Objective To evaluate clinical results of concomitant mitral valve replacement （MVR） and modified maze procedure with Atricure bipolar radiofrequency for chronic atrial fibrillation （AF）. Methods Clinical data of 59 patients with mitral valve diseases and chronic AF who underwent concomitant MVR and bipolar radiofrequency ablation in Subei People’s Hospital from June 2010 to September 2012 were retrospectively analyzed. There were 22 male and 37 female patients with their age of 29-71 （48±11） years. The AF duration was 1.2-26.0 （7.2±3.4） years. Preoperatively，there were 20 patients with New York Heart Association （NYHA） class Ⅱ，31 patients with NYHA class Ⅲ and 8 patients with NYHA class Ⅳ. There were 32 patients with moderate to severe mitral stenosis，9 patients with moderate to severe mitral regurgitation and 18 patients with combined mitral stenosis and regurgitation. There were 42 patients with tricuspid regurgitation. The left artial dimension was 39-98 （55.2±8.9） mm. Left atrial thrombus was found in 9 patients. Atricure bipolar radiofrequency system was used for right atrial ablation under normothermic cardiopulmonary bypass （CPB） with beating heart first，then for ablations of the left and right pulmonary vein orifices and left atrium under moderate hypothermia with heart arrest. MVR was performed after ablation procedures were completed. Amiodarone was routinely used postoperatively and patients were periodically followed up after discharge. Results There was no in-hospital death. CPB time was 65-180 （99±28）minutes，aortic cross-clamping time was 46-123 （69±17）minutes，and ablation time was 15-28 （21±4）minutes. Postoperatively，heart rhythm immediately changed to sinus rhythm （SR） in 44 patients，remained AF in 10 patients and atrial flutter in 1 patient. Temporary pacemaker was used for 4 patients with bradycardia （3 patients recovered SR and 1 patient remained AF later）. Fifty-eight patients were followed up after discharge for 6-33 months，and 1 patient was lost during follow-up. Patients’ SR rate was 86.2 % （50/58），91.4% （53/58），89.7 % （52/58），84.6 % （33/39）and 71.4 % （5/7）at discharge，3 months，6 months，1 year and 2 years after discharge respectively. There was no thrombotic event during follow-up. Conclusion Concomitant MVR and modified maze procedure with Atricure bipolar radiofrequency is a safe procedure for chronic AF with good short-term results.
Abstract: Objective To investigate the effect of modified ultrafiltration on attenuating the inflammatory reaction and endothelial cell activation or damage after cardiopulmonary bypass (CPB). Methods Forty patients undergoing cardiac operation with CPB were randomly divided into two groups. Ult rafiltration group ( n = 20) : patients underwent modified ultrafiltration after CPB; control group ( n = 20 ) : without ultrafiltration. Plasma concentrations of soluble intercellular adhesion molecules-1 ( s ICAM -1) and tumor necrosis factor-α (TNF-α) were determined with enzyme linked immunosorbent assay and radioimmunity pre-operat ively (baseline) , at the end of CPB, 4h and 24h post-operatively in both groups. Results The concentrations of sICAM -1 in the cont rol group at 4h and 24h po st-operatively were higher than those pre-operatively (P lt; 0. 01). The concentrations sICAM -1 in the ultrafiltrat ion group in pre-operatively and at the end of CPB were not significantly different from that of the control group, but they were lower at 4h and 24h post-operatively (269. 6±33. 8Lg/L vs. 409. 6±37. 3Lg/L , 245. 9±32. 2Lg/L vs. 379. 3±35. 7Lg/L ; P lt; 0. 01). In the ultrafiltration group, the concentration of TN F-α at the end of CPB and 4h post-operatively were higher than that pre-operatively (P lt; 0. 01). The concent rations of TNF-α in the ultrafiltration group at 24h post-operatively recoved to the pre-operative level (0. 177±0. 024Lg/L vs. 0. 172±0. 030Lg/L ; P gt;0.05). In the control group, the concentration of TN F-α was higher at the end of CPB than that pre-operatively (P lt;0.01) , and decreased slightly at 4h and 24h post-operatively, but remained higher than those pre-operat ively (0. 264±0.045Lg/L vs. 0.174±0.033Lg/L , 0.218±0.028Lg/L vs. 0.174±0. 033Lg/L ; P lt; 0. 05). Conclus ion CPB is known to induce inflammatory reaction and endothelial cell activation or damage. Modified ultrafiltration appears to attenuate these adverse reactions and is beneficial to postoperative convalescence.
Objective To compare the therapeutic effects between endoscopic thyroidectomy by anterior chest approach and modified Miccoli thyroidectomy. Methods Sixty patients with thyroid goiter were performed endoscopic thyroidectomy by anterior chest approach (endoscopic thyroidectomy by anterior chest approach group, n=30) and modified Miccoli thyroidectomy (modified Miccoli group, n=30) respectively. The operative time, the drainage volume, cosmetic benefit, the postoperative hospitalization time, the expenses of hospitalization and postoperative complications of two groups were compared. Results The operative time and the drainage volume after operation of endoscopic thyoidectomy by anterior chest approach group were significantly more than modified Miccoli group 〔(99.9±23.4) min vs. (74.0±29.6) min; (68.6±8.7) ml vs. (40.9±6.1) ml, respectively〕, Plt;0.05. The cosmetic benefit score of endoscopic thyoidectomy by anterior chest approach group was higher than that of modified Miccoli group 〔(4.7±0.2) points vs. (3.7±0.1) points〕, Plt;0.05. The postoperative hospitalization time and expenses of hospitalization were no significant differences between the two groups 〔(6.5±1.7) d vs. (5.5±0.9) d; (9 328.3±1 107.1) yuan vs. (8 568.2±1 032.3) yuan, respectively〕, Pgt;0.05. One case had transient hoarseness in 2 groups respectively, no other complications happened. Conclusions Modified Miccoli operation is both minimally invasive and cosmetic, but endoscopic thyroidectomy by anterior chest approach has better cosmetic benefit, which can release patients’ psychological trauma. The patients with specific cosmetic demand may choose endoscopic thyroidectomy by anterior chest approach.
Objective To investigate the therapeutic effectof the modified anterior approach in treatment of the patients with cervicothoracic junction spinal lesions. Methods From September 2000 to January 2005, 23 patients (15 males, 8 females) with spinal lesions in the cervicothoracic junction underwent a standard cervical approach, which was combined with apartial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Among thepatients, 3 had fracture, 7 had dislocation, 6 had tuberculosis, and 7 had tumor. The pathologic change regions was as follows: 2 in the C6-T1 segment, 2in the C6-T2 segment, 3 in the C7-T1 segment, 3 in the T3 segment, 8 in the T1 segment, and 5 in the T2egment. The classification of Frankel were as follows: 2 at grade A, 4 at grade B, 7 at grade C, 4 at grade D, and 6 at grade E. All the patients underwent a radical excision of the affected spinal bone, were given a proper tricortical iliac crest and anterior instrumentation to reconstruct the anterior spinal column, followed by immobilization in a brace for 3-6 months. Results The mean followup period was 30 months (range, 1042 months). Bony fusion was obtained in all the patients.One patient died of pulmonary cancer metastasis 10 months after operation. The nerve function of the spinal cord recovered at different degrees (1 at grade A, None at grade B, 2 at grade C, 10 at grade D, 10 at grade E). Conclusion Ourmodified anterior approach can provide a direct and safe access to the lesions in the region.
ObjectiveTo explore the feasibility and accuracy of modified three longitudinal and five transverse method in locating perforating branches before anterolateral thigh perforator flap (ALTP) repair.MethodsBetween January 2019 and December 2019, 41 patients with skin and soft tissue defects were repaired with ALTP. There were 31 males and 10 females. The age ranged from 18 to 61 years, with an average of 32 years. The soft tissue defects were caused by trauma in 38 cases, and the time from injury to operation was 3-7 days, with an average of 4 days. The wounds left after excision of scar contracture deformity because of burn in 3 cases. Soft tissue defects located at upper limbs in 16 cases and lower limbs in 25 cases. The size of soft tissue defects ranged from 10 cm×4 cm to 25 cm×12 cm. Before operation, zonesⅠ, Ⅱ, Ⅲ, and Ⅳwere formed on the anterolateral thigh by modified three longitudinal and five transverse method. The perforating branches were detected in these four zones by Doppler ultrasound, and the skin flaps were designed according to the wound area. The perforating branches were explored during operation, and the distribution and types of perforating branches in each zone and the relationship between perforating branches and lateral femoral cutaneous nerve were observed. The ALTP with the size of 12 cm×5 cm to 30 cm×10 cm was used to repair the wound, and the donor site was sutured directly or repaired with the flap. ResultsA total of 117 perforating branches were detected in 41 patients before operation, and 111 perforating branches were found during operation, with a false positive rate of 5%. The probability of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were 56%, 73%, 76%, and 66% respectively, and the false positive rates were –9%, 7%, 16%, and 4%, respectively. All perforating branches located near the trunk of lateral femoral cutaneous nerve, especially in posterolateral area. There were only 1 perforating branch in 6 cases, 2 perforating branches in 12 cases, 3 perforating branches in 10 cases, and 4 perforating branches in 13 cases. The main types of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were transverse perforating branches, oblique perforating branches, descending perforating branches, and descending perforating branches, respectively. Partial distal necrosis occurred in 2 cases and complete necrosis occurred in 1 case after operation, and the wounds were repaired with skin grafts. The remaining 38 flaps survived successfully, and the wounds and the incisions of donor sites healed by first intention. All patients were followed up 3 to 12 months, with an average of 6 months. The appearance and texture of the skin flap were acceptable, and linear scar remained in the donor site.ConclusionIt can simply locate and distinguish the perforating branches and better protect the lateral femoral cutaneous nerve by using the modified three longitudinal and five transverse method before ALTP repair.
Objective To summarize the effectiveness of modified surgical repair for severe ingrown toenail. Methods Between January 2005 and December 2010, 13 patients with severe ingrown toenail (16 toes) were treated. There were 12 males (15 toes) and 1 female (1 toe), aged 18-32 years with an average of 20 years. The disease duration was 1-15 years (mean, 2 years and 9 months). All affected toes were great toes. Ingrown toenail occurred bilaterally in 3 cases and unilaterally in 10 cases. Granulation tissue surrounding nail-edge, embedded toenail, and necrotic nail bed were completely removed; tension glue was used to make wound edge close to nail bed. Results At 3-5 days after operation, wound congestion, swelling, and exudation were improved; at 7 days, new nail bed formed; at 2 weeks, all wounds healed, and nail bed was epitheliogenic, wound edge healed well close to nail plate, and patients returned to normal life. At 6 months after nail extraction, new toenail grew and nail groove formed. No recurrent sign was found during 24-month follow-up. Conclusion Modified surgical repair is one of effective methods to treat severe ingrown toenail with the advantages of good appearance and low recurrent rate.
Objective To investigate the effect of new type ultrafiltration technique in preventing and relieving the main organ injury that may follow open heart surgery with cardiopulmonary bypass (CPB),and improve the operative effects and decrease the postoperative complications. Methods Thirty patients with congenital heart diseases were randomly divided into two groups. Modified ultrafiltration group: modified ultrafiltration was used after CPB; new type ultrafiltration group: new type ultrafiltration technique was used throughout CPB. The serum concentrations of nflammatory mediators,hematocrit,serum albumin concentrations, pulmonary function, operative duration time and main organ function parameters were measured in both groups. Results Ultrafiltration time after CPB in new type ultrafiltration group was significantly shorted as compared with modified ultrafiltration group（6.35±1.28 min vs. 12.45±4.52 min，P=0.000）; serum concentrations of interleukin6(IL-6)and tumor necrosis factor α(TNF-α) after CPB were significantly decreased as compared with modified ultrafiltration group（292.84±58.23 μg/L vs. 383.79±66.24 μg/L,P=0.000; 13.32±2.31 μg/L vs. 16.41±2.65 μg/L,P=0.000）; the hematocrit and serum albumin concentrations at the ten minutes after CPB were increased as compared with modified ultrafiltration group (0.39±0.04 vs. 0.35±0.03,P=0.003; 38.32±4.26 g/L vs. 34.04±2.83 g/L, P=0.003); the mechanical ventilation support time and ICU time after operation was shorted as compared with modified ultrafiltration group (Plt;0.05); main organ function was improved as compared with the modified ultrafiltration group. Conclusion The clinical application of new type ultrafiltration throughout CPB can effectively exclude some harmful inflammatory mediators, concentrate blood,short operation time,attenuate the main organ edema and injury.
Objective To investigate the effects of titanium modified by ultrasonic acid etching/anodic oxidation (UAT) loaded with endothelial progenitor cells-exosome (EPCs-exo) on proliferation and osteogenic and angiogenic differentiations of adipose-derived stem cells (ADSCs). Methods The adipose tissue and bone marrow of 10 Sprague Dawley rats were harvested. Then the ADSCs and EPCs were isolated and cultured by collagenase digestion method and density gradient centrifugation method, respectively, and identified by flow cytometry. Exo was extracted from the 3rd to 5th generation EPCs using extraction kit, and CD9 and CD81 were detected by Western blot for identification. The three-dimensional printed titanium was modified by ultrasonic acid etching and anodic oxidation to prepare the UAT. The surface characteristics of UAT before and after modification was observed by scanning electron microscopy; UAT was placed in EPCs-exo solutions of different concentrations (100, 200 ng/mL), and the in vitro absorption and release capacity of EPCs-exo was detected by BCA method. Then, UAT was placed in DMEM medium containing different concentrations of EPCs-exo (0, 100, 200 ng/mL), and co-cultured with the 3rd generation ADSCs to construct UAT-ADSCs-exo. Cell morphology by laser confocal microscopy, live/dead cell staining, and cell proliferation were observed to evaluate biocompatibility; alkaline phosphatase (ALP) staining and alizarin red staining, RT-PCR detection of osteogenesis-related genes [osteocalcin (OCN), RUNT-related transcription factor 2 (Runx2), ALP, collagen type 1 (COL-1)] and angiogenesis-related gene [vascular endothelial growth factor (VEGF)], immunofluorescence staining for osteogenesis (OCN)- and angiogenesis (VEGF)-related protein expression were detected to evaluate the effect on the osteogenic and angiogenic differentiation ability of ADSCs. Results Scanning electron microscopy showed that micro-nano multilevel composite structures were formed on the surface of UAT. About 77% EPCs-exo was absorbed by UAT within 48 hours, while EPCs-exo absorbed on the surface of UAT showed continuous and stable release within 8 days. The absorption and release amount of 200 ng/mL group were significantly higher than those of 100 ng/mL group (P<0.05). Biocompatibility test showed that the cells in all concentration groups grew well after culture, and the 200 ng/mL group was better than the other groups, with fully spread cells and abundant pseudopodia, and the cell count and cell activity were significantly higher than those in the other groups (P<0.05). Compared with the other groups, 200 ng/mL group showed enhanced ALP activity and mineralization ability, increased expressions of osteogenic and angiogenic genes (OCN, Runx2, COL-1, ALP, and VEGF), as well as increased expressions of OCN and VEGF proteins, with significant differences (P<0.05). Conclusion EPCs-exo can effectively promote the adhesion, proliferation, and osteogenic and angiogenic differentiation of ADSCs on UAT surface, the effect is the most significant when the concentration is 200 ng/mL.
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
Objective To modify orthotopic liver transplantation method with two-cuff technique. Methods On the basis of cuff technique, the donor liver was perfused through the abdominal aorta with 20 ml cold perfusate. The anastomosis of the suprahepatic vena cave(SVC) was sutured end-to-end with 8/0 nylon line,and the continuity of infrahepatic vena cave(IVC) and portal vein(PV) were established by means of cuff method respectively.The bile duct anastomosis was performed by internal stent. Results Orthotopic liver transplantations were performed in 360 rats. The time for donor operation and liver preparation was (31.2±5.0) min and (12.0±3.0)min，and the recipient operative and anhepatic time was (45.0±5.5) min and (20.0±2.5) min, respectively. The two-day survival rate was 91.4%.In nonintervention group, one-week survival rate was 86.5%. Conclusion The modified model is easily available and highly reproducible which provides a practical and stable experimental model for the study of liver transplantation.