Correlation between cardiac resynchronization response and pulmonary artery hemodynamic parameters / 中南大学学报(医学版)

OBJECTIVES@#To evaluate the response to cardiac resynchronization therapy (CRT) and the correlation between CRT and pulmonary artery hemodynamic parameters.@*METHODS@#The patients with chronic heart failure indicator for CRT were enrolled. The left ventricular end-systolic volume (LVESV) was measured by echocardiography and New York Heart Association (NYHA) classification was evaluated between one week before and six months after CRT. Mean pulmonary artery pressure (mPAP), pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) were measured by right heart catheterization. Left ventricular reverse remodeling (LVRR) is defined as a decrease of 15% or more in LVESV at the 6th month after CRT; Clinical response is defined as a decrease of NYHA classification at or above grade 1 at the 6th month after CRT. Pulmonary hypertension (PH) was defined as mPAP≥25 mmHg. According to the response, patients were divided into 3 groups: group A (LVRR+clinical response), group B (no LVRR+clinical response) and group C (no LVRR+no clinical response). The changes of NYHA classification, echocardiographic and pulmonary hemodynamic parameters were observed in the 3 groups. The Kaplan-Meier survival curve was used to analyze the differences in all-cause mortality, combined end-point events of death or re-hospitalization due to heart failure among different groups.@*RESULTS@#A total of 45 patients with CRT implantation [aged (63.27±9.55) years, 36 males] were included. The average follow-up period was (33.76±11.50) months. Thirty-one patients (68.89%) were in group A, 9 of whom with PH. Eight patients (17.78%) were in group B, 7 of whom with PH. Six patients were in group C, all with PH. Cardiac function including NYHA classification, echocardiographic and pulmonary hemodynamic parameters had been significantly improved in group A after CRT implantation (0.05). There were no significant changes in NYHA classification, echocardiographic and pulmonary hemodynamic parameters in group C (>0.05). Compared with group C, group A and group B had lower all-cause mortality (=0.005) and lower incidence of composite endpoint events (=0.001).@*CONCLUSIONS@#Patients with LVRR and clinical response after CRT have a good prognosis. Patients with clinical response but without LVRR have a better prognosis than those without clinical response and LVRR, which may be related to the decrease of pulmonary hemodynamic parameters such as mPAP and TPG.

Diagnosis and surgical treatment of differentiated thyroid carcinoma in 40 years / 国际肿瘤学杂志

Differentiated thyroid cancer (DTC) is the most common type of thyroid cancer. Most of patients with DTC are characterized by low invasiveness and good prognosis. With the development of medical imaging, fine needle biopsy and molecular biology technology, especially the progress of surgical technology, the early diagnosis rate of DTC and the survival rate after operation are significantly increased. However, the cognition understanding of DTC and some views of surgical treatment are still controversial. A systematic review and summary of the diagnosis and surgical treatment of DTC are made based on the changes in the past 40 years, especially the treatment strategy, surgical resection scope and indications of DTC primary focus and cervical lymph node metastasis, in order to propose a more reasonable and accurate individual diagnosis and treatment plan for patients with DTC.

Ablation of paroxysmal supraventricular tachycardia guided by Carto Univu electroanatomic mapping system / 中南大学学报(医学版)

To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia (PSVT) guided by Carto Univu three-dimensional mapping system.
 Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation (RFCA) were assigned to a Carto Univu group (51 patients) and a two-dimensional X-ray group (48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product (DAP), operation success rate and complication rate were compared between the two groups.
 Results: The Carto Univu group and the two-dimensional X-ray group were not significant difference in the operation time, the X-ray exposure time of placing catheter, the X-ray DAP of placing catheter, the number of discharge, the discharge power, and the total discharge time (P>0.05). The mapping and ablation time, total exposure time, mapping and ablation DAP and total DAP in the Carto Univu group were significantly lower than those in the two-dimensional X-ray group (P<0.01). In the right accessory pathway cases, the mapping and ablation DAP and the total DAP in the Carto Univu group decreased compared with X-ray group (P<0.05), but it decreased more profound (P<0.01) in the left accessory pathway cases and the dual atrioventricular nodal pathways cases. Seven cases in the Carto Univu group achieved "zero X-ray", including 5 cases of the dual atrioventricular nodal pathways and 2 cases of the left accessory pathway. The immediate success rate for the two groups was 100%. After 3-12 months of follow-up, there was no recurrence in the Carto Univu group but 3 suspected recurrences in the two-dimensional X-ray group. In addition, no complications occurred in the two groups. 
 Conclusion: Carto Univu electroanatomic mapping system can guide PSVT safely and effectively during radiofrequency ablation and reduce radiation exposure to both doctors and patients. It is especially suitable for dual atrioventricular nodal pathways, which may even achieve "zero X-ray". Perhaps Carto Univu will be the first choice for RFCA of dual atrioventricular nodal pathways.

Correlations of age and gender with the effects of cardiac resynchronization therapy in chronic heart failure patients / 医学研究生学报

Objective Various factors may affect the effects of cardiac resynchronization therapy or cardiac resynchronization and implantable cardioverter-defibrilator ( CRT/CRTD) in chronic heart failure patients ( CHF) .The aim of our study was to explore the correlation of age and gender with the effects of CRT/CRTD in chronic heart failure patients. Methods This study included 136 CHF patients, 92 males and 44 females, treated by CRT/CRTD from January 2005 to March 2015.We divided the patients into three age groups:≥70 yr (n=29), 50-70 yr (n=77), and 0.05).However, the CRT responding rate was remarkably higher in the female than in the male patients (66%vs 47%, P=0.027).Cox multivariate and Kaplan-Meier analyses revealed no significant differences in all-cause mortality between different genders or age groups.Multivariate logistic regression analysis showed that the left ventricular diastolic diameter and base QRS duration were independent factors of the CRT response. Conclusion Age does not affect the CRT response in chronic heart failure patients, while female patients have a higher CRT respon-ding rate than male patients.

Effects of cardiac resynchronization therapy on time-domain T wave alternans in patients with chronic heart failure / 中南大学学报(医学版)

OBJECTIVE@#To study the effects of cardiac resynchronization therapy (CRT) with different pacing rates and modes on MTWA.
@*METHODS@#From March, 2012 to October, 2014, 43 patients who received CRT or CRT-D implantation in the first affiliated hospital, Nanjing Medical University were studied. Time-domain MTWA test were assessed following CRT implantation. MTWA was measured at 90 min(-1) and 110 min(-1) by treadmill exercise test with GE CASE 8000 during CRT-on (BIV biventricular) and CRT-off (RA right atrial) pacing modes. The comparsion of MTWA values between different pacing mode and pacing rates were analyzed. According to the heart function classification the patients were divided into 3 groups. The correlation between MTWA and cardiac function was analyzed.
@*RESULTS@#MTWA-AAI was significantly increased compared to MTWA-BIV at the pacing rate of 90 min(-1) [(11.27±9.94) µV vs (7.09±7.16) µV, P=0.001]. The value of MTWA at pacing rate of 110 min(-1) was nonsignificantly higher than MTWA during AAI pacing [(16.91±12.51) µV vs (15.58± 10.97) µV, P=0.517]. The value of MTWA at pacing rate of 110 min(-1) was higher than MTWA at pacing rate of 90 min(-1) during AAI or BIV (P<0.05). MTWA-AAI and MTWA-BIV in group of NYHA IV were higher than those in group of NYHA II (P<0.05).
@*CONCLUSION@#Biventricular pacing mode at lower pacing rates can significantly attenuate MTWA. The value of MTWA is associated with the severity of CHF.

Decompressive craniectomy and temporal muscle sticking therapy of cerebral infarction:experience and problems / 中国组织工程研究

BACKGROUND:A surgery can relieve the increased intracranial pressure, brain tissue edema, and brain stem compression in patients with massive cerebral infarction, and reduce the risk of serious complications, provide more time for medical treatment, and decrease the mortality and disability rate. OBJECTIVE:To investigate the clinical value of decompressive craniectomy plus temporal muscle sticking therapy of cerebral infarction. METHODS:A retrospective analysis was performed among the clinical data of 37 cerebral infarction patients, including 24 males and 13 females, they aged 10-55 years old. After decompressive craniectomy plus temporal muscle sticking therapy, the involved patients were fol owed up. The prognosis was evaluated according to the Glasgow Outcome Scale, as excel ent, good, moderate, none, and poor. RESULTS AND CONCLUSION:At 6 months of fol ow-up, the total efficiency of surgical treatment in 37 patients was up to 89%, including excel ent in 5 cases (14%), good in 15 cases (41%), moderate in 13 cases (35%), none in 4 cases (11%). No cases exhibited aggravation. Thirty-one patients with cerebral infarction were detected by cranial CT scans, among them 19 patients exhibited significantly reduced infarct size, and 12 patients who had self-care ability were found to restore the cerebral cortex activity. During the 1-year fol ow-up, 31 patients completed the fol ow-up, the remaining 6 cases were lost due to contact failure. Twenty-three cases achieved satisfactory long-term results, and returned to normal work and simple labor, two cases occurred contralateral cerebral infarction and became sicker. Decompressive craniectomy plus temporal muscle sticking therapy is an effective treatment for the majority of cerebral infarction.

Olfactory ensheathing cell transplantation repairs spinal cord injury / 中国组织工程研究

BACKGROUND:Spinal cord injury can cause the motor, sensory and autonomic dysfunction below the damaged surface, so the repair of spinal cord injury has been the problem of neuroscience research. OBJECTIVE:To analyze the mechanism, experimental research and clinical application of olfactory ensheathing cel transplantation for the repair of spinal cord injury, and to investigate the effect of olfactory ensheathing cel transplantation on neurological function recovery. METHODS:The basic experimental and clinical researches on olfactory ensheathing cel transplantation for the repair of spinal cord injury were retrospectively analyzed, in order to analyze the relationship between the number and time of the survival cells and the structure and function of the damages spinal cord after olfactory ensheathing cel transplantation. The inclusion and exclusion criteria of the included clinical researches, and the sources, types and transplantation method of the cells used for transplantation were clearly defined, then the effective and objective evaluation criteria was established. RESUTLS AND CONCLUSION:The animal experiments of olfactory ensheathing cel transplantation for the repair of spinal cord injury have achieved satisfactory effects. The spinal cord function score and the sensory and motor function were significantly improved compared with those before transplantation (P<0.001). The successful animal experiment could provide basis for the clinical experiment and application. Parts of the clinical experiments were fol owed-up for 5 years. Because of a smal amount of the cases in the clinical research and the short fol ow-up period, the final recovery of large number of cases cannot judged yet, further observation and research were required. The great significance of the research result is to help to find a reasonable strategy that can make the olfactory ensheathing cells displayed repairing effect sufficiently.