一站式杂交技术与传统手术治疗复杂冠心病的临床研究

目的 比较一站式杂交技术与胸骨正中切口体外循环冠脉搭桥术的效果和并发症,对一站式杂交技术的疗效和安全性作系统评价.方法 选择行一站式冠脉杂交手术(杂交组)34例和胸骨正中切口体外循环冠脉搭桥术(传统组)34例患者,经左胸小切口在不停跳状态下行左乳内动脉至前降支旁路移植术,手术结束后即行经皮冠状动脉介入治疗(PCI),术后口服阿司匹林及氯吡格雷抗凝.比较两组患者术中、术后及并发症情况.结果 两组患者围术期均无死亡病例.杂交组的手术时间[(257.6±49.1)min]较传统组[(387.0±57.1)min]短,术中出血量[(312.5±86.1)ml]较传统组[(796.9±161.6)ml]少(均P＜0.05),而传统组开通靶血管数[(3.7±0.8)支]比杂交组[(2.9±0.6)支]多(P＜0.05).术后杂交组ICU停留时间[(52.5±23.0)h]、机械通气时间[(18 3±15.1)h]、住院时间[(11.1±2.9)d]较传统组[分别为(122.2±31.3)h、(36.8±22.6)h、(17.7±5.5)d]短(均P＜0.05),而术后杂交组引流量[(657.6±17.8)ml]及住院费用[(12.8±17)万元]均较传统组[分别为(484.3±228.4)ml、(10.5±2.3)万元]多(P＜0.05),但术后输血量无统计学差异(P＞0.05).两组均无院外死亡病例,无脑血管意外、心绞痛或心肌梗死再发.结论 一站式杂交技术治疗复杂冠心病安全、有效,与传统手术比较,创伤更小、恢复更快,值得临床推广应用.     

深圳妇女改良巴氏涂片联合HPV筛查宫颈癌的应用前景

目的:研究深圳妇女改良巴氏涂片联合HC-Ⅱ法HPV筛查宫颈癌的应用前景。方法:2012年2月至2012年7月对深圳市3年内从未行宫颈癌筛查的30~59岁的1000名妇女进行子宫颈癌筛查。单数妇女行改良取样巴氏涂片(Pap)(采用液基细胞学刷取样)和HC-Ⅱ法HPV检测;双数妇女行薄层液基细胞学(LCT)和HC-Ⅱ法HPV检测。对细胞学结果≥不典型鳞状细胞(ASCUS)或HPV检测阳性者行阴道镜下多点活检,以病理为金标准评价各种宫颈癌筛查方案的价值,研究改良巴氏涂片联合HPV筛查方案的性价比。结果:本次筛查Pap阳性50例;LCT阳性57例;高危型HPV阳性200例。213例取病理:CINⅠ(含HPV感染)97例,CINⅡ23例,CINⅢ37例,宫颈癌3例,慢性宫颈炎和鳞状上皮化生40例。改良Pap的灵敏度、特异度、阴性预测值及约登指数分别是63.2%、94.43%、96.9%及0.58;LCT以上相应指数分别是76.0%、92.0%、98.7%及0.64;HC-Ⅱ法HPV的相应指数分别是96.8%、85.0%、98.5%及0.82;改良Pap联合HC-Ⅱ法HPV平行试验的相应指数分别100.0%、83.3%、100.0%及0.83;LCT联合HC-Ⅱ法HPV平行试验的相应指数分别是100.0%、83.2%、100.0%及0.83;改良Pap联合HC-Ⅱ法HPV系列试验的相应指数分别60.5%、95.9%、96.7%及0.56;LCT联合HC-Ⅱ法HPV系列试验的相应指数分别是72.0%、94.3%、98.5%及0.66。不同筛查试验受试者工作特征(receiver operating characteristic,ROC)曲线下面积分别为Pap 0.788、LCT 0.840、HPV 0.910、Pap-HPV平行0.917、LCT-HPV平行0.916、Pap-HPV系列0.782、LCT-HPV系列0.832。Pap-HPV平行试验筛查宫颈癌ROC曲线面积最大。改良巴氏涂片的筛查宫颈癌的效价比最高。结论:改良Pap联合HC-Ⅱ法HPV平行试验对深圳妇女宫颈癌筛查具有最大的应用前景。     

One-stage hybrid procedure for distal aortic arch disease: mid-term experience at a single center

BackgroundThis study analyzes the outcomes of a one-stage hybrid procedure combining thoracic endovascular aortic repair (TEVAR) with extra-anatomic bypass in patients with distal aortic arch disease.MethodsThis retrospective study collected 103 hybrid procedures combining TEVAR with extra-anatomic bypass (mean age, 62.2±9.3 years; 90 males) performed from January 2009 to January 2019 at Beijing Anzhen Hospital. We analyzed 30-day and mid-term outcomes including survival rate and the incidence of stroke, spinal cord injury (SCI), and endoleak.ResultsFive deaths (4.6%) occurred within 30 days, including type I endoleak in Zone 1 (n=1), hemorrhagic shock (n=1), stroke (n=2), and stent migration (n=1). Two patients developed SCI. The median follow-up time was 39.5 (interquartile range, 13.6-69.0) months. In all, 14 late deaths occurred; these were due to stroke (n=2), severe pneumonia (n=1), aortic rupture caused by type I endoleak (n=3), and sudden death (n=8). Six late endoleaks occurred including three type I and one type II in Zone 1 and two type I in Zone 2. In a competing risks analysis, the incidences of reintervention at 7 years, late death, and survival without reintervention were 8%, 22%, and 70%, respectively. In a Cox risk model, stroke (HR, 21.602; 95% CI: 2.798–166.796; P=0.003) was the only risk factor for 30-day mortality. Stroke (HR, 19.484; 95% CI: 5.245–72.380; P<0.001), SCI (HR, 15.548; 95% CI: 2.754–87.786; P=0.002), and endoleak (HR, 4.626; 95% CI: 1.068–20.040; P=0.041) were independent risk factors for long-term mortality.ConclusionsThe one-stage hybrid procedure provides acceptable mid-term results with good mid-term patency of extra-anatomic bypass. Strict selection of patients suitable for hybrid repair can effectively improve the survival rate and reduce the incidence of complications. At the same time, close follow-up patients should receive close long-term follow-up after hybrid procedure.     

Hybrid procedure of bilateral pulmonary artery banding and bilateral ductal stenting in an infant with aortic atresia and interrupted aortic arch

We report an infant with aortic valve atresia, interrupted aortic arch, ventricular septal defect, confluent pulmonary arteries, bilateral arterial ducts, absent common carotid arteries, and anomalous coronary arteries arising from main pulmonary artery. Hybrid procedure consisting of bilateral pulmonary artery banding and bilateral arterial duct stenting was performed at 4 weeks of age. Hybrid procedure can be an alternative palliative approach in an infant with this complex cardiac anatomy. © 2014 Wiley Periodicals, Inc.     

Prosthetic Rehabilitation of a Hemisected Maxillary Molar: A Rare Entity

Gingival recession beyond grade III and grade IV level involving furcation defects can lead to tooth loss if not intervened at appropriate time. The treatment options include scaling and root planing, Furcation-plasty, Tunnel preparation, Root separation and resection. The chief complaint of the patient was pain in the upper left first molar because of grade III furcation involvement. Since it was a four rooted molar, the treatment of choice was hemisection of the tooth and extraction of the distal half following endodontic treatment. As the second molar was mesially tilted the prosthodontic rehabilitation was done with a hybrid prosthesis involving a full coverage conventional porcelain fused to metal retainer on the hemisected molar and a resin bonded partial coverage retainer on the tilted second molar. The resultant prosthesis is termed as "Hybrid prosthesis".     

Ciliogenesis and autophagy are coordinately regulated by EphA2 in the cornea to maintain proper epithelial architecture

PurposeTo understand the relationship between ciliogenesis and autophagy in the corneal epithelium.MethodssiRNAs for EphA2 or PLD1 were used to inhibit protein expression in vitro. Morpholino-anti-EphA2 was used to knockdown EphA2 in Xenopus skin. An EphA2 knockout mouse was used to conduct loss of function studies. Autophagic vacuoles were visualized by contrast light microscopy. Autophagy flux, was measured by LC3 turnover and p62 protein levels. Immunostaining and confocal microscopy were conducted to visualize cilia in cultured cells and in vivo.ResultsLoss of EphA2 (i) increased corneal epithelial thickness by elevating proliferative potential in wing cells, (ii) reduced the number of ciliated cells, (iii) increased large hollow vacuoles, that could be rescued by BafA1; (iv) inhibited autophagy flux and (v) increased GFP-LC3 puncta in the mouse corneal epithelium. This indicated a role for EphA2 in stratified epithelial assembly via regulation of proliferation as well as a positive role in both ciliogenesis and end-stage autophagy. Inhibition of PLD1, an EphA2 interacting protein that is a critical regulator of end-stage autophagy, reversed the accumulation of vacuoles, and the reduction in the number of ciliated cells due to EphA2 depletion, suggesting EphA2 regulation of both end-stage autophagy and ciliogenesis via PLD1. PLD1 mediated rescue of ciliogenesis by EphA2 depletion was blocked by BafA1, placing autophagy between EphA2 signaling and regulation of ciliogenesis.ConclusionOur findings demonstrate a novel role for EphA2 in regulating both autophagy and ciliogenesis, processes that are essential for proper corneal epithelial homeostasis.     

Adhesion of 10-MDP containing resin cements to dentin with and without the etch-and-rinse technique

PURPOSE

This study evaluated the adhesion of 10-MDP containing self-etch and self-adhesive resin cements to dentin with and without the use of etch-and-rinse technique.

MATERIALS AND METHODS

Human third molars (N=180) were randomly divided into 6 groups (n=30 per group). Conventional (Panavia F2.0, Kuraray-PAN) and self-adhesive resin cements (Clearfil SA, Kuraray-CSA) were bonded to dentin surfaces either after application of 3-step etch-and-rinse (35% H₃PO₄ + ED Primer) or two-step self-etch adhesive resin (Clearfil SE Bond). Specimens were subjected to shear bond strength test using the universal testing machine (0.5 mm/min). The failure types were analyzed using a stereomicroscope and quality of hybrid layer was observed under a scanning electron microscope. The data (MPa) were analyzed using two-way ANOVA and Tukey''s tests (α=.05).

RESULTS

Overall, PAN adhesive cement showed significantly higher mean bond strength (12.5 ± 2.3 - 14.1 ± 2.4 MPa) than CSA cement (9.3 ± 1.4 - 13.9 ± 1.9 MPa) (P<.001). Adhesive failures were more frequent in CSA cement groups when used in conjunction with two-step self-adhesive (68%) or no adhesive at all (66%). Hybrid layer quality was inferior in CSA compared to PAN cement in all conditions.

CONCLUSION

In clinical situations where bonding to dentin substrate is crucial, both conventional and self-adhesive resin cements based on 10-MDP can benefit from etch-and-rinse technique to achieve better quality of adhesion in the early clinical period.