Ultrasonic Characteristics of Cardiovascular Changes in Children with Hutchinson-Gilford Progeria Syndrome: A Comparative Study with Normal Children and Aging People.

BACKGROUND: The cardiovascular characteristics of children with Hutchinson-Gilford progeria syndrome (HGPS) remain unclear. The present study is aimed at evaluating the cardiovascular changes with ultrasound examination in children with HGPS and compared these with those in normal children and older people. METHODS: Seven HGPS children, 21 age-matched healthy children, and 14 older healthy volunteers were evaluated by three-dimensional echocardiography (including strain analysis) and carotid elasticity examination with the echo-tracking technique. RESULTS: Children with HGPS had higher left ventricular ejection fraction (LVEF) and global longitudinal strain, when compared to older healthy volunteers (P < 0.05). However, these parameters were not significantly different, when compared to those in healthy children. Furthermore, children with HGPS had lower average peak times in the left ventricle, when compared with the other two groups. For the structure of the carotid artery detected by ultrasound, the abnormality rates were similar between children with HGPS and older healthy volunteers (83.3% vs. 71.4%). The elastic parameters, elastic modulus, stiffness parameter, and pulsed wave transmittal velocity of children with HGPS were lower, when compared to those in older healthy volunteers (P < 0.05), while they were higher with arterial compliance (P > 0.05). Furthermore, no significant difference existed among the vascular elastic parameters between HGPS and normal children. CONCLUSION: HGPS children had impaired left ventricular (LV) synchrony, when compared to normal children, although the difference in LVEF was not statistically significant. Furthermore, the structural abnormality of the carotid artery in HGPS children was similar to that in older people, although the index of elasticity appears to be more favorable. These results suggest that the cardiovascular system in HGPS children differs from natural aging.

Tongxinluo Improves Apolipoprotein E-Deficient Mouse Heart Function.

BACKGROUND: Our previous studies have shown that Tongxinluo (TXL), a compound Chinese medicine, can decrease myocardial ischemia-reperfusion injury, protect capillary endothelium function, and lessen cardiac ventricle reconstitution in animal models. The aim of this study was to illuminate whether TXL can improve hypercholesterolemia-impaired heart function by protecting artery endothelial function and increasing microvascular density (MVD) in heart. Furthermore, we will explore the underlying molecular mechanism of TXL cardiovascular protection. METHODS: After intragastric administration of TXL (0.1 ml/10 g body weight) to C57BL/6J wild-type mice (n = 8) and ApoE-/- mice (n = 8), total cholesterol, high-density lipoprotein-cholesterol, very-low-density lipoprotein (VLDL)-cholesterol, triglyceride, and blood glucose levels in serum were measured. The parameters of heart rate (HR), left ventricular diastolic end diameter, and left ventricular systolic end diameter were harvested by ultrasonic cardiogram. The left ventricular ejection fraction, stroke volume, cardiac output, and left ventricular fractional shortening were calculated. Meanwhile, aorta peak systolic flow velocity (PSV), end diastolic flow velocity, and mean flow velocity (MFV) were measured. The pulsatility index (PI) and resistant index were calculated in order to evaluate the vascular elasticity and resistance. The endothelium-dependent vasodilatation was evaluated by relaxation of aortic rings in response to acetylcholine. Western blotting and real-time quantitative reverse transcription polymerase chain reaction were performed for protein and gene analyses of vascular endothelial growth factor (VEGF). Immunohistochemical detection was performed for myocardial CD34 expression. Data in this study were compared by one-way analysis of variance between groups. A value of P < 0.05 was considered statistically significant. RESULTS: Although there was no significant decrease of cholesterol level (F = 2.300, P = 0.240), TXL inhibited the level of triglyceride and VLDL (F = 9.209, P = 0.024 and F = 9.786, P = 0.020, respectively) in ApoE-/- mice. TXL improved heart function of ApoE-/- mice owing to the elevations of LVEF, SV, CO, and LVFS (all P < 0.05). TXL enhanced aortic PSV and MFV (F = 10.774, P = 0.024 and F = 11.354, P = 0.020, respectively) and reduced PI of ApoE-/- mice (1.41 ± 0.17 vs. 1.60 ± 0.17; P = 0.037). After incubation with 10 µmol/L acetylcholine, the ApoE-/- mice treated with TXL aortic segment relaxed by 44% ± 3%, significantly higher than control group mice (F = 9.280, P = 0.040). TXL also restrain the angiogenesis of ApoE-/- mice aorta (F = 21.223, P = 0.010). Compared with C57BL/6J mice, the MVD was decreased in heart tissue of untreated ApoE-/- mice (54.0 ± 3.0/mm2 vs. 75.0 ± 2.0/mm2; F = 16.054, P = 0.010). However, TXL could significantly enhance MVD (65.0 ± 5.0/mm2 vs. 54.0 ± 3.0/mm2; F = 11.929, P = 0.020) in treated ApoE-/- mice. In addition, TXL obviously increased the expression of VEGF protein determined by Western blot (F = 20.247, P = 0.004). CONCLUSIONS: TXL obviously improves the ApoE-/- mouse heart function from different pathways, including reduces blood fat to lessen atherosclerosis; enhances aortic impulsivity, blood supply capacity, and vessel elasticity; improves endothelium-dependent vasodilatation; restraines angiogenesis of aorta-contained plaque; and enhances MVD of heart. The molecular mechanism of MVD enhancement maybe relate with increased VEGF expression.

Percutaneous Radiofrequency Ablation of Obstructive Right Ventricular Giant Myxoma.

Surgical resection is the conventional therapeutic action for patients with an obstructive cardiac tumor. However, for patients in poor clinical condition, cardiac operation can be risky. We report on the successful percutaneous radiofrequency (RF) ablation treatment of a right ventricular giant myxoma in a 70-year-old woman with right ventricular outflow tract (RVOT) and pulmonary artery stenosis, who was unable to tolerate operation. The treatment was effective in relieving RVOT stenosis and improving symptoms. We believe the RF ablation may also be used as a supplementary technique for the treatment of obstructive cardiac tumors, when only partial resection is possible.

Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months.

OBJECTIVE: To report the 12-month results of the first human uterus transplantation case using robot-assisted uterine retrieval. This type of transplantation may become a treatment for permanent uterine factor infertility. DESIGN: Case study. SETTING: University hospital. PATIENT(S): A 22-year-old woman with complete müllerian agenesis who underwent a previous surgery for vaginal reconstruction. The live uterine donor was her mother. INTERVENTION(S): The uterus transplantation procedure consisted of robot-assisted uterine procurement, orthotopic replacement and fixation of the retrieved uterus, revascularization, and end-to-side anastomoses of bilateral hypogastric arteries and ovarian-uterine vein to the bilateral external iliac arteries and veins. MAIN OUTCOME MEASURE(S): Data from preoperative investigations, surgery, and follow-up (12 months). RESULT(S): The duration of the donor and recipient surgeries were 6 and 8 hours, 50 minutes, respectively. No immediate perioperative complications occurred in the recipient or donor. The recipient experienced menarche 40 days after transplant surgery, and she has had 12 menstrual cycles since the surgery. No rejection episodes occurred in the recipient. CONCLUSION(S): These results demonstrate the feasibility of live-donor uterine transplantation with a low-dose immunosuppressive protocol and the role of DaVinci robotic assistance during human uterine procurement. CLINICAL TRIAL REGISTRATION NUMBER: XJZT12Z06.

High-resolution ultrasonography for the diagnosis of brachial plexus root lesions.

The aim of this study was to investigate the feasibility of using high-resolution ultrasonography in the diagnosis of brachial plexus (BP) root lesions. A prospective study of ultrasonographic evaluation of BP nerve roots was performed in 37 patients with BP root lesions (29 with root injuries, 8 with tumors). The pre-operative ultrasonographic findings were compared with the surgical and pathohistological findings. All C5-7 roots were detected by ultrasonography in all patients, whereas 92% (68/74) of C8 and 51% (38/74) of T1 nerve roots were visualized. Among 29 patients with BP root avulsion, partial injuries or totally interrupted BP roots were detected in all patients. Cystic masses and neuromas were detected in 16 and 23 patients, respectively. In 8 patients with BP root tumors, 8 hypo-echoic masses were detected inside or partly outside of intervertebral foramina connecting to nerve roots. Surgical exploration revealed that there were 57 BP root avulsions in 29 patients. However, 2 T1 nerve root avulsions had been missed by pre-operative ultrasonography. Pathohistology revealed that all 8 BP root tumors pre-operatively diagnosed by ultrasonography were schwannomas. High-resolution ultrasonography can provide a convenient and accurate imaging modality for quick diagnosis and location of BP root lesions.

Clinical characteristics of 274 non-small cell lung cancer patients in China.

BACKGROUND: The mortality from non-small cell lung cancer (NSCLC) in China is increasing, and studies about clinical characteristics of recent NSCLC are rare. The primary objective of this study was to explore clinical features in a large general hospital in Northwest China, and to determine risk factors for stage, pathology and survival, with a view to prevention and treatment of NSCLC as well as establishment and improvement of national medical insurance policies. PATIENTS AND METHODS: We retrospectively analyzed the characteristics of NSCLC patients (n = 274), as well as risk factors for advanced stage and squamous cell carcinoma (SCC). Survival features in different groups were analyzed, as well as risk factors of survival. Follow-up was at least 3 years. RESULTS: 179 were male (65.3%); 136 had adenocarcinoma (49.6%) and 109 had SCC (39.8%); 186 (67.9%) had advanced-stage disease (IIIB-IV); 130 (47.4%) had smoking habits; 195 came from an urban area (71.2%); 69 had local urban resident basic medical insurance; 58% were younger than 60 years. Female, adenocarcinoma, rural patients were significantly younger than male, SCC, and urban patients. Pathology was the only independent risk factor for advanced stage. Age, sex, and smoking status were independent prognostic factors for SCC. The proportion of male SCC was higher than female SCC even without the influence of smoking. Without local urban resident basic medical insurance, higher stage and not having surgery, but not smoking status, were independent risk factors for lower median progression-free survival (PFS). Patients with adenocarcinoma and SCC in advanced stage accepting EGFR-TKI during treatment had a higher 1-year survival rate and longer overall survival (OS) compared with those never accepting EGFR-TKI. EGFR-TKI treatment and chemotherapy regimen numbers were independent risk factor for median OS in advanced adenocarcinoma and SCC patients. CONCLUSION: More prevention and screening should be carried out for the female and rural population. EGFR-TKI could benefit advanced NSCLCs. China's medical insurance policy has some adverse effect on NSCLC survival calling for further improvement.

Differential diagnosis between pre- and postganglionic adult traumatic brachial plexus lesions by ultrasonography.

The goal of this study was to prospectively investigate the feasibility of preoperative ultrasonography evaluation in the differentiation between pre- and postganglionic traumatic brachial plexus lesions. Two expert radiologists employed ultrasonography to observe the morphology of the brachial plexus in 23 patients with suspected traumatic brachial plexus lesions and 40 healthy volunteers. The detection rate was 100% (126/126) for the C5 through C7 nerve roots and upper and middle trunks and three fascicles, 84% (106/126) for the C8 roots and the lower trunks and 64% (81/126) for T1 roots in all subjects. Surgical inspections found 58 lesions in 23 patients (40 preganglionic lesions and 18 postganglionic lesions). Ultrasonography detected most of the brachial plexus lesions (56/58) but misjudged two preganglionic and two postganglionic lesions. The rate of differentiation was 93% (52/56). This study demonstrated that ultrasonography is a useful but experience-dependent supplemental imaging technique for preoperative diagnosis of brachial plexus lesions and differentiation between pre- and postganglionic brachial plexus lesions.

Extracorporeal ablation of uterine fibroids with high-intensity focused ultrasound: imaging and histopathologic evaluation.

OBJECTIVE: The purpose of this study was to evaluate the therapeutic efficacy of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids by using imaging and histopathologic examination. METHODS: From May 2004 to June 2005, 119 consecutive patients with 187 uterine fibroids were treated with HIFU. Sixty-two fibroids received ultrasonographically guided needle puncture biopsy 1 week before and after HIFU treatment, respectively, to confirm the diagnosis and to assess the early therapeutic efficacy. Hematoxylin-eosin staining and electron microscopy were performed to characterize more subtle phenotypic changes to determine treatment success. Immediate therapeutic effects were assessed at follow-up with Doppler ultrasonography and computed tomography or magnetic resonance imaging. All patients were followed for 6 to 12 months to observe long-term therapeutic effects. Fibroid mean diameters, volumes, and reduction rates 1, 3, 6, and 12 months after HIFU treatment were calculated and compared with 1-way analysis of variance and Student-Newman-Keuls tests. RESULTS: No severe complications were observed after HIFU ablation. Fifty-one (82.3%) of 62 biopsy specimens revealed obvious signs of necrosis under light microscopy, and more subtle changes in cellular structure that indicated nonviability could be found in 60 specimens (96.8%) under electron microscopy. However, viable cells still could be found in 16 specimens (25.8%). Follow-up images showed absence or reduction of blood supply in the lesions after HIFU ablation. Median reductions in tumor size as a percentage of initial tumor volume at 1, 3, 6, and 12 months after HIFU treatment were 21.2%, 29.6%, 44.8%, and 48.7%, respectively. CONCLUSIONS: Imaging and histopathologic evidence directly validate HIFU ablation as an effective treatment of uterine fibroids.

Therapeutic response assessment of high intensity focused ultrasound therapy for uterine fibroid: utility of contrast-enhanced ultrasonography.

PURPOSE: To assess the utility of contrast-enhanced ultrasonography (ceUS) in the assessment of the therapeutic response to high intensity focused ultrasound (HIFU) ablation in patients with uterine fibroid. MATERIALS AND METHODS: Sixty-four patients with a total of 64 uterine fibroids (mean: 5.3+/-1.2 cm; range: 3.2-8.9 cm) treated with HIFU ablation under the ultrasound guidance were evaluated with ceUS after receiving an intravenous bolus injection of a microbubble contrast agent (SonoVue) within 1 week after intervention. We obtained serial ceUS images during the time period from beginning to 5 min after the initiation of the bolus contrast injection. All of the patients underwent a contrast enhanced MRI (ceMRI) and ultrasound guided needle puncture biopsy within 1 week after HIFU ablation. And as a follow-up, all of the patients underwent US at 1, 3, 6 and 12 months after HIFU treatment. The volume change was observed and compared to pre- and post-HIFU ablation. The results of the ceUS were compared with those of the ceMRI in terms of the presence or absence of residual unablated tumor and pathologic change in the treated lesions. RESULTS: On ceUS, diagnostic accuracy was 100%, while residual unablated tumors were found in three uterine fibroids (4.7%) and failed treatment was found in eight uterine fibroids (12.5%). All the 11 fibroids were subjected to additional HIFU ablation. Of the 58 ablated fibroids without residual tumors on both the ceUS and ceMRI after the HIFU ablation, the volumes of all the fibroids decreased in different degrees during the 1 year follow-up USs. And histologic examinations confirmed findings of necrotic and viable tumor tissue, respectively. CONCLUSION: CEUS is potentially useful for evaluating the early therapeutic effect of percutaneous HIFU ablation for uterine fibroids.