional technique, sutureless technique can dramatically decrease the incidence of postoperative anastomotic or pulmonary vein stenosis and the mortality of surgical repair for total anomalous pulmonary venous connection in neonates.

Long-term clinical studies on the treatment of lumbosacral spinal tuberculosis with CT-guided minimally invasive surgery / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis.</p><p><b>METHODS</b>From January 2002 to March 2013, 145 patients (84 males and 61 females) with lumbosacral spinal tuberculosis underwent failed conservative treatment were treated with CT-guided minimally invasive surgery. Their clinical data were retrospectively analyzed. Among them, 143 patients were followed up, aged from 2.5 to 81 years with an average of (42.60 +/- 17.14) years. Fourteen cases (6 cases with internal fixation and 8 cases without internal fixation) recurred and 32 cases complicated with paraspinal abscess after operation. Preoperatively 1 case complicated with lower limb weakness and superficial sensation worse, 1 case with muscle strength decrease, this 2 cases were grade D of Frankle, other cases were grade E. And 1 patient underwent fenestration operation and local chemotherapy, 144 cases with CT-guided percutaneous puncture and local chemotherapy. ESR and lumbar lordosis angle of all patients were observed preoperatively and final follow-up.</p><p><b>RESULTS</b>The mean follow-up time was 67 months (ranged, 21 to 149 months) in 143 cases, and 73 cases more than 5 years. All patients obtained clinical healing. ESR was (44.96 +/- 12.41) mm/h before operation and (7.25 +/- 3.43) mm/h at final follow-up, there was significant difference between preoperative and postoperative (t=35.06, P=0.000). Lumbar lordosis angle was (36.32 +/- 8.55) degrees before operation and (33.35 +/- 8.16) at final follow-up, there was significant difference between preoperative and postoperative (t=13.90, P=0.000).</p><p><b>CONCLUSION</b>When conservative treatment fails for 3 months or more, the patients have good spinal stabilization, nerve function is more than grade D of Frankel, CT-guided percutaneous puncture and local chemotherapy can get satisfactory outcomes for lumbosacral spinal tuberculosis.</p>

Discrete potentials guided ablation for idiopathic outflow tract ventricular arrhythmias / 中华心血管病杂志

<p><b>OBJECTIVE</b>Discrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias. The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs).</p><p><b>METHODS</b>Seventeen out of 24 consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation between September 2012 and December 2013 in our department were included. Intracardiac electrograms during the mapping and ablation were analyzed.</p><p><b>RESULTS</b>During sinus rhythm, sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular electrograms in all of the 17 patients, peak amplitude was (0.51 ± 0.21) mV. The same potential was recorded prior to the local ventricular potential of the PVCs/VTs. Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram was noted during the arrhythmias. The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping. At the sites with DPs, unipolar and bipolar ventricular voltage of sinus beats were lower compared with the adjacent regions without DPs (unipolar: (6.1 ± 1.8) mV vs. (8.3 ± 2.3) mV, P < 0.05; bipolar: (0.62 ± 0.45) mV vs. (1.03 ± 0.60) mV, P < 0.05). The targeted DPs were still present in 12 patients after successful elimination of the ectopies. Discrete potentials were not present in seven controls.</p><p><b>CONCLUSIONS</b>Discrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias. Discrete potential- and substrate-guided ablation strategy could help to reduce the recurrence of idiopathic outflow tract arrhythmias.</p>