Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases / 中华外科杂志

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ2=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

IL-33 and sST2 levels in Serum of Children with Henoch-Schnlein Purpura and Their Clinical Significance / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the serum IL-33 and sST2 levels in children with Henoch-Schonlein purpura (HSP), and explore their clinical significance.</p><p><b>METHODS</b>Total 27 HSP patients and 22 healthy controls were enrolled in present study. The expressions of IL-33 and sST2 were measured by enzyme linked immunosorbent assay (ELISA). Using real-time quantitative polymerase chain reaction (RT-PCR), the mRNA expression of IL-33 and sST2 were detected in all subjects.</p><p><b>RESULTS</b>The level of the IL-33 in the serum of HSP group and control group was 365.5±160.6 pg/ml and 175.9±92.8 pg/ml(P< 0.05). The level of the sST2 was increased in the serum of HSP group (1788.6±523.8 pg/ml) as compared with that in control group (1083.6±489.6 pg/ml)(P>0.05), but the ratio of sST2/IL-33 in HSP patients was much lower than that in the controls(P<0.05), IL-33 and sST2 mRNA levels were up-regulated in HSP patients by 5.47±1.97-fold(P<0.05) and 3.13±2.01-fold(P<0.05) compared with controls, but sST2/IL-33 significantly decreased in HSP patients(P<0.05).</p><p><b>CONCLUSION</b>The levels of IL-33 and sST2 increase in the serum of HSP patients, but the ratio of sST2/IL-33 is much lower than that in control.</p>

Effect of oral mucosa transplantation in the treatment of severe contracted conjunctival sac after ocular prosthesis implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To observe the clinic effect of oral mucosa transplantation in the treatment of severe contracted conjunctival sac after ocular prosthesis implantation . METHODS: Thirty-three cases ( 33 eyes ) with globe disorders and severe contracted conjunctval sac were operated ocular prosthesis implantation firstly, and conjunctival sac plasty using oral mucosa after 6mo. RESULTS: Thirty - one cases were successful, no complications appeared. One case had primary ptosis and 1 case had recurrent conjunctival sac contracture. CONCLUSlON:lt is recognised that the methods of oral mucosa transplantation in severe contracted conjunctival sac after ocular prosthesis implantation are effective on those cases.

Effect of acupuncture on pattern-visual evoked potential in rats with monocular visual deprivation / 中国针灸

<p><b>OBJECTIVE</b>To explore electrophysiology mechanism of acupuncture for treatment and prevention of visual deprivation effect.</p><p><b>METHODS</b>Eighteen healthy 15-day Evans rats were randomly divided into a normal group, a model group and an acupuncture group, 6 rats in each one. Deprivation amblyopia model was established by monocular eyelid suture in the model group and acupuncture group. Acupuncture was applied at "Jingming" (BL 1), "Chengqi" (ST 1), "Qiuhou" (EX-HN 7) and "Cuanzhu" (BL 2) in the acupuncture group. The bilateral acupoints were selected alternately, one side for a day, and totally 14 days were required. The effect of acupuncture on visual evoked potential in different spatial frequencies was observed.</p><p><b>METHODS</b>Under three different kinds of spatial frequencies of 2 X 2, 4 X 4 and 8 X 8, compared with normal group, there was obvious visual deprivation effect in the model group where P1 peak latency was delayed (P<0.01) while N1 -P1 amplitude value was decreased (P<0.01). Compared with model group, P1 peak latency was obviously ahead of time (P<0.01) while N1-P1 amplitude value was increased (P<0.01) in the acupuncture group, there was no statistical significance compared with normal group (P>0.05). Under spatial frequency of 4 X 4, N1-P1 amplitude value was maximum in the normal group and acupuncture group. With this spatial frequency the rat's eye had best resolving ability, indicating it could be the best spatial frequency for rat visual system.</p><p><b>CONCLUSION</b>The visual system has obvious electrophysiology plasticity in sensitive period. Acupuncture treatment could adjust visual deprivation-induced suppression and slow of visual response in order to antagonism deprivation effect.</p>

Decreasing effect of electro-acupuncture at Sanyin points on inflammatory cytokines in autoimmune prostatitis rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the changes of inflammatory cytokines in autoimmune prostatitis (AIP) rats treated by electro-acupuncture (EA) at Sanyin points.</p><p><b>METHODS</b>We selected 40 Wistar male rats in this study, 10 as normal controls, and the other 30 made AIP models by intradermal injection of protein purification liquid from the prostate of allogeneic male rats with dual immune adjuvant. Then we randomly divided the AIP models into a model, a Cernilton control and an EA group of equal number, the latter two groups treated by Cernilton enema and EA, respectively. After 15 days of treatment, all the animals were sacrificed for detection of the levels of TNF-alpha, iNOS, MDA and T-AOC in the prostate tissue.</p><p><b>RESULTS</b>Compared with the normal controls, the model rats showed significantly elevated TNF-alpha expression ([15.31 +/- 1.36] vs [32.20 +/- 1.65] pg/ml, P < 0.01), iNOS activity ([0.81 +/- 0.33] vs [1.25 +/- 0.23] U/ml, P < 0.01) and MDA content ([0.66 +/- 0.14] vs [0.91 +/- 0.21] nmol/ml, P < 0.05), but markedly reduced T-AOC activity ([1.56 +/- 0.16] vs [1.11 +/- 0.15] U/ml, P < 0.01). In comparison with the model group, the EA group exhibited significantly reduced levels of TNF-alpha ([17.32 +/- 2.69 ] pg/ml, P < 0.01), iNOS ([0.98 +/- 0.5 ] U/ml, P < 0.05) and MDA ([0.70 +/- 0.20] nmol/ml, P < 0.05), but remarkably increased level of T-AOC ([1.44 +/- 0.26] U/ml, P < 0.05).</p><p><b>CONCLUSION</b>Electro-acupuncture at Sanyin points can protect the prostate tissue from morphological damage and reduce inflammatory reaction by decreasing pro-inflammatory cytokine activity, vascular permeability and inflammatory cell infiltration and increasing the activity of the antioxidant defense system.</p>

Clinical significance of rapid detecting bone marrow BCL2/IGH and BCL6/IGH fusion genes in patients with diffuse large B cell lymphoma by multiplex PCR / 中国实验血液学杂志

Diffuse large B cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin's lymphoma (NHL), characterized by great heterogeneity in clinical manifestations and molecular genetics. This study was aimed to explore the clinical significance of applying multiplex PCR to detect BCL2/IGH and BCL6/IGH fusion genes in DLBCL. Multiplex PCR was used to detect bone marrow samples from 80 cases of DLBCL. The results showed that 12 patients (15%) carried BCL2/IGH or BCL6/IGH fusion genes, BCL2/IGH was found in 6 patients (7.5%), and BCL6/IGH in another 6 patients (7.5%). The patients with different molecular markers displayed different clinical features and outcomes. It is concluded that multiple PCR is rapid and accurate method to identify gene abnormalities in DLBCL, but further studying a quantitative or semi-quantitative assay for the expression of fusion genes is needed.

Surgical site infection in pancreas surgery and the use of perioperative antibiotics / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the pathogen profiles and the use of perioperative antibiotics after surgical site infection (SSI) in pancreas operation.</p><p><b>METHOD</b>We retrospectively analyzed the pathogen profiles and the use of perioperative antibiotics in 48 SSI patients who received pancreas operations from Jan 2001 to Dec 2005.</p><p><b>RESULTS</b>Totally 79 strains of pathogens (74 strains of bacteria) were isolated, including 17 strains of methicillin-resistant Staphylococcus aureus (MRSA), 17 strains of enterococcus species, 12 strains of Escherichia species, and 5 strains of enterobacteriaceae. Combination of the third generation of cephalosporins and antianaerobic agents were the main prophylactic therapies, with an average duration of (4.7 +/- 1.2) days. Most SSI episodes happened 6-14 days postoperatively (median 9 days). Celiac infections were most common (n=39). Therapeutic antibiotics gave priority to combined-antibiotics of the third cephalosporins and antianaerobic antibiotics, glycopeptides and carbapenems.</p><p><b>CONCLUSIONS</b>SSI commonly occurs on the 6-14 postoperative day, with MRSA and enterococci as the common pathogens of SSI after pancreas surgery. Antibiotic resistance should be considered when applying prophylactic therapies.</p>