Sensitivity of Sniffer Dogs for a Diagnosis of Parkinson's Disease: A Diagnostic Accuracy Study.

BACKGROUND: The diagnostic criteria for Parkinson's disease (PD) remain complex, which is especially problematic for nonmovement disorder experts. A test is required to establish a diagnosis of PD with improved accuracy and reproducibility. OBJECTIVE: The study aimed to investigate the sensitivity and specificity of tests using sniffer dogs to diagnose PD. METHODS: A prospective, diagnostic case-control study was conducted in four tertiary medical centers in China to evaluate the accuracy of sniffer dogs to distinguish between 109 clinically established medicated patients with PD, 654 subjects without PD, 37 drug-naïve patients with PD, and 185 non-PD controls. The primary outcomes were sensitivity and specificity of sniffer dog's identification. RESULTS: In the study with patients who were medicated, when two or all three sniffer dogs yielded positive detection results in a sample tested, the index test sensitivity, specificity, and positive and negative likelihood ratios were 91% (95% CI: 84%-96%), 95% (95% CI: 93%-97%), and 19.16 (95% CI: 13.52-27.16) and 0.10 (95% CI: 0.05-0.17), respectively. The corresponding sensitivity, specificity, and positive and negative likelihood ratios in patients who were drug-naïve were 89% (95% CI: 75%-96%), 86% (95% CI: 81%-91%), and 6.6 (95% CI: 4.51-9.66) and 0.13 (95% CI: 0.05-0.32), respectively. CONCLUSIONS: Tests using sniffer dogs may be a useful, noninvasive, fast, and cost-effective method to identify patients with PD in community screening and health prevention checkups as well as in neurological practice. © 2022 International Parkinson and Movement Disorder Society.

Obesity and novel cardiovascular markers in a population without diabetes and cardiovascular disease in China.

OBJECTIVE: To investigate associations of novel cardiovascular markers with obesity in a general population. METHODS: A total of 9361 individuals without diabetes or cardiovascular disease were studied between 2009 and 2012 in China. High-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), brachial-ankle pulse wave velocity (baPWV), pulse pressure, and central systolic blood pressure (cSBP) were assessed according to body mass index (BMI) levels and different BMI/metabolic syndrome (MetS) combinations. RESULTS: 'Levels of hs-cTnT, baPWV, pulse pressure, and cSBP increased across BMI levels. Obesity was positively associated with these markers in multivariate models (P<0.05 for all). When stratified by MetS, these associations remained significant in the non-MetS group, and compared with normal weight participants, the obese participants had 1.87 (95% confidence interval: 1.48, 2.36), 1.27 (1.02, 1.57), 1.89 (1.39, 2.57), and 2.71 (2.11, 3.47) fold risks for having elevated hs-cTnT, baPWV, pulse pressure, and cSBP, respectively, and had 1.61 (1.26, 2.05), 1.75 (1.27, 2.42), 2.45 (1.46, 4.11), and 3.14 (2.13, 4.62) fold risks for having 1, 2, 3, and 4 elevated cardiovascular markers, respectively; while no relationship was observed between obesity and these novel markers in the MetS group, after multivariate adjustment. These results were unchanged when using a waist-hip ratio, body fat per cent, and visceral adiposity index to redefine obesity. CONCLUSIONS: Obesity was positively associated with novel cardiovascular markers (except NT-proBNP) in participants without MetS rather than in participants with MetS. Obese participants without MetS also had higher odds of having more number of elevated cardiovascular markers.

Combined treatment of ulinastatin and tranexamic acid provides beneficial effects by inhibiting inflammatory and fibrinolytic response in patients undergoing heart valve replacement surgery.

OBJECTIVE: To investigate the effect of ulinastatin and tranexamic acid administered alone or in combination on inflammatory cytokines and fibrinolytic system in patients undergoing heart valve replacement surgery during cardiopulmonary bypass (CPB). BACKGROUND: CPB-induced fibrinolytic hyperfunction and systemic inflammatory response syndrome (SIRS) are the leading causes responsible for the occurrence of postsurgical complications such as postsurgical cardiac insufficiency and lung injury, which may lead to an increase in postsurgical bleeding, prolongation of hospital stay, and increased costs. METHODS: One hundred twenty patients undergoing heart valve replacement surgery during CPB were randomly assigned into 4 groups of 30 patients each: blank control group (Group C), tranexamic acid group (Group T), ulinastatin group (Group U), and tranexamic acid-ulinastatin combination group (Group D). Physiological saline, tranexamic acid, ulinastatin, and a combination of tranexamic acid and ulinastatin were given to each group, respectively. Arterial blood was collected from the radial artery at 4 time points: after induction of anesthesia (T1), unclamping the ascending aorta (T2), and at 1 hour (T3) and 24 hours (T4) after CPB. The levels of plasma tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), neutrophil elastase (NE), and the concentrations of tissue plasminogen activator (t-PA) and α2-antiplasmin (α2-AP) were detected. The changes in the volume of pericardial mediastinal drainage after surgery were observed and recorded. RESULTS: The plasma TNF-α, IL-6, and NE levels significantly increased in patients from all 4 groups at time points of T2, T3, and T4 in comparison to those before CPB (P < .05), and the plasma TNF-α and IL-6 levels in groups U and D were significantly lower than those in the other 2 groups (P < .05). The plasma t-PA, α2-AP, and D-dimer concentrations significantly increased in patients from all 4 groups at T2 and T3 compared with those before CPB (P < .05), and the plasma t-PA and D-dimer concentrations were significantly lower in groups T and D than those in groups U and C (P < .05) at T2 and T3. The plasma α2-AP concentrations in groups T and D were significantly higher than those in Group C at T3 (P < .05). The volumes of pericardial mediastinal drainage per body surface area were significantly lower in groups T and D than those in Group C 6 hours after the surgery (P < .05). CONCLUSIONS: Ulinastatin inhibits the release of inflammatory medium and reduces the inflammatory response during CPB. Tranexamic acid can effectively inhibit the fibrinolytic hyperfunction caused by CPB and thus decreases postsurgical bleeding. In addition, it exhibits a minor anti-inflammatory response. As a consequence, a combined treatment of ulinastatin and tranexamic acid reduces postsurgical bleeding and shortens postoperative hospital stay in patients undergoing heart valve replacement surgery.

[Robotic internal thoracic artery harvesting and the mid-term follow up of arterial graft patency].

OBJECTIVE: To summarize our experience of robotic internal thoracic artery (ITA) skeletonized harvesting in Asian patients and evaluate the learning curves of robotic ITA harvesting and ITA graft patency. METHODS: A total of 200 patients underwent totally robotic ITA takedown at our department from April 2007 to August 2012. ITA was harvested in a skeletonized fashion and learning curve estimated. Coronary artery bypass grafting was completed in minimally invasive direct coronary artery bypass graft (MIDCAB) or totally endoscopic coronary bypass graft on beating heart (BH-TECAB) manners after robotic ITA harvesting. The coronary angiography or 64-MSCT was performed to evaluate the patency of ITA graft before discharge and at Year 1-5 postoperatively. RESULTS: One patient underwent median sternotomy for severe plural adhesion. Left ITA (LITA, n = 190), right ITA (RITA, n = 5) and double-ITA (n = 4) were harvested. The mean duration of single ITA harvesting was 18-70 (35.8 ± 10.7) min. A significant learning curve was observed: y (min) = 58.0 - 5.3×ln(x) (r(2) = 0.33, P < 0.01). ITA patency was 98.1% at Year 1 and 97.8% at Year 2 postoperatively respectively. And there was no recurrence of ITA occlusion at Years 3-5. CONCLUSIONS: Robotic ITA takedown is a prerequisite for totally endoscopic coronary bypass graft and can be performed safely and within an acceptable time after overcoming a learning curve. ITA graft patency has comparable outcomes of conventional surgery.

[Values of computed tomography angiogram in non-cardiac surgery planning and cardiac risk assessment of coronary atherosclerosis during perioperative period].

OBJECTIVE: To explore the values of detecting coronary atherosclerosis by computed tomography angiogram (CTA) on non-cardiac surgery planning and cardiac risk assessment of coronary atherosclerosis during perioperative period. METHODS: A total of 89 patients with suspected coronary heart disease (CHD) scheduled for non-cardiac surgery underwent coronary CTA to evaluate luminal stenosis and calculate calcification score. There were 56 males and 33 females with a mean age of 65.1 years. Operative sites included chests (n = 29), abdomens and pelvis (n = 26), large vessels (n = 3), bones and joints (n = 19) and other regions (n = 12). Reasons of abandoned or postponed surgery were documented to analyze the influence of CTA results on surgery planning. Cardiac events were recorded to assess the correlation with coronary atherosclerosis. RESULTS: Among them, 75 patients (84.27%) were diagnosed as atherosclerosis while 10 patients (11.24%) were negative; 2 patients had coronary artery bypass and another 2 had stent implantation. According to the results of CTA, 12 operations (13.48%) were canceled and 8 (8.98%) postponed after interventions. Severe stenosis of coronary lumen had significant effects on surgery planning (P = 0.003) while calcification score did not. In patients undergoing surgery as scheduled or after intervention, 1 had atrial fibrillation at post-operation. CONCLUSION: For the patients with suspected CHD scheduled for non-cardiac surgery, severity of coronary stenosis may greatly influence surgery planning. Preoperative coronary CTA may decrease the incidence of cardiac events during perioperative period.

[Clinical factors influencing surgical approach selection of robotic-enhanced minimally invasive coronary artery bypass grafting].

OBJECTIVE: To investigate clinical factors that influence the selection of minimally approach between minimally invasive direct coronary artery bypass (MIDCAB) and totally endoscopic coronary artery bypass (TECAB). METHODS: From February 2007 to January 2013, patients were selected under uniform criteria. A total of 202 patients including 142 male and 60 female patients with age range from 33 to 80 years and average age of (59 ± 10) years were included and were all routinely prepared for TECAB. Either TECAB or MIDCAB was performed based on the intraoperative condition. There were 90 patients who underwent TECAB (TECAB group) and 112 patients who received MIDCAB surgery (MIDCAB group). Univariate analysis was used to compare preoperative, intraoperative and early postoperative parameters. Logistic multivariate regression analysis was used to discuss independent influencing factors of minimally invasive approach selection. RESULTS: All of the patients successfully received TECAB or MIDCAB surgery without mortality, severe complications or conversion to sternotomy. The early and midterm follow up of graft patency (by computed tomography angiography) was satisfactory. The mean operative time was (160 ± 64)minutes, mean graft flow was (27 ± 18) ml/min. Univariate analysis showed that sex ratio (3.5 vs.1.8, t = 4.350, P = 0.037), weight [(69 ± 11)kg vs.(72 ± 11)kg, t = -1.979, P = 0.049], multivessel coronary disease (43.3% vs.60.7%, t = 6.051, P = 0.014), and learning curve case (4.4% vs.14.3%, t = 5.418, P = 0.02) were significant predictors of conversion to MIDCAB. By multivariate analysis, multivessel coronary disease (HR = 1.964, 95%CI: 1.049-3.680, P = 0.035) and learning curve case (HR = 4.538, 95%CI: 1.219-16.891, P = 0.024) were independent influencing factors of MIDCAB approach. CONCLUSIONS: Robotic-assisted minimally invasive coronary artery bypass grafting can be performed safely and effectively either by TECAB or MIDCAB. Multivessel coronary disease and early learning curve cases are independent influencing factors of minimally invasive approach selection.

[Intraoperative transesophageal echocardiography in robotic perimembranous ventricular septal defect repair].

OBJECTIVE: To explore the role of intraoperative transesophageal echocardiography (TEE) in robotic perimembranous ventricular septal defect (VSD) repair. METHODS: A retrospective analysis was conducted with intraoperative TEE data of 18 consecutive patients who underwent robotic perimembranous VSD repair from January 2009 to August 2012. (1) Before cardiopulmonary bypass (CPB), TEE was performed to document the anatomic types, numbers, and the size of VSD. The procedures were predetermined by the surgeon according to TEE information. (2) During the establishment of peripheral CPB, TEE was used to guide the placement of cannulae in inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). (3) After weaning from CPB, TEE was conducted to evaluate the effect of the procedure. RESULTS: (1) Accuracy of TEE was 100% for diagnosing the anatomic types of VSD. All the surgical procedures were performed based on the predetermined information. (2) Under TEE guidance, all the cannulae in the SVC, IVC and AAO were located in correct positions. (3) In all patients, TEE confirmed successful VSD repair. CONCLUSION: TEE is a useful tool in the assessment of robotic perimembranous VSD repair.

Effects of linear-polarized near-infrared light irradiation on chronic pain.

In order to study the efficacy of linear-polarized near-infrared light irradiation (LPNIR) on relieving chronic pain in conjunction with nerve block (NB) or local block (LB), a 3-week prospective, randomized, double-blind, controlled study was conducted to evaluate the pre- and post-therapy pain intensity. Visual analogue scales (VASs) were measured in all patients before and 6 months after therapy visiting the pain clinic during the period of August 2007 to January 2008. A total of 52 patients with either shoulder periarthritis or myofascial pain syndrome or lateral epicondylitis were randomly assigned into two groups by drawing lots. Patients in Group I were treated with NB or LB plus LPNIR; Group II patients, for their part, were treated with the same procedures as in Group I, but not using LPNIR. In both groups, the pain intensity (VAS score) decreased significantly immediately after therapy as compared to therapy. There was a significant difference between the test and control groups immediately after therapy (P < 0.05), while no effect 6 months later. No side effects were observed. It is concluded that LPNIR is an effective and safe modality to treat various chronic pains, which has synergic effects with NB or LB.

Surgical treatment of patients with Lennox-Gastaut syndrome phenotype.

Lennox-Gastaut syndrome (LGS) is a devastating and refractory generalized epilepsy affecting children and adolescents. In this study we report the results of resective surgery in 18 patients with LGS phenotype who underwent single-lobe/lesionectomy or multilobe resection plus multiple subpial transection and/or callosotomy. After surgery, seven patients became completely seizure-free (Engel Class I) and five almost seizure-free (Engel Class II). Additional four had significant seizure control (Engel Class III), and two had no change in seizure frequency (Engel Class IV). Of the 4 patients without any lesion on brain MRI, 2 ended with Engel Class II, 1 with III and the other with IV in Engels' classification. Mean intelligence quotient (IQ) increased from 56.1 ± 8.1 (mean ± SD) before operation to 67.4 ± 8.2 (mean ± SD) after operation, a significant improvement (P = 0.001). Results also indicated that the younger the patient at surgery, or the shorter the interval between onset of seizure and resective operation, the better the intellectual outcome. Our data suggest that resective epilepsy surgery can be successful in patients with LGS phenotype as long as the EEG shows dominance of discharges in one hemisphere and corresponding ipsilateral imaging findings, even with contralateral ictal discharges.

[Long-term effects of permanent pacemaker implantation on tricuspid valve regurgitation].

OBJECTIVE: To explore the long-term effects of permanent pacemaker implantation (PPI) on tricuspid valve regurgitation (TR) in Chinese patients so as to determine the incidence and related factors, evaluate its effects on heart structure and function and ascertain the exact mechanism of TR after PPI. METHODS: A total of 430 patients undergoing permanent pacemaker replacement at our hospital between January 2000 and June 2011 were recruited. The patients with isolated atrial lead implantation procedures, significant heart valve disease or chronic obstructive pulmonary disease were excluded. The data of 108 patients who had Doppler echocardiograms performed before the first pacemaker implantation procedure and this pacemaker replacement procedure were obtained and retrospectively analyzed. According to the post-implant grade of TR, the patients were divided into two groups: normal tricuspid (n = 79) and abnormal tricuspid (n = 29). Their clinical characteristics and echocardiographic data between two groups were analyzed and compared. RESULTS: The mean follow-up time (from the first pacemaker implantation) was (13 ± 6) years (range: 4 - 34). Among 108 patients with initially normal tricuspid post-implant, 29 patients (26.9%) developed significant TR during the follow-up. In comparison to those in normal tricuspid group, the patients in abnormal tricuspid group had a longer time from the first pacemaker implantation ((16 ± 7) vs (12 ± 5) years, P = 0.003), more transtricuspid leads (1.31 ± 0.66 vs 1.10 ± 0.30, P = 0.026), larger right atrial size ((38 ± 7) vs (35 ± 4) mm, P = 0.028) and higher prevalence of mild TR and mitral valve regurgitation (MR) pre-implantation (TR: 21% vs 4%, P = 0.015, MR: 28% vs 5%, P = 0.003). The size of right atrium, right ventricle and left atrium in abnormal tricuspid group were more than those in normal tricuspid group. The prevalence of significant MR post-implantation in abnormal tricuspid group was higher than that in normal tricuspid group. The ejection fraction in abnormal tricuspid group was lower than that in normal tricuspid group during the follow-up. CONCLUSIONS: Abnormal TR after PPI during a long-term follow-up is quite common. The related factors include the time interval from the first pacemaker implantation, number of transtricuspid lead, right atrial size, mild TR and MR pre-implantation.

[Clinical experiences on correction of congenital heart diseases with robotic technology: a report of 160 cases].

OBJECTIVE: To summarize the clinical experiences on correction of congenital heart disease with robotic technology at a single center. METHODS: Between January 2007 and May 2012, this retrospective study recruited 160 consecutive patients undergoing robotic surgery for congenital heart diseases. There were 74 males and 86 females with a median age of 35 years (range: 11-62). The procedures included secundum-type atrial septal defect repair (n = 130), ostium primum defect repair (n = 1), perimembranous ventricular septal defect repair (n = 21), mitral valve repair for anterior leaflet cleft (n = 7) and mitral valve repair plus left atrial myxoma resection (n = 1). Cardiopulmonary bypass graft was established through cannulation of right femoral artery, vein and right internal jugular vein under the guidance of transesophageal ultrasound. Myocardial protection was performed with cold blood cardioplegic solution or HTK solution and a transthoracic Chitwood clamp was used to occlude ascending aorta. Via three 8-mm ports and one 15-mm port in right chest, the microscopic instruments were manipulated to complete defect closure or mitral valve plasty, utilizing da Vinci S or da Vinci SI robotic system. Echocardiography was performed intraoperatively and at pre-discharge. Routine follow-ups were conducted. The clinical data of operating time, cardiopulmonary bypass time and follow-up examinations were retrospectively analyzed. RESULTS: All cases were treated successfully without a conversion into median sternotomy. No operative mortality or severe surgical complications were observed. Seventy-six cases of secundum-type atrial septal defect were completed on beating heart. The learning curves were noted for operating time of beating heart group and cross clamp time of arrest heart group. No residual shunt, malignant arrhythmia or mitral valve regurgitation was detected on intraoperative or postoperative echocardiography and during a median follow-up period of (29.1 ± 16.3) months. CONCLUSION: Robotic minimal access is technically feasible and it may be applied in selective patients with atrial septal defect, perimembranous ventricular septal defect and mitral valve cleft.

[Comparison of sternotomy off-pump coronary artery bypass and minimally invasive technique for isolated single vessel grafting].

OBJECTIVE: To compare the outcomes of minimally invasive coronary artery bypass grafting operation performed via a small thoracotomy versus da Vinci S system (Endo-A-CAB) with sternotomy off-pump coronary artery bypass grafting (OPCAB) for single vessel lesion. METHODS: From April 2000 to August 2011, a total of 194 patients with single coronary artery stenosis accepted CABG on beating heart were divided into 2 groups by different surgical approaches. Group A (n = 99) received sternotomy OPCAB while Group B (n = 95) underwent Endo-A-CAB. All patients had a history of unstable angina and coronary arteriography showed severe stenosis in left anterior descending artery (LAD). The procedure performed in Group B included robotic internal mammary artery (IMA) harvesting and single manual anastomosis to LAD and/or diagonal branch through small incision thoracotomy. IMA flow was evaluated by the Doppler flow meter after the completion of anastomosis. Grafting patency was evaluated postoperatively by computed tomography angiography (CTA) or angiography. RESULTS: The ventilation time and postoperative drainage volume in Group B were less than those in Group A ((5.1 ± 2.1) vs (10.1 ± 5.8) h, P = 0.03; (411 ± 295) vs (605 ± 244) ml, P = 0.000). No significant difference existed in blood flow, mortality and postoperative complication morbidity between two groups. All symptoms of angina disappeared. CONCLUSION: As a new advanced modality of revascularization, in comparison with OPCAB, Endo-A-CAB procedure is a less invasive and safer method of coronary artery bypass grafting for single vessel lesion.

[Acute kidney injury early after cardiac surgery with cardiopulmonary bypass: clinical analysis].

OBJECTIVE: To explore the occurrence of acute kidney injury (AKI) in early stage after cardiac surgery under cardiopulmonary bypass (CPB) and discuss the perioperative risk factors and its impact on clinical outcome. METHODS: Retrospective analysis was performed among 1472 adult patients undergoing cardiac surgery with CPB between January 2008 and April 2011. The postoperative occurrence of AKI following cardiac surgery was stratified according to the RIFLE criteria. And the perioperative risk factors of AKI and its impact on clinical outcome were analyzed. RESULTS: AKI occurred in 437 patients (29.7%) within 72 hours postoperation. Of these, 292 (19.8%) fulfilled AKI-Risk, 110 (7.5%) AKI-Injury and 35 (2.4%) AKI-Failure. Logistic regression analysis showed that age, hypertension, chronic renal insufficiency, reoperation, aortic surgery, CPB duration, intraoperative transfused erythrocyte volume and perioperative use of intra-aortic balloon pump were independent risk factors for AKI. A postoperative elevation of AKI level was associated with a prolonged duration of mechanical ventilation, intensive care unit stay, postoperative hospital stay, delayed extubation, extubation failure and death. Receiver operator characteristic (ROC) curve showed that AKI classification was a postoperative predictor of delayed extubation, extubation failure and death. CONCLUSION: As a common complication after cardiac surgery, AKI is associated with many perioperative risk factors. And the AKI classification is predicator of delayed extubation, extubation failure and death.

[Impact of prior percutaneous coronary intervention on outcome of coronary artery bypass graft surgery].

OBJECTIVE: To determine the impact of prior percutaneous coronary intervention (PCI) on outcome of coronary artery bypass graft (CABG) surgery. METHODS: Perioperative data were collected from 1306 patients undergoing CABG from January 2002 to November 2010, including 117 patients with prior PCI and 1 189 patients without prior PCI. Among 117 patients with prior PCI, 99 patients had a single PCI procedure and 18 had multiple PCI procedures. The surgical outcomes including in-hospital mortality and major adverse cardiac events were compared between two groups. RESULTS: Patients with prior PCI were younger, less likely to have triple vessel and left main stem disease, and less recent myocardial infarction. Interval time between PCI and CABG was (13.39 ± 13.81) months. There were no significant difference in in-hospital mortality (1.7% compared with 0.5 % P=0.156) and major adverse cardiac events (including postoperative myocardial infarction, stroke, and in-hospital death,2.6% compared with 1.1% P=0.167) between two groups. CONCLUSION: There was no association between prior PCI and isolated CABG. Good outcomes can be obtained in the group of patients undergoing CABG who have had previous PCI.

[Surgical treatment with modified Morrow procedure in hypertrophic obstructive cardiomyopathy].

OBJECTIVE: To summarize the experience of ventricular septal myectomy (modified Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: From June 2003 to March 2011, 38 patients (26 male and 12 female) with HOCM underwent modified Morrow procedure. The mean age was 36.3 years (ranging from 18 to 64 years). The diagnosis was made by echocardiography and spiral CT. The mean systolic gradient between the left ventricle and the aorta from transthoracic echocardiography (TTE) was (89±31) mmHg (ranging from 50 to 184 mmHg, 1 mmHg=0.133 kPa) before operation. There was moderate or severe systolic anterior motion (SAM) in 38 cases and mitral regurgitation in 29 cases. Ventricular septal myectomy with modified Morrow procedure was performed in all 38 cases. TEE was used intraoperatively to evaluate the results of the surgical procedures. After 1 to 2 weeks of operation, TTE was performed to evaluate the effect of operation. All patients were followed up with TTE after operation. RESULTS: All patients were discharged without complications. Intraoperative TEE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (95±36) mmHg before procedures to (14±11) mmHg after operation (t=13.265, P=0.000), and the thickness of ventricular septum was decreased from (28±8) mm to (12±3) mm (t=11.656, P=0.000). TTE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (89±31) mmHg preoperatively to (18±13) mmHg (t=12.729, P=0.000) in 1 to 2 weeks after operation. Mitral regurgitation and SAM were significantly improved or disappeared (t=7.930, t=5.213, both P=0.000). During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only and syncope was abolished, and TTE showed that the pressure gradient was kept on the postoperative level or slightly decreased (P=0.494). CONCLUSIONS: Ventricular septal myectomy with modified Morrow procedure is a mostly effective method for patients with HOCM. Good surgical exposure and the hypertrophied septum thoroughly excised are paramount for successful surgery.

[Early and midterm outcomes of coronary artery bypass grafting in octogenarians].

OBJECTIVE: To investigate the early and midterm postoperative outcomes and analyze risk factors of coronary artery bypass grafting (CABG) in octogenarians. METHODS: Clinical data of 38 patients aged 80 years or greater receiving isolated coronary artery bypass grafting from September 2001 to November 2010 were reviewed. There were 33 male and 5 female patients, aging from 80 to 87 years with a mean of (82.6 ± 1.2) years. Twelve patients underwent conventional (on-pump) CABG and 26 patients underwent off-pump CABG. The number of bypass grafts was 1 to 5 (mean 2.5 ± 1.1). Left internal mammary artery was used in 37 (97.3%) patients. RESULTS: The perioperative mortality was 2.6% (1/38). Postoperative complications included stroke (4 cases), respiratory infection (1 case). The atrial arrhythmias occurred in 25 patients. Intensive care unit and hospital length of stay lasted (3.8 ± 1.4) days and (15 ± 6) days, respectively. Totally 38 patients were followed up for 4 to 70 months. Six patients died during the follow-up period. The 92.6% patients recovered without any cardiac events. CONCLUSIONS: Isolated CABG can be performed safely with acceptable postoperative morbidity and mortality in octogenarians. Appropriate surgical strategy and intensive perioperative treatment must be enhanced in octogenarians who underwent CABG.

A Practical Assessment of the Disinfectant Efficacy of UV Light with and without Ozone Using a Novel Transfer Hatch in a Research Animal Facility.

Most in vivo animal research and breeding using mice and rats in China takes place in facilities under barrier conditions. Items being moved across the barrier are typically disinfected using UV radiation in a transfer hatch. However, the time periods necessary for this disinfection technique are inefficient, and disinfection is frequently incomplete, especially if concealed surfaces are present. The current study used a newly developed transfer hatch incorporating both UV and ozone disinfection to examine disinfection efficacy against 4 bacteria species (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii). Disinfection trials used UV and ozone, applied separately and in combination, for up to 30 min. Separate and combined treatments were also tested with a UV barrier. We found that if UV radiation has direct contact with surfaces, it is an efficient disinfection method. However, where surfaces are concealed by a UV barrier, UV radiation performs relatively poorly. The results of this study indicate that a combination of UV and ozone produces the most effective disinfection and is markedly quicker than current disinfection times for UV applied on its own. This novel transfer hatch design therefore allows more complete and efficient disinfection, improves workflow, and reduces barrier breaches by pathogens that may affect animal health and welfare and compromise research outcomes.

Effectiveness of treatment of bedding and feces of laboratory animal with ozone.

BACKGROUND: The incineration and burying of the soiled bedding of laboratory animals, as well as using detergents to treat their feces, is hazardous to the environment. This highlights the need for an alternative, environmentally friendly solution for the treatment of the waste of laboratory animal facilities. This study aims to evaluate the efficacy of ozone disinfection of the soiled bedding and feces of laboratory animals. METHODS: Two grams of soiled beddings were randomly sampled from the cages of mice and rats. These samples were mixed in a beaker with 40ml saline. Ozone was piped into the beaker at a concentration of 500mg/h. Samples were taken from the beaker at time 0min, 30min, 45min and 60min after ozone treatment for microbiological culturing in an incubator for 48h. Colony form unit of each plate (CFU/plate) at each time point were counted, the mean CFU/plate at each time point after ozone treatment were compared with that present at time zero. Feces of rabbits and dogs were treated and pathogens were counted the similar way as that of bedding of the mice and rats; samples being taken at 0min, 15min, 30min, 45min and 60min. RESULTS: Pathogens were observed in beddings of both mice and rats as well as in feces of rabbits and dogs. Ozone treatment for 30min killed more than 93% of pathogens in the bedding of the two rodent species and 60min of treatment killed over 99% of pathogens. Treatment of rabbit and dog feces for 30min killed over 96% pathogens present, and 60min's treatment killed nearly all the pathogens. Both Gram positive and Gram negative pathogens were sensitive to ozone treatment. CONCLUSION: Ozone treatment of bedding and feces is an effective and environment friendly way to deal with the waste of animal facilities, saving energy and potentially enabling their reuse as fertilizer.

L-arginine promotes DNA repair in cultured bronchial epithelial cells exposed to ozone: involvement of the ATM pathway.

Ozone may lead to DNA breaks in airway epithelial cells. p-ATM (phosphorylated ataxia telangiectasia mutated) plays a pivotal role in DNA repair. Derivatives of NO (nitric oxide) are regulators of the phosphorylation, and NO is increased under oxidative stress. The present study was aimed to study the effect of NO donor L-arg (L-arginine) on DNA damage repair in human bronchial epithelial cells exposed to ozone and the potential mechanisms involved. HBECs (human bronchial epithelial cells) were cultured with or without ozone (1.5 ppm, 30 min), DNA breaks were measured with a comet assay and agarose gel electrophoresis, cell cycling was determined by flow cytometry and p-ATM was measured by immunofluorescence and Western blot. Data were analysed by ANOVA (analysis of variance). P<0.05 was considered as significant. Ozone induced marked DNA breaks, G1-phase arrest and increased expression of p-ATM in HBECs, while wortmannin reduced the levels of p-ATM induced by ozone; the NO donor, L-arg, minimized the effects of ozone-induced DNA breaks and increased the level of p-ATM, while the NO synthase inhibitor, L-NMMA [N(G)-minomethyl-L-arginine], restrained those effects of L-arg. The effect of L-arg on DNA repair is NO-mediated, and p-ATM is implicated in the processes of DNA repair.