1.Early and long-term outcomes of mitral valve repair in degenerative mitral regurgitation
Tianyu ZHOU ; Jun LI ; Hao LAI ; Yongxin SUN ; Kai ZHU ; Jiawei GU ; Yulin WANG ; Dingqian LIU ; Wenjun DING ; Tao HONG ; Chunsheng WANG
Chinese Journal of Thoracic and Cardiovascular Surgery 2018;34(6):335-338,343
Objective The aim of the study is to evaluate the early and long-term outcomes of mitral valve repair for degenerative mitral regurgitation.Methods From January 2003 to December 2015,clinical profiles of 1 903 patients with degenerative mitral regurgitation who underwent mitral valve repair at our institution were analyzed retrospectively.There were 1 312 males (68.9 %) and 591 females (31.1%) the mean age was (54.2 ± 13.1) years.Early and long-term outcomes were summarized and risk factors for adverse events were assessed.Results There were 35 in-hospital deaths(1.8%) and in-hospital mortality for isolated mitral valve repair was 0.9% (10/1 163).Perioperative complications included central nerve system complications(0.7%),respiratory failure requiring tracheotomy(1.8%),acute renal injury requiring hemodialysis(1.2%) and reoperation for bleeding(0.7 %).NYHA function class Ⅲ-Ⅳ (OR =3.65),atrial fibrillation (OR =2.85) and ejection fraction <0.6(OR =2.34) were identified as independent risk factors for in-hospital mortality.12 years over follow-up,overall survival,freedom from reoperation for mitral valve and freedom from recurrent moderate/severe regurgitation were 85% 、91% and 75%,respectively.Age > 60 years(HR =7.43),preoperative stroke(HR =6.51),ejection fraction < 0.6 (HR =3.87),left ventricular end-systolic dimension > 40 mm (HR =3.98) and pulmonary systolic pressure > 50 mmHg (1 mmHg =0.133 kPa) (HR =2.85) were independent predictive factors for late death.Ejection fraction < 0.6 (HR =4.01),left ventricular end-diastolic dimension > 60 mm(HR =1.88),leaflet lesion involving anterior leaflet (HR =2.40) and residue mild regurgitation(HR =4.17) were independent predictors for late recurrent regurgitation.Leaflet lesion involving anterior leaflet(HR =2.40) and residue mild regurgitation (HR =3.35) were independent predictor for late reoperation for mitral valve.Conclusion Mitral valve repair is safe and effective in degenerative mitral regurgitation.Early surgical intervention for asymptomatic patients with preserved left ventricular function before onset of atrial fibrillation and pulmonary artery hypertension is associated with decreased incidence of adverse events and improved long-term outcomes.Early surgical intervention should be restricted in experienced high-volume centers.
2. Advances in immunotherapy of extranodal NK/T cell lymphoma
Dingqian HAO ; Lianqing LI ; Maocai LI ; Lili GONG
Chinese Journal of Otorhinolaryngology Head and Neck Surgery 2019;54(12):949-953
Extranodal NK/T-cell lymphoma (ENKTCL) is a relatively rare group of highly aggressive non-Hodgkin′s lymphoma (NHL). The disease has rapid clinical progress, high degree of malignancy and poor prognosis. Traditional chemoradiotherapy regimens have not shown good efficacy. In recent years, the immunotherapy of tumors has developed rapidly. At present, it has shown strong therapeutic activity in the treatment of various solid tumors such as non-small cell lung cancer, prostate cancer, melanoma and kidney cancer. Multiple tumor immunotherapy drugs have been approved by the US Food and Drug Administration (FDA) for clinical use. This article reviews recent novel immunotherapeutic regimens of ENKTCL, hoping to change the treatment modality of this malignant disease.