Outcomes After Aortic Valve Replacement for Asymptomatic Severe Aortic Regurgitation and Normal Ejection Fraction

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99mTc-DTPA核素肾动态显像评价主动脉夹层患者术后肾功能受损研究

目的:应用99mTc-DTPA肾动脉显像评价Stanford不同分型主动脉夹层患者术后左、右侧肾功能及总体肾功能受损程度,帮助临床制定进一步的治疗方案,改善患者预后。方法:回顾性分析2018年3月8日至2019年7月19日,在本院核医学科行99mTc-DTPA肾动态显像的主动脉夹层术后患者48例,评价患者双肾血流灌注、总肾小球滤过率(GFR)和分肾的GFR,比较Stanford主动脉夹层A型(简称A型)患者和主动脉夹层B型(简称B型)患者之间总肾功能及分肾功能,血肌酐、血尿素氮及血尿酸水平的差异。结果:B型患者术后总GFR低于A型患者(67.5 vs.80.6 m L/min,P<0.05),其中以左肾功能受损为著(30.9 vs.40.3 m L/min,P<0.05),差异有统计学意义。结论:肾动态显像对主动脉夹层术后患者早期评价肾功能有重要价值。主动脉夹层B型患者GFR较A型减低,且左侧肾GFR减低更明显,临床可以早期采取干预措施,改善主动脉夹层患者预后。     

Increased hospital costs are associated with low skeletal muscle mass in patients undergoing elective open aortic surgery

Objective

Low psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the United States. We sought to evaluate this effect on hospital expenditure for patients undergoing vascular repair in a health care system with universal access.

髌周去神经化预防全膝关节置换术后膝前疼痛

目的　依据髌周解剖学特点，探讨全膝关节置换术（total knee arthroplasty，TKA）中应用髌周电灼去神经化的临床效果。 方法　纳入82名诊断为骨性关节炎的患者（91膝），予行双侧或单侧不置换髌骨的TKA，按随机对照原则将病人分为两组，共有41名实验组患者（45膝）在TKA中接受了髌周去神经化处理，41名对照组患者（46膝）未做该处理。手术主刀为同一骨科医师，均使用相同的膝关节假体系统。主要评价项目包括膝关节KSS评分、Western Ontario and McMaster Universities（WOMAC）、Feller髌骨评分及VAS评分。 结果　82名患者术后均获随访，平均随访时间为12个月，两组病人的膝关节KSS评分、WOMAC、Feller髌骨评分及VAS评分均无显著统计学差异（P>0.05）。 结论　在TKA中行髌周电灼去神经化，不能显著改善病人的预后。     

Impact and Predictors of Noncircular Left Ventricular Outflow Tract Shapes on Estimating Aortic Stenosis Severity by Means of Continuity Equations

Determining aortic stenosis (AS) severity is clinically important. Calculating aortic valve (AV) area by means of the continuity equation assumes a circular left ventricular outflow tract (LVOT). The full impact of this assumption in calculating AV area is unknown. Predictors of noncircular LVOT shape in patients with AS are undefined.In 109 adult patients with AS who underwent multiplanar transesophageal echocardiography, we calculated AV area by means of the standard continuity method and by a modified method involving planimetric LVOT area.We found 54 circular, 37 horizontal-oval, 8 vertical-oval, and 10 irregular LVOTs. Area derived by direct planimetry correlated better with the modified than the standard continuity method (r=0.89 vs r=0.85; both P=0.0001). Valve areas of patients with mild, moderate, or severe AS by planimetry were more often mischaracterized with use of the standard than modified method (29 vs 18; P <0.0001). Horizontal-oval AV area derived by planimetry (1.28 ± 0.55 cm²) was underestimated by the standard method (1.05 ± 0.47 cm²; P=0.001), but not by the modified method. Congenital AV morphology and low cardiac index were the only multivariate predictors of horizontal-oval shape. Low cardiac index was the only predictor of noncircular shape.More than half our patients with AS had noncircular LVOTs. Using the modified method reduces mischaracterizations of AS severity. Congenital AV morphology and low cardiac index predict horizontal-oval or noncircular shape. These data suggest the value of direct LVOT measurement to calculate AS severity in patients who have congenital AV or a low cardiac index.     

Renal Denervation for Treatment of Cardiac Arrhythmias: State of the Art and Future Directions

Renal Denervation for Treatment of Cardiac Arrhythmias . It has now been more than a quarter of a century since modulation of the sympathetic nervous system was proposed for the treatment of cardiac arrhythmias of different origins. But it has also been some time since some of the early surgical attempts have been abandoned. With the development of ablation techniques, however, new approaches and targets have been recently introduced that have revolutionized our way of thinking about sympathetic modulation. Renal nerve ablation technology is now being successfully used for the treatment of resistant hypertension, but the indication spectrum might broaden and new therapeutic options might arise in the near future. This review focuses on the possible impact of renal sympathetic system modulation on cardiac arrhythmias, the current evidence supporting this approach, and the ongoing trials of this method in electrophysiological laboratories. We will discuss the potential roles that sympathetic modulation may play in the future.