Transapical approach under 3D printing guidance for myectomy in apical hypertrophic cardiomyopathy: A case report / 中国胸心血管外科临床杂志

@#We reported a 26-year-old male who was diagnosed with apical hypertrophic cardiomyopathy with left ventricular aneurysm. The location of the hypertrophic myocardium and the extent of resection were accurately assessed preoperatively using 3D modeling and printing technology. Myectomy was performed via transapical approach, and the intraoperative exploration was consistent with the description of the preoperative 3D modeling. The patient underwent the surgery successfully without any complications during the hospitalization, and the cardiopulmonary bypass time was 117 min, the aortic cross-clamping time was 57 min, and the hospital stay time was 7 d. The postoperative echocardiography demonstrated left ventricular cavity flow patency. This case provides a reference for the management of patients with apical hypertrophic cardiomyopathy.

Totally endoscopic transmitral septal myectomy for the treatment of recurrent left ventricular outflow tract obstruction after alcohol septal ablation / 中国胸心血管外科临床杂志

@#Objective    To investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. Methods    The clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results     Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. Conclusion    Personalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.

Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement / 中国胸心血管外科临床杂志

@#Objective     To analyze the clinical efficacy and survival outcome of totally thoracoscopic redo mitral valve replacement and evaluate its efficiency and safety. Methods     The clinical data of patients with totally thoracoscopic redo mitral valve replacement in Guangdong Provincial People’s Hospital between 2013 and 2019 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to determine the risk factors for postoperative death. Results     There were 48 patients including 29 females and 19 males with a median age of 53 (44, 66) years. All the procedures were performed successfully with no conversion to median sternotomy. A total of 15, 10 and 23 patients received surgeries under non-beating heart, beating heart and ventricular fibrillation, respectively. The in-hospital mortality rate was 6.25% (3/48), and the incidence of early postoperative complications was 18.75% (9/48). Thirty-five (72.92%) patients had their tracheal intubation removed within 24 hours after the operation. The 1- and 6-year survival rates were 89.50% (95%CI 81.30%-98.70%) and 82.90%(95%CI 71.50%-96.20%), respectively. Age>65 years was an independent risk factor for postoperative death (P=0.04). Conclusion     Totally thoracoscopic redo mitral valve replacement is safe and reliable, with advantages of rapid recovery, reducing blood transfusion rate, reducing postoperative complications and acceptable long-term survival rate. It is worthy of being widely popularized in the clinic.

Early outcomes of thoracoscopic trans-mitral myectomy in obstructive hypertrophic cardiomyopathy patients with left midventricular obstruction / 中华外科杂志

Objective: To examine the early effect of thoracoscopic trans-mitral myectomy for hypertrophic cardiomyopathy patients with left midventricular obstruction. Methods: From April 2020 to July 2021, 10 hypertrophic cardiomyopathy patients with left midventricular obstruction underwent thoracoscopic trans-mitral myectomy at Guangdong Provincial People's Hospital. The whole group of patients consisted of 7 males and 3 females aged (52.0±16.4) years (range: 18 to 68 years). The EuroSCORE Ⅱ predicted mortality rate was 1.78% (1.20%) (M(IQR)) (range: 0.96% to 4.86%). The clinical data were collected and analyzed retrospectively to evaluate the clinical efficacy by comparing preoperative and postoperative echocardiographic parameters using paired t-test, paired Wilcoxon test or Fisher exact test, including left ventricular outflow tract peak pressure gradient, maximum interventricular septum thickness, systolic anterior motion of the anterior mitral leaflet and so on. The safety was determined by summarizing the incidence of perioperative and follow-up complications. Results: All the procedures successed with no conversion to median sternotomy, septal defect, ventricular rupture. There was no in-hospital 30-day death, neither serious complications like permanent pacemaker implantation, re-sternotomy for bleeding, low cardiac output syndrome, stroke, or multiple organ dysfunction syndrome. The left ventricular outflow tract obstruction was effectively relieved in all patients expect a patient developed residual obstruction. Compared with that of pre-operation, the thickness of the interventricular septum was significantly reduced from (22.1±4.0) mm to (10.3±1.7) mm (t=10.693, P<0.01), while the left ventricular outflow tract peak pressure gradient was significantly reduced from (81.7±21.1) mmHg to 12.3 (11.5) mmHg (Z=-2.805, P<0.01) (1 mmHg=0.133 kPa). Conclusion: Thoracoscopic trans-mitral myectomy is an effective and safe procedure for hypertrophic cardiomyopathy patients with left midventricular obstruction.

Effect analysis of myectomy guided by personalized three-dimensional reconstruction and printing in the treatment of obstructive hypertrophic cardiomyopathy / 中华外科杂志

Objective: To examine the clinical efficacy of myectomy guided by personalized three-dimensional reconstruction and printing for patients with obstructive hypertrophic cardiomyopathy. Methods: The clinical data of 28 patients with obstructive hypertrophic cardiomyopathy, who underwent septal myectomy guided by personalized three-dimensional reconstruction and printing in the Department of Cardiaovascular Surgery, Guangdong Provincial People's Hospital from May 2020 to December 2021, were retrospectively analyzed. There were 14 males and 14 females, aging (51.1±14.0) years (range: 18 to 72 years). Enhanced cardiac computed tomography images were imported into Mimics software for preoperative three-dimensional reconstruction. The direction of the short axial plane of each segment was marked perpendicularly to the interventricular septum on the long axial plane of the digital cardiac model, then the thickness was measured on each short axial plane. A figurative digital model was used to determine the extent of resection and to visualize mitral valve and papillary muscle abnormalities. Correlation between the length, width, thickness, and volume of the predicted resected myocardium and those of the surgically resected myocardium was assessed by Pearson correlation analysis or Spearman correlation analysis. The accuracy of detecting mitral valve and papillary muscle abnormalities of transthoracic echocardiography and three-dimensional reconstruction was also compared. Results: There was no death or serious complications like permanent pacemaker implantation, re-sternotomy for bleeding, low cardiac output syndrome, stroke, or multiple organ dysfunction syndromes in the whole group. Namely, the obstruction of the left ventricular outflow tract was effectively relieved. The systolic anterior motion of the anterior mitral valve leaflet was absent in all patients after myectomy. The length, width, and thickness of the predicted resected myocardium by three-dimensional reconstruction were significantly positively correlated with the length (R=0.65, 95%CI: 0.37 to 0.82, P<0.01), width (R=0.39, 95%CI: 0.02 to 0.67, P<0.01), and thickness (R=0.82, 95%CI: 0.65 to 0.92, P<0.01) of the surgically resected myocardium, while the relation of the volume of the predicted resected myocardium and the volume of the surgically resected myocardium was a strong positive correlation (R=0.88, 95%CI: 0.76 to 0.94, P<0.01). Importantly, the interventricular septal myocardial thickness measured by preoperative transthoracic echocardiography showed a moderate positive correlation with the volume of surgically resected myocardium (R=0.52, 95%CI: 0.19 to 0.75, P<0.01). During a follow-up of (14.4±6.8) months (range: 3 to 22 months), no death occurred, and 1 patient was readmitted for endocardial radiofrequency ablation due to atrial fibrillation. Conclusion: Personalized three-dimensional reconstruction and printing can not only visualize the intracardiac structure but also guide septal myectomy by predicting the thickness, volume, and extent of resected myocardium to achieve ideal resection.

Preliminary clinical outcomes of the domestic Renatus® balloon-expandable valve system for the treatment of severe aortic stenosis: A prospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the early clinical outcomes of the Renatus® balloon-expandable valve in the treatment of severe aortic stenosis. Methods    From November 2021 to April 2022, a total of 38 patients who received Renatus® balloon-expandable valve for severe aortic stenosis in Guangdong Provincial People's Hospital were included. There were 22 males and 16 females, with an average age of 73.7±5.3 years. Mean aortic gradient and peak aortic jet velocity at baseline, post-procedure, and follow-up were compared. Clinical outcomes including all-cause mortality, perivalvular leakage, serious adverse cardiovascular events and the occurrence of permanent pacemaker implantation were assessed. Results    All patients completed the procedure successfully without conversion to thoracotomy or perioperative death. The post-implant mean aortic pressure gradient was decreased from 41.5 (27.8, 58.8) mm Hg to 6.0 (3.0, 8.0) mm Hg, and the peak aortic jet velocity was also decreased from 4.1±0.9 m/s to 1.7±0.4 m/s (P<0.001). Pacemakers were required in 2 (5.3%) patients. The median follow-up time was 27.5 (23.0, 87.5) d, with a follow-up rate of 100.0%. The mean aortic gradient was 8.0 (7.0, 10.8) mm Hg and peak aortic jet velocity was 2.0±0.3 m/s, showing significant improvement compared with those in the preoperative period (P<0.001). No severe aortic regurgitation or paravalvular leak was observed. There was no serious cardiovascular adverse event or reoperative event during the study period. Conclusion    Transcatheter aortic valve replacement with the domestic Renatus® balloon-expandable valve system is a safe and effective procedure for selected patients with severe aortic stenosis who are at high risk or not candidates for surgical aortic valve replacement.

Transapical transcatheter aortic valve replacement for aortic regurgitation in a patient with extremely horizontal aorta / 中国胸心血管外科临床杂志

@#An 81-year-old male patient was admitted to Guangdong Provincial People's Hospital due to chest distress and shortness of breath after activity for half a year. Examination after admission revealed severe aortic insufficiency, tricuspid aortic valve and extremely horizontal aorta with an aortic root angulation of 99°. The Society of Thoracic Surgeons score was 7%. And taking the strong demand of the patient and his family into consideration, we decided to perform transapical transcatheter aortic valve replacement after multidisciplinary evaluation. The procedure was successfully performed by means of low deployment land zone and traction of pre-exist Prolene suture. Three-month follow-up confirmed the normal function of aortic prosthetic valve without residual regurgitation. This case provides a reference for the interventional treatment in patients with extremely horizontal aorta.

Efficacy and safety of lactase additive in preterm infants with lactose intolerance: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVE@#To study the efficacy and safety of lactase additive in improving lactose intolerance in preterm infants.@*METHODS@#A total of 60 preterm infants with lactose intolerance who were admitted to the Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2019 were randomly divided into a lactase treatment group and a control group, with 30 infants in each group. The infants in the lactase treatment group were given 4 drops of lactase additive (180 mg) added into preterm formula or breast milk, and those in the control group were given placebo, oral administration of probiotics (live combined @*RESULTS@#Finally 29 infants in the lactase treatment group and 26 infants in the control group completed the trial. At the end of the first week after intervention, compared with the control group, the lactase treatment group had significantly lower frequency of daily milk vomiting and gastric retention amount (@*CONCLUSIONS@#Lactase additive can safely and effectively improve the clinical symptoms caused by lactose intolerance in preterm infants.

High tibial osteotomy combined with lateral retinacular release for the treatment of knee varus osteoarthritis with lateral patellar compression syndrome / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of high tibial osteotomy combined with arthroscopic lateral retinacular release in the treatment of knee varus osteoarthritis.@*METHODS@#From October 2017 to April 2019, a retrospective analysis was performed on 43 patients with knee varus osteoarthritis and lateral patellar compression syndrome treated by high tibial osteotomy combined with arthroscopic lateral retinacular release. There were 15 males and 28 females, aged 53 to 72(62.05±5.17) years. The visual analogue scale(VAS), Lysholm, and the knee range of motion were used to evaluate knee pain and functional recovery before operation, 2 weeks, 3 months and 12 months after operation. And the congruence angle (CA), patellar tilt angle (PTA), and femala-tibial angle (FTA) were measured respectively before and 12 months after operation to evaluate the congruence of patellar joint, and the improvement of line of gravity of lower limb.@*RESULTS@#All 43 patients were followed up for more than 12 months, with a follow-up time of 14 to 28 (19.60±4.50) months. The VAS scores decreased from 6.65±0.65 before operation to 2.16±0.95, 0.51±0.77 and 0.33±0.64 at 2 weeks, 3 months and 12 months after operation, and the difference was statistically significant (@*CONCLUSION@#High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis.

Transapical transcatheter valve-in-valve implantation treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement / 中国胸心血管外科临床杂志

@#Objective    To determine the clinical efficacy of transapical transcatheter mitral valve-in-valve treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement. Methods    The clinical data of 9 patients who underwent transapical transcatheter mitral valve-in-valve implantation after aortic-mitral double valve replacement due to mitral bioprosthesis deterioration from May 2020 to January 2021 in our hospital were retrospectively analyzed, including 4 males and 5 females with a mean age of 72.44±7.57 years. Results    Surgeries were performed successfully in all patients with no conversion to median sternotomy. The mean procedural time was 101.33±48.49 min, the mechanical ventilation time was 23.11±26.54 h, the ICU stay was 1.89±1.05 d and the postoperative hospital stay was 6.11±2.02 d. Residual mild mitral regurgitation was only observed in 1 patient. Only 1 patient needed postoperative blood transfusion. No major complications were observed in all patients. There was no death in postoperative 90 days. Conclusion    For patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement, transapical transcatheter mitral valve-in-valve implantation achieves good clinical results and effectively  improves the hemodynamics without increasing the risk of postoperative left ventricular outflow tract obstruction. The surgery is feasible and effective.

Evaluation of cartilage regeneration by arthroscopy after high tibial osteotomy / 中国骨伤

OBJECTIVE@#To evaluate the cartilage regeneration in the knee joint by arthroscopy after high tibial osteotomy.@*METHODS@#Eleven patients were included in the study who were treated with high tibial osteotomy and underwent microscopy when the internal fixation was unloaded from September 2017 to September 2019. Among them, there were 2 males and 9 females, aged from 55 to 64 years old. The internal and external compartment pictures of the knee were taken before and after surgery of removing the internal fixation and the International Cartilage Repair Society (ICRS) grading systerm was used to evaluate the degree of cartilage damage on the medial and lateral femoralcondyles and tibial plateau. The Westrn Ontarioand Mcmaster Universities osteoarthritis index (WOMAC) and the weight bearing line (WBL) were used to evaluate the function of the knee and the alignment of the lower limb.@*RESULTS@#All 8 patients were followed up for more than 12 months, ranging from 12 to 22 months. The degenerated cartilage of the medial femoral condyle and medial tibial plateau was covered by newly regenerated cartilage. WOMAC score decreased from 102-127 to 41-52 and WBL was improved from 17%-34% to 58%-64%. All incisions healed in stageⅠ, and no complications such as internal fixation rupture and infection occurred during and after the operation.@*CONCLUSION@#High tibial osteotomy can relieve the pain of the knee and the dysfunction by adjusting lower limb alignment, and the degenerated cartilage could be regenerated in the medial femoral condyle and medial tibial plateau.

Rapid Identification on Chemical Components in Dalbergiae Odoriferae Lignum by UPLC-Q-TOF-MS/MS / 中国实验方剂学杂志

Objective::Dalbergiae Odoriferae Lignum is a rare traditional Chinese medicine material in China. However, there are many varieties of various sources and different qualities in the market at present. In order to further define the pharmacodynamic substance basis, electrospray time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS) was used to rapidly analyze chemical constituents of methanol extract of Dalbergiae Odoriferae Lignum. Method::Chromatographic separation was performed on an UPLC RRHD SB-C18(3.0 mm×100 mm, 1.8 μm)for gradient elution, with mixtures of acetonitrile and 0.1%formic acid-water as mobile phases at a flow rate of 0.3 mL·min-1. The column temperature was maintained at 40 ℃. The data was collected in a negative ion mode with electro-spray ionization source(ESI). Result::According to molecular ion peaks and MS2 mass spectrometry characteristic fragment ions, Mass Bank databases, as well as the mass spectrometry information of reference substances and relevant literatures, a total of 83 constituents were identified, including 18 flavones, 31 isoflavones, 10 neoflavonoids, 9 isoflavanones, 7 other flavonoids and 8 other components. Conclusion::UPLC-Q-TOF-MS/MS can quickly, accurately and comprehensively identify chemical constituents in methanol extract of Dalbergiae Odoriferae Lignum, and isoflavones, flavones, neoflavonoids and isoflavanones are the main chemical constituents, which laid a foundation for the basic research of medicinal substances of Dalbergiae Odoriferae Lignum, and provided theoretical basis and technical support for the improvement of quality standards of Dalbergiae Odoriferae Lignum.

Observation on the therapeutic effect of Wuzhuyu acupoint application on gastrointestinal dysfunction in severe patients / 国际中医中药杂志

Objectives To observe the clinical curative effect of Wuzhuyu acupoint on the treatment of gastrointestinal dysfunction in severe patients. Methods A total of 60 patients with gastrointestinal dysfunction were randomly divided into treatment group and control group, 30 patients in each group. The control group was treated with routine western medicine, and the treatment group was given the acupoint application of Wuzhuyu on the basis of routine treatment. The treatment last 7 days. The clinical efficacy was evaluated by observing bowel sounds recovery time, exhaust time and defecating time, enteral nutrition tolerability, gastrointestinal dysfunction score and acute physiology and chronic health evaluation (APACHE Ⅱ). Results The treatment group showd significantly shorter bowel sound recovery time and anal exhaust time than the control group (t value were 8.811, 5.538, 8.908, all P value <0.01). The enteral tolerance rate was 80.0％ (24/30), and the control group tolerance rate was 53.3％ (16/30). The tolerance rate of treatment group was significantly higher than that of control group (χ2=4.720, P=0.030). The Gastrointestinal dysfunction score and APACHE Ⅱ score in treatment group were significantly lower than control group (t value were 3.873,2.805,all P value <0.01). Conclusions The acupoint application of Wuzhuyu can promote the recovery of gastrointestinal function, increase the tolerance of enteral nutrition, and reduce the severity of the patient's condition and improve the prognosis of patients.

Early rehabilitation intervention reduces the incidence of extrauterine growth retardation in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of early rehabilitation intervention on the incidences of extrauterine growth retardation (EUGR) and early diseases in preterm infants.</p><p><b>METHODS</b>The appropriate-for-gestational-age preterm infants with a gestational age of <34 weeks and a birth weight of 1 000 to <2 000 g who were admitted to the neonatal intensive care unit (NICU) within 24 hours after birth were enrolled in a prospective randomized controlled trial. These infants were randomly divided into rehabilitation intervention group and control group. The infants in the rehabilitation intervention group were given early rehabilitation after their vital signs became stable, including oral sensory and muscle strength training and pressure touching of the head, chest, abdomen, extremities, hands, and feet. The primary outcome measures were the time to independent oral feeding, length of hospital stay, and incidence rate of EUGR. The secondary outcome measures were the incidence rates of related diseases in preterm infants, such as apnea, feeding intolerance, and sepsis.</p><p><b>RESULTS</b>A total of 97 preterm infants who met the inclusion criteria and had complete data were enrolled, with 48 in the control group and 49 in the rehabilitation intervention group. The rehabilitation intervention group had a shorter time to independent oral feeding than the control group (P<0.05). Compared with the control group, the rehabilitation intervention group had a shorter length of hospital stay and a lower corrected gestational age at discharge (P<0.05), as well as a lower incidence rate of EUGR (P<0.05). The rehabilitation intervention group ONCLUSIONS: Early rehabilitation intervention for preterm infants in the NICU may reduce the incidence rates of apnea, feeding intolerance, and EUGR and help them to achieve independent oral feeding early.</p>

Severe infection with H1N1 requiring intensive care--lessons for preparedness programmes

<p><b>INTRODUCTION</b>The influenza pandemic has generated much interest in the press and the medical world. We report our experience with 15 cases of severe novel influenza A H1N1 (2009) infections requiring intensive care. The aim of this review is to improve our preparedness for epidemics and pandemics by studying the most severely affected patients.</p><p><b>CLINICAL PICTURE</b>During the epidemic, hospitals were required to provide data on all confirmed H1N1 cases admitted to an intensive care unit (ICU) to the Ministry of Health. We abstracted information from this dataset for this report. To highlight learning points, we reviewed the case notes of, and report, the fi ve most instructive cases.</p><p><b>TREATMENT</b>There were 15 cases admitted to an ICU from July 4, 2009 to August 30, 2009. Two patients died.</p><p><b>CONCLUSIONS</b>The lessons we wish to share include the following: preparedness should include having intermediate-care facilities that also provide single room isolation and skilled nursing abilities, stringent visitor screening should be implemented and influenza may trigger an acute myocardial infarction in persons with risk factors.</p>

"Future" threat of gram-negative resistance in Singapore

The emergence of multidrug-resistant gram-negative bacteria is challenging the treatment of serious nosocomial infections. This is an international trend that is mirrored in Singapore too. Reports of strains resistant to all currently available agents have surfaced here and possibly have taken root here as well. The direst situation is among the non-fermenters, Pseudomonas aeruginosa and Acinetobacter baumannii. This is followed closely by the Enterobacteriaceae family with their array of extended-spectrum beta-lactamases, AmpC beta-lactamases and carbapenemases. There are also resistance mechanisms such as efflux pumps and porins downregulation that effect resistance against multiple classes of agents. Potentiating these developments is the dwindling "pipeline" of new agents. Hence, there is a real concern that we are running out of options for our patients. Novel antibiotic combinations, enhanced infection control, antibiotic cycling, computer-assisted programmes, and maybe in the distant future, non-antimicrobial agents is all that we have.