目的:对前路病灶清除取髂骨植骨融合K型钢板内固定治疗胸腰段脊柱结核的临床疗效进行分析。方法:2003年1月至2007年1月,对我科22例患者进行随访。结果:20例患者腰痛完全消失,植骨块完全融合,内固定材料稳定牢固,无松动及断裂,脊柱后突有效纠正,仅2例患者结核复发。结论:前路病灶清除植骨融合K型钢板内固定术能有效治疗胸腰段脊柱结核,有效纠正脊柱后突畸形,恢复椎体的高度,建立脊柱的稳定性。
Mitral regurgitation (MR) is one of the most common valvular heart diseases, imposing a significant economic burden on society. Transcatheter mitral valve replacement (TMVR), as an emerging therapeutic strategy for MR, is expected to fill the gap in the treatment of transcatheter edge-to-edge repair in the future. This article reviews the progress of TMVR clinical research both domestically and internationally in the past two years and analyzes the current challenges faced by TMVR research, such as mitral valve anatomy, device access transition, valve design, and mitral valve calcification. Finally, the prospects of mitral valve product research are discussed.
ObjectiveTo systematically review the predictive factors of new-onset conduction abnormalities(NOCAs) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) patients. MethodsThe CNKI, VIP, WanFang Data, PubMed, Cochrane Library and EMbase databases were electronically searched to collect the relevant studies on NOCAs after TAVR in patients with BAV from inception to December 5, 2022. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsSix studies involving 758 patients with BAV were included. The results of the meta-analysis showed that age (MD=−1.48, 95%CI −2.73 to −0.23, P=0.02), chronic kidney disease (OR=0.14, 95%CI 0.06 to 0.34, P<0.01), preoperative left bundle branch block (LBBB) (OR=2.84, 95%CI 1.11 to 7.23, P=0.03), membranous septum length (MSL) (MD=0.93, 95%CI 0.05 to 1.80, P=0.04), implantation depth (ID) (MD=−2.06, 95%CI −2.96 to −1.16, P<0.01), the difference between MSL and ID (MD=3.05, 95%CI 1.92 to 4.18, P<0.01), and ID>MSL (OR=0.27, 95%CI 0.15 to 0.49, P<0.01) could be used as predictors of NOCAs. ConclusionCurrent evidence shows that age, chronic kidney disease, LBBB, MS, ID, the difference between MSL and ID, and ID>MSL could be used as predictors of NOCAs. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusion.
Objective To investage the relationship among the visual loss, the disease course, and retinal circulation time in patients with central retinal artery occlusion (CRAO)． Method The data about the central vision, disease course, and results of fundus fluorescein angiography (FFA) of 99 patients (99 eyes) with CRAO were statistically analyzed. Results Between 2 days and 21 days after the occurrence of CRAO, the disease course didnrsquo;t relate to the central visual loss (Pgt;0.05). In the retinal circulation, a correlation was found between the time of fluorescein perfusion and the central visual loss (Plt;0.05) but not between the time of arm-retina circulation and the central visual loss (Pgt;0.05). Conclusion In the duration of retinal circulation, the time of fluorescein perfusion in retinal artery relates to the central visual loss; the longer the duration is, the worse the vision is. (Chin J Ocul Fundus Dis, 2007, 23: 177-179)
Objective To review the mechanisms of cholesterol gallstones caused by female hormone so as to explore new treatments to prevent gallstones associated with estrogen and progesterone. Methods The literatures on gallstones related with female hormone were reviewed and the mechanisms of cholesterol gallstones were summarized. Results The cholesterol gallstones mechanisms was affected by estrogen through genomic effects，and the nucleation of cholesterol was promoted by estrogen through nongenomic，which resulted in the formation of cholesterol gallstones. And the bile empty dysfunction associated with estrogen through nongenomic effects was also the reason of cholesterol gallstone formation. The G proteins α subunit responsible for the motility of gallbladder were disrupted by progesterone through genomic effects，and the ionic channels and signal transduction were also interfered through nongenomic pathway，which impaired the contraction of gallbladder. However，the nongenomic effects might not play an important role in the gallstones formation caused by progesterone. Conclusions The mechanisms of cholesterol gallstones formation associated with female hormone are complicated，the understanding of chelesterol gallstones formation mechanisms might be helpful to prevent gallstones associated with estrogen and progesterone.
Objective To investigate the anatomical evidence of low end-to-side anastomosis of median nerve and ulnar nerve in repair of Dejerine Klumpke type paralysis or high ulnar nerve injury. Methods Twelve formaldehyde anticorrosion specimens (24 sides) and 3 fresh specimens (6 sides) were observed. There were 9 males (18 sides) and 6 females(12 sides). The specimen dissected under the microscope. S-shape incision was made at palmar thenar approaching ulnar side, the profundus nervi ulnaris and superficial branch of ulnar nerve were separated through near end of incision, and the recurrent branch of median nerve and comman digital nerve of the ring finger were separated through far end of incision. The distances from pisiform bone to the start point of the recurrent branch of median nerve, and to the start point of comman digital nerve of the ring finger were measured. The width and thickness of the profundus nervi ulnaris and superficial branch of ulnar nerve, and the recurrent branch of median nerve and comman digital nerve of the ring finger were measured, and the cross-sectional area was calculated. The number of nerve fiber was determined with HE staining and argentaffin staining. Results The crosssectional area and the number of nerve fiber were (2.46 ± 1.03) mm2 and 1 305 ± 239 for the profundus nervi ulnaris, (2.62 ± 1.75) mm2 and 1 634 ± 343 for the recurrent branch of median nerve, (1.60 ± 1.39) mm2 and 1 201 ± 235 for the superficial branch of ulnar nerve, and (2.19 ± 0.89) mm2 and 1 362 ± 162 for the comman digital nerve of the ring finger. There were no significant differences (P gt; 0.05) in the cross-sectional area and the number of nerve fiber between the profundus nervi ulnaris and the recurrent branch of median nerve, between the superficial branch of ulnar nerve and the comman digital nerve of the ring finger; and two factors had a l inear correlation (P lt; 0.05) with correlation coefficients of 0.68, 0.66 and 0.56, 0.36. The distances were (36.98 ± 4.93) mm from pisiform bone to the start point of the recurrent branch of median nerve, and (28.35 ± 6.63) mm to the start point of comman digital nerve of the ring finger. Conclusion Low end-to-side anastomosis of median nerve and ulnar nerve has perfect match in the cross-sectional area and the number of nerve fiber.
Cardiac three-dimensional electrophysiological labeling technology is the prerequisite and foundation of atrial fibrillation (AF) ablation surgery, and invasive labeling is the current clinical method, but there are many shortcomings such as large trauma, long procedure duration, and low success rate. In recent years, because of its non-invasive and convenient characteristics, ex vivo labeling has become a new direction for the development of electrophysiological labeling technology. With the rapid development of computer hardware and software as well as the accumulation of clinical database, the application of deep learning technology in electrocardiogram (ECG) data is becoming more extensive and has made great progress, which provides new ideas for the research of ex vivo cardiac mapping and intelligent labeling of AF substrates. This paper reviewed the research progress in the fields of ECG forward problem, ECG inverse problem, and the application of deep learning in AF labeling, discussed the problems of ex vivo intelligent labeling of AF substrates and the possible approaches to solve them, prospected the challenges and future directions for ex vivo cardiac electrophysiology labeling.
The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease not only updates aortic valve stenosis, mitral regurgitation, prosthetic valves, infective endocarditis and antithrombotic treatment on the basis of the 2017 guidelines update for valvular heart disease, but also involves aortic valve regurgitation, bicuspid aortic valve, mitral stenosis, tricuspid regurgitation, combined valve disease, pregnancy with valvular disease, valve disease complicated with coronary heart disease, valve disease complicated with non-cardiac surgery and the prospect of comprehensive management of valve disease. It covers a wide range of contents, which are introduced in detail and comprehensively. This paper interprets some highlights and core issues, including the top 10 take-home messages, the severity of valvular heart disease, and the updates in the management of aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, mitral stenosis and mitral regurgitation.
An 82-year-old male was hospitalized complaining of dyspnea for 1 year and aggravating for 2 weeks. He had been treated in other hospitals for several times due to such situation and his symptom could be relieved by diuretics. After admission, he was diagnosed as severe aortic stenosis with extremely low left ventricular contractile function; transthoracic echocardiography showed a left ventricular ejection fraction of only 16.1%. He was classified as a typical case of severe aortic stenosis with “low transaortic velocity and low transaortic gradient” since the transaortic velocity being 2.36 m/s and transaortic gradient being 22/14 mm Hg (1 mm Hg=0.133 kPa). Dobutamine-stress echocardiography suggested that the patient’s left ventricular reserve function was extremely poor and the potential benefits of valvular surgery were finite as the former data being 2.59 m/s and 27/16 mm Hg respectively. In consideration of progressive exacerbation of the patient’s symptoms, we eventually conducted transcatheter aortic valve replacement surgery with the support of extracorporeal membrane oxygenation. His symptoms such as dyspnea disappeared after the surgery and clinical parameters had also got a significant improvement.
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.