Atrial fibrillation is the main complication of patients who suffer from valvular heart disease (VHD), which may lead to an increased susceptibility to ventricular tachycardia, atrial dysfunction, heart failure, and stroke. Therefore, seeking a safe and effective therapy is crucial in prolonging the lives of patients with VHD and improving their quality of life.Our target database included PubMed, Web of Science, Embase, and Cochrane Library, from which published articles were retrieved from inception to June 2020. We retrieved all randomized controlled trials (RCTs) that compared patients undergoing valve surgery with (VSA) or without ablation (VS) procedure. Studies to be included were screened and data extraction was performed independently by 2 investigators. The Cochrane risk-of-bias table was used to evaluate the methodological quality of the included RCTs. The mean difference (MD) with 95% confidence interval (CI) and relative risk (RR) ratio was calculated to analyze the data. Heterogeneity was evaluated using I2 and chi-square tests. Egger test and the trim and fill analysis were used to further determine publication bias.Fourteen RCTs that included 1376 patients were eventually selected for this meta-analysis. Surgical ablation was found to be effective in restoring sinus rhythm in valvular surgery patients at discharge (RR 2.91, 95% CI [1.17, 7.20], I2 97%, P = .02), 3 to 6 months (RR 2.85, 95% CI [2.27, 3.58], I2 49%, P < .00001), 12 months, and more than 1 year after surgery (RR 3.54, 95% CI [2.78, 4.51], I2 27%, P < .00001). All-cause mortality (RR 0.98, 95% CI [0.64, 1.51], I2 0%, P = .94) and stroke (RR 1.29, 95% CI [0.70, 2.39], I2 0%, P = .57) were similar in the VSA and VS groups. Compared with VS, VSA prolonged cardiopulmonary bypass time (MD 30.44, 95% CI [17.55, 43.33], I2 88%, P < .00001) and aortic cross-clamping time (MD 19.57, 95% CI [11.10, 28.03], I2 89%, P < .00001). No significant differences were found between groups with respect to the risk of bleeding (RR 0.64, 95% CI [0.37, 1.12], I2 0%, P = .12), heart failure (RR 1.11, 95% CI [0.63, 1.93], I2 0%, P = .72), and low cardiac output syndrome (RR 1.41, 95% CI [0.57, 3.46], I2 18%, P = .46). However, the demand for implantation of a permanent pacemaker was significantly higher in the VSA group (RR 1.84, 95% CI [1.15, 2.95], I2 0%, P = .01).Although we found high heterogeneity in the restoration of sinus rhythm at discharge, we assume that the comparison is valid at this time, given the current state in the operating room. This study provides evidence of the efficacy and security of concomitant ablation intervention for patients with VHD and atrial fibrillation. Surgical ablation would increase the safety of implantation of a permanent pacemaker in the population that underwent valve surgery.
Objective To analyze the pathological characteristics of IgA nephropathy(IgAN).Methods A positive diagnosis of primary IgAN was made after successive native renal biopsies in 407 in-patients.The pathological features of these patients were analyzed retrospectively.ResultsLee′s pathological grades of Ⅱ and Ⅲ were the most common types.Pathologically,focal segmental glomerulonephritis accounted for 38.04%,mesangial proliferative glomerulonephritis for 32.24% and minimal lesion for 24.28% in 407 patients with IgAN.Lee′s classification was correlated to the intensity of IgA deposition(Z=17.187,P0.05).Conclusion The pathological characteristics of IgAN are varied.There is a correlation between Lee′s classification and the intensity of IgA deposition in IgAN.
Objective To observe the compensatory changes of rabbits’neck vascular blood flow after ligation of rabbits’ left vertebral artery(VA),in order to verify the relevance between the VA and cerebral ischemia.Methods A rabbit model of left VA ligation was made.Color Doppler ultrasound was used to detect changes in the neck vessels of the experimental group before and after VA ligation.Observe brain ischemia and necrosis after VA ligation through histopathology.Results The vmax,vmin,standard aleviation(SD) and resistance index(RI) of VA on the right side were higher after the left VA ligation;vascular diameter(VD) became bigger after the operation.The vmax,SD and pulsatility index(PI) of the common carotid artery(CCA) became higher than pre-operation.The RI of the CCA on the right side became higher than pre-operation.Both the vmax and the vmin of the right internal carotid artery were higher than pre-operation.Both the PI and RI of the left internal carotid artery were higher after the left VA ligation.Pathological showed no necrosis in brain tissues after surgery.Conclusion After ligation of the rabbits’unilateral VA,the neck vessels compensatory blood flow will accelerate and the diameters will become bigger in order to prevent brain tissue from ischemic necrosis,which has guiding significance to the recognization of VA injury and cervical spondylosis of VA.
This study aimed to find other methods of blind insertion of Arndt endobronchial blocker (AEB) for lung isolation when a fiberoptic bronchoscope (FOB) is unavailable. We compared the effectiveness and safety of 3 insertion techniques of AEB: Gum elastic bougie (GEB)-, bougie combined with cricoid displacing (BCD)-, and fiberoptic bronchoscope (FOB)-guided insertion. Seventy-eight patients undergoing esophageal procedure and requiring left thoracotomy were randomly assigned to 1 of 3 groups: GEB group, BCD group, and FOB group. We recorded the successful placement of AEBs at first attempt, placement time, malposition of AEBs in supine and lateral decubitus position, the bronchus injury score, and other complications. The successful placement of AEB for the first attempt was 22/26, 25/26, and 26/26 patients in GEB, BCD, and FOB groups, respectively. The placement times in GEB and BCD groups were longer than those in the FOB group (P < 0.05). AEB malposition occurred in 1/26, 2/26, 1/26 patients after lateral decubitus position, and AEBs were repositioned in 5/26, 3/26, 1/26 patients by FOB due to poor lung isolation in GEB, BCD, and FOB groups, respectively. There was no difference for the bronchus injury scores and other complications among 3 groups (P > 0.05). Bougie and cricoid displacing-guided blind insertion of AEB seems to be a novel method, which is an effective and safe alternative when FOB was unavailable.
Objective To analyze the clinicopathological characteristics of different types of IgA nephropathy(IgAN). Methods Retrospective analysis of clinical and pathological data of 402 primary IgAN cases diagnosed with renal biopsy was performed.IgAN was divided into 6 types of isolated hematuria(I-H),asymptomatic urinary abnormality(U-ab),recurrent gross hematuria(R-GH),vasculitis(Vas),massive proteinuria(MP) and hypertension(HT). Results U-ab and HT were clinically the most common IgAN.Lee grade Ⅱ and Ⅲ were pathologically the most common IgAN. IgA type,IgA+C3 type and IgA+IgM+C3 type were the most common types on the immunofluorescence. As the deterioration of renal function and the severity of pathological damage increased,the 24-hour urine protein and serum creatinine were increased,but estimated glomerular filtration rate(eGFR) and hemoglobin gradually decreased.eGFR was the greatest factor to impact renal pathological damage. Conclusion The clinical manifestations of IgAN is closely associated with renal pathology.
Objectives The extracellular matrix(ECM)of pigskin origin has been extensively used in the field of tissue engineer- ing,but some times it was required to be modified by some other materials for different objectives.In this study,we fabricated a complex with PLGA acellular-pigskin,and its property ofbiomechanics and 3-D structure were detected.Methods(1)Samples were prepared with PLGA and acellular pigskin.(2)The microarchitecture was observed with SEM.(3)Their elongation property was tested by me- chanical test machine.Results(1)Mechanical testing showed that the stress was 1.32 MPa,strain was 1.32 and the elastic modulus was 1.6×10~6 Pa.(2)SEM observing showed PLGA has permeated into the porous-structure of acellular pigskin to form a cellular structure. Conclusions The complex showed appropriate mechanical properties,and its cellular structure is suitable for cell adhering and migration. So,the scaffold fabricated with PLGA and acellular pigskin maybe a potential scaffold of tissue engineering.
Objective
To understand the clinical characteristics and analyze the risk factors of extraurothelial recurrence(EUR) of upper urinary tract urothelial carcinoma(UTUC).
Method
We retrospectively reviewed 269 patients with UTUC who had performed radical nephroureterectomy between 2003 and 2013 in our hospital. Of all the patients, 158 were male and 111 were female, average age was 67(range: 37-86), 157 occurred in renal pelvis and 112 in ureter, 122 received open RNU and 147 received laparoscopic RNU. Univariate and multivariate analyses were performed using Cox proportional hazard regression models to identify prognostic factors for extraurothelial recurrence.
Results
The follow-up period was 4.4~131.8 months(average 43.7 months). 65 patients had a extraurothelial recurrence with a median intermittent period of 4.1~71.3months (average 18.6). The 1 year, 3 year and 5-year EUR-free survival rates were 89.0%, 78.6% and 75.9% respectively. In univariate analysis, sessile tumor(RR=5.142, P=0.000), tumor multifocality(RR=2.252, P=0.016), pT stage≥3(RR=5.400, P<0.00.4=, high-grade tumor(G3)(RR=2.830, P=0.010), LVI(RR=4.515, P=0.000), concomitant variant histology(RR=5.114, P=0.000), preoperative NLR≥2.0(RR=2.911, P=0.001), and preoperative plasma fibrinogen≥3.2 g/L (RR=2.217, P=0.005) were associated with EUR. In multivariate analysis, sessile tumor(RR=2.523, P=0.000), pT stage≥3(RR=3.281, P=0.016), and LVI(RR=2.494, P=0.009) were independent risk factors. Patients were stratified into low, intermediate and high-risk groups and there are statistically significant differences in survival among the 3 groups(P<0.001).
Conclusions
The extraurothelial recurrence rate is high in UTUC patients and the majority was occured within 3 years after surgery. The initial local area and lung, liver was the most prevalent site of EUR. Sessile tumor, pT stage≥3, and LVI were independent risk factors for extraurothelial recurrence.
Key words:
Upper urinary tract urothelial carcinoma; Recurrence; Characteristics; Risk factors
：Objective To explore thefeasibility of building tissue engineered cartilage by bone marrow stromal cells andpbotografting modified copolymers of 3-hydroxybutymte and 3-hydroxyvalerate.Methods SheepBMSCs were seeded in three-dimensional photografting modified PHBV scaffoids.Twenty-fourhours later.composites were cultured with ehondrogenically inductivemedium(DMEM)containing TGF-B(10 ng/m1),IGF-1(150 ng/m1)and 20% fetal bovine serum.Threeweeks later,the constructs were evaluated by scanning electron microscopy(SEM)and lightmicroscopy with alcian blue,safrine 0 and type Ⅱcollageimmunohistochemical staining.GAG contents of constructs were determined byDMB(1,9-dimethylmethylene blue)binding assay at weekly intervals up to 3 weeks.Thecomposites were implanted subcutaneously in sheep abedoml and were evaluatedmacroscopically and bistologically at 4 weeks postoperatively.Results SEM photographshowed.after one week culture,cell morphology changed from fibroblast-like elongatedspindle to the flat rounded like chondrocytes,and the extra cellular matrix also increasedobviousl~.Furthmore,with the culture time extension,this change were more evident.HEstaining showed that cells filled all the inter-connected pores in the constructs.And morecells were observed in the outer layer of the constructs.ECM(extraeellular matrix)Wasstrongly positive by Aleian blue,Safrine O staining and type Ⅱ collage immunohistechemical staining.DMB binding assay revealed that the inducedBMSCs GAG secretion(1306.7±192.3)wag significantly higher than BMSCs(205.0±26.2)(P<0.001),butit was significantly lower than passage 2 ehondrocytes(1969.2±235.3)(P<0.001).SaltineO and type Ⅱ collageimmunohistochemical staining were positive in constructs implantedsubcutaneously.Conclusion Tissue engineered cartilage could be obtained using BMSCs andphotografting modified PHBV,but there are still gaps physiologically between theconstructs and the nature cartilage.
Key words:
Cartilage; Tissue engineering; Bone marrow stromalcells(BMSCs)
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