[Clinical analysis of chronic sternal osteomyelitis with sinus tract after cardiovascular surgery].

Objective: To explore the diagnosis, therapy and prevention method of chronic sternal osteomyelitis with sinus tract after cardiovascular surgery. Methods: A total of 53 patients with chronic sternal sinus tract after cardiovascular surgery between January 2000 and January 2016. After definite diagnosis by contrast fistulography and CT scanning, all the patients received combined modality therapy including debridement, musculocutaneous flap transplantation and intermediate thickness free skin graft transplantation if necessary. Results: One patient died of false aneurysm due to the sternal sinus tract infection, there were no peri-operative death for all the left 52 patients. Forty-five patients had primary healing and 7 patients had secondary healing. All the patients became total recovery within 3-12 weeks after operation and maintained well during the 5-18 months' follow-up. Conclusions: For the patients with chronic sternal osteomyelitis, operative therapy should be performed as soon as possible once the diagnosis is confirmed. Combined modality therapy including debridement, musculocutaneous flap transplantation and intermediate thickness free skin graft transplantation is confirmed to be effective and secure.

The distribution of MNS hybrid glycophorins with Mur antigen expression in Chinese donors including identification of a novel GYP.Bun allele.

BACKGROUND AND OBJECTIVES: MNS hybrid glycophorins are identified by characteristic antigen profiles. One of these is the Mur antigen, which is expressed on red cell hybrid glycophorins of several phenotypes of the 'Miltenberger' series found predominantly in East Asian population. The aim of this study was to investigate the distribution of Mur-positive hybrid glycophorins and clarify the genetic basis in the donors from southern China. MATERIALS AND METHODS: Blood samples from 528 donors were collected for Mur antigen serological typing. Sequencing of GYPB pseudoexon 3 and MNS phenotyping were conducted in Mur-positive samples. The multiplex ligation-dependent probe amplification (MLPA) was used to confirm the zygosity of the GYP.Mur allele and determine the MNSs genotype. The expression of Mur antigen was evaluated by flow cytometry. RESULTS: Fifty-one Mur-positive samples were identified by serological testing. Sequencing analysis showed 50 donors (50/528, 9.5%) with the GYP.Mur allele (48 heterozygotes and two homozygotes), which were confirmed by the MLPA genotyping analysis, and one donor (1/528, 0.19%) with a novel GYP.Bun allele. Flow cytometry analysis revealed higher Mur antigen expression on GP.Mur (Mi.III) homozygotes than heterozygotes. For the GYP.Mur homozygotes, an incorrect 'N' positive typing with anti-N lectin was obtained. CONCLUSION: GP.Mur (Mi.III) is the main Mur-positive hybrid glycophorin in Guangzhou donors. The dosage effect of Mur antigen observed provides a basis for selecting the homozygous GP.Mur RBCs as the reagent cells to avoid neglecting weak antibodies. A separate GYP.Bun lineage found in the southern China provides evidence for further complexity in the MNS system.

The effect of microwave and bipolar radio-frequency ablation in the surgical treatment of permanent atrial fibrillation during valve surgery.

BACKGROUND: Atrial fibrillation (AF) is a frequent problem in patients undergoing valve surgery. This study compared microwave and bipolar radio-frequency ablation of the left atrium in AF patients undergoing valve surgery. METHODS: Patients who required left atrial ablation for permanent AF (duration > 6 months) during valve surgery were randomized to a microwave group (n = 94) or a radio-frequency group (n = 93). Regular follow-up was carried out at 3, 6, 9 and 12 months post-procedure and annually thereafter. RESULTS: There were 4 postoperative deaths in the microwave group and 2 in the radio-frequency group. The median follow-up for all patients was 24.0 months (range: 12-36.0 months). Freedom from AF recurrence was significantly higher in the radio-frequency group than in the microwave group at 3 months (85.7 vs. 72.2 %, P = 0.026), 6 months (87.9 vs. 73.3 %%, P = 0.013), 9 months (84.6 vs. 68.9 %, P = 0.012), 12 months (84.6 vs. 67.8 %%, P = 0.008), and 24 months (88.7 vs. 71.2 %, P = 0.022) and at the latest follow-up (81.3 vs. 65.6 %, P = 0.016). CONCLUSION: Bipolar radio-frequency ablation is superior to microwave ablation for the treatment of permanent AF in patients undergoing valve surgery.