Objective To comprehend the concept， pathology， molecular mechanisms， diagnosis， and treatmentof aggressive fibromatosis （AF）， and to find a novel way to cure aggressive fibromatosis. Method The literatures about the definition， molecular mechanisms， and clinical research of AF were reviewed and analized. Results AF is rare and benign fibromatous lesion that is the result of abnormal proliferation of myofibroblasts. The pathologic features of AF isa benign disease， but it has “malignant” biological behavior. The tumor often involved the surrounding organs and bloodvessels， and caused death of patients. For patients with clinical symptoms or complications， complete excision of thetumor is the treatment of choice. Even if the operation to ensure the negative margin also has a higher recurrence rate， soits treatment requires multidisciplinary treatment. Conclusions The mechanism of AF is very complex， and it’s mecha-nism is still unclear. Clinical management of patients with AF is difficult and controversial， at present， the most effective treatment for AF is operation resection. The effects of adjuvant radiotherapy， chemotherapy， and other treatment after operation for AF still need further study.
Objective To investigate the mechanism and clinical significance of vincristine (VCR) inhibiting gastrinproliferation effects on human colon cell line SW480. Methods Effects of VCR on the viable cell count (A value), myoinositol triphosphate (IP3, CPM value), 〔Ca2+〕i and protein kinase C (PKC) activity of human colon cell line SW480 were evaluated in vitro by MTT assay,3Hmyoinositol incorporation, fluorescence measurements and γ-32P-ATP incorporation.Results A value of VCR+PG group was lower than that of PG or control group (Ｐ＜0.01 vs control, Ｐ＜0.01 vs PG). The concentration of IP3 or 〔Ca2+〕i in VCR+PG group was lower than that in PG group (Ｐ＜0.01 vs PG); and the PKC activity of membrane was lower than that in PG group (Ｐ＜0.05 vs PG, Ｐ＞0.05 vs control). Conclusion Effects of vincristine may be through the phosphoinositide signaling pathway on gastrinstimulating cell proliferation in human colon cell line SW480. It has provided an experimental evidence for antisignaling therapy for patients with colon cancer.
ObjectiveTo investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. MethodsThe clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. ResultsTwo (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. ConclusionMIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.
Objective To discuss the diagnosis, treatment, and follow-up visit mode of thyroid carcinoma showing thymus-like elements (CASTLE). Mothods For a systematic review of a case with CASTLE, the domestic and overseas literature was searched to analyze final diagnosis, treatment and follow-up visit indexes of that case. Results For CASTLE, the pathology combined with immunohistochemistry was the only method for final diagnosis, the operation was the main treatment, and the ultrasound as well as the computed tomography (CT) could be the follow-up visiting indexes. Conclusion CASTLE is a special kind of thyroid carcinoma, which is different from differentiated thyroid carcinoma in diagnosis, treatment and follow-up visit.
Objective To evaluate the outcomes and summarize the clinical experience of totally endoscopic mitral valve repair with artificial chordae implantation. Methods From May 2013 to June 2016, 71 patients with mitral valve insufficiency were admitted to our hospital who underwent totally endoscopic mitral valve repair with artificial chordae implantation. There were 47 males and 24 females with the age of 46.0±14.4 years ranging from 13-78 years. The pathogenesis included degenerative valvular diseases in 63 patients, congenital valvular diseases in 4, infectious endocarditis in 2, rheumatic disease in 1 and cardiomyopathy in 1. Prolapse of anterior, posterior, or both leaflets was present in 26 (36.6%), 19 (26.8%), and 25 (35.2%) patients, respectively; one patient (1.4%) presented valve annulus enlargement and thirteen were associated with commissure lesion. The mitral regurgitation area ranged from 4.2 to 26.3 cm2 (mean, 12.2±5.6 cm2). All the procedures were performed by total endoscopy under cardiac arrest. 5-0 Gore-tex sutures were used as the material of artificial chordae which was implanted one by one. Results There was no in-hospital death. One patient was transferred to mitral valve replacement, and one median sternotomy due to bleeding. The mean cardiopulmonary bypass time was 156.0±31.6 min and aortic cross-clamp time 110.0±20.1 min. We finally had 39 isolated mitral valve repair, 28 mitral valve repair combined tricuspid valve repair, 3 mitral valve repair combined atrial septal defect closure, and 1 mitral valve repair combined correction of partial anomalous pulmonary vein connection. Each patient was implanted artificial chordae of 2.5±1.7 (ranging from 1 to 7), and 65 patients received mitral annulus (full ring). The intraoperative transoesophageal echocardiography found no mitral regurgitation in 44 patients, the area of mitral regurgitation was 0-2 cm2 in 24, and 3 patients with mitral regurgitation>2 cm2 experienced serious systolic anterior motion. Of the 3 patients with systolic anterior motion (SAM), one transferred to mitral valve replacement, one underwent mitral re-repair, and one took conservative treatment. The mean follow-up was 12.7±10.5 months (range: 1 to 36 months), while 2 patients were lost to follow up with the follow-up rate of 97.2%. Recurrent severe regurgitation occured in 3 patients, moderate in 5, mild or trivial in 27 and no regurgitation in 36. During the follow-up, 1 patient died of myocardiopathy-induced heart failure post discharge, 1 suffered from cerebral infarction, and no patient underwent reoperation. Conclusion The totally endoscopic surgical treatment of mitral valvuloplasty with artificial chordae is reliable for patients with mitral valve prolapse, which provides favorable clinical efficacy and outcomes. The difficulty lies in how to determine the appropriate length of the chordae and keep the stability of length.
Objective To investigate the preliminary experience, the evolution of surgical approach of multidisciplinary therapy for atrial fibrillation and the advantages and disadvantages of each procedure. Methods We retrospectively analyzed the clinical data of 69 patients with stand-alone surgical ablation with or without transcatheter radiofrequency ablation for atrial fibrillation in our center from January 2015 to May 2017. There were 50 males and 19 females at average age of 57.2 years. The patients were divided into three groups according to the surgical approach including a median sternotomy group (n=9), a left unilateral thoracoscopy group (n=7) and a bilateral thoracoscopy group (n=53). One (11.1%) patient, 3 (42.9%) patients and 26 (49.1%) patients received transcatheter mapping and radiofrequency ablation after surgical ablation in each group, respectively. Results The mean follow-up time in the median sternotomy group was 10.2 months. All 9 patients maintained sinus rhythm. The mean follow-up time of the left unilateral thoracoscopy group was 7.4 months. Five (71.4%) patients maintained sinus rhythm. While the mean follow-up time of the bilateral thoracoscopy group was 5.0 months. Forty-seven (88.7%) patients maintained sinus rhythm. There was no perioperative death, or death, stroke, major bleeding nor pulmonary vein stenosis during follow-up. Conclusion The classic Cox-Maze Ⅳ procedure with high success rate is still the basic operation for the surgical treatment of atrial fibrillation, while the thoracoscopic mini maze procedure has the advantages of minimally invasiveness, repeatibility, and can achieve similar results as Cox-Maze Ⅳ procedure when combined with transcatheter radiofrequency ablation. Multidisciplinary therapy could be the best solution for non-paroxysmal atrial fibrillation.
ObjectiveTo investigate the effectiveness and safety of totally endoscopic transmitral myectomy (TETM) for hypertrophic obstructive cardiomyopathy (HOCM), comparing with traditional sternotomy modified Morrow procedure (SMMP).MethodsThirty-eight patients with HOCM who needed surgical intervention were selected from our hospital in 2019, including 14 males and 24 females, with an average age of 56 (44-68) years. According to the operation method, they were divided into a TETM group (n=18) and a SMMP group (n=20). Appropriate patients were screened by propensity matching scores. Finally, the clinical data of two matched groups were compared and analyzed.ResultsThere was no death, septal perforation, residual left ventricular outflow tract obstruction or third degree atrioventricular block in either group. After propensity score matching, there was no statistical difference between the two groups in the ICU length of stay (41.5±5.0 h vs. 53.0±24.0 h, P=0.620), ventilation time (19.5±9.2 h vs. 38.0±24.0 h, P=0.463), cardiopulmonary bypass time (190.7±45.6 min vs. 156.0±70.7 min, P=0.627), aortic cross-clamp time (100.1±25.3 min vs. 94.5±57.3 min, P =0.915), left ventricular outflow tract gradient (17.0±1.4 mm Hg vs. 5.0±0.5 mm Hg, P=0.053), left atrial anterior and posterior diameter (37.0±1.3 mm vs. 40.0±0.7 mm, P=0.090), interventricular septum thickness (12.5±0.7 mm vs. 13.0±1.4 mm, P=0.712), left ventricular posterior wall thickness (10.0±1.4 mm vs. 10.5±2.1 mm, P=0.811), left ventricular end-diastolic diameter (43.5±3.5 mm vs. 46.0±4.2 mm, P=0.589), and mitral regurgitation (1.0±0.2 vs. 0.7±0.5, P=0.500). The follow-up time was 6±3 months, and no death occurred. In the TETM group, one patient underwent mitral valvuloplasty again three months after surgery because of a tear in the A3 region of mitral valve..ConclusionTETM is a safe and effective procedure that can well expose the interventricular septum at the basal & middle obstruction site and effectively eliminate the mitral regurgitation associated with systolic anterior motion syndrome caused by left ventricular outflow tract obstruction.