Hemodynamic Effects of Banding Width on Pulmonary Artery / 医用生物力学

Objective To investigate the effects of banding width on hemodynamic characteristics of pulmonary artery (PA) by constructing pulmonary artery banding (PAB) models with different widths. Methods Based on clinical practice, with the same banding position and degree, computer-aided design (CAD) was utilized to reconstruct three-dimensional PAB models with different banding widths (2, 3, 4, 5 mm). Hemodynamic characteristics of the models with different banding widths, including pressure, streamlines, energy loss, energy efficiency and blood flow distribution ratio, were compared and analyzed through computational fluid dynamics (CFD). Results The pressure of PA decreased significantly, while the change of banding width had no significant effects on the pressure drop level at banding position. With the increase of banding width, the energy loss decreased, and the energy efficiency showed an upward trend. The blood flow of the left PA raised, and the ratio of blood flow distribution between the left PA and right PA increased, with the maximum reaching up to 2.28 : 1. Conclusions The increase of banding width can reduce the energy loss of PA and improve the energy efficiency of blood flow, but it will lead to the imbalance of blood flow distributions between the left and right lungs. Both the balance of blood flow distribution and the energy loss should be considered in choice for banding width of PAB. The virtual design of PAB surgery based on CAD and CFD will assist individualized banding width selection in future.

Gold in the dust: the re-evaluation of early surgical results of Ross procedure for aortic valve disease in children / 中华胸心血管外科杂志

Objective:To study the surgical results of Ross procedure in pediatric patients. We report our early outcomes of the Ross procedure for congenital aortic valve disease.Methods:Retrospective analysis was performed on all 16 children with congenital aortic valve disease that underwent a Ross procedure from May 2018 to December 2019. Three patients had aortic stenosis(AS), 5 had aortic regurgitation(AR), and 8 patients had AS/AR. Two patients had endocarditis. Nine patients had prior aortic valve surgeries or interventions, 7 had percutaneous balloon aortic valvuloplasty, 1 had surgical valvotomy and 1 had aortic valve repair by cusp extension. Six patients had bicuspid and 1 had quadricuspid aortic valves.Results:There was no early death. Mean CPB time was (193.8±66.9) min (range 123~359 min), mean aortic cross-clamping time was (125.9±29.7) (range 82-186 min). Mean ventilation time was (58.0±42.4) h (range 22.7-163.0 h), and mean ICU and hospital length of stay was (5.4±3.4) d (range 2-16 d) and (25.9±18.7) d (range 7-77d). Six patients developed low cardiac output syndrome and 2 patient had hepatic dysfunction, which all improved after treatment. Follow-up was complete in all patients from 3 to 23 months, and there was no late death. Thirteen patients were in NYHA grade Ⅰ, and 3 in grade Ⅱ. The peak gradients through the aortic valve and pulmonary valve were (8.3±5.5)mmHg (3.7-26.6mmHg) and (20.5±16.4) mmHg (6.8-62.1 mmHg), respectively. The aortic regurgitation was negative in 3 patients, trivial in 1 patient and mild in 12 patients. The pulmonary regurgitation was trivial in 4 patients, mild in 9 patients and moderate in 3 patients.Conclusion:Ross procedure is a safe, effective surgical operation for congenital aortic valve disease in children >1-year of age.

Cinical characteristics of small common bile duct stone's spontaneous excretion / 中华普通外科杂志

Objective To investigate the excretion probability,clinical characteristics of gallstones with small common bile duct stone.Methods The clinical data of 216 patients were analyzed retrospectively.The relevant clinical characteristics of small common bile duct stone's excretion were analyzed.x2 and Pearson correlation coefficient were used to analyze correlation between small common bile duct stone's excretion and relevant clinical characteristics,multiple logistic regression analysis was performed to identify these excretion related factors.Results Univariate analysis showed that patients of age less than 50 years,female sex,abdominal pain relieved and liver function recovered rapidly in 3 days of treatment,normal or slightly dilated diameter of common bile duct,single or multiple stones located in one place,stones completely located in the common bile duct or completely within the sphincter were more likely to be discharged.Multivariate analysis indicated that rapid relief of abdominal pain,rapid recovery of liver function,single or multiple stones located in one place were independently correlated with small common bile duct stone's excretion.Conclusion Small stones in common bile duct have a high probability of spontaneous removal in patients with gallstones and small common bile duct stone.

An investigation on the transcatheter closure of antegrade pulmonary blood flow with high-risk Fontan operations / 中华胸心血管外科杂志

Objective To investigate the therapeutic effect of the transcatheter closure of antegrade pulmonary blood flow with high-risk Fontan operations.Methods Retrospective analysis of 6 Fontan surgical patients, 4 males and 2 females, who received surgical treatment in the cardiothoracic surgery of Shanghai Children's Medical Center from May 2016 to August 2018;Age(5.7 ±2.9) years;(19.8 ±5.5) kg weight.All 6 patients were treated with primary pulmonary artery banding operation and secondary bilateral Glenn operation(BDG) and re-PAB.Before Fontan surgery, cardiac catheterization was performed in the department of cardiology to close the antegrade pulmonary blood flow .Results These six patients received interventional therapy in the department of cardiology.The mean pulmonary artery pressure(Pp) before occlusion was(17.0 ±0.8) mmHg (1 mmHg=0.133 kPa), the ventricular diastolic pressure(VEDP) was (11.2 ±0.9) mmHg, and the mean pulmonary artery pressure after occlusion was effectively decreased to(14.2 ±0.7) mmHg and VEDP to(9.7 ±0.7) mmHg.Fontan surgery was performed 6 to 12 months after the occlusion.No death was found after the operation, and all the clinical indicators were normal after the operation.Follow-up was conducted for 2-24 months, and the cardiac function and the function of each organ recov-ered well.Conclusion For some patients with high risk Fontan before operation , this method can safely and effectively reduce the average pulmonary artery pressure and reduce the ventricular and pulmonary vascular load , which is of positive help for the successful Fontan operation.

Significance of WT1 gene detection in the prognosis of acute myeloid leukemia patients with normal karyotype after hematopoietic stem cell transplantation / 白血病·淋巴瘤

Objective To investigate the monitoring significance of WT1 gene level in the prognosis of acute myeloid leukemia (AML) patients with normal karyotype after hematopoietic stem cell transplantation (HSCT). Methods The clinical data of 115 AML patients with normal karyotype who were treated with HSCT from July 2009 to March 2017 in the First Affiliated Hospital of Soochow University were retrospectively analyzed. The dynamic detection of bone marrow WT1 gene was carried out by using reverse transcription_polymerase chain reaction (RT_PCR). According to the relative expression level median of WT1 gene before transplantation, the whole patients were divided into the two groups (<median group and ≥median group) for survival analysis. Results There were 52 males and 63 females in 115 patients. The average age was (39± 10) years old. The median white blood cell count at initial diagnosis was 20.45×109/L [(0.5-355.9)×109/L], the ratio of blast cells in the bone marrow was 0.60±0.28, and the relative expression level median of WT1 gene was 87×104, while the median time of the follow_up was 24 (3-79) months. Among 115 patients, 19 cases relapsed. Remission group (96 cases) and relapse group (19 cases) were followed up. The WT1 gene level was monitored by using bone marrow puncture in 1 month, 3 months, 6 months, 12 months after transplantation. It was found that the WT1 gene relative expression level of relapse group was higher than that of remission group, and the differences between the two groups at 6 month_point [remission group (187±50)×104, relapse group (871±211)×104, t ＝ 2.519, P＝ 0.014] and 12 month_point [remission group (51±9)×104, relapse group (1 797±312)×104, t ＝ 4.000, P< 0.05] were statistically different. The overall survival (OS) rate of 2_year, progression_free survival rate in WT1 gene relative expression level < 87×104 group were higher than those in WT1 gene relative expression level ≥87×104 group, the relapse rate in WT1 gene relative expression level <87×104 group was lower than that in WT1 gene relative expression level ≥87×104 group, and the differences were statistically different (all P<0.05). Multivariate analysis showed that the level of WT1 gene at 12 months after transplantation was an independent factor affecting OS ( HR＝4.12, P＝0.046) and PFS ( HR＝5.95, P＝0.001). There were 19 cases of recurrence (16.5%), with a median relapsed time of 11 (1-60) months. When WT1 gene relative expression level was significantly increased in 19 patients, firstly immunosuppressive agents were reduced, of which 6 patients were not influenced by this intervention; in other 13 cases, only 5 cases were influenced by intervention. Conclusions For CN_AML patients, the expression level of WT1 gene before transplantation has a negative correlation with the prognosis. The expression level of WT1 gene at 12 months after transplantation is an independent factor for affecting the survival. The relapsed patients have a higher WT1 expression level, and clinical interventions for relapsed patients have a favorable effect.

Outcomes of refractory or relapsed DNMT3A + cytogenetically normal acute myeloid leukemia patients followed the therapy including decitabine combined with CAG or CAG-like regimen / 中华血液学杂志

<p><b>OBJECTIVE</b>To study clinical characteristics of refractory or relapsed DNMT3A⁺ cytogenetically normal acute myeloid leukemia（CN-AML）patients, and to explore the overall response rate（ORR）and side effects of these patients followed the therapy including decitabine with CAG or CAGlike regimen.</p><p><b>METHODS</b>In this study we retrospectively analyzed 53 refractory or relapsed CN- AML patients receiving the therapy including decitabine combined with CAG and CAG- like regimen in our center from April 2011 to October 2014. The clinical characteristics and ORR were further analyzed. Based on gene mutations, these patients could be divided into 2 groups: DNMT3A⁺ AML patients（n=24）and DNMT3A- AML patients（n=29）.</p><p><b>RESULTS</b>The median age of DNMT3A⁺AML patients was 46 years old, higher white blood cells and bone marrow blasts were observed in DNMT3A+ AML group. The ORR and complete response（CR）rate of DNMT3A+ group were 62.50% and 54.17%, respectively. No differences were observed in ORR and CR rates（P>0.05）between these two groups. DNMT3A⁺/FLT3-ITD⁺ CN-AML patients（n=14）had higher ORR and CR rates than DNMT3A-/FLT3-ITD⁺CN- AML patients（n=15）（P= 0.040 and 0.042, respectively）. The one- year overall survival （OS） of DNMT3A⁺ AML group and DNMT3A- AML group were 59.58% , 54.09% , no differences were observed （P=0.438）. 25 patients received further therapy of allo-HSCT, the one-year OS of DNMT3A⁺ CN-AML was 87.50% and one-year disease free survival（DFS）was 72.73%, while the one- year OS was 61.54% and one- year DFS was 58.02% in DNMT3A⁻ group. No differences were observed between 2 groups （P=0.456, 0.217）.</p><p><b>CONCLUSION</b>Decitabine combined with CAG or CAG-like regimen was an effective and safe treatment for refractory or relapsed CN- AML patients. Compared to DNMT3A⁻/FLT3- ITD⁺ CN- AML patients, DNMT3A⁺/ FLT3-ITD⁺ CN-AML patients had higher ORR and CR rates. Decitabine bridged hematopoietic stem cells transplant could likely improve the survival of refractory or relapsed CN-AML patients.</p>

Relationship between the expression of CCR4 and invasion and metastasis of gallbladder cancer cell GbC-SD / 临床与实验病理学杂志

Purpose To investigate the effects of chemotactic factor CCR4 on the abi1ity of pro1iferation,ce11 cyc1e,invasion,and mi-gration of human ga11b1adder cancer ce11. Methods Western b1ot was used to detect the expression 1eve1 of CCR4 in ga11b1adder carci-noma ce11s. Ga11b1adder carcinoma ce11s was infected by means of s1ow virus,the CCR4 gene si1encing was conducted using siRNA-CCR4 interference techno1ogy. Ga11b1adder carcinoma ce11s GBC-SD were divided into three groups( GBC-SD,GBC-SD/CCR4-RNAi and GBC-SD/contro1). CCL17,a 1igand of CCR4,was used to act on these three groups of ce11s. CCK8 method was used to detect the ce11 pro1iferation abi1ity of three groups. F1ow cytometry was used to test ce11 cyc1e. Tanswe11 assay was app1ied to detect ce11 migration and invasion abi1ity. Western b1ot was performed to detect the expression of its corresponding 1igands CCL17 and CCL22 proteins. Re-sults CCR4 gene si1ence did not inf1uence ce11 cyc1e and pro1iferation of ga11b1adder ce11 GBC-SD,but can significant1y inhibit GBC-SD ce11 invasion and movement abi1ity,CCR4 gene si1ence had no inf1uence on the expression of CCL17 and CCL22 gene in tumor ce11s. Conclusion Ga11b1adder carcinoma ce11s GBC-SD express chemokine receptor CCR4,chemokine receptor CCR4 can promote the invasion and metastasis of GBC-SD ce11s.

Expression of CCR4 in gallbladder carcinoma tissues and its clinical significance / 中华肝胆外科杂志

Objective To study the expression of CCR4 in gallbladder carcinoma tissues,and to determine its relationship with clinical pathological factors and its influence on prognosis of gallbladder cancer.Methods The expressions of CCR4 in gallbladder carcinoma tissues,and chronic cholecystitis gallbladder mucosal tissues were detected using immune histochemical methods and they were analyzed together with the clinical records.Survival analysis was used to compare the expressions of CCR4 between the positive group and the negative group.Multiple factors analysis was carried out using the Cox regression model.Correlation between the expressions of CCR4 in gallbladder tissues and the clinical pathologic factors was done using the Chi-square test.Results CCR4 is expressed tan-yellow in gallbladder cell cytoplasm and/or cell membrane.The expression of CCR4 protein in the gallbladder carcinoma was obviously higher than in the chronic cholecystitis gallbladder epithelial tissues (P ＜ 0.05).A high expression of CCR4 was not correlated with patients' age,gender,pathological classification,distant metastasis and nerve/lymphatic invasion factors.It was,however correlated with tumor lymph node metastasis (P ＜ 0.05) and histological grading (P ＜ 0.05).Kaplan Meier survival analysis showed the postoperative survival between the CCR4 positive group and the negative group were significant different (P ＜0.05).On multiple factors analysis,CCR4 expression level was an independent risk factor of survival of patients after gallbladder surgery.Conclusions The chemokine receptor CCR4 expressed in gallbladder carcinoma.Its level of expression correlated with lymph node metastasis and histological grading.It was an independent risk factor of survival in patients with gallbladder carcinoma after surgery.As it was associated with invasion and metastasis of gallbladder carcinoma,antitumor treatment targeting CCR4 is expected to become a novel treatment of gallbladder carcinoma.

Application of a new design of cryo-jaw and its biomechanical evaluation in rat achilles tendon in vitro / 生物医学工程学杂志

This study was aimed to design a new, accurate and easy-to-use water bath cryo-jaw, and try to solve the problems met in small animals achilles tendon mechanical testing. The muscle-tendon-bony units were fixed in the clamps. SD rats achilles tendon were randomly divided into group A and B. Group A was tested by the newly designed water bath cryo-jaw, while group B was treated by non-water bath cryo-jaw. The mechanical tests revealed that non of the samples of the newly-designed water bath cryo-jaw in group A slipped and fell off, and the achilles tendons were in a physiologically active state, but one of the group B samples slipped and fell off, and the others had the frozen phenomenon obviously. The maximum stress, fracture displacement and Young's modulus of the rats in group A were significantly different compared to those in group B (P < 0.05). In conclusion, the new water bath cryo-jaw has more advantages than traditional ones. It exhibits a good simulation in vivo in the environmental conditions for testing the mechanical properties of the achilles tendon.

Comparison of different methods to revascularize the isolated left anterior descending artery disease / 中华胸心血管外科杂志

Objective Off-pump coronary artery bypass (OPCAB),minimally invasive direct coronary artery bypass (MIDCAB) and robotic-assisted coronary artery bypass (RA-CAB) are all used to treat isolated left anterior descending artery (LAD) disease.The aim of this study is to compare the early outcomes after these three procedures.Methods From February 2009 to May 2012,102 consecutive patients underwent revascularization of LAD.31 patients were treated by OPCAB,45 by MIDCAB and 26 by RA-CAB.Patients received sternotomy in the OPCAB procedures.The MIDCAB procedures were performed through a 10-cm anterolateral muscle-sparing minithoracotomy.In the RA-CAB procedures,left internal mammary arteries (LIMA) were harvested with the aid of da Vinci surgical system and sewing of the anastomoses was performed under direct vision by a 3-cm anterolateral minithoracotomy.Results No significant difference was observed in graft flow,pulse index,renal failure,reoperation for hleeding,new onset of arterial fibrillation and deep wound infection between these three groups.There was also no significant difference in peri-operative mortality,major adverse cerebro-cardiovascular events (MACCE) between these three groups.Compared with OPCAB,MIDCAB and RA-CAB significantly reduced the need of blood transfusion (4.4％ vs.32.3％,P＜ 0.05; 7.7％ vs.32.3％,P＜0.05).The patients receiving RA-CAB had shorter length of postoperative stay than whom receiving OPCAB[(8.8 ± 3.2) days vs.(12.4 ± 7.7) days,P ＜ 0.05)].There is no significant difference between the outcomes of MIDCAB and RA-CAB.Conclusion These findings indicated that MIDCAB and RA-CABwere feasible,effective and safe options for revascularization of isolated LAD disease.MIDCAB and RA-CAB showed the advantage of less invasive and faster recovery,compared with OPCAB.Therefore,MIDCAB and RA-CAB should be the routine treatment for patients with isolated LAD disease.In some advanced centers,RA-CAB will be the preferred method.The mid-and long-term outcomes of these three methods should be further investigated.

Application of cardiac pacemaker in laparoscopic cholecystectomy—an analysis of 215 cases / 中华消化内镜杂志

ObjectiveTo evaluate the influence of electrotome on permanent and temporary cardiac pacemaker in laparoscopic cholecystectomy ( LC),and the application of cardiac pacemaker to the cases of cholecystolithiasis combined with bradyarrhythmia.MethodsClinical data of 215 patients with permanent or temporary cardiac pacemaker who underwent were studied for the preoperative and postoperative variation of pacemaker function,and for the influence of electricity coagulation during the operation on cardiac pacemaker function.ResultsLC was successfully completed in all 215 patients.The function of cardiac pacemaker was not obviously interfered during the operation,and the parameters of cardiac pacemaker did not remarkably change after the operation.ConclusionCardiac pacemaker is slightly interfered when electrotome and electrocoagulation were used in LC; LC is feasible and safe for patients with bradyarrhythmia by placement of cardiac pacemaker.