ObjectiveTo explore the effect of transplanting neonatal porcine islet cells of pig via hepatic portal vein in type Ⅰ diabetic monkeys.MethodIn this study, three pig-monkey islet xenotransplantation experiments were carried out by using α-1, 3-galactosyltransferase (GGTA1) gene knockout neonatal pig islet cells.ResultsThree macaques were successfully transplanted with islet cells. After the operation, their vital signs were stable and no symptoms of venous embolism occurred. After transplantation, the blood glucose and the dosage of exogenous insulin were significantly reduced, and the specific porcine C-peptide could be detected. Three macaques developed symptoms of ketoacidosis, and one macaque developed wound infection. After symptomatic treatment, all of them survived for 16 weeks.ConclusionGGTA1 knockout neonatal porcine islet cells transplanted through hepatic portal vein is effective for the treatment of type Ⅰ diabetes.
Objective To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. ResultsTotally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P＜0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1±2 542.0 steps, P＜0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.
Objective To verify the predictive value of Sino System for Coronary Operative Risk Evaluation（SinoSCORE） on quality of life in patients undergoing coronary artery bypass graft （CABG） surgery. Method A total of 234 patients in Peking University People’s Hospital undergoing CABG between November 2008 and September 2010 hadcompleted the preoperative and 6-month postoperative Short Form-36 （SF-36）. There were 172 （73.5%） male patients and63 （26.5%） female patients. The average age was 63.0±10.1 years. According to the SinoSCORE， 234 patients were dividedinto three groups：low risk （SinoSCORE score less than 1 point，n=67）， medium risk （SinoSCORE score 2-5 points，n=77） and high risk （SinoSCORE score more than 6 points，n=90） group. Clinical information of the 234 patients was collected， andthe score values of all patients were calculated according to the SinoSCORE model. Statistic methods were performed toevaluate the relationship between quality of life and SinoSCORE. Results The postoperative quality of life have improvedsignificantly， but the improvement of quality of life have no significantly different between groups. There was statisticallysignificant correlation between quality of life and SinoSCORE （P＜0.05， r value at-0.150 to 0.255）.Linear regression analysis showed that SinoSCORE was significantly collected with quality of life in multiple subgroups （P＜0.05， r 2＜0.1） .Conclusion SinoSCORE have statistically correlated with quality of life， and have certain but limited predictive value on quality of life in CABG patients.
ObjectiveTo compare the outcomes following emergency surgery or conservative treatment for patients with acute type A aortic intramural hematoma (IMH).MethodsClinical data of consecutive patients diagnosed with acute type A aortic IMH in our hospital from September 2014 to December 2018 were retrospectively analyzed. The patients who met our surgical indications received surgery (an operation group) and other patients received strict conservative treatment (a conservative treatment group).ResultsFinally 127 patients were enrolled, including 112 males and 15 females with an average age of 53.6±13.0 years. Of 127 patients, 85 (66.9%) patients accepted emergency surgery and 42 (33.1%) patients accepted strict conservative treatment. There was no difference between the two groups in early mortality or complications (P＞0.05). The 5-year survival rate was 90.4% in the operation group and 74.3% in the conservative treatment group (P=0.010). A maximum aortic diameter in the ascending aorta and aortic arch≥45 mm and maximum thickness of IMH in the same section≥8 mm were risk factors for IMH-related death in patients undergoing conservative treatment (P＜0.001).ConclusionThe mortality associated with emergency surgery for patients with acute type A aortic IMH is satisfactory. In clinical centers with well-established surgical techniques and postoperative management, emergency surgical treatment may provide a better outcome than conservative treatment for patients with acute type A aortic IMH.
ObjectiveTo analyze the short- and mid-term outcomes of patients undergoing reconstruction of intervalvular fibrous body (IVFB) via double valve replacement (Commando procedure) or aortic valve replacement and mitral valve repair (Hemi-Commando procedure). MethodsThe patients who underwent Commando or Hemi-Commando procedure between September 2014 and September 2022 in Guangdong Provincial People’s Hospital were collected. The perioperative and follow-up data were reviewed and analyzed for the assessment of short- and mid-term outcomes. Results Eleven patients received Commando procedure (a Commando group), including 4 males and 7 females with a median age of 61 (33, 68) years; 7 patients received Hemi-Commando procedure (a Hemi-Commando group), including 5 males and 2 females with a median age of 50 (36, 58) years. Two patients died in the postoperative 30 days (1 patient in the Commando group and 2 patients in the Hemi-commando group). Low cardiac output syndrome complicated with multiple organ dysfunction syndrome was the main cause of death. Fifteen patients were discharged and followed up for 13 (6, 42) months, with a survival rate of 100%. The rates of free from recurrent endocarditis or re-operation were both 100%. ConclusionCommando and Hemi-Commando procedures are effective strategies for IVFB reconstruction, and can achieve excellent mid-term outcomes if patients survive from the frailest period of early postoperative stage.
Infective endocarditis is one of the severest valvar diseases, commonly affecting the mitral valve. Currently, valvuloplasty and replacement are the main surgical options for mitral infective endocarditis. However, the complexity of the infectious lesions has caused a raging debate on which surgical approach offers more benefits. With the development of surgical treatment for endocarditis, mitral valvuloplasty may be a superior solution. It can preserve the integrity of the valve structure, avoiding complications caused by replacement. However, there is a lack of evidence from randomized clinical trials and other evidence-based medical supports. Furthermore, issues regarding the timing of surgery, repair methods, and material choices for mitral valvuloplasty in these patients have not been standardized. Therefore, this article summarizes existing literature to assist clinicians in making appropriate treatment decisions.
Objective To analyze the surgical effect of total aortic arch replacement and stented elephant trunk (Sun’s procedure) for acute or chronic Stanford type A aortic dissection, and to investigate the optimal surgical timing for Stanford type A aortic dissection involving aortic arch. Methods We retrospectively reviewed the clinical data of 327 patients with acute or chronic Stanford type A aortic dissection treated by Sun's procedure from June 2010 to June 2014 in Guangdong Cardiovascular Institute. Patients were divided into two groups according to whether the time from onset to operation was longer than 2 weeks: an acute group with 229 patients (≤2 weeks, the average time of onset to operation 5.70±3.50 d) and a chronic group with 98 patients (>2 weeks, the average time of onset to operation 21.60±15.70 d). There were 186 males and 43 females with a mean age of 47.47±11.19 years in the acute group, and 76 males and 22 females with a mean age of 45.62±12.92 years in the chronic group. The patients discharged from hospital were followed up for one year. Results There was no significant difference between the two groups in preoperative data. The rate of coronary artery bypass grafting, cardiopulmonary bypass time, aortic cross-clamping time, intraoperative and postoperative 24 h red blood cell intake were higher or more in the acute group than those in the chronic group (P<0.05). The in-hospital morality, ICU stay, mechanical ventilation time, the incidence of neurological dysfunction, low cardiac output syndrome, acute renal failure with continuous renal replacement therapy, hepatic insufficiency, poor wound healing were higher or more in the acute group than those in the chronic group (P<0.05). During one year follow-up, the survival rate of the acute and chronic groups was 97.0% and 97.6% respectively (P>0.05). No new complications were found in the two groups. The irreversible neurological dysfunction, paraplegia and renal failure showed no significant difference between the two groups. Conclusion The short-term mortality and complications of acute Stanford A aortic dissection involving aortic arch treated by Sun’s procedure are significantly higher or more than those of chronic Stanford type A aortic dissection. The risk of surgical treatment in acute phase is high.
Lung transplantation has been a standard treatment option for patients with end-stage lung disease. However, the demand for donor lungs exceeds the poor of available organs, resulting in considerable waiting list mortality. Among all the useful methods so far, ex vivo lung perfusion (EVLP) has been considered a useful technique in lung transplantation, which helps prolong donor lung preservation and repair donor lung injuries. Current studies have demonstrated EVLP can evaluate the donor lung function continuously and provide platform for pharmaceutical or even gene therapy. Moreover, EVLP improves the function of marginal donor lungs and increases the quantity of lungs meeting the transplant criteria, which could extend the donor pool. This article reviews the clinical application and research progress of EVLP in lung transplantation.