Successful Use of Surgically Placed Impella 5.0 and Central Extracorporeal Membrane Oxygenation Circuit in a Patient with Postcardiotomy Shock

The Impella 5.0, a percutaneously inserted left ventricular assist device, has been used to support patients who have severe heart failure or who are undergoing high-risk percutaneous coronary intervention. We report our surgical placement of the Impella 5.0, through a graft sewn to the aorta, to unload the left ventricle of a 59-year-old man who was undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy shock. The patient underwent successful placement of a long-term left ventricular assist device before his discharge from the hospital. The versatility of the Impella 5.0 is exemplified in this patient who was successfully bridged to long-term support.     

A Reminder of Methylene Blue's Effectiveness in Treating Vasoplegic Syndrome after On-Pump Cardiac Surgery

The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. Indeed the hypotension consequent to on-pump cardiac surgery often necessitates vasopressor and intravenous fluid support. Methylene blue counteracts vasoplegic syndrome by inhibiting the formation of nitric oxide.We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. After the administration of methylene blue, his hypotension improved to the extent that he could be weaned from vasopressors. The use of methylene blue should be considered in patients who develop hypotension refractory to standard treatment after cardiac surgery.     

SIX2在骨肉瘤组织中表达及其对细胞血管生成与阿霉素耐药逆转的影响

探究SIX2在骨肉瘤组织中表达及其对细胞血管生成与阿霉素耐药逆转的影响。方法 收集2019年3月—2021年12月我院行骨肉瘤手术切除的105例患者的组织标本,免疫组化检测骨肉瘤组织中SIX2表达和微血管密度（MVD）计数;检测骨肉瘤组织中SIX2 mRNA表达水平。将人骨肉瘤细胞系MG-63分为MG-63组、si-NC A组、si-SIX2 A组,将通过阿霉素耐药得到的骨肉瘤阿霉素耐药细胞株MG-63/R分为MG-63/R组、si-NC B组和si-SIX2 B组。分别用MTT法、克隆实验、流式细胞术及Transwell法检测细胞耐药性、细胞增殖、细胞凋亡和细胞侵袭。结果 在骨肉瘤组织中,SIX2阳性表达会随着MVD值升高而增加（P＜0.05）。骨肉瘤组织中SIX2阳性表达与TNM分期、软组织浸润和淋巴结远处转移相关（P＞0.05）。与MG-63组相比,si-SIX A组细胞的血管形成能力明显降低（P＜0.05）;与MG-63/R组相比,si-SIX2 B组细胞IC50、细胞克隆数和细胞侵袭能力均显著降低,细胞凋亡能力明显增加,细胞耐药指数逆转倍数为2.51倍（P＜0.05）。结论 SIX2在骨肉瘤组织中呈高表达,且随着SIX2表达的升高肿瘤血管生成能力也增加;抑制SIX2表达可有效抑制骨肉瘤组织的生成,逆转骨肉瘤细胞阿霉素耐药     

Effect of interferon alpha,interferon beta,and interferon gamma on the in vitro growth of human renal adenocarcinoma cells

Interferon-, interferon-, and interferon- differ in their antiproliferative effects for several cell lines. Interferons were thus assessed for their activity in inhibiting proliferation of three renal cell carcinoma cell lines. The malignant epithelial phenotype of each of these cell lines was confirmed by electron microscopy, histology, karyotype and tumorigenicity. When compared on an anti-viral unit basis, naturally produced interferon- was more effective than natural interferon- for all cell lines and clones. Proliferation of each of the cell lines was inhibited by interferon-. In all cases, removal of interferons from culture media resulted in resumption of the rate of cell growth after a variable delay of 6–10 days. If the antiproliferative effects of interferons predominate in mediating tumor regression, clinical response may depend upon the type of interferon to which the tumor is exposed.     

Outcome of lateral pelvic lymph node dissection with total mesorectal excision in treatment of rectal cancer: A systematic review and meta-analysis

BackgroundTotal mesorectal excision is the gold standard treatment of mid- and low-lying rectal cancer. Lateral pelvic lymph node dissection has been suggested as an approach to decrease recurrence and improve survival. Our meta-analysis presented here aimed to review the current outcomes of lateral pelvic lymph node dissection and total mesorectal excision in comparison with total mesorectal excision alone.MethodsA systematic literature search querying electronic databases was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We reviewed articles that reported the outcomes of lateral pelvic lymph node dissection combined with total mesorectal excision in comparison with total mesorectal excision alone. The main outcome measures were local recurrence, distant metastasis, overall and disease free-survival, and complications.ResultsThis systematic review included 29 studies of 10,646 patients. Of those patients, 39.4% underwent total mesorectal excision with lateral pelvic lymph node dissection. The median operation time for the lateral pelvic lymph node dissection + total mesorectal excision was significantly longer than total mesorectal excision alone (360 minutes versus 294.7 minutes, P = .02). Lateral pelvic lymph node dissection + total mesorectal excision was associated with higher odds of overall complications (odds ratio = 1.48, 95% confidence interval: 1.18–1.87, P < .001) and urinary dysfunction (odds ratio = 2.1, 95% confidence interval: 1.21–3.67, P = .008) than total mesorectal excision alone. Both groups had similar rates of male sexual dysfunction (odds ratio = 1.62, 95% confidence interval: 0.94–2.79, P = .08), anastomotic leakage (odds ratio = 1.15, 95% confidence interval: 0.69–1.93, P = .59), local recurrence (hazard ratio = 0.96, 95% confidence interval: 0.75–1.25, P = .79), distant metastasis (hazard ratio = 0.96, 95% confidence interval: 0.76–1.2, P = .72), overall survival (hazard ratio = 1.056, 95% confidence interval: 0.98–1.13, P = .13), and disease-free survival (hazard ratio = 1.02, 95% confidence interval: 0.97–1.07, P = .37).ConclusionLateral pelvic lymph node dissection was not associated with a significant reduction of recurrence rates or improvement in survival as compared with total mesorectal excision alone; however, LPLND was associated with longer operation time and increased complication rate.     

Single-stage medial plateau elevation and metaphyseal osteotomies in advanced-stage Blount’s disease: a new technique

PurposeSurgical treatment in advanced-stage infantile Blount’s disease with medial plateau (MP) depression is challenging. Several osteotomies and fixation methods have been described with no established benchmark. We conducted this study to evaluate the efficacy and safety of a new single-stage technique for acute medial condyle elevation and metaphyseal osteotomies with internal fixation.MethodsA prospective case series of 19 consecutive patients (21 knees) with severe infantile Blount’s disease underwent a single-stage MP elevation and metaphyseal osteotomies, with internal fixation. The mean age was 10.3 years (8.2 to 13.6) and the mean follow-up was 5.1 years (3.2 to 8.3). The outcome measures included clinical and radiological parameters and patient-reported pediatric outcomes data collection instrument (PODCI) score.ResultsThe mean PODCI score improved significantly from 50% to 88%. The mean internal tibial torsion improved from -27° to 11°. All cases maintained full knee extension, no limitation in flexion range of movement and no signs of instability or lateral thrust gait. All the radiographic parameters improved significantly; the mean tibiofemoral angle improved from -29° to 7°, the metaphyseal-diaphyseal angle improved from 33.4° to 4.7° and the angle of depressed MP improved from 38.3° to 2.4° (p < 0.001). At the latest follow-up, no cases of deformity recurrence were identified, the final limb-length discrepancy was < 1 cm in all patients.ConclusionSingle-stage MP elevation and metaphyseal osteotomies with internal fixation significantly improved the clinical and radiographic parameters and PODCI score in advanced infantile Blount’s disease and precluded the use of external immobilization, with no evidence of deformity recurrence.Level of evidenceIV     

妊高征母亲早产儿IL—6和GM—CSF检测的意义

目的:探讨妊高征母亲早产儿的IL-6和GM-CSF变化.方法:用ELISA方法检测11例妊高征母亲娩出早产儿的IL-6和GM-CSF并与11例正常新生儿对照组比较.结果:妊高征母亲早产儿的IL-6(1084±113pg/m1)和GM-CSF(144士20.1pg/ml)均较正常对照组增高(P＜0.01).结论:IL-6和GM-CSF可能在妊高征及早产中发挥重要作用.     

Pelvic and lower extremity arterial imaging: diagnostic performance of three-dimensional contrast-enhanced MR angiography

OBJECTIVE: The diagnostic performance of a three-dimensional MR angiography-based strategy was assessed with regard to its ability to characterize the arterial vasculature from the aortic bifurcation to the lower extremity runoff vessels. A single-injection, two-station protocol in combination with a lower-extremity vascular coil was used. SUBJECTS AND METHODS: Both conventional digital subtraction angiography and three-dimensional contrast-enhanced MR angiography with a dedicated peripheral vascular coil were performed in 61 patients with suspected peripheral vascular disease. In a prospective analysis, one reviewer evaluated the digital subtraction angiographic images and a second reviewer evaluated the MR angiographic images; both were unaware of the results of the other imaging technique. Each vascular segment (29 segments per patient) was evaluated for the presence of occlusive vessel disease. The following grading system was applied: 0, normal; 1, vessel irregularity with a luminal reduction of less than 10%; 2, mild stenosis (lumen reduction, 10-49%); 3, severe stenosis (lumen reduction, 50-99%); and 4, occlusion (lumen reduction, 100%). In 11 patients surgical graft patency was assessed. RESULTS: MR angiography provided an image quality comparable with that of digital subtraction angiography. Overall sensitivity and specificity for MR angiography were 92% and 96.6%, respectively, for the detection of hemodynamically significant disease and 92.3% and 99.4%, respectively, for the detection of occlusions. CONCLUSION: Two-station contrast-enhanced three-dimensional MR angiography with a dedicated lower-extremity vascular coil proved effective enough to consider it as a noninvasive alternative to digital subtraction angiography in the assessment of the pelvic and lower extremity arterial vasculature.