Surgical therapy in patients with active infective endocarditis: seven-year single centre experience in a subgroup of 255 patients treated with the Shelhigh stentless bioprosthesis

OBJECTIVE: We investigated outcomes after surgical therapy in patients with active infective endocarditis (AIE) with regard to survival in relation to surgical urgency, valve position, number of valves implanted and abscess formation. We aimed to identify independent risk factors for early mortality. METHODS AND RESULTS: Two hundred and fifty-five patients received Shelhigh bioprostheses between February 2000 and March 2007. A total of 74.1% had native and 25.9% prosthetic AIE. Surgery was regarded as urgent in 57.3% and as an emergency procedure in 38.4%. There was a highly significant difference in survival rate between patients who were operated on urgently versus in an emergency (p<0.0001), between single and double valve replacement (p=0.0206) and between patients with and without abscess formation (p=0.0245). There were two cases of early reinfection (0.78%) and six of late reinfection (2.35%) leading to re-operation. CONCLUSIONS: The survival of patients differs significantly in dependence on their surgical urgency. Better outcome could have been achieved if patients had been referred earlier for surgery and operated upon before heart failure or septic shock developed. Long-term survival was better in patients without abscess formation. The low reinfection rate of Shelhigh bioprostheses in AIE is promising and the early and mid-term results achieved need to be verified in the long-term course.     

Coronary atherosclerosis of the donor heart--impact on early graft failure.

OBJECTIVE: Due to the shortage of donor hearts, the criteria for organ acceptability have been considerably extended and donor grafts with coronary atherosclerosis are among those offered. This study evaluated whether and to what degree pre-existing coronary atherosclerosis may be acceptable. METHODS: A total of 1253 consecutive HTx recipients were investigated retrospectively for donor-transmitted coronary atherosclerosis (DCAS). Donor-transmitted coronary atherosclerosis was defined as focal atherosclerosis with stenosis of at least 50%. Inclusion criteria were absence of pre-HTx angiogram but performance of angiogram or autopsy within 6 months after heart transplantation. Kaplan-Meier analysis and log-rank test were used. RESULTS: Eighty-five out of 1253 (6.8%) cases were excluded, since coronary evaluation was not performed within 6 months (n=45) or hearts had undergone pre-transplant angiography (n=40). In 1086 patients no donor-transmitted coronary atherosclerosis was found (NDCAS group) and in 82 patients (7%) donor-transmitted coronary atherosclerosis was diagnosed by angiography (n=49) or autopsy (n=33). Single-vessel donor-transmitted coronary atherosclerosis was found in 53/82 patients (DCAS1 group) and double- or triple-vessel donor-transmitted coronary atherosclerosis in 26/82 patients (DCAS2/3 group). Three of the 82 patients with donor-transmitted coronary atherosclerosis were excluded since the autopsy report was unclear regarding degree of atherosclerosis. Early after heart transplantation the 30-day mortality in the NDCAS and DCAS1 groups was 12.2% versus 13.2% whereas in the DCAS2/3 group it was 61.5%. Beyond the first year the annual decrease with and without donor-transmitted coronary atherosclerosis (single-vessel disease) is comparable. CONCLUSIONS: Donor screening without coronary angiogram overlooks significant atherosclerotic lesions in a considerable number of cases (7.0%). Therefore, angiographic donor screening should be performed. Donor grafts with single-vessel coronary atherosclerosis may be accepted as marginal hearts; however, in our opinion, revascularisation (CABG, PTCA) should be considered. Grafts with two- or even three-vessel coronary atherosclerosis seem to have a serious risk for early graft failure. Beyond the first year the outcome of healthy grafts and grafts with donor-transmitted coronary atherosclerosis seems to be comparable.     

Traumatic eyelid invagination: case reports

Three rare cases of upper eyelid trauma are presented. In high-speed traffic accidents, the upper eyelids were penetrated by glass, avulsed, and then, together with pieces of glass, pushed over the globe and buried deeply in the retrobulbar area. The invaginated eyelids were pulled out gently, the conjunctiva still attached to the globes. They were repaired primarily. In these patients eyelid function and cosmesis were preserved.     

短潜期体感诱发电位及其临床意义

本文测试了40例健康成人(男女各半)刺激腕正中神经和踝部胫后神经的短潜期体感诱发电位(SLSEPs),结果如下:1.SLSEPs多数PLs女性均较男性为短,这主要与肢长、身高有关,2.提供了SLSEPs的正常值,可供参考,3.检测SLSEPs对某些神经病损的定位诊断、治疗和预后的判断有重要临床意义。     

有助改善人体健康的纳米生物科技

纳米技术是20世纪80年代末期兴起的新技术。此种新技术是指在1-100nm这一尺度范围内对原子和分子运动规律和特性进行研究和应用。通过直接操纵和安排原子、分子将物质转变成具有特殊性能的新材料的科学技术。纳米技术研究的最终目标是直接以原子和分子为起点，从纳米材料出发或采用纳米加工技术，制造出具有特殊功能的产品，从而改变人类的生产和生活模式。纳米科技保健产品对促进人类健康有积极作用。     

VACUOLE SIGN AND SMALL NODE SIGN IN EARLY PERIPHERAL LUNG CANCER PATHOLOGIC BASIS AND DIAGNOSTIC VALUE

Radiologic and pathologic mani;estations of 30 peripheral pulmonary masses around l.5-3 cm in dia- meter were compared to the pathologic basis of va- cuole sign and small node sign on tomogram. Stati stics of 100 conventional X-ray tomograms of peri- pheral pulmonary masses about l-3 cm in diameter suggested that the vacuole sign and small node sign, more common in early peripheral lung cancer than in tuberculoma, are valuable for differentiating early peripheral lung cancer from tuberculoma.     

sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情转归关系探究

目的 探讨可溶性白细胞分化抗原14（soluble cluster of differentiation antigen 14,sCD14）、血管生成素2（angiopoietin 2,Ang2）、C反应蛋白（C-reactive protein,CRP）与急诊创伤骨折伴多发伤患者病情转归的关系及意义。 方法 选取创伤骨折伴多发伤患者324例,根据患者出院时病情转归情况分为良好组（275例）、不良组（49例）,比较2组一般资料、sCD14、Ang2、CRP水平,应用Pearson分析sCD14、Ang2、CRP与损伤严重程度评分（injury severity score,ISS）关系,采用Cox回归分析急诊创伤骨折伴多发伤患者病情转归的相关影响因素,采用受试者工作特征曲线（receiver operating characteristic,ROC）分析sCD14、Ang2、CRP对病情转归预测价值。 结果 不良组ISS评分高于良好组（P＜0.05）;不良组sCD14、Ang2、CRP高于良好组（P＜0.05）;sCD14（r=0.785）、Ang2（r=0.778）、CRP（r=0.842）与ISS评分呈正相关（P＜0.05）;sCD14、Ang2、CRP均是预后相关独立危险因素（P＜0.05）;sCD14、Ang2、CRP预测病情转归的ROC下面积（area under the curve,AUC）依次为0.813、0.757、0.749;挑选出预测敏感度最高（sCD14）、特异度最高（Ang2）的两个指标进行sCD14+Ang2的联合ROC分析显示,两者联合预测病情转归的AUC为0.935,大于任一单一指标（P＜0.05）。 结论 sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情严重程度及病情转归有关,均可作为预测病情转归的标志物,但联合检测sCD14、Ang2能提高预测可靠性,为临床诊疗及护理提供更准确的参考信息。     

宫颈粘液过氧化物酶在月经周期中的变化规律

本文对29例月经周期正常妇女的宫颈粘液过氧化物酶进行了30个周期的研究。在月经周期不同时间测定宫颈粘液过氧化物酶(CMPx)活性及血清促黄体生成素(LH)、雌二醇(E_2)和孕酮(P)。结果表明:在排卵前三天酶活性明显下降,至排卵后一天开始上升。卵泡期,酶活性与E_2呈负相关(r=-0.67);黄体期,酶活性与P呈正相关(r=0.79)。本研究提示:1.CMPx在排卵周期具有特定的变化规律,其变化受体内激素水平影响,可作为预告排卵的指标。2.如简化测定方法,可为自然避孕提供新途径。