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Objective: Pelvic high-resolution magnetic resonance imaging (MRI) has now become a standard method for evaluating the efficacy of neoadjuvant treatment for locally advanced rectal cancer (LARC). However, this traditional morphological qualitative assessment method based on T2-weighted imaging (T2WI) is not effective in predicting pathological complete remission (pCR). The purpose of this study is to investigate whether combining the magnetic resonance tumor regression grade (mrTRG) with apparent diffusion coefficient (ADC) can improve diagnostic value for pCR after preoperative neoadjuvant chemoradiotherapy (nCRT) of LARC. Methods: This was a diagnostic study. Clinicopathological data of 134 LARC patients who received nCRT and radical surgery in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed. All the patients underwent MRI which included T2WI and DWI sequences before and 8 weeks after nCRT. Two radiologists independently drew ROIs on T2WI and DWI to estimate mrTRG stage and calculate the mean ADC value. Receiver operating characteristics (ROC) method was applied to evaluate the predict value of mrTRG combined with mean ADC value for pCR. Results: Of 134 LARC patients, 85 were male and 49 were female with median age of 58 (28-82) years. After nCRT, MRI suggested 21 patients (15.7%) had clinical complete remission (cCR), e.g. mrTRG stage 1-2. Postoperative pathology revealed 31 (23.1%) patients had pCR. The evaluations of mrTRG and ADC value by the two readers were highly consistent, and the intra-group correlation coefficients were 0.83 (95% CI: 0.703-0.881) and 0.96 (95% CI: 0.989-0.996), respectively. There was a negative correlation between mrTRG and pCR (r(s)=-0.505, P<0.01), and a positive correlation between mean ADC value and pCR (r(s)=0.693, P<0.01). The ROC curve showed that mrTRG alone had a medium predictive value for pCR, with an area under the curve (AUC) of 0.832 (95% CI: 0.743-0.921); the mean ADC value had a higher predictive value for pCR, with AUC of 0.906 (95% CI: 0.869-0.962). The predictive value of the combined model of mrTRG and ADC value for pCR was significantly better than that of mrTRG alone (P=0.015), and the AUC was 0.908 (95% CI: 0.849-0.968). Conclusion: Both mrTRG and mean ADC value can be non-invasive methods to predict the efficacy of nCRT for LARC. Combining the mean ADC value with mrTRG can result in better pCR prediction.
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Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quimiorradioterapia , Imagem de Difusão por Ressonância Magnética , Imageamento por Ressonância Magnética , Terapia Neoadjuvante , Neoplasias Retais/terapia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objective To investigate whether γ-aminobutyric acid (GABA) receptor signaling pathway is involved in the regulation of thalamic undefined (ZI)-nucleus accumbens (NAc) neural pathways on gastric distraction (GD)-sensitive neuronal firing activity and the impact on food intake,the number of times and the frequency in rats.Methods Six rats were randomly selected and the neural pathway between Zl and NAc in rat thalamus was observed by fluorescent gold (FG) retrograde tracing method.Eighty-two rats were randomly selected,and the gastric balloon was placed in gastric cavity,the microelectrode was placed in the NAc,and the stimulating electrode was placed in the ZI.The single-cell discharge recording method was used to observe the effect of electrical stimulation ZI on the excitability of GD-sensitive neurons in rat NAc.Eighteen rats were randomly selected and were divided into three groups according to the random number table.They were NS group,GABA group,GABA + GABA receptor antagonist bicuculline (BIC) group with 6 in each group,and the rat NAc was used to embed the cannula.The method of GABA and BIC was injected to observe the changes of cumulative food intake in rats for 4 h.Eighteen rats were randomly selected and randomly divided into three groups:sham stimulation (SS) group,50 μA electrical stimulation group,50 μA electrical stimulation + BIC group with 6 in each group.The 4 h cumulative food intake of rats was observed by electro-stimulation of rat ZI and rat NAc injection of BIC.Results Fluorescent gold retrograde tracking combined with fluorescent immunohistochemical staining showed that there were visible GABA and fluorescent gold double labeled neurons in ZI.Electrical stimulation of ZI,the frequency of GABA-sensitive GD neurons in rat NAc increased significantly (GD-E increase:(78.8±8.4) ％,GD-I increase:(89.3±9.2) ％,P＜0.01),but the inhibitory effect was antagonized by BIC (GD-E increase:(113.8 ± 13.6)％,GD-I increase:(121.8± 14.2)％,P＜0.01).Microinjection of GABA in rat NAc significantly increased the cumulative food intake for 4 h ((155.72± 18.84) kcal,t=3.41,P＜0.05),which was antagonized by partial BIC (123.43± 15.11) kcal,t =3.28,P＜ 0.05).Electrical stimulation of ZI significantly increased the food intake in rats ((39.07± 11.27) kcal,t =2.96,P＜0.05),and this effect can be partially antagonized by BIC ((34.17 ± 10.85) kcal,t =2.33,P＜ 0.05).Conclusion The ZI-NAc neural pathway regulates the discharge activity of rat gastric distension (GD)-sensitive neurons and the feeding status of rats,and the GABA receptor signaling pathway may be involved in mediating the process.
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Objective@#To investigate whether γ-aminobutyric acid (GABA) receptor signaling pathway is involved in the regulation of thalamic undefined (ZI)-nucleus accumbens (NAc) neural pathways on gastric distraction (GD)-sensitive neuronal firing activity and the impact on food intake, the number of times and the frequency in rats.@*Methods@#Six rats were randomly selected and the neural pathway between ZI and NAc in rat thalamus was observed by fluorescent gold (FG) retrograde tracing method.Eighty-two rats were randomly selected, and the gastric balloon was placed in gastric cavity, the microelectrode was placed in the NAc, and the stimulating electrode was placed in the ZI. The single-cell discharge recording method was used to observe the effect of electrical stimulation ZI on the excitability of GD-sensitive neurons in rat NAc.Eighteen rats were randomly selected and were divided into three groups according to the random number table. They were NS group, GABA group, GABA + GABA receptor antagonist bicuculline (BIC) group with 6 in each group, and the rat NAc was used to embed the cannula. The method of GABA and BIC was injected to observe the changes of cumulative food intake in rats for 4 h. Eighteen rats were randomly selected and randomly divided into three groups: sham stimulation (SS) group, 50 μA electrical stimulation group, 50 μA electrical stimulation + BIC group with 6 in each group. The 4 h cumulative food intake of rats was observed by electro-stimulation of rat ZI and rat NAc injection of BIC.@*Results@#Fluorescent gold retrograde tracking combined with fluorescent immunohistochemical staining showed that there were visible GABA and fluorescent gold double labeled neurons in ZI. Electrical stimulation of ZI, the frequency of GABA-sensitive GD neurons in rat NAc increased significantly (GD-E increase: (78.8±8.4)%, GD-I increase: (89.3±9.2)%, P<0.01), but the inhibitory effect was antagonized by BIC (GD-E increase: (113.8±13.6)%, GD-I increase: (121.8±14.2)%, P<0.01). Microinjection of GABA in rat NAc significantly increased the cumulative food intake for 4 h ((155.72±18.84) kcal, t=3.41, P<0.05), which was antagonized by partial BIC (123.43±15.11) kcal, t=3.28, P<0.05). Electrical stimulation of ZI significantly increased the food intake in rats ((39.07±11.27) kcal, t=2.96, P<0.05), and this effect can be partially antagonized by BIC ((34.17±10.85)kcal, t=2.33, P<0.05).@*Conclusion@#The ZI-NAc neural pathway regulates the discharge activity of rat gastric distension (GD)-sensitive neurons and the feeding status of rats, and the GABA receptor signaling pathway may be involved in mediating the process.
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Objective To investigate the effects of orexin-A on firing activity of gastric distensionsensitive (GD) neurons in the basomedial amygdala (BMA) and food intake in diet-indaced obese rats.Methods Healthy male Wistar rats were selected,and the diet-induced obesity (DIO) rat model and dietinduced resistant (DR) rat model were established by high-fat diet.The effects of orexin-A and an opioid receptor antagonist naloxone on BMA GD neurons were observed by recording the extracellular potentials of single neurons.The effects of orexin-A and naloxone on the food intake of different rats were observed by using BMA catheterization.The mRNA expression and protein expression of orexin-1 receptor (OX-1R) and μ opioid receptor were detected by real-time PCR and Elisa,respectively.Results After microinjection of orexinA into the BMA,the firing frequency of GD-sensitive neurons in the normal rats was significantly increased (GD-E:(78.3±6.9)％,GD-Ⅰ:(55.5±4.7) ％,P＜0.01),and this effect was completely blocked by OX-1R receptor antagonist SB334867,and naloxone partially blocked the discharge-promoting effect of orexin-A;Compared with the normal rats,the firing frequency of GD-sensitive neurons in the DIO (GD-E:(91.6±7.1) ％,GD-Ⅰ:(67.9±8.1) ％) and DR(GD-E:(87.9±6.8) ％,GD-Ⅰ:(69.2±5.8) ％) rats was significantly increased after BMA injection of orexin-A (P＜0.05).After administration of orexin-A into the BMA,food intake of the normal rats,DIO rats and DR rats ((2.38±0.34) g,(3.75 ±0.32) g,(4.01 ±0.38) g,respectively) was significantly increased (P＜0.01),and the food intake of DR and DIO rats were significantly higher than that of normal rats (P＜0.05).After BMA was injected with naloxone,the food intake of rats was inhibited,and the food intake of the DIO rats was significantly lower than that of the DR rats (P＜0.05),food intake of the DR rats was significantly lower than that of the normal rats (P＜0.05).The results of real-time PCR showed that the mRNA levels of OX-1R in DIO and DR rats were(5.85±0.45)and (6.03±0.42)were higher than that of normal rats,and the difference was significant (P＜0.05);and mRNA levels of μ-opioid receptors in DIO and DR rats((4.51±0.42) and (8.31±0.41) times) were higher than those in normal rats (P＜0.05).The results of Elisa showed that the protein levels of OX-1R in DIO ((2.98±0.28) ng/μl)and DR rats ((3.05±0.31) ng/μl) were higher than those in normal rats ((1.53±0.31) ng/μl,P＜0.05).The content of μ-opioid receptor protein in DR rats ((4.21±0.35) ng/μl) was higher than that of DIO rats ((2.77±0.27) ng/μl),and higher than that of normal rats((1.48±0.32) ng/μ),the difference was significant (P＜0.05).Conclusion BMA orexin-A promotes the spontaneous discharge of GD-sensitive neurons and food intake in normal rats,DIO rats and DR rats,μ-opioid receptors may be involved in the regulation of this process.
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Objective To investigate the early diagnostic and prognostic value of plasma D-dimer level in acute aortic dissection.Method Data of totally 500 acute chest pain patients were studied,in which 250 cases were in group of acute aortic dissection (group AAD) confirmed by aortic computerized tomographic angiography (CTA) or cardiac ultrasonography,and the rest 250 cases were in non AAD group (group control).The D-dimer test was performed in all patients within 72 hours after onset of chest pain,and comparison of plasma D-dimer concentration was carried out between two groups.The D-dimer diagnostic value in AAD was analyzed by plotting the receiver operating characteristic (ROC) curve.According to AAD patients with aortic CTA findings,the whole aortic artery was divided into four segments by the major vascular branches,and the false lumen area was measured by degree score,the relationship between the score and D-dimer level were analyzed.To study the prognostic value of D-dimer in AAD,the comparison of D-dimer level was carried out between survival group and death group,and the AAD patients were further stratified by the surgery and Stanford type.Results The plasma D-dimer concentrations in AAD group were significantly higher than those in controls (P ＜0.01).The sensitivity,specificity,positive predictive value and negative predictive value of D-dimer (＞ 1.14 mg/L) in the diagnosis of AAD were 81.2％,79.39％,74.63％ and 72.4％ respectively,and the area under the ROC curve was 0.083.The elevated level of D-dimer was positively correlated with the extent of AAD false lumen (Spearman-Rho =0.418,P ＜ 0.01).D-dimer levels in the death group were higher than those in the survival group.Conclusions D-dimer may be a valuable biomarker in early diagnosis of AAD.The elevated level of D-dimer was useful to evaluate the extent of the dissection and prognosis of AAD.
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This study is prepared to provide the basis of rheological parameters for the additional quality standard of ophthalmic gels, the rheological properties of the ophthalmic gels and the other three types of ophthalmic preparations. The medicines were compared through the study of the rheological properties for four types of ophthalmic preparations. The cone-plate rheometer was used to determine the dynamic and steady rheological parameters of four types of ophthalmic preparations. The similarities and differences of the measured results were analyzed to summarize the rheological indexes and parameters which are applied to distinguish the ophthalmic gels and the other types of ophthalmic preparations. ① The elastic modulus should be greater than the viscous modulus for the ophthalmic gels in the range of the linear viscoelastic region. ② The ophthalmic gels should be shear thinning non-Newtonian fluid with a certain yield stress and thixotropy. ③ The dynamic viscosity of the ophthalmic gels should be greater than 0.5 Pa·S at the temperature of 25℃ with the 50 s-1 shear rate. The typical rheological indexes and parameters of the ophthalmic gels were proposed in this article. The determination methods are simple and feasible. The rheological indexes and parameters have an important significance in the prescription design, production technology and quality control of the ophthalmic gels.
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Objective · To discuss the relationship between unexplained recurrent spontaneous abortion (URSA) and T follicular helper (Tfh) cell subtypes. Methods · Twenty-eight normal early pregnancy women, who had undergone induced abortion, were taken as control, and 28 patients with URSA were enrolled in the abortion group. The mononuclear cells in peripheral blood and decidual tissues were separated in the two groups, and CXCR3+CCR6- Tfh cells, CXCR3-CCR6- Tfh cells, CXCR3-CCR6+ Tfh cells and B cells were tested by flow cytometry. Results · The decidual CXCR3-CCR6- Tfh cells significantly increased in the abortion group compared with control group (P=0.015). And there was a strong association between the decidual CXCR3-CCR6- Tfh cells and B cells in URSA patients (R2=0.779, P=0.025). Conclusion · The up-regulation of decidual CXCR3-CCR6- Tfh cells in early pregnancy women may be related with the occurrence of URSA.
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Objective · To discuss the relationship between unexplained recurrent spontaneous abortion (URSA) and T follicular helper (Tfh) cell subtypes. Methods · Twenty-eight normal early pregnancy women, who had undergone induced abortion, were taken as control, and 28 patients with URSA were enrolled in the abortion group. The mononuclear cells in peripheral blood and decidual tissues were separated in the two groups, and CXCR3+CCR6- Tfh cells, CXCR3-CCR6- Tfh cells, CXCR3-CCR6+ Tfh cells and B cells were tested by flow cytometry. Results · The decidual CXCR3-CCR6- Tfh cells significantly increased in the abortion group compared with control group (P=0.015). And there was a strong association between the decidual CXCR3-CCR6- Tfh cells and B cells in URSA patients (R2=0.779, P=0.025). Conclusion · The up-regulation of decidual CXCR3-CCR6- Tfh cells in early pregnancy women may be related with the occurrence of URSA.
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Objective:This study aimed to explore the Ventromedial Hypothalamic Orexin-1 and Orexin-1 Receptors in Regulation of Gastric Acid Secretion in Conscious Rats.Methods:Rats were anaesthetized and fitted with a stainless steel carmula placed just above the VMH or paracele,after random allocation orexin-A,[Pro34]-peptide YY and [CPP1-7,NPY19-23,Ala31,Aib32,Gln34] -pancreatic polypeptide were injected in the VMH;SB-334867 was intraperitoneal injection;atropine was subcutaneous injection;GR-231118 and CGP-71683 were injected in the paracele.Using pyloric ligation model,tests the effect of different drugs on rat gastric acid secretion and gastric juice volume.Results:OXA induced dose-dependent increase of gastric acid secretion;SB-334867 induced dose-dependent inhibition of gastric acid secretion.The stimulatory effect of OXA on acid secretion was inhibited by SB-334867;atropine induced dose-dependent increase of gastric acid secretion and block the effect of orexin-A on gastric acid secretion;the gastric acid secretion was inhibited by GR-231118 or CGP-71683,and GR-231118 or CGP-71683 were blocked the effect of orexin-A on gastric acid secretion;Intraventromedial hypothalamic injections of [CPP1-7,NPY19-23,Ala31,Aib32,Gln34]-pancreatic polypeptide increased gastric acid secretion.Conclusion:It is suggested that endogenous orexin-A acts on the ventromedial hypothalamus to stimulates acid secretion.This stimulatory effect is probably mediated through orexin receptor,Y1 and Y5 receptor,and the vagus nerve system.
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Objective:The current study investigated the effects of nesfatin-1 in the hypothalamic paraventricular nucleus (PVN) on gastric motility and the regulation of the lateral hypothalamic area (LHA).Methods:The projection of nerve ?ber and expression of nesfatin-1 were observed by retrograde tracing and fluo-immunohistochemistry staining;The nuclei microinjection and nuclei electrical stimulation,extracellular discharges of single unit neuron were used to observe the effects of nesfatin-1 on the GD neurons;Gastric motility recording in vivo were used to monitor the effects of nesfatin-1 on the amplitude of constriction and frequency of gastric motility in conscious rats.Results:Nesfatin-1 inhibited the majority of the GD-E neurons(1.97± 0.12 Hz vs.1.15± 0.07 Hz) and excited GD-I neurons (1.74± 0.10 Hz vs.3.04± 0.18 Hz) in the PVN,which were weakened by oxytocin receptor antagonist H4928 (GD-E:1.38± 0.08 Hz,P＜0.05 vs.nesfatin-1;GD-I:2.49± 0.15 Hz,P＜0.05 vs.nesfatin-1).Gastric motility experiments showed that administration ofnesfatin-1 in the PVN decreased gastric motility.Retrograde tracing and immunofluorescent staining showed that nucleobindin-2/nesfatin-1 and fluorogold double-labeled neurons were observed in the LHA.Electrical LHA stimulation excited the firing rate of GD-responsive neurons (GD-E:2.06± 0.12 Hz vs.4.23± 0.21 Hz,GD-I:1.61± 0.09 Hz vs.4.83± 0.25 Hz) in the PVN.Pre-administration of an antinucleobindin-2/nesfatin-1 antibody in the PVN strengthened gastric motility,decreased GD-E neurons (1.74± 0.10 Hz vs.3.04± 0.18 Hz) and excited the discharging of the GD-I neurons(4.15± 0.18 Hz vs.4.83± 0.25) induced by electrical stimulation of the LHA.Conclusion:Nesfatin-1 in the PVN could serve as an inhibitory factor to inhibit gastric motility,which might be regulated by the LHA.
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Objective:This study aimed to explore the effects ofnesfatin-1 on gastric distension (GD)-sensitive neurons in the basomedial amygdala (BMA) and the potential mechanism for nesfatin-1 to regulate gastric motility through the arcuate nucleus (Arc).Methods:The projection of nerve fiber and expression of nesfatin-1 were observed by retrograde tracing and fluo-immunohistochemistry staining;The nuclei microinjection and nuclei electrical stimulation,extracellular discharges of single unit neuron were used to observe the effects ofnesfatin-1 on the GD neurons;Gastric motility recording in vivo were used to monitor the effects ofnesfatin-1 on the amplitude of constriction and frequency of gastric motility in conscious rats.Results:NUCB2/Nesfatin-1/fluorogold-double labeled neurons were from ARC to BMA;Nesfatin-1 could excited the firing rate of most of the GD-E neurons (4.25± 1.02 Hz vs.5.32± 1.17 Hz,P＜0.01) and decreased the firing rate of most of the GD-I neurons (3.73± 0.92 Hz vs.2.64± 0.86 Hz,P＜0.01),inhibited the gastric motility,amplitude and frequency,SHU9119 could weaken the responses induced by nesfaton-1;Electrical stimulation of the Arc,the firing rate of nesfatin-1-induced GD-response neurons (GD-E:5.14± 1.32 Hz vs.6.75± 1.84 Hz,P＜0.05;GD-I:2.84± 0.86 Hz vs.4.05± 1.12 Hz,P ＜0.05) and the gastric amplitude and frequency were increase.Conclusion:It was suggested that nesfatin-1 in the BMA plays an important role in decreasing gastric motility and the Arc may be involved in this regulation process.
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<p><b>OBJECTIVE</b>To study the expression of nNOS and ultrastructural changes in the penile tissue of rats with prolactinoma-induced erectile dysfunction (ED).</p><p><b>METHODS</b>We established the model of prolactinoma in 20 male Westar rats by peritoneal injection of diethylstilbestrol (DES) and treated the control rats with normal saline (n = 10) or sterilized arachis oil (n = 10). After 8 weeks, we performed the apomorphine test and measured the weight of the pituitary gland and the levels of serum prolactin (PRL) and testosterone (T) to confirm the successful construction of the prolactinoma-induced ED model. Then we determined the expression of nNOS in the penile tissue by immunohistochemistry and examined the ultrastructural changes of the penile cavernosum under the transmission electron microscope.</p><p><b>RESULTS</b>The prolactinoma-induced ED model was successfully established in 15 rats. The weight of the pituitary gland was significantly increased in the rats treated with DES as compared with the normal saline and sterilized arachis oil controls ([46.7 ± 15.5] vs [11.7 ± 2.4] and [12.4 ± 2.3] mg, both P < 0.05). The level of serum PRL was markedly higher while that of T remarkably lower in the former than in the latter two groups ([1,744.9 ± 304.5] vs [11.5 ± 2.4] and [10.6 ± 1.9] ng/ml, both P < 0.0l; [1.54 ± 0.46] vs [3.11 ± 1.08] and [3.04 ± 1.11] ng/ml, both P < 0.05). The rate of penile erection was significantly reduced in the prolactinoma-induced ED model rats in comparison with the normal saline and arachis oil controls (16.7% vs 100% and 87.5%, both P < 0.05), and so was the expression of nNOS in the penile tissue (0.024 ± 0.011 vs 0.066 ± 0.019 and 0.058 ± 0.021, both P < 0.05). Transmission electron microscopy manifested significant ultrastructural changes in the endothelial and smooth muscle cells of the cavernous tissue in the prolactinoma-induced ED models.</p><p><b>CONCLUSION</b>The ultrastructural changes of the penile cavernous tissue and the reduced expression of nNOS in penile tissue may be the most important mechanisms of prolactinoma-induced ED in rats.</p>
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Animais , Humanos , Masculino , Ratos , Apomorfina , Carcinógenos , Dietilestilbestrol , Disfunção Erétil , Miócitos de Músculo Liso , Óxido Nítrico Sintase Tipo I , Metabolismo , Tamanho do Órgão , Ereção Peniana , Pênis , Neoplasias Hipofisárias , Prolactina , Sangue , Prolactinoma , Ratos Wistar , Testosterona , SangueRESUMO
Objective To study the effect of Ghrelin on food choice of rats.Methods Twenty-four Wistar rats were randomly divided into control group,0.1 nM Ghrenlin group and 1.0 nM Ghrenlin group,and 8 rats in each group.0.2 μl arificial cerebrospinal fluid were injected into the lateral ventricle in control group,and the same volume 0.1nM and 1.0 nM Ghrelin were done in 0.1 nM Ghrenlin group and 1.0 nM Ghrenlin group respectively.The changes of food intake,feeding interval,and torlerance of different flavors of food intake were observed.The SCH23390,an antagonist of dopamine D1 receptor,was used to explore the mechanisms of Ghrelin.Results The rats' food consumption increased significantly and the intake intervals reduced dose dependently after injecting Ghrelin into the lateral ventricles (P＜0.05 ～ 0.01).Compared with normal liquid food,the rats' intake of food added with quinine was reduced((16.73±5.21)ml vs (23.47±9.46)ml,P＜0.01),and injecting Ghrelin into the lateral ventricles could not reverse this effect ((13.74±3.29) ml vs (16.73±5.21)ml,P＞0.05).Mter injecting Ghrelin,the rats' intake of liquid food added with sugar increased in a dose dependent manner(P＜0.05 ～ 0.01),and higher than the food intake of fasted rats ((59.24 ± 17.32) ml vs (38.13 ± 10.98) ml,P＜ 0.05).The food intake reduced obviously after injecting SCH23390 ((22.69±6.54) ml vs (28.21±7.35)ml,P＜0.05).But the rats' food intake was significantly lower after injecting SCH23390 ± Ghrehn than the rats only injected of Ghrehn ((3Z44±10.62)ml vs (65.81±13.47)ml,P＜0.05).Conclusion Ghrelin can affect the food choice of rats,and dopamine may be involved in the regulation of this process.
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Objective To assess the risk factors of the in-hospital mortality of acute type A aortic dissection after operation. Method From January 2003 to June 2008,185 patients, 144 males and 41 females, with acute type A aortic dissection operated on were enrolled. The average age of patients was (49.46 ± 11.04 ) years old.The patients' demographics, history, clinical features, and some laboratory examinations were reviewed. Univariate and multivariate analysis followed by logistic regression analysis were carried out to identify the predictors of inhospital mortality. Results The in-hospital mortality rate was 9.1%. The results of univariate and multivariate analyses as follows: pre-operation positive neurological symptom (Univariate OR = 5.084,95%CI:1.792 -14.426, P = 0.002; Multivariate OR = 5.538,95%CI: 1.834 - 16.721, P = 0.002, respectively), hypotension (Univariate OR = 6.986,95%CI:1.510- 32.323,P =0.013; multivariate OR = 1.998,95%CI:0.315-12.679,P = 0.463, respectively) and renal failure (Univariate OR = 3.594,95%CI:1.237 - 10.438,P =0.019; Multivariate OR = 3.254,95%CI:1.034- 10.242, P= 0.044, respectively). Conclusions There are two predictors, pre-operation positive neurological symptom and renal failure, of pre-hospital mortality found in current analyses. Our results may improve the regimen made by cardiac surgeons and emergency doctors so as to help patients and their relatives to make correct decision.
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<p><b>OBJECTIVE</b>To observe the influence of endoscopic radial artery harvesting techniques on the prevalence of complications after coronary artery bypass grafting, and to assess the potential trauma to the radial artery through the histological changes.</p><p><b>METHODS</b>From August 2003 to June 2008, 87 patients undergoing CABG had radial artery harvested by endoscopic harvesting system. About 4 mm proximal and distal radial artery end segment of 10 patients undergoing endoscopic and conventional harvesting were examined with light and electro-microscope.</p><p><b>RESULTS</b>The endoscopic harvest time was 42 to 98 min, with a mean of (57.6 +/- 17.3) min. The harvested conduit length was 15 to 20 cm, with a mean of (17.5 +/- 1.6) cm. Objective dorsal thenar numbness remained in 7 patients, none complained of forearm numbness at 3-month follow-up. The result of light and electro-microscope had no differences in the intima, media, or adventitia between endoscopically and conventionally obtained radial artery segments.</p><p><b>CONCLUSION</b>The use of endoscopic radial artery harvesting in coronary artery bypass grafting can be performed safely with infrequent complications. This method results in excellent patient satisfaction, particularly regarding the cosmetic outcome.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária , Endoscopia , Artéria Radial , Transplante , Coleta de Tecidos e Órgãos , Métodos , Resultado do TratamentoRESUMO
<p><b>OBJECTIVE</b>To apply the off-pump epicardial microwave ablation (MW) to treat the permanent atrial fibrillation (PAF) and evaluate the clinical effect.</p><p><b>METHODS</b>From April 2003 to April 2005, a total of 46 patients with PAF underwent off-pump epicardial MW, including the patients with mitral valve disease (28 cases), mitral and aortic valve disease (5 cases), coronary artery disease (8 cases) and lone PAF (5 cases). FLEX 10 probe was placed around four pulmonary orifices and the access orifice of the inferior vena cava to tricuspid annulus. The microwave application was set 65 W, 90 s and a continuous ablation line was finished encircling the pulmonary veins. Subsequently, patients underwent either off-pump coronary artery bypass graft or valve surgery on-pump. Mean left atrial diameter was (52.5 +/- 15.3) mm, LVEF 42% - 70% before operation. All patients were followed up in the discharge, 3, 6, 12 months after surgery by standard 12-lead ECG, 24 h Holter, UCG and clinical examination.</p><p><b>RESULTS</b>All procedures were completed successful on the off-pump cardiac surgery and 46 patients were converted sinus rhythm when the operations were performed. Mean ablation time was (37.7 +/- 7.8) min, without any related complications. At discharge, 3, 6 and 12 months follow-up, 63.0%, 66.7%, 72.7% and 80.6% of the patients kept sinus rhythm and left atrial diameter of < 50 mm.</p><p><b>CONCLUSIONS</b>Using MW, electrical isolation of the pulmonary veins can be achieved epicardially without cardiopulmonary bypass support. Off-pump epicardial microwave ablation is an efficient option with an excellent benefit/risk ratio for the treatment of PAF with or without other cardio-surgical disease.</p>