The prognostic value of age-adjusted Charlson comorbidity index in laparoscopic resection for hilar cholangiocarcinoma.

The prognostic role of the Age-Adjusted Charlson Comorbidity Index (ACCI) in hilar cholangiocarcinoma patients undergoing laparoscopic resection is unclear. To evaluate ACCI's effect on overall survival (OS) and recurrence-free survival (RFS), we gathered data from 136 patients who underwent laparoscopic resection for hilar cholangiocarcinoma at Zhengzhou University People's Hospital between 1 June 2018 and 1 June 2022. ACCI scores were categorized into high ACCI (ACCI > 4.0) and low ACCI (ACCI ≤ 4.0) groups. We examined ACCI's association with OS and RFS using Cox regression analyses and developed an ACCI-based nomogram for survival prediction. Our analysis revealed that higher ACCI scores (ACCI > 4.0) (HR = 2.14, 95%CI: 1.37-3.34) were identified as an independent risk factor significantly affecting both OS and RFS in postoperative patients with hilar cholangiocarcinoma (p < 0.05). TNM stage III-IV (HR = 7.42, 95%CI: 3.11-17.68), not undergoing R0 resection (HR = 1.58, 95%CI: 1.01-2.46), hemorrhage quantity > 350 mL (HR = 1.92, 95%CI: 1.24-2.97), and not receiving chemotherapy (HR = 1.89, 95%CI: 1.21-2.95) were also independent risk factors for OS. The ACCI-based nomogram accurately predicted the 1-, 2-, and 3-year OS rates, with Area Under the Curve (AUC) values of 0.818, 0.844, and 0.924, respectively. Calibration curves confirmed the nomogram's accuracy, and decision curve analysis highlighted its superior predictive performance. These findings suggest that a higher ACCI is associated with a worse prognosis in patients undergoing laparoscopic resection for hilar cholangiocarcinoma. The ACCI-based nomogram could aid clinicians in making accurate predictions about patient survival and facilitate individualized treatment planning.

Predictive significance of tumor budding in postoperative liver metastasis of pancreatic neuroendocrine tumors.

BACKGROUND: Although pancreatic neuroendocrine tumors (PNETs) are considered indolent tumors, nearly half of cases metastasize to the liver, which can be lethal. However, effective indicators to predict aggressive behavior have not been well-established. METHODS: In the current study, we explored the prognostic significance of tumor budding in Grade 1-2 PNETs. Hematoxylin-eosin and immunohistochemically stained slides of surgically removed Grade 1-2 PNETs were evaluated. RESULTS: Tumor budding, a histomorphological parameter that corresponds to single cells or small cell clusters (<5 cells), was classified as low (0-10 buds) and high (>10 buds) grade. We observed that tumor budding was correlated with aggressive histopathological parameters, such as T stage, lymph node status, metastasis, and vascular invasion (p < .05). Univariate and multivariate analyses showed that high-grade budding was an independent predictive factor for postoperative liver metastasis (p = .012). Moreover, Grade 1-2 PNETs with high-grade budding was associated with worse overall survival and disease-free survival (p = .0015 and p = .0041, respectively). CONCLUSIONS: We conclude that tumor budding may serve as a valuable parameter in the risk stratification of postoperative liver metastasis and that incorporating tumor budding into histopathological reports may aid in appropriate clinical management.

Individuals having variant genotypes of cytochrome P450 2C19 are at increased risk of developing primary liver cancer in Han populations, without infection with the hepatitis virus.

Recently, many researchers have reported that the genetic polymorphisms of CYP2C19 may account for the interpatient variability of the clinical course in cancers including primary liver cancer (PLC). Besides the genetic polymorphisms of CYP2C19, hepatitis viruses (HV, including HAV, HBV, HCV, HDV, HEV, especially HBV and/or HCV) also account for the interpatient variability of the clinical course in PLC. This research covered the above two factors and divided the patients with PLC into two groups (one group with HBV infection and another without any HV infection) to find out whether the genetic polymorphisms of CYP2C19 have different effects in the progressing of PLC in different groups of patients. Eight hundred sixty-four cancer-free Han people (controls, named group 1), 207 Han PLC patients with HBV infection (group 2), and 55 Han PLC patients without any HV infection (group 3) were involved in this study. A wild-type allele (CYP2C19*1) and two mutated alleles (CYP2C19*2 and CYP2C19*3) were identified. The frequencies of the mutant alleles and genotypes were then compared with each other. The frequencies of the homozygous and heterozygous variant genotypes (*2/*2, *2/*3, *3/*3) in group 3 (25.5 %) were significantly higher than those in other groups (11.9 % in group 1 and 13.5 % in group 2, P = 0.014, 95 % confidence interval (CI)). The differences were statistically significant between group 1 and group 3 (P = 0.004, 95 % CI), but they were not statistically significant between group 1 and group 2 (P = 0.527, 95 % CI). Thus, we conclude that people which were not infected with HV but with the homozygous or heterozygous variant genotypes (*2/*2, *2/*3, *3/*3) of CYP2C19 may have higher possibilities of getting PLC than people with other allelic genotypes (*1/*1, *1/*2, *1/*3) (odds ratio (OR) = 2.523, 95 % CI = 1.329 ~ 4.788). However, in patients with HBV infection, the genetic polymorphisms of CYP2C19 did not seem to be an important factor in the risk of developing PLC (OR = 1.156, 95 % CI = 0.738 ~ 1.810).

Preoperative Oral Carbohydrate Levels in Patients with Type 2 Diabetes Mellitus: The Clinical Guiding Significance of Free Fatty Acids.

Background: It is still controversial whether preoperative oral carbohydrate (POC) should be applied to patients with type 2 diabetes mellitus (T2DM) in the enhanced recovery after surgery (ERAS) protocol. There is no relevant consensus or indicators to provide guidance as to whether T2DM patients should take POC. Methods: In total, 164 T2DM patients who underwent laparoscopic hepatectomy were analyzed. According to the level of blood free fatty acids (FFAs) and whether the patients received POC, the patients were divided into 6 groups: the low FFA carbohydrate group (LFFAC group), low FFA fasting water group (LFFAF group), medium FFA carbohydrate group (MFFAC group), medium FFA fasting water group (MFFAF group), high FFA carbohydrate group (HFFAC group) and high FFA fasting water group (HFFAF group). Results: Patients with low FFA levels showed better perioperative blood glucose control and a lower incidence of postoperative complications than those in the medium and high FFA groups, especially when patients received POC. Further analyses revealed that the postoperative plasma concentrations of IL-6 and TNF-α were significantly decreased in the POC group compared with the fasting water group, except for patients with high FFA levels. Receiver operating characteristic (ROC) curve analysis revealed that when the FFA concentration was higher than 0.745 mmol/L, the risk of poor blood glucose control during the perioperative period was increased. Conclusions: FFAs have clinical guiding significance for the application of POC in patients with T2DM under ERAS administration. T2DM patients with low FFAs are more suitable for receiving POC.

Enhancement of thermal and mechanical properties of silicone rubber with γ-ray irradiation-induced polysilane-modified graphene oxide/carbon nanotube hybrid fillers.

In this study, a polysilane-modified graphene oxide (GO) and carbon nanotube (CNT) nanocomposite (GO/CNTs-Si) was prepared as a thermal conductive nanofiller to enhance the thermal and mechanical properties of silicone rubber composites. By γ-ray-radiation 3-methacryloxypropyltrimethoxy silane (MPTMS) was polymerized on the surface of GO and CNTs to improve the interfacial interaction between the GO/CNTs-Si and SR matrix. FTIR characterization results demonstrated that polysilane modified the GO/CNTs successfully. The pristine GO/CNTs and resultant GO/CNTs-Si were individually incorporated into α,ω-dihydroxypolydimethylsiloxane to vulcanize SR composites. Compared with SR-GO/CNTs, SR-GO/CNT-Si exhibited better mechanical and thermal performance. Moreover, the time-dependent complex modulus of SR-GO/CNTs-Si was much higher than that of SR-GO/CNTs, which indicates longer service time and more stable performance. In terms of electronic packaging, SR-GO/CNTs exhibited better performance than the 1180B counterpart. The low value of warpage of chip packaged by SR-GO/CNTs implied that SR-GO/CNTs-Si could have potential application as the thermal interface electronic packaging material.

Clinical significance of B7-H1 and B7-1 expressions in pancreatic carcinoma.

BACKGROUND: Cancer cells develop mechanisms to evade immune cells and achieve progression. Aberrant B7-H1 and B7-1 expressions may help pancreatic carcinoma (PC) cells escape immune attack; these molecules can be considered as prognostic markers for patients with PC who have undergone radical resection. METHODS: We recruited 81 patients who had undergone radical surgical resection for PC between 1999 and 2007. To investigate the prognostic factors, we evaluated the B7-H1 and B7-1 protein expressions in the tissue specimens of these 81 patients by immunohistochemistry and analyzed the clinical and pathological features of these specimens. RESULTS: B7-H1 was expressed mainly in pancreatic islets, and no B7-1 expression was detected in normal pancreatic tissues. B7-H1 and B7-1 expressions were higher in pancreatic carcinoma tissues than in normal pancreatic tissues (P < 0.05). B7-H1 and B7-1 significantly correlated with the pathological grade and tumor-node-metastasis (TNM) stage, respectively (P < 0.05). Furthermore, B7-1-negative or B7-H1-positive statuses were prognostic indicators of poor disease-specific survival (P < 0.05), but only combined B7-1/B7-H1 expression retained the prognostic potential after adjusting by Cox proportional hazards regression models (P < 0.05). CONCLUSIONS: Both B7-H1 and B7-1 are expressed in PC; these molecules are important markers for PC progression. Furthermore, combined B7-1/B7-H1 expression can serve as an independent prognostic marker for PC.

Norepinephrine-induced invasion by pancreatic cancer cells is inhibited by propranolol.

Active migration and invasion by cancer cells are a prerequisite for the development of metastases. Recent studies have shown that neurotransmitters are involved in the regulation of cancer cell invasion via beta-adrenoceptors (beta-ARs). However, little is known regarding the effect of neurotransmitters on pancreatic cancer cells. The aim of our study was to examine the regulative effect of norepinephrine (NE), which belongs to the group of classical neurotransmitters, on the invasiveness of pancreatic cancer cells and the therapeutic effect of the beta-blocker, propranolol, on them. The human pancreatic cancer cell lines, Miapaca-2 and Bxpc-3, were selected for this study, and in both cell lines, beta1-AR and beta2-AR expression was determined by RT-PCR and Western blotting. The invasiveness of pancreatic cancer cells was examined using the Matrigel invasion assay. The concentrations of MMP-2, MMP-9, and VEGF in the culture medium and in the cancer cells were examined by ELISA and RT-PCR, respectively. We observed that NE promoted the invasiveness of Miapaca-2 cells in a concentration-dependent manner, and NE increased the expression of MMP-2, MMP-9, and VEGF. However, these effects could be inhibited by the beta-blocker, propranolol. In conclusion, the development of metastases is not only genetically determined, but is also influenced by NE, which is one of the signal substances present in the tumor environment. This study also provides experimental evidence for the use of beta-blockers in the chemoprevention of pancreatic cancer metastasis.

Pleiotrophin expression in human pancreatic cancer and its correlation with clinicopathological features, perineural invasion, and prognosis.

Pleiotrophin (PTN), a heparin-binding growth factor also known as neurite growth-promoting factor, exhibits several properties related with tumor development. PTN and its receptor, N-syndecan, may play a very important role in tumor growth and neural invasion of pancreatic cancer. We investigated PTN and N-syndecan protein levels in 38 patients with pancreatic cancer by immunohistochemistry, and analyzed for its correlation with clinicopathological features, perineural invasion, and prognosis. The results showed that PTN and N-syndecan proteins were found in 24 (63.2%) and 22 (57.9%) specimens, respectively. PTN and N-syndecan expressions were associated with perineural invasion (P = 0.016 and P = 0.029, respectively). High PTN expression was closely related to an advanced TNM stage (P = 0.007), lymph node metastasis (P = 0.040), and decreased postoperative survival at 3 years (50.0% versus 20.8%, respectively; P = 0.001). We conclude that high expression of PTN combined with N-syndecan may contribute to the increased perineural invasion and poor prognosis of pancreatic cancer.

Effects of resveratrol on calcium regulation in rats with severe acute pancreatitis.

Intracellular calcium overload plays a key role in severe acute pancreatitis. Resveratrol can decrease the severity of pancreatitis; however, the mechanism of action of resveratrol has not been determined. The aim of our study was to examine the relationship between calcium overload and the effects of resveratrol in severe acute pancreatitis. Animals were randomly divided into 3 groups: control group (sham operation), model group (0.1 ml/100 g of 3.5% sodium taurocholate used to induce severe acute pancreatitis), and treated group (treated with resveratrol, 10 mg/kg). In model group, the severity of pancreatitis was aggravated; this was evaluated by pancreatic weight/body weight and lung weight/body weight ratios, serum amylase activities, and pancreatic histopathological scoring; the Ca(2+)-Mg(2+)-ATPase and Ca(2+)-ATPase activities decreased while PLA(2) activity and [Ca(2+)](i) increased gradually with time. Compared to the control group, in the model group, these changes were observed in the pancreatic tissue at the 3 h time point and in the lung tissue at the 6 h time point. Resveratrol ameliorated the changes in the laboratory parameters and significantly reduced the pathological damage in the tissues at the corresponding time points. In conclusion, intracellular calcium overload leads to tissue damage in severe acute pancreatitis, and the beneficial effects of resveratrol appear to be mediated by reducing the intracellular calcium overload; this not only limits pancreatic cellular injury but also secondary lung injury.

[Effect of steam sterilization on poly(ether-ester)s copolymer and its vascular cell compatibility].

The aim of this research was to evaluate the influence of steam sterilization on poly(ethylene glycol-terephthalate) and poly(butylene terephthalate) copolymer (PEGT/PBT) and its vascular cells compatibility, which was used as the scaffolds in vascular tissue engineering. Endothelial cells, smooth muscle cells and fibroblasts were cultured separately on the films after steam sterilization and after ultraviolet sterilization. These cells can grow well on the films after ultraviolet sterilization, while they can hardly adhere on steam sterilized films. Differential scanning calorimetry, static contact angle, X-ray photoelectron spectroscopy, surface carboxyl density quantity, H-nuclear magnetic resonance and scanning electronic microscope were employed to characterize the properties of poly(ether-esters) films before and after sterilization. These results showed that steam sterilization had little effect on the surface morphology and on the constitution of the copolymer, but the copolymer segments were redistributed during steam sterilization. The hydrophilic poly(ethylene glycol) (PEG) and the end carboxyl groups transferred from the bulk and enriched on the surface and the degree of crystallinity of hard segments increased slightly. Both the end carboxyl and PEG enriched on the surface can hinder the protein adhesion on the surface; so, lacking in receptor, the vascular cells cannot adhere on the films surfaces.

Gamma Irradiation-Induced Preparation of Graphene⁻Ni Nanocomposites with Efficient Electromagnetic Wave Absorption.

A facile and environmentally friendly method is proposed to prepare reduced graphene oxide⁻nickel (RGO⁻Ni) nanocomposites using γ-ray irradiation. Graphene oxide (GO) and Ni2+ are reduced by the electrons which originated from the gamma radiolysis of H2O. The structure and morphology of the obtained RGO⁻Ni nanocomposites were analyzed using X-ray diffraction (XRD) and Raman spectroscopy. The results show that Ni nanoparticles were dispersed uniformly on the surface of the RGO nanosheets. As expected, the combination of RGO nanosheets and Ni nanoparticles improved the electromagnetic wave absorption because of the better impedance matching. RGO⁻Ni nanocomposites exhibited efficient electromagnetic wave absorption performance. The minimum reflection loss (RL) of RGO⁻Ni reached -24.8 dB, and the highest effective absorption bandwidth was up to 6.9 GHz (RL < -10 dB) with a layer thickness of 9 mm.

Indoleamine 2, 3-dioxygenase and B7-H1 expressions as prognostic and follow-up markers in human pancreatic carcinoma.

This study was to test hypotheses that indoleamine 2, 3-dioxygenase and B7-H1 expressions can be used as prognostic markers in human pancreatic carcinoma (PC). Ninety-five patients were recruited who had undergone radical surgical resection for PC. IDO and B7-H1 expressions in PC tissue specimens were evaluated by immunohistochemistry (IHC) techniques. The clinical and pathological features of these specimens were analyzed. IDO positive, B7-H1 positive, and combined IDO/B7-H1 positive tumors exhibited significant correlations with lymphocytic infiltration, perineural invasion, TNM status, and pathologic grade (p < .05), which tended to show strong correlations with malignant progression of PC. Also, IDO correlated with diabetes mellitus (DM) and HAD scale and B7-H1 correlated with smoke (p < .05). In addition, the correlation analysis indicated that IDO had a positive correlation with B7-H1 (p < .05). Moreover, the results showed that a combination of IDO and B7-H1 expressions could serve as independent prognostic marker after adjusting by Cox proportional hazards regression models (p < .05). IDO and B7-H1 expressions were observed in patient with PC tissues and are important markers for PC malignant progression. A combination of IDO and B7-H1 expression can be served as an independent prognostic marker for PC.

[Evaluation of surgical technique and indication on descending aortic aneurysms].

OBJECTIVE: To evaluate the surgical technique and indication on descending aortic aneurysms. METHODS: From January 1996 to June 2006, 41 patients with descending aortic aneurysm underwent operation, including DeBakey type III dissection in 26, false aneurysm in 6, true aneurysm in 4, and residual or newly complicated type III dissection after the surgery of Marfan syndrome in 5. Operations were performed by left heart bypass in 9, femoral-femoral bypass in 7, pulmonary-femoral bypass in 2, and deep hypothermic circulatory arrest in 23. The whole thoracic descending aorta was replaced in 15, and intercostal arteries were reimplanted in 12. RESULTS: One patient died of acute renal failure with the hospital mortality 2.4%. Main complications: respiratory dysfunction in 6, renal dysfunction in 6, recurrent nerve injuries in 4, chylothorax in 2, and no paraplegia. CONCLUSIONS: Surgical intervention of descending aortic aneurysm still has its unique advantages and indications; surgical safety is markedly improved by the use of deep hypothermic circulatory arrest.

Effect of resveratrol on NF-kappaB activity in rat peritoneal macrophages.

This study was to investigate the inhibitive effect of resveratrol (RESV) on nuclear factor kappa B (NF-kappaB) expression and activity induced by lipopolysaccharide (LPS) in rat peritoneal macrophages (PMA). Male Sprague-Dawley (SD) rats were randomly divided into 7 groups, including control group, LPS group and RESV I-V group. In the LPS group, PMA were incubated in DMEM containing LPS (10 microg/ml), whereas in control group, PMA were incubated in DMEM only. In the RESV I-V groups, PMA were incubated in DMEM containing LPS (10 microg/ml) and different concentrations of RESV. After 24 hours of incubation, NF-kappaB activity in PMA, and the levels of tumor necrosis factor alpha (TNF-alpha), interleukin-1 (IL-1) and nitric oxide (NO) in the culture medium were measured. In the concentrations of 1.25-5 microg/ml, RESV had a dose- dependent inhibitive effect on NF-kappaB activity in PMA as well as the expressions of TNF-alpha, IL-1 and NO in the culture medium contrasted with the LPS group. There was no significant difference in the levels of these pro-inflammatory factors between the groups of 5 microg/ml and 10 microg/ml RESV. In conclusion, RESV has the potential for the future application of preventing inflammatory diseases involving PMA.

YAP overexpression promotes the epithelial-mesenchymal transition and chemoresistance in pancreatic cancer cells.

The expression of Yes-associated protein (YAP) has been reported to be dysregulated in pancreatic cancer. However, its contributions to tumor formation and progression remain to be elucidated. The present study demonstrated that YAP overexpression promoted the epithelial­mesenchymal transition (EMT) in a manner associated with pancreatic cancer invasion in vitro. RNA interference­mediated silencing of YAP attenuated cell invasion in vitro. Mechanistically, the present study demonstrated that YAP overexpression fosters pancreatic cancer progression by inducing the EMT in pancreatic cancer cells by activating the AKT cascade, which can counteract the effect of gemcitabine. These data suggested that the YAP acts synergistically to promote pancreatic cancer progression by hyperactivation of AKT signaling. The present study revealed YAP as a potential therapeutic target for pancreatic cancer and a biomarker for predicting gemcitabine treatment response.

Laparoscopic Splenectomy and Esophagogastric Devascularization for Liver Cirrhosis and Portal Hypertension Is a Safe, Effective, and Minimally Invasive Operation.

BACKGROUND: In the recent years, laparoscopic splenectomy and esophagogastric devascularization (LSD) for liver cirrhosis and portal hypertension rapidly gained the interest of hepatobiliary surgeons due to its minimal invasion. This study aimed to gather and analyze available data from the observational studies that have compared LSD and open splenectomy and esophagogastric devascularization (OSD) for liver cirrhosis and portal hypertension. MATERIALS AND METHODS: All the studies comparing LSD and OSD for liver cirrhosis and portal hypertension were searched on the available databases, including the Cochrane Central Register of Controlled Trials, Medline, Science Citation Index, EMBASE, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Database. Data were analyzed using Review Manager software version 5.0. RESULTS: After the literature search, a total of 17 studies were included in the meta-analysis, which involved 1093 patients: 552 in the laparoscopic group and 541 in the open group. The laparoscopic group was shown to have a lower overall postoperative complication rate (0.43; 95% confidence interval [CI; 0.29-0.64]) than the open group (P < .0001), which was not associated with heterogeneity between the studies. The laparoscopic group was shown to have a lower intraoperative blood loss (-320.62; 95% CI [-552.35 to -88.9]), shorter time of oral intake (-29.08 hours; 95% CI [-35.28 to -22.88]), and shorter hospital stay (95% CI [-6.19 to -2.19]) than those of the open group (P < .00001). The operative time of the laparoscopic group was 42.16 minutes longer (95% CI [32.20-52.11]) compared with the open group (P < .00001). There was no significant difference of hospitalization costs between the studies. CONCLUSION: This meta-analysis demonstrated that laparoscopic left lateral resection is a safe and feasible option associated with a reduced overall complication rate. The current evidence suggested that it could be performed routinely in liver centers.

Laparoscopic Liver Resection can be an Effective Way in Obese Patients: A Single Center of 2-Year Experience.

OBJECTIVE: To evaluate the feasibility and safety of laparoscopic liver resection in obese patients, we compared the operative outcomes between obese and nonobese patients, also between laparoscopic liver resection and open liver resection of obese and nonobese patients. MATERIALS AND METHODS: A total of 86 patients suffering from liver resection in our department from January 2013 to December 2014 were divided into 3 groups: the obese patients group for laparoscopic liver resection, the nonobese patients group for laparoscopic liver resection and the obese patients group for open liver resection. Characteristics and clinic data of 3 groups were studied. RESULTS: Characteristics of patients and clinic data were equivalent between the 3 groups. The groups were well matched in age, sex distribution, and liver function (P>0.05). There were no significant differences in the operative time, estimated blood loss, time to oral intake, and postoperative hospital stay in the 3 groups. Tumor diameter of laparoscopic liver resection groups in obese patients was smaller than open liver resections groups in obese patients (P<0.05), but there were no obvious difference of tumor diameter in the laparoscopic liver resection groups of the obese patients and the nonobese patients. CONCLUSIONS: Obesity should not be seen as a contraindication for laparoscopic liver resection, which is a safe and feasible procedure for obese patients.

Laparoscopic Versus Open Resection for Liver Cavernous Hemangioma: A Single Center of 2-Year Experience.

OBJECTIVE: To evaluate the feasibility and safety of laparoscopic versus open resection for liver cavernous hemangioma (LCH). MATERIALS AND METHODS: A total of 131 patients suffering from LCH operated in our department between January 2013 and December 2014 were divided into 2 groups: 31 for laparoscopic liver resection (LR) and 100 for open liver resection (OR). RESULTS: Age, sex, presence or absence of chronic liver disease, tumor size, tumor location, type of resection, estimated intraoperative blood loss, operative time, length of postoperative hospital stay, morbidity, and mortality were equivalent between the 2 groups. There were no significant differences in estimated intraoperative blood loss between the LR and OR groups. The operation time of the LR group was longer than the OR group and the hospitalization expenses less than the OR group. However, the time of postoperative hospital stay and time of oral intake were shorter in the LR group than the OR group. The tumor of the LR group was smaller than the OR group. In liver function, alanine aminotransferase after operation of the LR group was lower than the OR group, the same as aspartate transaminase after operation. But there were no significant differences in total bilirubin after operation. CONCLUSIONS: Laparoscopic resection for LCH is a safe and feasible procedure as OR.

[Giant left atrium combined with mitral valvular disease: morphologic classification and its clinical significance].

OBJECTIVE: To study the morphologic classification and its clinical significance of giant left atrium (GLA) combined with mitral valvular disease. METHODS: Between January 1993 and December 1999, a total of 62 consecutive patients with mitral valvular disease, whose preoperative left atrial endodiastolic volume index >/= 300 ml/m(2) or endosystolic diameter >/= 6.0 cm, were enrolled as research candidates. Morphologically, GLA was classified by Q Hierarchical cluster analysis according to the right or left side cardiothoracic ratio of the left atrium (r- or l-LATR) on an anteroposterior chest roentgenogram and the ratio of the distant diameter of the left main bronchus to the approximate diameter of the left main bronchus (LBDd/Dp) or to the trachea (LB/TR) on an left anterior oblique chest roentgenogram. RESULTS: According to r-LATR and l-LATR, the morphology of GLA was classified clinically into three types: type L (l-LATR >/= 0.6 and r-LATR < 0.58), type R (r-LATR >/= 0.58 and l-LATR < 0.6) and type B (r-LATR >/= 0.58 and l-LATR >/= 0.6). According to LBDd/Dp and LB/TR, GLA in type L and B was further classified into two subtypes, respectively: left posterior downward type (L(I) and B(I)), in which LBDd/Dp is equal or exceeds 0.38 or LB/TR is equal or exceeds 0.33, and left posterior upward type (L(II) and B(II)), in which LBDd/Dp is less than 0.38 or LB/TR less than 0.33. CONCLUSION: The morphologic classification of GLA may represent the main pathophysiological changes of GLA and might be a guideline for the selection of the optimal plication procedures of GLA in patients with valve diseases.

[Long-term results of mitral-aortic valve replacement in 1,154 patients with rheumatic valvular disease].

OBJECTIVE: To analyze the early and long-term results after mitral-aortic valve replacement for rheumatic valvular disease and the determinant factors involved and subsequent therapies. METHODS: 1 154 patients receiving combined mitral-aortic valve replacement for rheumatic valvular disease from May 1981 to May 2001 were reviewed. The mean age of the patients was 41.48 +/- 10.00 years. Concomitant valve plasty was performed for associated tricuspid organic or significant functional lesions. Lateral tilting disc or bileaflet valve prostheses were used for replacement. New York Heart Association functional status showed Class III or IV in 91.77% of the patients. Moderate to severe pulmonary hypertension occurred in 29.38% of the patients. The duration of follow-up varied from 8 months to 20 years. RESULTS: The hospital mortality was decreased from 6.50% to 4.45%. The 5-, 10- and l5-year survival rates were 89.46% +/- 1.35%, 86.50% +/- l.91% and 67.86% +/- 6.16%, respectively. The 5-, 10- and l5-year thromboembolic event free rates were 97.80% +/- 0.74%, 88.31% +/- 2.20% and 94.08% +/- 2.29%, respectively. the 5-, 10- and l5-year anticoagulant related bleeding free rates were 94.80% +/- 1.09%, 89.32% +/- 2.10% and 83.12% +/- 3.57% respectively. Cardiac functional status returned to Class II in 98% patients and to Class III in 2% during follow-up. CONCLUSIONS: Both left and right ventricular functions may be impaired as a result of rheumatic valvular disease. Tricuspid valve should be explored during surgery and any significant tricuspid annular enlargement and regurgitation showed be corrected in concomitance. Long-acting penicillin regimen is needed for 3 - 5 years for the prevention of rheumatic fever relapse. A low intensity anticoagulant regimen after valve replacement with prothrombin time targeting at 1.5 - 2.0 times is advisable in lessening anticoagulant related bleeding yet optimizing sufficient prevention against thromboembolic complications.