OBJECTIVETo compare the efficacy and safety of segmental pulmonary vein isolation (SPVI) and circumferential pulmonary vein isolation (CPVI) guided by EnSite NavX system in patients with atrial fibrillation (AF).

METHODSEighty-five patients with paroxysmal AF and persistent AF were enrolled in this study. Forty patients (30 with paroxysmal AF and 10 with persistent AF) underwent SPVI procedure, and 45 (31 with paroxysmal AF and 14 with persistent AF) underwent CPVA guided by EnSite NavX three-dimensional electrophysiological mapping system. All the patients were followed up for over six months.

RESULTSThe success rate was 65% in the SPVI group and 84.4% in the CPVI group (P=0.0332), with incidence of major complications of 17.5% and 6.7%, respectively (P=0.0845). In the SPVI group, 12.5% patients had pulmonary vein stenosis after the operation, which occurred in none of the patients in the CPVI group (P=0.0312). The total procedure time was 200.4+/-37.0 min in the SPVI group, significantly shorter than that in the CPVI group (226.5+/-26.1 min, P=0.002). The fluoroscopy time in the SPVI group was obviously longer than that in the CPVI group (54.7+/-9.7 vs 27.1+/-3.1 min, P<0.001).

CONCLUSIONSCPVI guided by EnSite NavX system is more effective than SPVI for treatment of atrial fibrillation with significantly shortened fluoroscopy time but prolonged procedure time. The two procedures results in comparable incidences of major complications, but CPVI is associated with reduced rate of pulmonary vein stenosis in comparison with SPVI.

Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; adverse effects ; methods ; Electrophysiologic Techniques, Cardiac ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pulmonary Veins ; physiopathology ; surgery

OBJECTIVETo investigate the efficacy and safety of circumferential pulmonary vein ostial isolation guided by EnSite NavX three-dimensional electrophysiological mapping in patients with atrial fibrillation (AF).

METHODSThirty-eight patients with drug refractory paroxysmal or persistent AF underwent circumferential pulmonary vein ostial isolation and were followed up to investigate the efficacy and safety of the treatment.

RESULTSAll cases reached the endpoint of the ablation, and both sides of the pulmonary vein were completely isolated, with an average procedure time of 200.4-/+37.0 min, X-ray exposure time of 54.7-/+9.7 min, and three-dimensional left atrial geometry reconstruction time of 27.5-/+7.5 min. During the follow-up for 9-/+3 months, the success rate of initial ablation was 89.5%, and the incidence of procedure-related complications were 7.9%.

CONCLUSIONSCircumferential pulmonary vein ostial isolation guided by EnSite NavX three-dimensional electrophysiological mapping can be effective and safe for AF treatment.

Adult ; Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Electrophysiologic Techniques, Cardiac ; methods ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Veins ; surgery ; Treatment Outcome

OBJECTIVETo investigate the clinical value of Paroxetine combined with mid-frequency electrical pulse acupoint stimulation (EPAS) in the treatment of premature ejaculation (PE).

METHODSTotally 69 PE patients were equally assigned to receive oral Paroxetine 20 mg/d, mid-frequency EPAS, or oral Paroxetine 10 mg/d combined with mid-frequency EPAS (P + EPAS) , all for 8 weeks. We obtained the intravaginal ejaculation latency time (IELT) and Chinese Index of Premature Ejaculation (CIPE-5) scores of the patients before and after treatment, and compared adverse reactions among the three groups of patients.

RESULTSOne patient of the Paroxetine group gave up treatment because of abdominal pain and nausea. Compared with the baseline, the patients in the Paroxetine, EPAS, and P + EPAS groups all showed markedly increased IELT ([0.92 ± 0.11] vs [4.07 ± 0.11] min, P < 0.01; [0.92 ± 0.12] VS [2.78 ± 0.17] min P < 0.05; [0.91 ± 0.09] vs [5.31 ± 0.13], P < 0.01) and decreased CIPE-5 scores (12.5 ± 3.0 vs 22.0 ± 2.1, P < 0.01; 12.8 ± 2.9 vs 19.5 ± 1.9, P > 0.05; 13.1 ± 2.8 vs 25.2 ± 2.1, P 0.01), with statistically significant differences between the P + EPAS group and the other two (P < 0.05). The total effectiveness rate was 95.7% in the P + EPAS group, remarkably higher than in the Paroxetine (72.7%, P < 0.05) and the EPAS group (47.8, P < 0.01).

CONCLUSIONOral Paroxetine combined with mid-frequency EPAS has a higher safety and efficacy than either Paroxetine or EPAS alone in the treatment of PE.

Acupuncture Points ; Aged ; Combined Modality Therapy ; methods ; Ejaculation ; Electroacupuncture ; methods ; Humans ; Male ; Paroxetine ; therapeutic use ; Premature Ejaculation ; therapy ; Serotonin Uptake Inhibitors ; therapeutic use ; Treatment Outcome

OBJECTIVETo investigate the late results of using posterior restoration and three-column fixation to treat lumbar spondylolisthesis.

METHODSOne hundred and eighty-four patients with lumbar spondylolisthesis were collected from March 1999 to May 2007, they were treated by posterior restoration and fixation with single nail-grooved tail steel plate and fixed with cage (WDFC). Among these cases, 87 cases were fixed with one WDFC, 97 cases were used two WDFCs.

RESULTSAll patients were followed up for 8 to 69 months(averaged 23 months). According to Nakai standard, the results was excellent in 142 cases, good in 34, fair in 8, the excellent and good rates were 95.6%. Seventy-nine vertebraes with I degree spondylolisthesis were reduced after surgery. Eighty-seven vertebraes with II degree spondylolisthesis were reduced except 9 with I degree spondylolisthesis left. Twenty-one with III degree spondylolisthesis were reduced except 5 with I degree spondylolisthesis left; In 2 with IV degree spondylolisthesis, one with I degree spondylolisthesis left and the other with II degree spondylolisthesis left. The follow-up results showed that there was no statistical significance in the height of intervertebral space between preoperation and post-operation, and no recurrence was observed and no single nail-grooved tail steel plate and WDFC were loose or crashed.

CONCLUSIONPosterior restoration and three-column fixation is a positive modus operandi to treat lumbar spondylolisthesis,which can reduce excellently,keep the height of intervertebral space and stabilization of segment, obtain high rate of fusion, and cut down complication.

Adolescent ; Adult ; Aged ; Bone Plates ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Fusion ; instrumentation ; Spondylolisthesis ; surgery

OBJECTIVETo study the clinicopathologic features of intraductal papillary mucinous neoplasm (IPMN) and its distinction from mucinous cystic neoplasm of pancreas.

METHODSThe clinical, radiologic and histologic features of 17 cases of IPMN and 13 cases of mucinous cystic neoplasm (MCN) were reviewed. Mucin profiles (MUC1, MUC2 and MUC5AC) were studied by histology (HE) and immunohistochemistry (EnVision).

RESULTS10 of the 17 cases of IPMN were males. 13 cases of the IPMN were located in head of pancreas. Communication with the main pancreatic duct was demonstrated in 15 cases. Histologically, there were mild to severe papillary ingrowths of dysplastic epithelial cells, associated with intervening normal or atrophic pancreatic parenchyma. Ovarian-like stroma was not seen. Ancillary investigations showed that MUC2 and MUC5AC were detected in tumor cells of 9 and 4 cases respectively. The 4 cases with invasive component showed MUC1 positivity. On the other hand, 11 of the 13 cases of MCN occurred in middle-aged to elderly females and were located in the body and tail of pancreas. Ovarian-like stroma was commonly seen and there was no connection with the main pancreatic duct. All non-invasive MCN, regardless of the degree of cytologic atypia, were positive for MUC5AC (but not MUC2). In the 2 cases with invasive component, MUC1 expression was observed, as in IPMN.

CONCLUSIONSThe age and sex of patients, tumor location, absence of ovarian-like stroma, communication with main pancreatic duct and characteristic mucin profiles represent useful parameters in distinguishing IPMN from MCN of pancreas. The tumor cells of IPMN express mainly MUC2, while those of MCN express MUC5AC. MUC1 may also be a useful marker in demonstration of stromal invasion in these tumors.

Adult ; Age Factors ; Aged ; Antigens, Neoplasm ; metabolism ; Biomarkers, Tumor ; metabolism ; Carcinoma, Pancreatic Ductal ; diagnosis ; metabolism ; pathology ; Carcinoma, Papillary ; diagnosis ; metabolism ; pathology ; Cystadenocarcinoma, Mucinous ; diagnosis ; metabolism ; pathology ; Cystadenoma, Mucinous ; diagnosis ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mucin 5AC ; Mucin-1 ; Mucin-2 ; Mucins ; metabolism ; Pancreas ; metabolism ; Pancreatic Neoplasms ; diagnosis ; metabolism ; pathology ; Precancerous Conditions ; diagnosis ; metabolism ; pathology ; Sex Factors

Objective To establish an automatic synthesis method for 11C-carfentanil (CFN) as an novel opiate receptor radioligand and study its biodistribution in rats. Methods 11C-Triflate-CH3 was bubbled into 0.5 mg precursor desmethyl-CFN (which was dissolved in 0.15 ml DMSO) to generate 11C-CFN in a V-tube at room temperature. Sep-Pak C2 column was used for purification of 11C-CFN, which was eluted by 3ml binary system aqueous solution, 10 ml water thrice, and then I ml ethanol. The biodistribution (% ID/g) of 11C-CFN in SD rats was studied. SPSS 13.0 was used for statistical analysis. Non-normal distribution data were analyzed using nonparametric test. Results The synthesis time for 11C-CFN was 20 min (end of bombardment, EOB). The synthesis yield was (35.5 ± 2.2) % on average (n = 12, uncorrected)with the radiochemical purity over 98%. Biodistribution study in rats showed that the tracer had a high brain uptake, rapid blood clearance, and a metabolic pathway via liver and kidney. The highest tracer uptake was in thalamus (4.26 ± 0.89) % ID/g and striatum (4.05 ± 1.08) % ID/g at 5 min after injection, followed by cerebral cortex (2.63±0.89) %ID/g, pons (2.26 ±0.57) % ID/g, hippocampus (2. 17 ±0.55) %ID/g and cerebellum (2. 15 ±0.39) %ID/g. Conclusions The automatic synthesis of 11C-CFN is fast and reliable, and this radioligand can be used for opiate receptor imaging.

BACKGROUND: Computed tomography (CT) and magnetic resonance imaging (MRI) data can be fused to identify the tumor boundaries. This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely. This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia. METHODS: Between September 2008 and December 2015, 24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation. The cohort comprised 16 males and eight females with a median age of 19.5 years (range: 12-48 years). The tumor location was the femoral diaphysis in three patients, distal femur in 19, and proximal tibia in two. The tumors were osteosarcoma (n = 15), chondrosarcoma (n = 3), Ewing sarcoma (n = 3), and other sarcomas (n = 3). We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation. RESULTS: Pathological examination verified that all resected specimens had appropriate surgical margins. The median distance from the tumor resection margin to the joint was 30 mm (range: 13-80 mm). The median follow-up duration was 62.5 months (range: 24-134 months). Of the 24 patients, 21 remain disease free, one is alive with disease, and two died of the disease. One patient developed local recurrence. Complications requiring additional surgical procedures occurred in six patients, including one with wound hematoma, one with delayed wound healing, one with superficial infection, one with deep infection, and two with mechanical failure of the prosthesis. The mean Musculoskeletal Tumor Society score at the final follow-up was 91% (range: 80%-100%). The 5- and 10-year implant survival rates were 91.3% and 79.9%, respectively. CONCLUSIONS Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.
Adolescent ; Adult ; Child ; Computers ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; Prostheses and Implants ; Sarcoma ; Young Adult

OBJECTIVETo study the clinicopathologic features and metastasizing potential of solid pseudopapillary tumor of the pancreas (SPT).

METHODSForty-five cases of SPT were retrieved from the archival file and subdivided into metastasizing group (MG, n = 4), and non-metastasizing group (NMG, n = 41), according to the follow-up clinical information. The histological features were reviewed and immunohistochemical study for vimentin, alpha 1-antitrypsin, alpha 1-antichymotrypsin, CD10, neuron-specific enolase, progesterone receptor, chromogranin A, synaptophysin, AE1/AE3, beta-catenin, p53, cyclin D1, CD34 and Ki-67 was carried out. The results were correlated with follow-up data.

RESULTSThere was no statistically significant difference between MG and NMG, in terms of age and gender of the patients, site, size and capsular status of the tumor. No single morphologic parameter could distinguish MG from NMG. In general, increased mitotic activity, tumor emboli in vessels and necrotic foci were more conspicuous in MG than in NMG. According to a morphologic scoring system, all cases of MG had score ≥ 5, in contrast to < 5 in 95.1% (39 cases) of NMG. Immunohistochemically, there was no statistically significant difference between MG and NMG for beta-catenin, p53, cyclin D1 and CD34 staining. Ki-67 positivity however was significantly higher in MG. Amongst the 37 cases with follow-up information available, the average duration of follow up was 37.4 months. Thirty-three patients were alive and disease-free.Four suffered from liver metastases; and none of them died of the tumor.

CONCLUSIONSMitotic activity, presence of tumor emboli and necrotic foci represent as the useful parameters in predicting metastasizing potential of SPT, especially with application of morphologic scoring system. Immunostaining for Ki-67 can also serve as an additional prognostic indicator.

Adolescent ; Adult ; Carcinoma, Papillary ; metabolism ; pathology ; secondary ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Ki-67 Antigen ; metabolism ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Mitosis ; Necrosis ; Pancreas ; pathology ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; metabolism ; pathology ; surgery ; Survival Rate ; Tumor Suppressor Protein p53 ; metabolism ; Young Adult ; beta Catenin ; metabolism

Objective To investigate the clinical efficacy of finger reconstruction in child with second toe transplantation,and evaluate the postoperative appearance and function regarding the reconstructed donor feet.Methods From June 2002 to May 2011,sixteen cases were reconstructed in sub-emergency with second toe transplantation.Two thumbs,eight index fingers,and 6 middle fingers were reconstructed.All patients were followed-up from 12 to 24 months.The functions of reconstructed fingers were analysed.Results All the reconstructed fingers survived.Vascular crisis occurred in 1 patient,and survived after re-anastomosis.Necrosis of skin grafts at the domon site with exposed tedons was seen in 1 ease,and healed after changing dressings.All the reconstructed fingers showed good in growth and development,and performed good functions as grabbing,grasping and nipping.Two-point discrimination was between 6 mm and 10 mm.The donor site of the foot had normal gait,without obvious influence on walking.Also,no pain was complained.Conclusion The method of transplanting the second toe can reconstruct the appearance and function of the finger defects in child,and has little effect on the appearance and motion of feet.It is an effective treatment method.

OBJECTIVETo evaluate the therapeutic potential of marrow-derived cardiac stem cell (MCSC) transplantation after myocardial infarction (MI) in rats.

METHODSMCSC were selected from the marrow mesenchymal stem cell (MMSC) of male SD rats by single-cell cloning culture. MI was induced by left anterior descending artery ligating in female SD rats. Equal volume PBS, MMSC and MCSC were transplanted at the border zone of the infarct one week after MI. Cardiac function was assessed by echocardiography at four weeks after cell transplantation. The hearts were removed and morphological changes of scar tissue were examined with HE staining and Masson trichrome staining, VEGFR-1(+) capillary vessels were labeled with immunohistochemical staining. Scar area and vessel density were measured by image analyzer. MCSC containing Y chromosome were examined using in situ fluorescent hybridization, and cardiomyocyte cTnT expression was also analyzed.

RESULTSCardiac transcription factor Nkx2.5 was expressed at low level in c-kit(+) MCSC. Four weeks after cell transplantation, left ventricular fractional shortening and ejection fraction were significantly higher while scar area was significantly lower in MCSC group compared to MMSC group and control group. cTnT was expressed in cells containing Y chromosome and these cells were connected with myocardium of recipient rats in the rats transplanted with MCSC. Vessel density around the infarcted tissue in MCSC group was similar as that in MMSC group and significantly higher than that in control group.

CONCLUSIONMSCS could effectually differentiate into functional cardiomyocytes at the border zone of the infarct, and MCSC transplantation post MI significantly improved cardiac functions and promoted angiogenesis.

Animals ; Bone Marrow Cells ; cytology ; Cell Differentiation ; Disease Models, Animal ; Female ; Myocardial Infarction ; therapy ; Myocytes, Cardiac ; transplantation ; Rats ; Rats, Sprague-Dawley ; Stem Cell Transplantation