Chlorin e6-loaded sonosensitive magnetic nanoliposomes conjugated with the magnetic field for enhancing anti-tumor effect of sonodynamic therapy.

In sonodynamic therapy (SDT), when Chlorin e6 (Ce6) accumulates in tumor tissues, its anti-tumor effect can be achieved by ultrasound activation. To increase the local drug concentration of Ce6 in tumor cells, we had established a novel drug delivery system, Ce6-loaded sonosensitive magnetic nanoliposome (Ce6/SML), which realized the targeting delivery by the external magnetic field. It was worth mentioning that the targeting release of Ce6/SML and the activation on Ce6 could be achieved simultaneously by ultrasound of SDT. In our study, after Ce6 was loaded into the sonosensitive magnetic nanoliposome (SML), the values of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in vitro and in vivo were determined, indicating the activation on Ce6 of ultrasound. The delivery system also displayed the tumor-targeting ability and anti-tumor activity, which associated with the determined tumor growth and expression levels of angiogenin (ANG), vascular endothelial growth factor (VEGF) and tumor necrosis factor-alpha (TNF-α). In conclusion, the Ce6/SML-SDT-Targeted delivery system could effectively enhance the anti-tumor activity of SDT and had a great potential application for the treatment of malignant tumors located in deep tissues.

Midterm outcome comparison between patients with bicuspid or tricuspid aortic stenosis undergoing transcatheter aortic valve replacement / 中华心血管病杂志

Objective: To compare the prognosis of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) stenosis. Methods: This was a retrospective study. Patients with symptomatic severe aortic stenosis, who underwent TAVR with follow-up time more than one year in Guangdong Provincial People's Hospital from April 2016 to August 2018, were included. According to aortic CT angiography, the patients were divided into BAV group and TAV group. The primary endpoint was the composite event of all-cause death and stroke, and the secondary endpoints were TAVR-related complications. Incidence of clinical endpoints and parameters derived from echocardiography were compared between the groups, and Kaplan-Meier survival analysis was used to compare the composite event between the two groups. Results: A total of 49 patients were included. The age was (73.6±6.3) years, and 25(51.0%) were male. There were 32 patients in BAV group and 17 in TAV group, the follow-up time was 466 (390, 664) days. The incidence of composite endpoint of death and stroke at one year were comparable in BAV and TAV groups (6.3% (2/32) vs. 5.9% (1/17), P=1.00). Kaplan-Meier curves also showed a similar risk of the composite endpoint(HR=1.03，95%CI 0.09-11.24，Log-rank P=0.98) between two groups. The incidence of all-cause death, stroke, myocardial infarction, severe bleeding, major vascular complications, new-onset atrial fibrillation or atrial flutter, and permanent pacemaker implantation were all similar between the two groups(all P>0.05), and there was no acute kidney injury (stage 2 or 3) in both groups. Echocardiographic parameters at one year were similar between the two groups (all P>0.05). Conclusions: The midterm prognosis of TAVR in patients with BAV and TAV stenosis is similar. Clinical trials of large sample size with long-term follow-up are warranted to verify our findings.

Medial Compartment Decompression by Fibular Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Pilot Study.

Compared with high tibial osteotomy and total knee arthroplasty, the authors found a simpler surgical procedure, partial fibular osteotomy, could effectively relieve knee pain and also correct the varus deformity for patients with medial compartment knee osteoarthritis (OA). From January 1996 to April 2012, a total of 156 patients with medial compartment OA were treated by proximal fibular osteotomy in the authors' hospital. A 2-cm-long section of fibula was resected 6 to 10 cm below the fibular head. A total of 110 patients with follow-up of more than 2 years were included in the study, including 34 males and 76 females with an average age of 59.2 years. Anteroposterior and lateral weight-bearing radiographs, the femorotibial angle (FTA) and lateral joint space, and the American Knee Society Score (KSS) and the visual analog scale (VAS) score of the knee joint were evaluated preoperatively and at final follow-up, respectively. At final follow-up, mean FTA and lateral joint space were 179.4°±1.8° and 6.9±0.7 mm, respectively, which were significantly smaller than those measured preoperatively (182.7°±2.0° and 12.2±1.1 mm, respectively; both P<.001). Mean KSS at final follow-up was 92.3±31.7, significantly higher than the mean preoperative score of 45.0±21.3 (P<.001). Mean VAS score and interquartile range were 2.0 and 2.0, significantly lower than the preoperative data (7 and 1.0, respectively; P<.001). The authors found that proximal fibular osteotomy can significantly improve both the radiographic appearance and function of the affected knee joint and also achieve long-term pain relief. This procedure may be an alternative treatment option for medial compartment OA.

Decrease of glomerular filtration rate may be attributed to the microcirculation damage in renal artery stenosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS). But the gap between artery stenosis and the glomerular filtration ability is still unclear.</p><p><b>METHODS</b>Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR), respectively. The different levels of eGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them.</p><p><b>RESULTS</b>A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS < 50%) or did not change correspondingly to RAS severity. The value of eGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR, with strong (r = -0.713, P < 0.001) and moderate (r = -0.580, P < 0.001) correlations. In the subgroup analysis of severe RAS (RAS ≥ 80%), the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = -0.827, P < 0.001) and (r = -0.672, P < 0.001) correlations, respectively.</p><p><b>CONCLUSIONS</b>Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.</p>

[Value of preventive tracheotomy in patients with acute cervical spinal cord injury].

OBJECTIVE: To evaluate the value of preventive tracheotomy in patients with acute cervical spinal cord injury. METHODS: A retrospective analysis was performed on 54 cases of severe C4-C8 cervical spinal cord injury patients undergoing anterior fixation. They were classified as A and B according to the criteria of American Spinal Injury Association. And no tracheotomy was performed preoperatively. The patients with a high risk of dyspnea and with an indication for preventive tracheotomy received a preventive tracheotomy right after anterior fixation. 11 cases were classified into tracheotomy group and 43 cases were in non-tracheotomy group. The preoperative and hospital stays, incidence of hypoxemia and pulmonary infection, incidence of surgical incision site infection and mortality were analyzed between two groups. RESULTS: The preoperative and hospital stays of tracheotomy group were shorter than those of non-tracheotomy group (2.9 ± 1.2 vs 5.7 ± 4.4 days, 10.3 ± 4.0 vs 16.5 ± 9.2 days). The incidence of hypoxemia was lower in tracheotomy group (9.1% vs 44.2%). There was difference existed between two groups. 44.2% patients in the non-tracheotomy group underwent tracheotomy or endotracheal intubation for dyspnea and hypoxemia. There was no significant difference between two groups in the incidence of pulmonary infection (9.1% vs 7.0%) or surgical incision site infection (0 vs 2.3%). The mortality of non-tracheotomy group was 3.07 folds of that of tracheotomy group (9.1% vs 27.9%). But there was no significant statistical difference. CONCLUSION: The preventive tracheotomy is an effective solution for the patients with respiratory compromises, a high risk of dyspnea and with an indication for preventive tracheotomy. The preventive tracheotomy for severe cervical spinal cord can improve respiratory function effectively and fixation may be performed earlier. And there are lower rates of mortality and infection.

Analysis of coronary rotational atherectomy related complications / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analysis the complications of coronary rotational atherectomy and evaluate the safety of this procedure.</p><p><b>METHOD</b>A total of 250 rotational atherectomy cases from April 1994 to February 2012 were screened retrospectively and 22 cases patients (8.8%) with rotational atherectomy-related complications were included in this analysis.</p><p><b>RESULTS</b>Among these 22 patients, all lesions were either type B2 or C calcified lesions as evidenced by coronary angiography. After the rotation procedure, there were seven cases (2.8%) with slow reflow and two (0.8%) cases with no reflow. Seven cases (2.8%) developed severe coronary spasm and two cases (0.8%) had sinus bradycardia. Coronary dissection occurred in two cases (0.8%), while one case (0.4%) had coronary perforation and cardiac tamponade. Burr entrapment happened in one case (0.4%). There was no malignant arrhythmia, acute myocardial infarction, emergent coronary artery bypass graft or device related death during and post procedure. Comparison with baseline data, the concentration of CK-MB elevated significantly after the rotational atherectomy [(31.2 ± 4.8) mmol/L vs. (11.4 ± 6.5) mmol/L, P < 0.05].</p><p><b>CONCLUSION</b>Coronary rotational atherectomy is safe and procedure-related complications are rare.</p>

Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure.</p><p><b>METHODS</b>The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software.</p><p><b>RESULTS</b>Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P = 0.213). The aortic rupture patients are more likely to have ascending aortic diameters = 4 cm (62.5% vs. 9.0%, P = 0.032), involvement the aortic arch concavity (62% vs. 27%, P = 0.041) and have had multiple stents placed (P = 0.039).</p><p><b>CONCLUSIONS</b>Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter = 4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.</p>

Application of triangular vector to functionally reconstruct the medial collateral ligament with double-bundle allograft technique.

PURPOSE: The purpose of this study was to present a novel medial collateral ligament (MCL) reconstruction technique and investigate the clinical outcomes of this surgical procedure. METHODS: From July 2006 to June 2009, 56 patients with medial instability of the knee were treated with MCL reconstruction and followed up for 33 months on average. These patients were divided into 2 groups based on whether anterior cruciate ligament (ACL) injury was present: 27 patients had isolated MCL injury, whereas 29 patients had combined MCL-ACL injury. All patients underwent reconstruction of the MCL with triangular double-bundle allograft, and we evaluated International Knee Documentation Committee (IKDC) scores, anteromedial rotatory instability (AMRI), and excessive knee medial opening (EKMO) both preoperatively and at follow-up. RESULTS: EKMO was significantly reduced to 2.9 mm at follow-up compared with 10.1 mm preoperatively. The incidence of AMRI was reduced to 9.4% (5 patients) compared with 67.9% (36 patients) preoperatively. Of the patients, 58.9% (33 patients) had a grade A IKDC subjective score and 35.7% (20 patients) had a grade B IKDC subjective score. Most patients had normal or nearly normal range of motion of the knee joint, whereas 4 patients (7.1%) lost more than 6° of range of motion in extension and 2 (3.6%) lost more than 25° in flexion. In 47 patients (83.9%) the symptoms were graded as normal or nearly normal according to IKDC symptom scores. No significant differences in IKDC subjective score, IKDC symptom score, flexion deficit score, AMRI, and EKMO were found between the isolated MCL injury group and the MCL-ACL injury group; however, a significant difference was found in knee extension deficit between groups. CONCLUSIONS: We have presented a new technique for reconstruction of the MCL with a triangular shape. This technique improved both valgus and rotational stability at short-term outcome. The clinical outcomes using IKDC evaluation indicate that no major difference exists in isolated MCL injury and combined MCL-ACL injury treated with this new technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Vulnerable plaque burden post pharmacological and interventional treatments in patients with acute coronary syndrome and borderline lesion: intravascular ultrasound follow up results / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety between the interventional and conservative treatment options for borderline vulnerable plaque lesion in acute coronary syndrome (ACS) patients by intravascular ultrasound (IVUS).</p><p><b>METHODS</b>A total of 100 ACS patients [78 male, age 43 - 74 (60.4 ± 14.1) years] undergoing coronary angiography (CAG) with borderline lesion (coronary artery stenosis between 50% - 70%) were enrolled in May 2007 to February 2009, who were randomly divided into PCI group (50 patients) and conservative therapy group (50 patients). According to minimal lumen area (MLA) detected by IVUS, patients were further divided into MLA ≥ 4.0 mm(2) sub-group and MLA < 4.0 mm(2) sub-groups. Outcomes during hospitalization and after 10 - 12 month follow-up were compared.</p><p><b>RESULTS</b>IVUS was performed in 40 patients at 10 - 12 months post PCI, there was no in-stent thrombosis and the extent of stent neointimal hyperplasia was comparable as at the time of immediately post PCI. IVUS was performed in 35 patients at 10 - 12 months post conservative therapy, IVUS results showed that MLA increased significantly [(7.32 ± 1.42) mm(2) vs. (4.98 ± 0.89) mm(2), P < 0.01], while plaque area [(7.70 ± 2.09) mm(2) vs. (10.01 ± 2.55) mm(2), P < 0.05], plaque burden [(55.94 ± 8.36)% vs. (67.97 ± 9.36)%] and low echo area [(4.08 ± 0.80) mm(2) vs. (2.27 ± 0.79) mm(2)] were significantly decreased at follow up compared to those as baseline (all P < 0.01). There was one patient in PCI group with MLA ≥ 4.0 mm(2) developed acute in-stent thrombosis in left anterior descending artery two days after the procedure and 9 patients in conservative therapy and MLA < 4.0 mm(2) group received PCI due to recurrent angina pectoris during follow-up.</p><p><b>CONCLUSIONS</b>For the borderline lesion with MLA ≥ 4.0 mm(2) detected by IVUS, adequate medication could effectively attenuate and or reverse the plaque progression and stabilize plaque.</p>

Intravascular ultrasound-guided interventional therapy for borderline lesions in patients with acute coronary syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the efficacy and safety of intravascular ultrasound (IVUS)-guided interventional therapy for borderline lesions in patients with acute coronary syndrome (ASC).</p><p><b>METHODS</b>Thirty-one ASC patients with borderline lesions (coronary artery stenosis between 40%-70% confirmed by coronary arteriography [CAG]) and a minimal lumen area (MLA) of the infarction related artery(IRA) < or =4.0 mm(2) shown by IVUS underwent percutaneous coronary intervention (PCI). Another 31 PCI cases without IVUS were also enrolled as the control group. The minimal luminal diameter, cross section luminal area, total cross section, plaque area and area stenosis rate were measured before and after stent deployment at a conventional or higher pressure in the IVUS group. All the patients were followed up for 10-12 months and clinically evaluated 1, 3, 6 month and 12 months after the procedure to collect the data of angina recurrence, myocardial infarction and revascularization.</p><p><b>RESULTS</b>All the 31 cases were successfully stented with satisfied CAG results (with residual stenosis <0, TIMI flow grade III) and without dissection or any related complications. Among the 32 stents, 28 showed insufficient adherence or underexpansion (stent malapposition) to require 18-20 atm dilation or another high pressure balloon to attain the adequate IVUS results. CAG and IVUS were repeated in 22 patients (70.97%) of the IVUS group during the 10 to 12 months of follow up. No stent restenosis occurred with the in-stent diameter late loss >50%, nor was in-stent thrombus found by IVUS. Endomembrane proliferation was found but without any significant difference. Minimal stent lumen area were not significantly different from the immediate results after PCI (10.12-/+1.15 mm(2) vs 8.98-/+2.12 mm(2), P>0.05). The 31 patients in the control group were successfully stented with satisactory CAG results, but 3 suffered angina at 3-6 months who showed stent restenosis and insufficient stent adherence.</p><p><b>CONCLUSION</b>IVUS can more effectively guide the interventional therapy for ACS borderline lesions and assess the immediate efficacy of therapy than CAG. Post-dilation with higher pressure (16-20 atm) guided by IVUS can further improve the procedural results. IVUS-guided PCI for ACS borderline lesions ensures high immediate and long-term success rate.</p>

Poly[diaqua-µ-oxalato-µ-pyrazine-2-carbox-yl-ato-lanthanum(III)].

In the title complex, [La(C(5)H(3)N(2)O(2))(C(2)O(4))(H(2)O)(2)](n), the La(III) ion is coordinated by one N and three O atoms from two pyrazine-2-carboxylate ligands, by four O atoms from two oxalate ligands and by two O atoms of two water molecules, displaying a distorted bicapped square-anti-prismatic geometry. The carboxyl-ate groups of pyrazine-2-carboxyl-ate and oxalate ligands link the lanthanum metal centres, forming layers parallel to (10). The layers are further connected by inter-molecular O-H⋯O and N-H⋯O hydrogen-bonding inter-actions, forming a three-dimensional supra-molecular network.