Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis. The localization and anchor of many transcatheter heart valves available in the clinic today are dependent on the calcific aortic valve leaflet of patients. We reported here a successful case of transapical aortic valve implantation with Ken-Valve heart valve in an 82-year-old male patient with pure severe aortic regurgitation without native valve calcium. Postoperative follow-up (3 months after the surgery) showed that the cardiac function significantly improved. The echocardiography indicated that the Ken-Valve prosthesis worked well without perivalvular regurgitation. The short-term clinical effect was satisfactory. The Ken-Valve with three position anchors is proved to be suitable for the treatment of pure aortic regurgitation.
ObjectiveTo compare the in-hospital outcomes of transapical transcatheter aortic valve replacement (TA-TAVR) for bicuspid aortic valve (BAV) patients and tricuspid aortic valve (TAV) patients. MethodsPatients (including BAV and TAV patients) who underwent TA-TAVR with the J-ValveTM in West China Hospital from July 2014 to July 2020 were included consecutively. The clinical outcomes of the patients were analyzed. ResultsA total of 354 patients were included in the study, 75 in the BAV group and 279 in the TAV group. There were 229 males and 125 females with a mean age of 72.2±6.0 years. No death occurred during the procedure, and the overall technical success rate was 97.7%. The all-cause in-hospital mortality rate was 1.4%. Twenty (26.7%) patients with BAV and 46 (16.5%) patients with TAV had mild or higher perivalvular leaks immediately after the procedure. No patients with BAV required permanent pacemaker implantation postoperatively, while 13 (4.7%) TAV patients required permanent pacemaker implantation, with an overall pacemaker implantation rate of 3.7%. One (1.3%) BAV patient and 7 (2.5%) TAV patients developed acute kidney injury postoperatively. One (1.3%) BAV patient and 1 (0.4%) TAV patient developed perioperative myocardial infarction. The average postoperative hospital stay was 7.6±3.6 d for BAV patients and 8.6±6.1 d for TAV patients. There was no statistical difference in primary or secondary in-hospital outcomes between BAV and TAV patients (P>0.05). ConclusionCompared to TAV patients, BAV patients have similar in-hospital outcomes, with a low incidence of adverse clinical outcomes, which provides preliminary evidence for its implementation in Chinese patients with a high proportion of BAV.
ObjectiveTo investigate the feasibility and safety of transcatheter aortic valve replacement (TAVR) through apical approach for aortic regurgitation of large annulus.MethodsFrom November 2019 to May 2020, 10 male patients aged 64.50±4.20 years with aortic valve insufficiency (AI) underwent TAVR in the Department of Cardiovascular Surgery, Xijing Hospital. The surgical instruments were 29# J-valveTM modified and the patients underwent TAVR under angiography. The preoperative and postoperative cardiac function, valve regurgitation, complications and left ventricular remodeling were summarized by ultrasound and CT before and after TAVR.ResultsA total of 10 valves were implanted in 10 patients. Among them, 1 patient was transferred to the aortic arch during the operation and was transferred to surgical aortic valve replacement; the other 9 patients were successfully implanted with J-valve, with 6 patients of cardiac function (NYHA) class Ⅱ, 4 patients of grade Ⅲ. And there was a significant difference between preoperation and postoperation in left ventricular ejection fraction (44.70%±8.78% vs. 39.80%±8.48%, P<0.05) or aortic regurgitation (1.75±0.72 mL vs. 16.51±8.71 mL, P<0.05). After 3 months, the patients' cardiac function was good.ConclusionTAVR is safe and effective in the treatment of severe valvular disease with AI using J-valve.
Caveolin-1 (Cav-1) protein plays a very important role in the central nervous system, and is closely related to Alzheimer’s disease (AD). Through literature review, this article summarizes the present research status of Cav-1 protein in the field of AD from three aspects: the relationship between Cav-1 gene and AD; the relationship of Cav-1 protein with learning and memory; the relationship of Cav-1 protein with amyloid β-protein and Tau protein. And the aim of this paper is to provide a new thought and evidence for exploring the mechanism of AD via Cav-1 protein.
Objective To systematically evaluate the effectiveness of somatostatin analogs versus placebo for Graves’ ophthalmopathy (GO). Methods Such databases as PubMed, EMbase, The Cochrane Library, WanFang Data, CNKI, VIP and CBM were searched to collect the randomized controlled trails (RCTs) about somatostatin analogs for Graves’ Ophthalmopathy (GO) pulished by March 2012, while the bibliographies of the included literatue were also retrieved. According to the inclusion criteria, two reviewers screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 5 RCTs involving 210 patients were included. The results of meta-analysis showed that somatostatin analogs could reduce the clinical activity score (CAS) of GO patients (MD=0.58, 95%CI 0.02 to1.13, P=0.04), but the effects in reducing the degree of proptosis (mm) was still unverifiable (MD=0.21, 95%CI –0.14 to 0.56, P=0.24). It did not show obvious effects for diplopia, orbital volume, intraocular pressure, visual acuity or the restriction of eye movements. The existing evidence could not confirm that somatostatin analogs were effective for GO (OR=1.32, 95%CI 0.45 to 3.9, P=0.61). Conclusion Somatostatin analogs can reduce the CAS of GO patients, but without significantly clinical significance. Moreover, the effect of reducing proptosis is sitll unverifiable. So the existing evidence cannot confirm that somatostatin analogs are effective for GO. For the quality and quantity limitation of the included studies, this conclusion needs to be proved by performing more high quality RCTs.
ObjectiveTo screen and identify an ideal lead compound with potential inhibitory effects on N-methyl-D-aspartate receptor (NMDAR) from the ZINC15 drug database, promoting drug design and development to improve epilepsy treatment. Methods Potential NMDAR inhibitors were identified through a series of computer-aided structural and chemical virtual screening techniques (Discovery Studio). Structure-based virtual screening was used to predict and further filter candidate compounds based on physicochemical, pharmacological, and toxicological properties. The binding affinity and chemical bond distribution between selected compounds and NMDAR were then analyzed, and the stability of the ligand-NMDAR complex in a natural environment was evaluated. Results The study identified one novel natural compound from the ZINC15 database, with ZINC000096085903 showing low rodent carcinogenicity, no Ames mutagenicity, no developmental toxicity, and ideal physicochemical properties. This compound demonstrated high binding affinity and favorable interaction energy, with the ZINC000096085903-NMDAR complex exhibiting more favorable potential energy than the complex formed by NMDAR and the reference ligand ketamine. Furthermore, molecular dynamics simulation indicated that this complex remains stable in vivo and can inhibit NMDAR similarly to ketamine. Conclusion ZINC000096085903 is an ideal lead compound for NMDAR inhibition. With higher binding affinity and stability when bound to NMDAR, as well as slower metabolism, ZINC000096085903 showed significant potential for long-term epilepsy treatment.
Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. The use of new heart valves prosthesis has improved surgical safety and efficacy. This report described a 72-year-old male patient with severe aortic stenosis combined with severe aortic regurgitation, who was evaluated at moderate-high risk of surgery and received a transapical TAVR using the Ken-Valve heart valve. The transcatheter operation time was 8 min, and the blood loss was 50 mL. The tracheal intubation was removed immediately after the surgery. Transesophageal echocardiography on the 4th postoperative day showed that the aortic valve leaflets worked well, and there was no valve orifice and paravalvular leakage. The patient was discharged on the 5th day after the surgery without complications. Transapical TAVR using Ken-Valve was an easy surgical procedure for aortic valve disease, and had short operation time.
ObjectiveTo explore the clinical value of modified Soave procedure with stapler for the treatment of Hirschsprung disease. MethodsThe clinical data of 26 patients with Hirschsprung disease adimitted in No.477 hospital from January 2002 to December 2010 were analyzed retrospectively. All the patients underwent modified Soave operation with rectal mucosa and proximal intestine stapled end-to-end. ResultsAll operations were successful without anastomotic leakage, aponeurosis of investment infection, and colonitis. Increased stool frequency presented in two cases, which were cured with astringents on day 15 and 30 after operation, respectively. Mild fecal contamination was in one case. All cases were followed up between 3 months to 60 months, with an average 32 months, without incontinence and constiptation. ConclusionModified Soave procedure with stapler is safe and effective for the treatment of Hirschsprung disease in elder children and adult.
【Abstract】 Objective To investigate the early effectiveness of the Discover cervical artificial disc replacement in treating cervical spondylosis. Methods Qualified for the selective standard, 24 patients with cervical spondylosis were treated between March 2010 and March 2011. Of 24 patients, 13 patients underwent anterior cervical decompression and fusion (ACDF) (ACDF group, between March 2010 and September 2010) and 11 patients underwent Discover cervical artificial disc replacement (CADR group, between September 2010 and March 2011). There was no significant difference in gender, age, disease duration, lesions typing, and affected segments between 2 groups (P gt; 0.05). The operative time, blood loss, and complications were recorded. Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) scores, and Odom’s scores were used to evaluate the postoperative effectiveness. In CADR group, the cervical range of motion (ROM) in all directions, and prosthesis eccentricity were measured before and after operation. Results Symptoms disappeared and no complication occurred after operation in the patients of 2 groups. The patients were followed up 12 to 18 months (mean, 15.3 months) in ACDF group and 6 to 12 months (mean, 9.6 months) in CADR group. The NDI scores in CADR group were significantly higher than those in ACDF group at 1, 3, and 6 months (P lt; 0.05), but no significant difference was observed in JOA score improvement rate between 2 groups (P gt; 0.05). According to Odom’s score at last follow-up, the results were excellent in 6 cases, good in 4 cases, and fair in 3 cases with an excellent and good rate of 76.92% in ACDF group, and were excellent in 9 cases, good in 1 case, and poor in 1 case with an excellent and good rate of 90.91% in CADR group, showing no significant difference (χ2=3.000, P=0.223). The patients in CADR group had significant limit of cervical joint ROM in flexion and extension and right bending at 1 month (P lt; 0.05), but cervical joint ROM restored after 3 months. The ROMs of left bending at 3 months and 6 months were bigger than preoperative value (P lt; 0.05). Meanwhile, ROM in left bending were bigger than that in right bending in replaced segment and upper segment (P lt; 0.05), and the ROM difference between left bending and right bending in upper segment was 2 times higher than that in the replaced segment; a marked linear correlation (P lt; 0.05) existed between the ROM difference and prosthesis eccentricity, and prosthesis bias had bigger ROM in lateral bending. Conclusion Discover cervical artificial disc replacement for treatment of cervical spondylosis can provide a good effectiveness and cervical postoperative movement function. As a new prosthesis, it has some merits such as simple operative steps and less complications.
Pure native aortic valve regurgitation (NAVR) is one of the common heart valve diseases, and the prognosis of symptomatic chronic NAVR is poor. Although transcatheter aortic valve replacement (TAVR) is currently an "off-label" procedure, it remains the option for patients with high risk for surgery. In this case, an 81-year-old man with multiple comorbidity and high Society of Thoracic Surgeons score, the risk for surgery is rather high. Through the preoperative evaluation by the multidisciplinary heart team, considering that the patient had calcification at the junction of annulus, as well as mild aortic stenosis, after careful consideration, 29# Venus A-Valve was chosen. After the procedure, the symptoms were obviously improved and the follow-up effect was good. Due to various causes of NAVR, great anatomical variation of annulus, little calcification of aortic valve, and lack of anchor point and other problems, the procedure to treat NAVR with TAVR is still difficult. At the same time, there are few valve systems developed for the anatomical characteristics of aortic regurgitation valve. TAVR in the treatment of patients with high risk for surgery still requires long-term practice and technical development.