Jitter analysis with concentric needle electrodes in the extensor digitorum communis for the diagnosis of myasthenia gravis: a pilot study

Background Single-fiber electromyography is the most sensitive neurophysiological test for the diagnosis of myasthenia gravis （MG）,but its use is limited by the potential risk of transmission of infections.Jitter analysis with disposable concentric needle electrodes （CNEs） is therefore being investigated.This pilot study aimed to evaluate jitter analysis with CNEs for the diagnosis of MG.Methods Forty-two healthy Chinese volunteers and 44 MG patients were prospectively enrolled.MG patients were classified according to the Osserman classification,and acetylcholine receptor antibody titer was measured.Jitter analysis with CNEs in the extensor digitorum communis and repetitive nerve stimulation （RNS） testing were performed.Jitter was expressed as the mean consecutive difference （MCD）,and 20 action potential pairs were analyzed in each subject.The mean MCD in each subject and the mean individual MCD of all action potential pairs were compared between groups.Results The mean MCD and mean individual MCD were higher in MG patients （（42.3±20.0） μs and （42.2±26.0） μs） than in healthy volunteers （（23.0±3.1） μs and （22.8±7.5） μs）.The area under the receiver operating characteristic curve for the mean MCD of MG patients and healthy volunteers combined was 0.85.The mean MCD and mean individual MCDwere higher in generalized MG patients （（64.1±18.5） μs and （63.6±30.0） μs） than in ocular MG patients （（33.1±12.0） μs and （33.2±17.6） μs）,and were higher in MG patients with abnormal RNS results （（57.2±18.3） μs and （57.3±29.2） μs） than in MG patients with normal RNS results （（32.9±14.8） μs and （32.7±18.3） μs）.Abnormal RNS results were observed in 38.60% （17/44） of MG patients and abnormal jitter were observed in 72.70% （32/44） of MG patients.Conclusion Jitter analysis with CNEs is feasible for the diagnosis of MG.     

Impairment of recovery of muscle function by residual rocuronium after re-transfusion of intraoperative salvaged blood

Background Recurarization has previously been described in the context of acute normovolemic hemodilution.The aim of this study was to investigate the impairment of recovery of neuromuscular function after re-transfusion of intraoperative salvaged blood in patients treated with rocuronium.Methods We enrolled 50 patients undergoing general anesthesia for lumbar surgery.Intraoperative blood salvage （IBS） was used in 30 patients （group Ⅰ）; the remaining 20 comprised a control group （group C）.Anesthesia was induced with fentanyl,midazolam,propofol and rocuronium.Rocuronium was infused to maintain neuromuscular blockade during surgery.Blood was collected from the operative field and re-transfused in the post-anesthesia care unit （PACU）.Neuromuscular function was monitored using the train-of-four ratio （TOFr）.Once the train-of-four ratio exceeded 90 in the PACU,neuromuscular function was evaluated every 5 minutes for 30 minutes.The TOFr and incremental recovery of TOFr from baseline were recorded.Salvaged blood was re-transfused at the beginning of the evaluation for patients in group Ⅰ,and afterwards for patients in group C.Blood gas analysis was assessed before anesthesia and in the PACU.Results Incremental recovery of TOFr from baseline was significantly less in group Ⅰ than controls at 25 minutes （6.1±3.2vs.9.1±3.2,respectively; P=0.001） and 30 minutes （7.1±3.2 vs.10.0±2.2,respectively; P=-0.001）.There were no significant differences in gas exchange between the groups.Conclusions In patients who had received a rocuronium infusion during anesthesia,re-transfusion of salvaged blood significantly impaired recovery of neuromuscular function recovery in the PACU,but without significant impairment of respiratory function.     

Role of microRNA-181a in the apoptosis of tubular epithelial cell induced by cisplatin 

Background  Cisplatin (DDP) is one of most effective and most commonly used therapeutic agent in treating tumors, it can accumulate in the kidney and lead to acute renal failure. MicroRNA-181a can induce cell apoptosis by suppressing the expression of Bcl-2 family. In the present study, we investigated the role of microRNA-181a in the apoptosis of tubular epithelial cell induced by DDP.

Methods  HK-2 cells were cultured, transfected with microRNA-181a inhibitor for 48 hours, and stimulated with 50 µmol/L cisplatin for 24 hours. MicroRNA-181a expression was analyzed by real time PCR, and cell apoptosis was detected by flow cytometry. Moreover, Bcl-2 and Bcl-2-associated X protein (Bax) expression were measured by Western blotting.

Results  MicroRNA-181a expression significantly down-regulated in cells transfected with microRNA-181a inhibitor, compared with that in untransfectd cells (21.19±2.01 vs. 38.87±1.97, P <0.05). Cell apoptosis induced by DDP significantly decreased in cells transfected with MicroRNA-181a inhibitor. Compared with DDP treated cells alone, Bcl-2 expression strikingly was up-regulated and Bax expression was down-regulated in cells transfected with microRNA-181a inhibitor.

Conclusion  One pathway of DDP induces apoptosis of tubular epithelial cell by suppressing Bcl-2 expression is achieved by regulating the target gene of MicroRNA-181a.

     

Antitumor effects of mutant endostatin are enhanced by Bcl-2 antisense oligonucleotides in UM-UC-3 bladder cancer cell line

Background Endostatin is a potent inhibitor of tumor angiogenesis. In the preliminary studies, we developed a mutant endostatin containing Arg-Gly-Asp-Arg-Gly-Asp (RGDRGD) sequences. In this study, we compared the antitumor effects of mutant endostatin and Bcl-2 antisense oligonucleotides both in combination and individually.

Methods The artificially synthesized Bcl-2 ASODN (antisense oligonucleotides) included a translation-initiation site and was transfected into the bladder cancer cells by Lipofectamine. Cell growth was investigated by the tumor cell growth chart, MTT assay, caspase-3 activity detection assay, AO/EB fluorescein stain, and the annexin V-FITC apoptosis detection assay. In the in vivo study, UM-UC-3 bladder cancer cells were subcutaneously implanted into nude mice and the growth of tumor was examined. The ultrastructure of the tumor tissues in the treated and control groups were observed.

Results The cell growth chart showed that the cell population of the treated combination group decreased by 52.04% compared to the control group. The inhibition rate of the treated combination group was (79.66±6.79)%, whereas those of the individual ASODN and ES groups were (53.39±3.22)% and (50.22±5.46)% respectively. In the caspase-3 activity detection using AO/EB fluorescein stain and annexin V-FITC apoptosis detection assay, the co-inhibitory effect was higher than the individual inhibitory effects (P<0.05). There were significant differences in the inhibition of the solid tumor growth in the in vivo study.

Conclusions Our findings indicated that Bcl-2 antisense oligonucleotides enhance the antitumor effects of mutant endostatin both in vitro and in vivo. We noted the synergistic effects of Bcl-2 antisense oligonucleotides combined with mutant endostatin.

     

Comparison of loading with maintenance dose of clopidogrel on platelet reactivity in Chinese with different CYP2C19 genotypes prior to percutaneous coronary intervention

Background Whether two clopidogrel pretreatment strategies prior to elective percutaneous coronary intervention （PCI）： a 300 mg loading dose （LD） in clopidogrel naive patients and a 75 mg maintenance dose （MD） once daily in patients on chronic clopidogrel therapy play the same role in the platelet inhibition in Chinese with different CYP2C19 genotypes remains unknown. We aim to evaluate the impact on platelet inhibition by clopidogrel pretreatment strategy and its interaction effect with CYP2C19 genotype. Methods Chinese patients undergoing PCI （n=840） were assigned to 2x2 groups in the trial according to different clopidogrel pretreatment strategies （470 patients in LD, 370 patients in MD） and CYP2C19 genotypes （494 carriers of any CYP2C19 ＊2 or ＊3 loss-of-function allele, 346 non-carriers）. The primary outcome was platelet aggregation （PA） as measured by the 10 umol/L adenosine diphosphate induced light transmission aggregation. Results Compared with MD group, LD strategy showed a significantly higher PA-（（59.22＋11.67）% vs. （52.83±12.17）%, P 〈0.01）, similar PA difference was observed in CYP2C19 loss-of-function carriers compared with non-carriers （（59.41±10.91）% vs. （52.10±12.90）%, P 〈0.01）. LD patients in either the CYP2C19 loss-of-function allele carrier or non- carrier group showed a significantly higher PA compared with MD group （（61.50±10.61）% vs. （56.84±10.74）%, P 〈0.01; （56.06±12.34）% vs. （46.88±11.78）%, P 〈0.01, respectively）. A quantitative interaction effect was observed between clopidogrel pretreatment strategy and CYP2C19 genotype （P=0.001）. Conclusion The 300 mg LD strategy results in a decreased effect on platelet inhibition compared with the 75 mg MD in Chinese patients receiving clopidogrel prior to PCI, especially in the CYP2C19 ＊2 or ＊3 loss-of-function allele non-carriers. （ClinicalTrials.gov number NCT01710436） Chin tided J 2014;127 （14）： 2571-2577     

Retinoschisis and intravitreal ranibizumab treatment for myopic choroidal neovascularization

Background Intravitreal ranibizumab injection is effecitve on treating myopic CNVs,but it could be a risk factor for developing more severe retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.This study aimed to explore the incidence and features of retinoschisis after intravitreal ranibizumab injection for myopic choroidal neovascularization.Methods Eighty-three eyes of 81 patients with choroidal neovascularization secondary to pathologic myopia were treated with intravitreal ranibizumab injection.The best corrected visual acuity and optical coherence tomography （OCT） images were recorded at baseline and every month thereafter.Central retina thickness and maximal retina thickness were measured.The subjects were divided into three groups.Eleven eyes that had retinoschisis and epiretinal membrane were in group 1,six eyes that had simple epiretinal membrane were in group 2,and 66 eyes that had neither retinoschisis nor epiretinal membrane were in group 3.Six contralateral eyes in group 1 which had retinoschisis and epiretinal membrane but were not treated with intravitreal ranibizumab injection were set as the control group.Results Seven of the 11 eyes in group 1 developed more severe retinoschisis,the mean maximal retinal thickness increased from （380.28±90.13） to （467.00±70.20） μm （P 〈0.05）.The retinoschisis of all 6 eyes of the control group did not aggravate.Compared with the control group,the aggravation ratio of retinoschisis increased significantly （P 〈0.05）.No new onset of retinoschisis took place in group 2 and group 3.Conclusion Intravitreal ranibizumab injection may be a risk factor for aggravation of retinoschisis in eyes with preexisted retinoschisis and epiretinal membrane.     

An anatomical comparison of two minimally invasive pelvic reconstructive surgeries using fresh female cadavers

Background During the past decade, graft materials have been widespread used in the vagina in order to correct pelvic organ prolapse. The aim of this study was to describe and compare the exact anatomical position of the puncture devices and their relations to the relevant anatomical structures in the ProliftTM and a modified pelvic reconstructive surgery with mesh. Methods Twelve fresh cadavers were allocated randomly to either the ProliftTM or the modified pelvic reconstructive surgery group. Each group had six fresh cadavers. Relevant distances between the puncture devices and anatomical structures were recorded in both minimally invasive puncture surgeries. Results The mean distances from the posterior puncture points of the obturator membrane to the posterior branch of obturator arteries were shorter （（0.60＋0.36） cm and （0.78＋0.10） cm） when compared with the distances to the anterior branch of obturator arteries （（1.53＋0.46） cm and （1.86＋0.51） cm） for the reconstruction of the anterior compartment in both surgeries （all P 〈0.05）. The distance from the puncture points of the pelvic floor through the ischiorectal fossa to the coccygeal and inferior gluteal arteries in the ProliftTM technique （（0.88＋0.10） cm） and （（1.59＋0.36） cm））were much shorter than that in the modified pelvic reconstructive surgery （（2.95＋0.09） cm） and （（3.40＋0,36） cm）） for the reconstruction of the middle and posterior compartments （all P 〈0.05）. Conclusions Compared with the ProliftTM technique, the modified pelvic reconstructive surgery with mesh would be safer not to cause great damage to the inferior gluteal arteries and the coccygeal arteries, The posterior branch of obturator arteries would be easier to be injured than the anterior branch of obturator arteries during anterior compartment reconstruction in both surgeries.     

Computer-assisted preoperative planning for proximal humeral fractures by minimally invasive plate osteosynthesis

Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.     

Effect of chronic intermittent hypoxia on theophylline metabolism in mouse liver

Background Chronic intermittent hypoxia (CIH) has been associated with abnormalities in the liver,which is the most important organ for drug metabolism.This study aimed to investigate the effect of CIH...     

Fourth-generation ceramic-on-ceramic total hip arthroplasty in patients of 55 years or younger: short-term results and complications analysis

Background The incidence of total hip replacement in the younger and more active patients is ever increasing.The ceramic-on-ceramic （COC） bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties.Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty （THA）.Methods A consecutive series of 132 young patients （177 hips） that underwent primary cementless THAs between January 2010 and December 2012 were included in this study.These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach.The average age was （41.8±8.3） years （ranging from 22 to 55 years）,and the mean follow-up period was （24.5±9.4） months （ranging from 12 to 47 months）.The results were evaluated both clinically and radiographically.Harris hip score （HHS） was determined before surgery and at the time of each follow-up.Presence of postoperative groin or thigh pain and squeaking were recorded.Other complications such as dislocations,periprosthetic fractures,and ceramic components fractures were diagnosed and treated in emergency.Results The average HHSs improved from preoperative 60.3±10.7 （ranging from 29 to 76） to 91.0±5.1 （ranging from 74 to 100） at the final follow-up （t=-45.064,P ＜0.05）,and 97.7％ of cases were scored as excellent and good results.At the last follow-up,incidental inguinal pain was found in three hips （1.7％） and thigh pain in 11 hips （6.2％）.Radiographs showed a high rate of new bone formation around the acetabular and stem components.No obvious osteolysis or prosthesis loosening was detected.Complications occurred in six hips （3.4％）：posterior dislocation in two hips （1.1％）,periprosthetic femoral fracture in one hip （0.6％）,asymptomatic squeaking in two hips （1.1％）,and ceramic liner fracture in one hip （0.6％）.Conclusions The fourth-generation COC THA showed excelle     

A recommended technique of renal vein anastomosis in rat kidney transplantation for trainee

Background Various rat kidney transplantation models have been introduced over the decades and the study on the models seems to lack novelty and necessity.However,vascular anastomosis,especially renal vein,is still very difficult for trainees.The aim of this study was to provide the modified renal venous anastomosis of rat kidney transplantation to substitute the currant method for trainees.Methods Male Wistar rats were used as donors and recipients,respectively.Left orthotopic transplantation was performed with a modified technique of renal vein anastomosis,combining the end-to-end sutures with epidural catheter.Meanwhile,the survival rate,warm ischemia time,renal venous anastomosis time,and complications were recorded to evaluate the merits of the modified technique compared with the current recommended technique of rat renal vein.Two trainees took part in the learning of the models in two methods for performing 30 operations,respectively.Results The difference in warm ischemia time （from （57.25±7.30） minutes in the first 10 operations to （30.05±1.85）minutes in the third 10 operations） and renal vein anastomosis time （from （32.80±3.80） minutes in the first 10 operations to （19.30±0.98） minutes in the third 10 operations） was significantly short （P＜0.01） and the survival rate was statistically high （from （25±7）％ in the first 10 operations to 70％ in the third 10 operations） in equal number of operations （P＜0.01） by comparing with the current recommended method （（47.60±7.19） minutes to （22.8±1.85） minutes,（22.40±3.10） minutes to （9.95±1.50） minutes,45％±7％ to 80％±0,respectively）.The intraoperative complications and postoperative complications of renal venous anastomosis were also significantly decreased （P＜0.01）.Conclusions The technique with epidural catheter can shorten the learning curve of the trainee learning rat kidney transplantation.It may replace the currently recommended technique of rat renal vein for trainees.     

Long term follow up of clinical outcome between patellar resurfacing and nonresurfacing in total knee arthroplasty: Chinese experience

Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.Methods From January 1993 to December 2002,265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery,Peking Union Medical College Hospital.Among them,226 patients （246 knees） were successfully followed up,with 176 knees for patellar resurfacing and 70 knees for nonresurfacing.The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score （HSS）,patellar score,patellar related complication and radiological results were studied at the latest follow-up.Results The HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up.Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group.There was no statistically significant difference for both HSS score,patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group.Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation.Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis.The 10-year survival rate was not statistically significant different between the two groups （P=0.12）.Conclusions There was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing.Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis.Selective patellar resurfacing for patients with rheumatoid arthritis can achieve lower patella related complication.     

Blockade of the OX40/OX40L pathway and induction of PD-L1 synergistically protects mouse islet allografts from rejection

Background OX40/OX40 ligand （OX40/OX40L） and programmed death-1/programmed death ligand-1 （PD-1/PD-L1） co- stimulator/signals play important roles in T cell-induced immune responses. The aim of this study was to investigate the roles of OX40/OX40L and PD-1/PD-L1 costimulatory pathways in mouse islet allograft rejection. Methods Lentiviral vectors containing OX40L siRNA sequences and an adenovirus vector containing the PD-L1 gene were constructed. The streptozotocin-induced model of diabetes was established in C57BL/6 （H-2b） mice. Diabetic C57BL/6 mice were randomly allocated into five groups： group 1, untreated control; group 2, Ad-EGFP treatment; group 3, Ad-PD-L1 treatment; group 4, OX40L-RNAi-LV treatment; group 5, OX40L-RNAi-LV combined with Ad-PD-L1 treatment. Lentiviral vector and the adenovirus vector were injected, singly or combined, into the caudal vein one day before islet transplantation. The islets of DBA/2 （H-2d） mice were transplanted into the renal subcapsular space of the diabetic recipients. Recipient blood glucose and the survival time of the allografts were monitored. Antigen-specific mixed lymphocyte reaction was also evaluated.     

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site （LESS） surgery through the retroperitoneal approach has been seldom reported.We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large,impacted ureteral calculi.Methods Between November 2011 and July 2013,retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape.Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy.We compared the operative time,complications,and surgical outcomes,retrospectively.Results All patients were completed without conversion to conventional laparoscopic or open surgery.The operative time of the LESS group and of the conventional laparoscopic group were （125.3±12.8） minutes and （116.9±14.4）minutes,respectively （P=0.119）.The intraoperative blood loss was （42.9±8.9） and （43.4±14.7） ml,respectively （P=0.914）.Postoperative radiologic evaluation revealed that the stones had been removed completely.Cosmetic results were superior in the LESS group （P=0.001）.Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.     

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management

Background Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen.     

Acute lung injury induced by H9N2 virus in mice

Background H9N2 avian influenza viruses （AIVs） have repeatedly caused infections in mammals even humans in many countries. The purpose of our study was to evaluate the acute lung injury （ALl） caused by H9N2 viral infection in mice. Methods Six- to eight- week-old female SPF C57BL/6 mice were infected intranasally with lx104 MIDso of A/HONG KONG/2108/2003 [H9N2 （HK）] virus. Clinical signs, pathological changes, virus titration in tissues of mice, arterial blood gas, and cytokines in bronchoalveolar lavage fluid （BALF） and serum were observed at different time points after AIV infection. Results H9N2-AIV-infected mice exhibited severe respiratory syndrome, with a mortality rate of 50%. Lung histopathological changes in infected mice included diffuse pneumonia, alveolar damage, inflammatory cellular infiltration, interstitial and alveolar edema, and hemorrhage. In addition, HgN2 viral infection resulted in severe progressive hypoxemia, lymphopenia, and a significant increase in interleukin 1, interleukin 6, tumor necrosis factor, and interferon in BALF and serum. Conclusions The results suggest that H9N2 viral infection induces a typical ALl in mice that resembles the common features of ALl. Our data may facilitate the future studies of potential avian H9N2 disease in humans.     

Pulmonary vein antrum isolation of pre-excited atrial fibrillation

Background Pulmonary vein antrum isolation (PVAI) of pre-excited atrial fibrillation (AF) is controversial. This study aimed to observe the therapeutic effects of PVAI on pre-excited AF.

Methods Twenty-nine patients with pre-excited AF were prospectively divided into a PVAI group (group I, 19 cases) and a control group (group II, 10 cases). To each case in group I, PVAI was performed, and then electroanatomical mapping of accessory pathways (AP) and ablation were constructed on a three-dimensional (3D) map of the valve annulus. Only AP ablation was performed in each case of group II.

Results Of the 29 cases, three were found to have dual APs, two had intermittent APs, and the remaining 24 had single APs. All APs were successfully ablated after the procedure. There were no significant statistical differences in the AP procedure duration ((77.4±21.3) minutes vs. (85.3±13.1) minutes), the AP ablation time ((204±34) seconds vs. (223±62) seconds) and the AP X-ray exposure time ((18.6±4.4) minutes vs. (19.1±4.5) minutes) respectively between groups I and II. As compared with the control group (5 of 10 cases, 50%), the PVAI group had a significantly lower AF recurrence rate (2 of 19 cases, 11%; P <0.05) during follow-up of (20.5±10.0) months. All seven patients who recurred were successfully abolished by a second ablation.

Conclusions In patients with pre-excited AF, PVAI is an effective therapeutic approach with a low AF recurrence rate. 3D electroanatomical maps of AP contributed to the high success rate of ablation without significantly prolonging of operational duration and X-ray exposure time.

     

Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating paroxysmal atrial fibrillation: a randomized, controlled short-term trial

Background It is unclear whether the effect of video-assisted thoracoscopic surgery ablation is better than catheter ablation on paroxysmal atrial fibrillation （PAF） or not. This study aimed to compare the effects of catheter ablation and video-assisted thoracoscopic surgery ablation on PAF. Methods From March 2008 to March 2012, 138 consecutive patients with PAF were randomly assigned to receive either video-assisted thorecoscopic surgery ablation （thoracoscopy group, n=66） or the traditional catheter ablation （catheter group, n=72）. Results No patient died during the study and all were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between the two groups. All patients were evaluated at 1 week, 1 month, 3 months, 6 months, and 12 months after discharge by physical examination and related laboratory tests. Preoperative left atrium dimensions （LADs） of the recurrent AF were （47±4） mm in the thoracoscopy group and （46±8） mm in the catheter group, whereas the LADs were （40±5） and （39±9） mm, respectively, in non-recurrent PAF. Conclusions The short-term outcome of video-assisted thoracoscopic surgery ablation is safe and effective; and the indications are wider than those for catheter ablation. The larger left atrium diameter is related to the recurrence of atrial fibrillation. Chin Med J 2014;127 （14）： 2567-2570     

附加钢板在治疗股骨干骨折髓内钉固定后肥大性骨不连中的应用：与更换钢板的比较

Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.