ObjectiveTo investigate the safety and effectiveness of pedicle screw implantation via vertebral arch-transverse pathway in clinical application by a prospective randomized controlled trial.MethodsTwenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group (screw implantation via vertebral arch-transverse pathway) and the control group (traditional screw implantation technology), with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury, injured segment, and the interval between injury and operation (P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation.ResultsThe time of screw implantation of trial group was (5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant (t=4.258, P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups (χ2=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47% (5/59), which was significantly lower than that in the control group [32.20% (19/59); χ2=4.125, P=0.021].ConclusionCompared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.
ObjectiveTo observe transforming growth factor β3 (TGF-β3) gene expression and the chondrogenesis of bone marrow mesenchymal stem cells (BMSCs) after TGF-β3 gene is transfected into BMSCs of Diannan small-ear pig. MethodsRecombinant adenovirus 5 (rAd5) was extracted as gene vector and packed into recombinant adenovirus rAd5-TGF-β3, double enzyme digestion and PCR identification were performed. BMSCs were isolated and cultured from bone marrow of 2-month-old Diannan small-ear pigs (weighing, 12-15 kg), and the 2nd generation of BMSCs were harvested for experiments. The experiments were divided into 3 groups. BMSCs were transfected with rAd5-TGF-β3 as experimental group and with empty vector as control group, and non-transfected BMSCs were used as blank control group. The transfection efficiency of exogenous gene was identified by flow cytometry, TGF-β3 protein expression by immunofluorescence and Western blot. The cell morphology of experimental group was observed by inverted phase contrast microscope, and the expression of collagen type II in each group was detected by Western blot. ResultsThe rAd5-TGF-β3 recombinant adenovirus was successfully constructed and transfected into BMSCs. Green fluorescence was observed by immunofluorescence microscope. Flow cytometry test showed the best transfection at 72 hours (transfection efficiency of 84.86%). Immunofluorescence staining showed that the expression of TGF-β3 protein was obvious at 72 hours; Western blot showed that there was a TGF-β3 positive band with a relative molecular mass of 30×103, while the control group and blank control group had no positive band. Obvious chondrogenic differentiation was observed in the experimental group after transfection in vitro, while the control group and blank control group had no obvious chondrogenic differentiation. Western blot showed that there was collagen type II positive band with a relative molecular mass of 130×103 at 21 days after culture, while the control group and blank control group had no positive band. ConclusionrAd5-TGF-β3 gene can be successfully transfected into BMSCs via adenovirus vectors, and stable expression of TGF-β3 protein can be observed, enhancing BMSCs differentiation into chondrocytes, which may provide an experimental basis for gene therapy of joint cartilage defects.
ObjectiveTo investigate clinical outcomes of isolated atrial septal defect (ASD)repair on the beating or non-beating heart through minimally invasive right axillary approach. MethodsForty-five patients underwent isolated ASD repair through minimally invasive right axillary approach in Research Institute of Surgery, Daping Hospital of the Third Military Medical University from September 2009 to August 2011. According to different surgical techniques, all the patients were divided into a beating-heart group and a non-beating heart group. In the beating-heart group, there were 22 patients including 13 males and 9 females with their mean age of 3.2±2.1 years and body weight of 13.1±4.0 kg. There were 20 patients with ostium secundum ASD and 2 patients with ostium primum ASD. Mean ASD diameter in the beating-heart group was 12.2±5.1 mm. In the non-beating heart group, there were 23 patients including 14 males and 9 females with their mean age of 3.5±2.5 years and body weight of 12.9±3.3 kg. There were 18 patients with ostium secundum ASD, 3 patients with sinus venosus ASD, and 2 patients with ostium primum ASD. Mean ASD diameter in the non-beating heart group was 11.6±4.7 mm. Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST)and highly sensitive cardiac troponin I (cTnI)were examined preoperatively, after weaning from cardiopulmonary bypass (CPB), 6 hours and 24 hours postoperatively. ResultsThere was no in-hospital death. Postoperatively, 1 patient had right atelectasis and another patient had right pneumothorax. CPB time and operation time of the beating-heart group were significantly shorter than those of the non-beating heart group (P < 0.05). There was no statistical difference in intraoperative blood transfusion, mechanical ventilation time, length of postoperative ICU stay or hospital stay, chest drainage within 24 hours postoperatively, or postoperative cardiac function between the 2 groups (P > 0.05). Preoperative levels of CK, CK-MB, AST and cTnI were all within the normal limit, and there was no statistical difference between the 2 groups (P > 0.05). After CPB, CK, CK-MB, AST and cTnI levels increased in both groups, but increased significantly greater in the non-beating heart group (P < 0.05). Postoperative levels of CK, CK-MB, AST and cTnI of the beating-heart group were significantly lower than those of the non-beating heart group (P < 0.05). ConclusionIsolated ASD repair on the beating heart via minimally invasive right axillary approach is a safe and cosmetic procedure with shorter operation time and less myocardial injury.
ObjectiveTo explore and analyze the risk factors for arrhythmia in patients after heart valve replacement.MethodsA retrospective analysis of 213 patients undergoing cardiac valve replacement surgery under cardiopulmonary bypass in our hospital from August 2017 to August 2019 was performed, including 97 males and 116 females, with an average age of 53.4±10.5 year and cardiac function classification (NYHA) grade of Ⅱ-Ⅳ. According to the occurrence of postoperative arrhythmia, the patients were divided into a non-postoperative arrhythmia group and a postoperative arrhythmia group. The clinical data of the two groups were compared, and the influencing factors for arrhythmia after heart valve replacement were analyzed by logistic regression analysis.ResultsThere were 96 (45%) patients with new arrhythmia after heart valve replacement surgery, and the most common type of arrhythmia was atrial fibrillation (45 patients, 18.44%). Preoperative arrhythmia rate, atrial fibrillation operation rate, postoperative minimum blood potassium value, blood magnesium value in the postoperative arrhythmia group were significantly lower than those in the non-postoperative arrhythmia group (P<0.05); hypoxemia incidence, hyperglycemia incidence, acidosis incidence, fever incidence probability were significantly higher than those in the non-postoperative arrhythmia group (P<0.05). The independent risk factors for postoperative arrhythmia were the lowest postoperative serum potassium value (OR=0.305, 95%CI 0.114-0.817), serum magnesium value (OR=0.021, 95%CI 0.002-0.218), and hypoxemia (OR=2.490, 95%CI 1.045-5.930).ConclusionTaking precautions before surgery, improving hypoxemia after surgery, maintaining electrolyte balance and acid-base balance, monitoring blood sugar, detecting arrhythmia as soon as possible and dealing with it in time can shorten the ICU stay time, reduce the occurrence of complications, and improve the prognosis of patients.
Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. ResultsA total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.
ObjectiveTo construct and identify the recombinant adenovirus vector expressing bone morphogenetic protein 2(BMP-2) and transforming growth factor β3(TGF-β3) genes,to observe the expressions of BMP-2 and TGF-β3 after transfected into bone marrow mesenchymal stem cells (BMSCs) of the Diannan small-ear pigs. MethodsBMP-2 cDNA and TGF-β3 cDNA were amplified by PCR,and were subcloned into the pEC3.1(+) plasmid to obtain pEC-GIE 3.1-BMP-2 and pEC-GIE3.1-TGF-β3 plasmid respectively.They were subcloned into pGSadeno vector by homologous recombination reaction and HEK293 cells were transfected after linearization to obtain Ad-BMP-2 and Ad-TGF-β3.The BMSCs were isolated from the bone marrow of Diannan small-ear pig and cultured.The 3rd passage BMSCs were transfered with Ad-BMP-2(group A),Ad-TGF-β3(group B),Ad-BMP-2+Ad-TGF-β3(group C),and untransfected cells served as a control (group D).The expressions of BMP-2 and TGF-β3 genes and proteins were detected by PCR,immunofluorescence,and Western blot.The chondrogenic differentiation of BMSCs was evaluated by immunohistochemical of collagen type Ⅱ. ResultsThe Ad-BMP-2 and Ad-TGF-β3 were constructed successfully and confirmed by PCR and sequencing.The expression clones of Ad-BMP-2 and Ad-TGF-β3 were packaged into maturated adenovirus successfully,the titer was 5.6×108 and 1.6×108 pfu/mL respectively.The PCR results showed a light band at 310 bp in group A and at 114 bp in group B,and both 310 bp and 114 bp bands in group C,but no band in group D.The image of immunofluorescence showed that there were red fluorescence and green fluorescence expressions in the cytoplasm of BMSCs at 72 hours after transfection in groups A and B,respectively;in group C,both red and green fluorescence expressions were detected,and no red or green fluorescence was detected in group D.The results of Western blot showed that there was a light band at 18×103 in group A and at 50×103 in group B;both 18×103 and 50×103 bands were detected in group C;but no band was detected in group D.The cells were positive for collagen type Ⅱ in groups A,B,and C;group C acquired strong collagen type Ⅱ staining when compared with group A and group B;in group D,the cells were negative for collagen type Ⅱ staining. ConclusionThe recombinant adenovirus vector expressing BMP-2 and TGF-β3 are constructed successfully.The BMP-2 and TGF-β3 genes could be expressed effectively in BMSCs of Diannan small-ear pig after transfection,which could afford modified seeding cells for cartilage tissue engineering.