ObjectiveTo analyze the early- and middle-term prognosis of various surgical methods in children with congenital aortic valve diseases, to provide reference for surgical methods in children with aortic valve stenosis or regurgitation.MethodsThe clinical data of 85 children with various aortic valve diseases treated in the Children’s Hospital of Fudan University from January 2005 to December 2018 were retrospectively analyzed. There were 64 males and 21 females, with an average age of 45 months ranging from 5 days to 15 years. Among them 18 patients underwent balloon aortic valvuloplasty (BAV), 8 surgical aortic valvotomy (SAV), 27 aortic valve autogenous pericardium repair, 16 mechanical arterial valve replacement and 16 Ross operation. They were followed up for 6.25±2.76 years. The re-intervention and survival status after different operations were analyzed.ResultsThere were 3 deaths and 17 reoperations in 85 children. The 5-year survival rate of the patients with SAV, BAV, aortic valve autogenous pericardium repair, mechanical arterial valve replacement and Ross operation was 87.4%, 88.9%, 100.0%, 100.0% and 100.0%, respectively; there was no statistical difference in the early and middle-term survival rates among various operations (P>0.05). The 5-year free from re-intervention rate of the patients with SAV, BAV, aortic valve autogenous pericardium repair, mechanical arterial valve replacement and Ross operation was 44.4%, 18.4%, 100.0%, 66.9% and 80.5%, respectively; there was a statistical difference in the early and middle-term re-intervention rate among various operations (P<0.05).ConclusionThe operation of congenital aortic stenosis or regurgitation needs to be performed according to the pathological changes of the valvular tissues. For children with severe lesions, SAV is recommended for the first intervention. For congenital aortic stenosis, SAV and BAV are both palliative operations which need further evaluation and re-intervention. Ross operation and mechanical arterial valve replacement have low re-intervention rate, and the middle- and long-term follow-up shows that the effect is accurate. Aortic valve autogenous pericardium repair is expected to become a method to delay or replace Ross operation and valve replacement.
Lower extremity movement is a complex and large range of limb movement. Arterial stents implanted in lower extremity are prone to complex mechanical deformation, so the stent is required to have high comprehensive mechanical properties. In order to evaluate the mechanical property of different stents, in this paper, finite element method was used to simulate and compare the mechanical properties of six nitinol stents (Absolute Pro, Complete SE, Lifestent, Protégé EverFlex, Pulsar-35 and New) under different deformation modes, such as radial compression, axial compression/tension, bending and torsion, and the radial support performance of the stents was verified by experiments. The results showed that the comprehensive performance of New stent was better than other stents. Among which the radial support performance was higher than Absolute Pro and Pulsar-35 stent, the axial support performance was better than Complete SE, Lifestent and Protégé EverFlex stent, the flexibility was superior to Protégé Everflex stent, and the torsion performance was better than Complete SE, Lifestent and Protégé Everflex stent. The TTR2 type radial support force tester was used to test the radial support performance of 6 types, and the finite element analysis results were verified. The mechanical properties of the stent are closely related to the structural size. The result provides a reference for choosing a suitable stent according to the needs of the diseased location in clinical applications.
Surgery is an important method for the treatment of malignant tumors. Sevoflurane is one of the most common general anesthetics, which can directly or indirectly affect the biological behavior of cells and the immune function of tumor patients, thereby affecting the recurrence and metastasis of tumor patients after surgery. From the aspects of microRNA, matrix metalloproteinase, phosphatidylinositol-3-kinase/Akt signaling pathway and hypoxia-inducible factor-1α, this article summarizes the molecular mechanisms of sevoflurane affecting the biological behavior of tumor cells, and clarifies the regulation mechanism of sevoflurane on the immune function of tumor patients. It is expected to provide a theoretical basis for precise anesthesia for tumor patients, and to provide medication basis for reducing postoperative recurrence and metastasis of tumor patients.
Objective To investigate the efficacy and prognostic factors of pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR) with chronic renal failure (CRF). MethodsA retrospective study. From January 2016 to June 2021, a total of 82 eyes of 58 patients diagnosed with PDR combined with CRF and treated with PPV in Department of Ophthalmology, The Second Hospital of Hebei Medical University were included in the study. There were 32 cases in males and 26 cases in females. The mean age was (48.45±10.41) years. The course of renal failure was (4.15±3.23) years, and the course of diabetes was (14.45±6.71) years. All patients undergo best-corrected visual acuity (BCVA). The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for recording. The mean number of logMAR BCVA was 2.04±0.82 (0.7-2.8). The duration of vitreous hemorrhage averaged (2.65±1.55) months. There were 38 eyes (46.3%, 38/82) with traction retinal detachment; 32 eyes had a history of panretinal photocoagulation (PRP) treatment (39.0%, 32/82). All eyes were treated with 25G PPV. Patients with traction retinal detachment were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) 3 days before surgery. Opacification of the lens affected the operation operator combined with phacoemulsification. Biochemical indexes such as hemoglobin, glycosylated hemoglobin, albumin, creatinine, uric acid, and alternative treatment (non-dialysis/hemodialysis/peritoneal dialysis) were collected. Postoperative follow-up time was ≥6 months. χ2 test or Fisher's exact test were used for comparison between groups. A logistic regression model was used for multivariate analysis, and Spearman correlation analysis was used to evaluate the correlations between variables. ResultsAt 6 months after surgery, the mean logMAR BCVA was 1.16±0.57. Compared with logMAR BCVA before surgery, the difference was statistically significant (t=－0.837, P＜0.001); 44 eyes had BCVA ≥0.1 and 38 eyes had BCVA ＜0.1. Postoperative vitreous hemorrhage (PVH) was observed in 17 eyes after surgery (20.7%, 17/82). PVH occurred in 15 (46.9%, 15/32), 1 (2.3%, 1/44), and 1 (16.7%, 1/6) eyes in patients without dialysis, hemodialysis and peritoneal dialysis, respectively. There was significant difference between those without dialysis and those on hemodialysis (χ2=26.506, P＜0.05). There was no significant difference between peritoneal dialysis patients and those without dialysis and hemodialysis patients (χ2=2.694, 2.849; P＞0.05). PVH occurred in 3 (10.0%, 3/30) and 14 (27.0%, 14/52) eyes of vitreous cavity filled with silicone oil and perfusion fluid, respectively. The difference was statistically significant (χ2=3.315, P＜0.05); 1 (33.3%, 1/3) and 10 (71.4%, 10/14) eyes were treated with PPV again, respectively, and the difference was statistically significant (P＜0.05). Neovascular glaucoma (NVG) occurred in 12 eyes (14.6%, 12/82). Logistic regression analysis showed that age [odds ratio (OR) =0.911, P＜0.05], diabetic retinopathy (DR) stage (OR=7.229, P＜0.05), renal failure duration (OR=0.850, P＜0.05), operation time (OR=1.135, P＜0.05) was an independent risk factor for poor vision prognosis. Diabetes duration (OR=1.158, P＜0.05), renal failure duration (OR=1.172, P＜0.05) and alternative therapy were independent factors affecting the occurrence of PVH. Diabetes duration (OR=1.138, P＜0.05) and renal failure duration (OR=1.157, P＜0.05) were independent risk factors for postoperative NVG. Spearman correlation analysis showed that PVH was strongly correlated with post-operative NVG (r=0.469, P＜0.01). There was no significant correlation between blood glucose, hemoglobin, creatinine and blood urea nitrogen and prognosis of postoperative vision, PVH and NVG occurrence (P＞0.05). ConclusionsIn PDR patients with CRF, DR Stage, age, renal failure course and operation duration are correlated with vision prognosis. Compared with those who do not receive alternative therapy, hemodialysis treatment can reduce the occurrence of PVH and NVG after surgery.
ObjectiveTo review the research progress of tissue engineered scaffolds and stromal-derived factor 1 (SDF-1) composite graft. MethodsThe recent papers about SDF-1 with different kinds of tissue engineered scaffolds were reviewed and analyzed. The primary mechanism of SDF-1 homing function for stem cells was retrospected. The results of different kinds of tissue engineered scaffolds carrying SDF-1 for repairing the injured tissues and organs were reviewed. ResultsIt is shown that SDF-1 combined with tissue engineered scaffolds will play a role of multipotent stem cells chemotaxis, however, the exact chemotaxis mechanism has not been fully understood. It still needs more researches of SDF-1 effects in vivo. ConclusionAlthough some research progress has been made in regeneration in situ of tissue engineered scaffolds combined with SDF-1, it will need to further study on the mechanism of chemotactic functions of SDF-1 and its influence on proliferation and differentiation of cells.
ObjectiveTo investigate the clinical effect of surgical treatment of Pilon fractures accompanied with fibula fractures with the improved double operative approaches. MethodsBetween January 2012 and June 2015, 19 patients with closed Pilon fractures accompanied with fibula fractures (Rüedi-Allgöwer type Ⅲ) underwent open reduction and internal fixation with improved anterior-median incision and posterior-lateral incision. There were 13 males and 6 females, aged 35 years on average (range, 23-68 years). Injury was caused by traffic accident in 11 cases, falling from height in 7 cases, and crash injury of heavy object in 1 case. According to AO/OTA classification, there were 4 cases of type C2, and 15 cases of type C3. According to Tscherne-Gotzen classification of soft tissue defect, 6 cases were rated as grade 1 and 13 cases as grade 2. The interval of injury and operation was 6-18 days (mean, 10.3 days). After operation, reduction of Pilon fracture was evaluated by the Burwell-Charnley radiological evaluation criteria, and the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. ResultsThe operation time was 1.8-4.6 hours (mean, 2.4 hours); the intraoperative blood loss was 200-500 mL (mean, 310 mL). All the 19 patients were followed up for 13.7 months on average (range, 12-18 months). The fracture healing time was 3.6 months on average (range, 2.5-8.0 months). Postoperative complications included anterior-median incision necrosis in 2 cases, traumatic arthritis in 2 cases, and ankle instability in 1 case. According to Burwell-Charnley radiological evaluation criteria, anatomical reduction was obtained in 15 cases and satisfactory reduction in 4 cases. According to AOFAS score, the excellent and good rate was 84.2% (excellent in 11 cases, good in 5 cases, and fair in 3 cases). ConclusionThe improved anterior-median incision combined with posterior-lateral incision is a safe and effective method to treat complex Pilon fractures accompanied with fibula fractures, which has the advantages of simple operation, adequate exposure and minimal invasion.
Objective To compare the application effects of three psychometric instruments including SF-36, FLIC and QOL-LC in measuring the quality of life of patients with liver cancer. Methods A total of 105 in-patients with liver cancer selected from 2010 to 2011 were included. The quality of life was measured by FLIC, SF-36 and QOL-LC, respectively, and the reliability, validity and responsiveness were calculated and analyzed. Results The reliability and validity of QOL-LC were better than those of SF-36 and FLIC. Both QOL-LC and FLIC showed significant differences in responsiveness based on the changes of physical function and overall quality of life (QOL-LC: t=5.08, P=0.000, t=3.16, P=0.002; FLIC: t=4.02, P=0.000, t=2.21, P=0.030). Except for general health and mental health, the other domains of SF-36 showed significant differences in changes after treatment (physical function: t=5.94, P=0.000; physical role: t=3.07, P=0.003; body pain: t=3.21, P=0.002; vitality: t=3.22, P=0.002; social role: t=2.60, P=0.012; emotional role: t=3.28, P=0.002). Conclusion QOL-LC is a specific scale for liver cancer, and it should be used preferentially. SF-36 and FLIC can measure the general state of quality of life and can be used in patients with liver cancer when specific scale is not available.
ObjectiveTo compare the effectiveness of single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction by two methods. MethodsQualified for the selective standard, 120 patients with ACL injury between May 2010 and April 2013 were divided into 4 groups: double-bundle reconstruction was performed by the conventional procedure in 30 cases (group A); anatomic double-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group B); single-bundle reconstruction was performed by the conventional procedure in 30 cases (group C); and anatomic single-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group D). There was no significant difference in gender, age, disease duration, pathogenesis, injury side, Lysholm scores, International Knee Documentation Committee (IKDC) ratings, Lachman test, anterior drawer test, and pivot shift test among groups (P>0.05). The impingement between the ACL implants and intercondylar notch was evaluated with postoperative immediate MRI scan and the three-dimensional digital model. Lachman test, anterior drawer test, and pivot shift test results, Lysholm scores, and IKDC ratings were used to compare the effectiveness among groups after operation. ResultsThree-dimensional digital model after operation showed impingement in 11 cases (36.7%) of group A, 1 case (3.3%) of group B, 9 cases (30.0%) of group C, and no impingement in group D. The impingement rates of groups A and C were significantly higher than that of groups B and D (P<0.05), but no significant difference was found between groups A and C, and between groups B and D (P>0.05). All incisions healed by first intention, and no early complication was found. The patients were followed up 24-30 months (mean, 26 months). Lysholm scores, Lachman test, anterior drawer test, and pivot shift test results at 24 months after operation were significantly better than preoperative ones in 4 groups (P<0.05), but no significant difference was shown among groups (P>0.05). The IKDC ratings of groups B and D were significantly better than that of groups A and C (P<0.05); but there was no significant difference between groups A and C, and between groups B and D (P>0.05). ConclusionCompared with the conventional procedure, the individual anatomic single- and double-bundle reconstruction in the original ACL residual footprints has decreased impingement rate and increased IKDC rating.
Objective To summarize the molecular biological research progress of non-coding RNAs modulating osteoarthritis (OA), and provide a reference basis for biological study and clinical treatment of OA. Methods Recent domestic and foreign related literature about the regulation of OA pathological process by non-coding RNAs was widely reviewed. Results Non-coding RNAs can be divided into three types based on the length of RNA. A lot of non-coding RNAs participating in OA pathological process are screened out by high throughput sequencing technology and microarray technology, and it is verified that these non-coding RNAs involve in the regulation of OA by RT-PCR. The mechanism of OA mediated target is clarified by knocking-down and overexpressing of the most prominent expressed non-coding RNAs in OA. There are the complicated gene expressed network topology in non-coding RNAs, and between non-coding RNAs and coding RNAs. It provides a basis for clearing the effect of gene structure and function, and finding the definite therapeutic target of OA. Conclusion There is preliminary study on molecular biological mechanism of non-coding RNAs mediating OA, but the key structure or sequence of non-coding RNAs, formation and interaction of effecting composite structure about mediating OA are unknown, and it needs further study.
Motor imagery (MI), motion intention of the specific body without actual movements, has attracted wide attention in fields as neuroscience. Classification algorithms for motor imagery electroencephalogram (MI-EEG) signals are able to distinguish different MI tasks based on the physiological information contained by the EEG signals, especially the features extracted from them. In recent years, there have been some new advances in classification algorithms for MI-EEG signals in terms of classifiers versus machine learning strategies. In terms of classifiers, traditional machine learning classifiers have been improved by some researchers, deep learning and Riemannian geometry classifiers have been widely applied as well. In terms of machine learning strategies, ensemble learning, adaptive learning, and transfer learning strategies have been utilized to improve classification accuracies or reach other targets. This paper reviewed the progress of classification algorithms for MI-EEG signals, summarized and evaluated the existing classifiers and machine learning strategies, to provide new ideas for developing classification algorithms with higher performance.