Warfarin is one of the most frequently prescribed oral anticoagulant. Many researches have shown that the genotypes have been strongly associated with warfarin maintenance doses. Especially, it has been accepted in academia that cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex 1 subunit (VKORC1) could affect the warfarin maintenance doses. There are also many other genotypes that were reported to be related to warfarin doses, but the results have been in controversial so far. The studies found that the dose formula which contained the genetic factors and clinical information could accurately predict the maintenance dose of warfarin, however, its usefulness is suspected due to the inconsistent results of clinical trials. Large-sample and multi-center studies are necessary to verify the specific effects of gene and non-gene factors to warfarin dose; at the same time, testing constructed models or building new models help to improve the explained percentages of individual differences.
Objective To establish and evaluate a hydrocephalus model in dogs. Methods Twelve healthy adult male mongrel dogs (weight, 10-15 kg) were randomly divided into the control group (n=6) and the experimental group (n=6). All the dogs were given CT and neurological examination to exclude congenital ventricular enlargement and neurological abnormity before they received hydrocephalus induction. Surgical procedures included the exposing of the foramen magnum area, the opening of the atlantooccipita anadesma, and the injecting of silicone oil (0.3 ml/kg) into the fourth ventricle through a silicone tube. Normal saline was injected in the control group. The Tarlov neurological fitness assessment and the Evan’s ratio were used to evaluatethe degree of hydrocephalus at 3, 14 and 56 days after operation. Results In the experimental group, the dogs were dull and unsteady in walking,and they drank and ate less. The lateral ventricle began to expand 3 days afteroperation, and then the temple horn of the lateral ventricle and the third ventricle were also affected 14 days after operation. The ventricles were enlarged progressively after operation. The Tarlov scores measured at 3, 14 and 56 days afteroperation had a significant difference at the same time point between the control group(5.83±0.75，6.50±0.55，6.00±0.63) and the experimental group (4.00±0.89，4.83±1.17，4.50±1.05，P＜0.01), but had no significant difference within the same group at different time points (P＞0.05). The Evan’s ratios measured at 3, 14 and 56 days after operation were 0.33±0.04,0.39±006，0.44±0.03，respectively,in the experimental group; and were 0.27±0.06，0.25±0.09, 0.26±0.05,respectively,in the control group. There was a significant difference atthe same time point between the two groups, and at different time points within the experimental group (P＜0.05).Conclusion The dog model of hydrocephalus induced by the injecting of silicone oil into the fourth ventricle has a highsuccess rate, and the model is appropriate for the studies on diagnosis and therapy of hydrocephalus.
Objective To share the experience of the diagnosis and treatment of children with hand-foot-mouth disease. Methods We retrospectively analyzed 31 children with hand-foot-mouth disease in our hospital from April 2007 to June 2007 in terms of epidemiology, clinical features, treatment and prognosis. Results The average age of the children was 2.8 years, and 20 out of the 31 cases were from nurseries and kindergartens. Eighteen had clear contact history. Typical signs and symptoms, including oral ulcerative herpes and blister-like rash in extremities, were found in all cases. All the children were cured after timely diagnosis and early treatment with ribavirin, without any severe complications. Conclusion Timely treatment based on early diagnosis and considerate care are important for children with hand-foot-mouth disease. Nurseries, kindergartens and primary schools should attach great importance to relevant prophylaxis and isolation. These are essential for reducing the occurrence and prevalence of this disease.
Objective To establish the swine to monkey auxiliary heterotopic liver transplantation model and to summarize surgical points. Methods Five healthy landrace piglets and five rhesus monkeys were adopted to establish the xenogenic auxiliary heterotopic liver transplantation model. In our trail landrace piglets were treated as donor andrhesus monkeys were treated as receptor. Putting the transplanted liver which included right posterior segment and part of right anterior segment into rhesus’ nest and left paracolic sulcus， and then blocking abdominal aorta and inferior vena cava shortly for end-to-side anastomosis in portal vein of transplanted liver and abdominal aorta of receptor， in infra-hepatic vena cava of transplanted liver and inferior vena cava of receptor. Ligation was performed at hepatic artery with no recon-struction. The postoperative situation and survival time of the receptors were observed. Results Four pairs of transplan-tation models were successfully established. The duration of donor liver harvesting， donor liver preparation， occlusion of recipient inferior vena cava， occlusion of abdominal aorta， and liver transplantation were （30±5） min （24-35 min），（40±10） min （31-51 min）， （30±6） min （23-36 min）， （30±8） min （22-38 min）， and （220±80） min （130-310 min）， respectively. The blood loss during transplantation was （42±6） mL （35-48 mL）. There were no thrombosis of the anas-tomosis and biliary fistula in receptors after operation， but 4 receptors died at 48， 54， 88， and 96 hours after liver transp-lantation respectively. Conclusions Swine to monkey auxiliary heterotopic liver transplantation model has b repea-tability， operation procedure is easy， and transplanted organ of it have good perfusion， which can be available for various kinds of basic and preclinical researches.
Objective To investigate the clinical significance of the three iodide transporters in thyroid diseases. Methods Literatures about the Na+/I- symporter (NIS), pendrin and human apical iodide transporter (hAIT) in recent years were reviewed and their expressions in different thyroid diseases were also analyzed. Results NIS proteins express at the basolateral membrane of thyrocytes in normal thyroid tissue, while pendrin and hAIT proteins are limited to the apical membrane of thyrocytes lining in the follicular lumen. In the tissues of thyroid carcinomas, it was found that the NIS proteins expressed in the cytoplasm and their expressions decreased; The mutation of NIS gene may be one of the main causes of congenital hypothyroidism. The expression of prendrin protein may be related to the function of follicles: its expression level increased significantly both in Graves diseases and toxic adenomas, but significantly decreased in differentiated thyroid carcinoma. However, the correlation between the decrease and the degrees of differentiation of carcinoma cell line are still disputable. The expression of hAIT protein does not significantly altered in hyperfunctioning tissues. It only slightly decreased occasionally in hypofunctioning adenomas, but it decreased significantly in thyroid carcinomas. Conclusion The abnormal expressions of the three iodide transporters may be related closely with the type of thyroid diseases. However, their pathogenic mechanisms and the causes of their abnormal expression are still unknown, which need to be studied further.
In the late-breaking trials session of the American Heart Association’s Scientific Sessions 2021, which took place in November 2021, six clinical trials in cardiac surgery published their primary results. This review will look into three of them including the management of patients with moderate or less-than-moderate tricuspid regurgitation at the time of surgery for degenerative mitral regurgitation, timing of ticagrelor cessation before coronary artery bypass grafting, and long-term outcomes of ticagrelor-based antiplatelet therapy for secondary prevention of coronary artery bypass grafting.
Patients undergoing coronary artery bypass grafting (CABG) belong to the very high-risk group of atherosclerotic cardiovascular disease. Although CABG gets advantages in relieving symptoms and improving long-term outcomes, a significant risk of cardiovascular adverse events after surgery still exists and standardized secondary prevention is needed. Lipid management plays a critical role as a secondary preventive strategy in CABG. However, lipid management of CABG patients in real clinical setting is inadequate, including lack of standardized lipid-lowering strategy, low goal attainment rate, as well as poor long-term medication adherence. In recent years, a series of clinical trials have provided a lot of groundbreaking new evidence for lipid management in patients with cardiovascular diseases which offers new strategies together with objectives of lipid-lowering and comprehensive management for patients undergoing CABG. This article reviews the strategy and research progress of lipid management after CABG, aiming to provide objective reference for clinical treatment.
Cardiac surgery presents specific challenges in conducting randomized controlled trials (RCTs). The American Heart Association made a scientific statement of methodological standards, with the purpose to review key concepts and standards in design, implementation, and analysis of cardiac surgery RCTs, and to provide recommendations. Recommendations include an evaluation of the suitability of the research question, clinical equipoise, feasibility of enrolling a representative patient cohort, impact of practice variations on the effect of the study intervention, likelihood and impact of crossover, and duration of follow-up. Trial interventions and study end points should be predefined, and adequate deliverability of the trial interventions should be ensured. Every effort must be made to keep a high completeness of follow-up. Trial design and analytic techniques must be tailored to the specific research question and trial setting. In this paper, the authors made an interpretation of this scientific statement based on their practical experience.
Since the advent of coronary artery bypass grafting (CABG), the selection of bypass conduits has always been one of the most controversial topics in this field. Arterial conduits have received extensive attention due to their excellent biological features and high patency. In recent years, the application of arterial grafting and total arterial grafting in China keeps increasing in recent years, but there is still a gap compared to the Europe and America. Previous clinical studies have indicated the benefits of the total arterial grafting in terms of patency and long-term outcomes, but the advantage of multiple arterial grafting over other procedures is still in need to be confirmed with high-quality randomized controlled trials. This article reviews the clinical application and strategy of total-arterial CABG, aiming to provide objective reference for future clinical research and application.
ObjectiveTo establish and validate a predictive nomogram for predicting the risk of distant metastasis in colorectal signet-ring cell carcinoma based on the Surveillance, Epidemiology, and End Results (SEER) database. MethodsA retrospective analysis was conducted on clinical and pathological data of patients diagnosed with colorectal signet-ring cell carcinoma in the SEER database from 2004 to 2015, and they were randomly divided into training and validation sets at a ratio of 7∶3. Independent risk factors for distant metastasis (DM) in colorectal signet-ring cell carcinoma were screened out in the training set through univariate and multivariate logistic regression analysis, and a nomogram was constructed. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, calibration, and clinical utility of the nomogram model. ResultsA total of 2 595 patients with colorectal signet-ring cell carcinoma were included, of whom 1 022 (39.4%) had DM. According to the univariate and multivariate logistic regression analysis, gender, age, T stage, N stage, surgical treatment, radiotherapy and chemotherapy were independent risk factors for DM of colorectal signet-ring cell carcinoma (P<0.05). Based on the above independent risk factors, a nomogram for DM of colorectal signet-ring cell carcinoma was constructed. The nomogram AUC of the ROC was 0.78 [ 95%CI (0.76, 0.80) ] and 0.77 [ 95%CI (0.74,0.81) ] in the training and validation sets, respectively. The calibration curves showed a good fit in the training and validation sets, with the Hosmer-Lemeshow test results being χ2=9.43, P=0.31 and χ2=12.47, P=0.13, respectively. The DCA curves showed that the model had a net benefit when the threshold probabilities of the training and validation sets were in the range of 10%–95% and 11%–990%, respectively. ConclusionThe nomogram constructed in this study exhibits higher accuracy and reliability, and can be used for early intervention and risk prediction of DM in colorectal signet-ring cell carcinoma.