Over the past 20 years, transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment option for patients with severe mitral regurgitation (MR) who are at high surgical risk. Initially, several landmark clinical studies established the basis of TEER for primary and secondary MR, but they only involved clinically stable patients with appropriate mitral valve anatomy. With the increasing experience of interventional therapy, the iteration of equipment and the improvement of intraoperative imaging technology, the scope of use of TEER has been continuously expanded, and its indications have been continuously expanded to more complex mitral valve lesions and clinical situations. Therefore, in clinical practice, selecting the appropriate device according to the individual anatomical characteristics of the patient can minimize MR and complications, thereby optimizing immediate and long-term prognosis. This article mainly introduces the pathogenesis and related mechanisms of MR, the main TEER devices and their clinical evidence, the limitations of TEER, and the future development direction.
Objective To introduce the possible effects and significances of angiogenesis and antiangiogenic in the development and treatment of hepatocellular carcinoma (HCC). Methods Recently relevant literatures were reviewed. Results Angiogenesis played a significant role in the development and therapy of HCC, and the development and metastasis of HCC could be effectively suppressed by antiangiogenic therapy. This might provide a new approach for the treatment of HCC. Conclusion Comprehending the molecular mechanism of angiogenesis and applying antiangiogenic therapy will contribute a lot for the prevention and treatment of HCC.
目的:比较不同麻醉方法在腹腔镜妇科不孕检查及治疗术中的效果和安全性。方法:选择不孕拟在腹腔镜下行检查及治疗术的患者60例,随机分为三组,每组20人,分别进行连续硬膜外麻醉(简称EA组);静吸复合全身麻醉(简称GA组);连续硬膜外麻醉加静吸复合全身麻醉(简称EGA组),观察比较三种麻醉方法对患者呼吸,循环及麻醉效果的影响。结果:三种麻醉方法均可保证手术完成,EA组术中管理较为麻烦,GA组循环波动大,EGA组麻醉效果更好,各种药物用量减少,患者血液动力学更稳定,恢复快,管理更轻松。结论:连续硬膜外麻醉加静吸复合全身麻醉(EGA)可避免其它两种麻醉方式不足,各取长处,更适用于腹腔镜妇科不孕检查及治疗术麻醉。
Objective To investigate the clinical value of " O”continuous biliary-enteric anastomosis combined with percutaneous transhepatic cholangial drainage (PTCD) in pancreaticoduodenectomy (PD). Methods The clinical data of 35 patients with PD who were admitted to Xinyang Central Hospital from June 2015 to June 2017 were retrospectively analyzed. Results All patients completed the " O” continuous biliary-enteric anastomosis combined with PTCD without perioperative death. ① The preoperative indwelling time of PTCD tube was (13.24±3.39) d, total bilirubin (TBIL) was (363.67±12.26) μmol/L on admission and (155.59±17.63) μmol/L on preoperative after PTCD, respectively. ② The operative time was (231.46±18.69) min, the intraoperative blood loss was (158.30±31.33) mL, the diameter of the hepatic ductal segment was (1.3±0.2) cm, and the duration of the " O” continuous biliary-enteric anastomosis was (7.31±1.52) min. ③ After surgery, the indwelling time of PTCD tube was (8.13±1.49) d, the hospitalization time was (27.31±5.49) d. Biliary leakage occurred in 1 case, pancreatic fistula occurred in 5 cases (3 cases of biochemical sputum and 2 cases of B-stage pancreatic fistula), abdominal infection occurred in 2 cases, pneumonia occurred in 3 cases, wound infection occurred in 2 cases. No postoperative biliary-enteric anastomosis stenosis, biliary tract infection, and intra-abdominal hemorrhage occurred. There was no laparotomy patients in this group and all patients were discharged. ④ All patients were followed-up for 180 days after surgery. No death, bile leakage, biliary-enteric anastomotic stenosis, biliary tract infection, pancreatic fistula, gastro-intestinal leakage, and abdominal infection occurred. One case of delayed gastric emptying and 2 cases of alkaline reflux gastritis were cured after outpatient treatment. Conclusions The preoperative PTCD can improve the preoperative liver function and increase the security of PD. " O” continuous biliary-enteric anastomosis is simple, safe, feasible, and has the function of preventing biliary-enteric anastomosis stenosis. For severe jaundice patients with blood TBIL >170 μmol/L, the " O” continuous biliary-enteric anastomosis combined with PTCD is an alternative surgical procedure for PD.
ObjectiveTo study the expression of survivin protein in primary hepatocellular carcinoma(PHC) and its relationship to the proliferation of the tumor cells and prognosis of PHC. MethodsThe expression of survivin protein and the proliferation of tumor cells marked by proliferating cell nuclear antigen (PCNA) in 48 cases of PHC were determined by immunohistochemical method. ResultsThe survivin protein was expressed in 31 of 48 cases of PHC (64.6%). The expression of PCNA was significantly higher in hepatocellular carcinoma (HCC) with positive survivin expression than in HCC with negative survivin expression. The patients with positive survivin expression had the worse prognosis than those with negative survivin expression. ConclusionThe expression of survivin may play an important role in the proliferation of PHC cells and closely associate with the prognosis of PHC, and probably become the prognostic factor and an important target of therapy.
ObjectiveTo preliminary study on the feasibility of constructing three-dimensional (3D) hippocampal neural network in vitro by using microfluidic technology.MethodsA network patterned microfluidic chip was designed and fabricated by standard wet etching process. The primary hippocampal neurons of neonatal Sprague Dawley rats were isolated and cultured, and then inoculated on microfluidic chip for culture. Immunofluorescence staining was used to observe the growth of hippocampal neurons at 3, 5, and 7 days of culture and electrophysiological detection of hippocampal neuron network at 7 days of culture.ResultsThe results showed that the number of hippocampal neurons increased gradually with the prolongation of culture time, and the neurite of neurons increased accordingly, and distributed uniformly and regularly in microfluidic chip channels, suggesting that the 3D hippocampal neuron network was successfully constructed in vitro. Single and multi-channel spontaneous firing signals of hippocampal neuronal networks could be detected at 7 days of culture, suggesting that neuronal networks had preliminary biological functions.ConclusionPatterned microfluidic chips can make hippocampal neurons grow along limited paths and form 3D neuron networks with corresponding biological functions such as signal transduction, which lays a foundation for further exploring the function of neuron networks in vitro.
Objective To study the results of in situ microwave thermocoagulation therapy for liver neoplasms. Methods Thirty-one patients (male 28, female 3) with liver neoplasms underwent in situ microwave thermocoagulation therapy in recent 4 years were studied. The time of the therapy arranged from 2 to 6 minutes with the core temperature from 110℃ to 125℃. Twenty six of the thirty one (83.9%) were followed up. Results Ninty point three percent of these patients have a good result. The average survival time after the operation was 19.7 months. One-year and three-year survival rate were 77.4% and 38.7%, respectively. Conclusion The in situ microwave thermocoagulation therapy have the advantages of causing slight trauma, promoting repair, good tolerance and curative effectiveness. It’s a simple, safe and effective method with less adverse effect for treating the liver neoplasms, especially for unresectable neoplasms.
ObjectiveTo investigate the effectiveness of modified extensor indicis proprius (EIP) tendon transfer for reconstruction of spontaneously ruptured extensor pollicis longus (EPL) tendon by comparing with the traditional EIP tendon transfer. MethodsBetween January 2009 and December 2011, 11 cases of spontaneously ruptured EPL tendon were treated by modified EIP tendon transfer to reconstruct extension function (modified group). On the base of traditional procedure, the proximal end of EPL tendon was sutured with EIP tendon and the distal end of EIP tendon was crossed round extensor pollicis brevis (EPB) tendon and sutured back with EPL tendon. A specific EI-EPL evaluation method (SEEM) was used to measure the EPL tendon function after transfer. The result was compared with that of the other 18 cases undergoing traditional operation (traditional group). There was no significant difference in gender, age, disease duration, and injury causes between 2 groups (P gt; 0.05). ResultsAll incisions healed by first intention. In traditional group, 5 cases were out of follow-up, and the other 24 cases were followed up 1 year and 6 months on average (range, 8 months-2 years and 6 months). At the last follow-up, according to the evaluation of SEEM, the thumb elevation and flexion deficits of modified group were significantly less than those of traditional group (P lt; 0.05). The independent elevation deficit of the index finger of modified group was similar to that of traditional group (P gt; 0.05). The effectiveness was excellent in 9 cases and good in 2 cases with an excellent and good rate of 100% in modified group, and was excellent in 5 cases, good in 6 cases, and fair in 2 cases with an excellent and good rate of 84.6%. The effectiveness of modified group was significantly better than that of traditional group (χ2=0.03, P=0.03). ConclusionReconstruction of EPL tendon function by modified EIP tendon transfer is effective and easy. It can increase strength of the transferred tendon and obtain satisfactory results, but the long-term effectiveness needs further follow-up.
Objective To access the efficacy and safety of different doses of metoprolol for patients with chronic heart failure. Methods We searched databases such as MEDLINE, EMbase, The Cochrane Library, CBM and CMCC. The search was conducted in March 2006. Randomised controlled trials, systematic reviews, and current guidelines of chronic heart failure were reviewed. The efficacy and safety of the high-dose (≥100 mg/d) and low-dose metoprolol (lt;100 mg/d) were compared. Results Only one small-scale, short-term randomised trial met our inclusion criteria. This found that metoprolol 100 mg/d was more effective than 25 mg/d and 50 mg/d. A sub-group analysis of MERIT-HF recommended individualized titration for drug administration. Most guidelines suggested that the administration of metoprolol CR/XL for chronic left ventricular systolic dysfunction should be performed by titrating up to 200 mg/d or the maximum tolerance dose. Patients receiving 100 mg/d might have more adverse events than those receiving a lower dose than this. However, in the long-term, it’s the benefits of high-dose treatment outweighed its risks. Race-related differences in tolerance or dose-related adverse effects were not found. Conclusion We couldn’t determine an optimal dose based on the existing evidence, but a target dose of metoprolol CR/XL 200 mg/d is safe and effective. We are unable to draw any conclusions about the relationship between dose and adverse effects.
ObjectiveTo review the research progress on the establishment of prevertebral pathway in the treatment of unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury by contralateral C7 nerve root transfer.MethodsThe literature about contralateral C7 nerve root transfer via prevertebral pathway at home and abroad was extensively reviewed, and the development, changes, advantages and disadvantages of various operation methods were analyzed and summarized.ResultsAfter unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury, it can be repaired by a variety of surgical methods of the contralateral C7 nerve root transfer via prevertebral pathway, which include the anterior subcutaneous tissue tunnel of the vertebral body, the passage under the sternocleidomastoid muscle, the posterior pharyngeal space and the anterior vertebral fascia passage, the modified posterior esophageal anterior vertebral passage, the anterior vertebral passage that cuts off the bilateral anterior scalene, and Huashan anterior pathway, etc. Among them, how to establish the shortest, safe, and effective way of anterior vertebral canal has been paid more attention and discussed by peripheral nerve repair doctors.ConclusionIt is a safe and effective surgical method to repair unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury patients with contralateral C7 nerve root transfer via prevertebral pathway.