Objective To provide a practicable method for the complete display and localization of the posterolateral structures (PLS) of the normal knee through MRI study. Methods 30 tibial bone specimens were observed to establish the bony landmark for localizing the knee. In 50 cadaver knees, the angles between lateral tibial plateau and the long axis of the individual structure of PLS were measured. Then the scan methods of the oblique MR images were determined based on above results. The routine and oblique scans of T 1WI were performed in 40 normal knees. The display effect and appearance of the PLS were observed on MRI. Results The lateral tibial plateau was a stable bony landmark for measuring and localizing of the knee. In the 40 normal knees, The fibular collateral ligament could be intactly displayed on 70? posterior coronal oblique images in 34 cases (85%). The popliteus could be better seen on either 45? medial sagittal oblique in 34 cases (85%) or 60? posterior coronal oblique planes in 36 cases (90%). The popliteofibular ligament could be intactly appreciated on both 60? posterior coronal oblique in 32 cases (80%) and 70? lateral sagittal oblique images in 34 cases (85%). Although the arcuate ligament and the fabellofibular ligament could occasionally be seen on routine and oblique images, but the display rate was lower. Conclusion The oblique MR imaging can intactly display the main structures of PLS, and can be useful in diagnosing the injuries in those structures.

OBJECTIVETo evaluate a retro-grade auricular flap for repairing large alar defects.

METHODSTwenty-nine adult cadavers were anatomically used for vascular investigation of the frontal, nasal and temporal regions by injecting a dye into the main vessels. Based on the anatomical study in these regions, a retro-grade auricular flap was designed for repairing alar defects in 16 patients.

RESULTSThe blood supply of the auricle could be nourished by the inner carotid artery system from the supratrachlear artery and supraorbital artery through the frontal arterial anastomotical network into the frontal branch of the superficial temporal artery. It is then passing the main trunk of the superficial temporal artery into the ear area through the auricular branches of the superficial temporal artery. The retro-grade auricular island flap could be formed by basing the supratrachlear artery and the supraorbital artery through the vascular network between the superficial temporal artery and the supratrachlear artery or the supraorbital artery. Sixteen patients with large alar defects and half-sized nasal defects were successfully repaired by this technique.

CONCLUSIONSThe retro-grade auricular island flap, based on the inner carotid artery system, could be a good and safe flap for repairing a large alar defect or half-sized nasal reconstruction.

Adult ; Arteries ; Cadaver ; Carotid Artery, Internal ; Ear Auricle ; blood supply ; Humans ; Nose Deformities, Acquired ; surgery ; Ophthalmic Artery ; Reconstructive Surgical Procedures ; Surgical Flaps ; blood supply ; transplantation ; Temporal Arteries

BACKGROUNDClinical observations have shown that the complex fractionated atrial electrogram (CFAE) associates with ganglionated plexus activity in the cardiac autonomic nervous system. This study aimed to investigate the impact of CFAE ablation on vagal modulation to atria and vulnerability to develop atrial fibrillation (AF).

METHODSTen adult mongrel dogs were involved. Cervical sympathovagal trunks were decentralized and sympathetic effects were blocked. CFAE was color tagged on the atrial 3-dimensional image and ablated during AF induced by S1S2 programmed stimulation plus sympathovagal trunk stimulation. Atrial effective refractory period (ERP) and vulnerability window (VW) of AF were measured on baseline and at vagal stimulation at 4 atrium sites. Serial tissue sections from ablative and control specimens received hematoxylin and eosin staining for microscopic examination.

RESULTSMost CFAE areas were localized at the right superior pulmonary quadrant, distal coronary sinus (CS(d)) quadrant, and proximal coronary sinus (CS(p)) quadrant (21.74%, separately). Sinus rhythm cycle length (SCL) shortening did not decrease significantly after ablation at the sites, including right atrial appendage, left atrial appendage, CS(d), and CS(p) (P > 0.05). ERP shortening during vagal stimulation significantly decreased after ablation (P < 0.01); the VW to vagal stimulation significantly decreased after ablation (P < 0.05). The architecture of individual ganglia altered after ablation.

CONCLUSIONSCFAE has an autonomic basis in dogs. The decreased SCL and ERP shortening to vagal stimulation after CFAE ablation demonstrate that CFAE ablation attenuates vagal modulation to the atria, thereby suppressing AF mediated by enhanced vagal activity. CFAE ablation could suppress AF mediated by enhanced vagal activity.

Animals ; Atrial Fibrillation ; therapy ; Autonomic Nervous System ; Catheter Ablation ; methods ; Dogs ; Electrophysiologic Techniques, Cardiac ; methods ; Electrophysiology ; Female ; Male

Objective The aim of this study was to investigate the efficiency and safety of ibutilide for cardioversion of persistent atrial fibrillation (AF) during radiofrequency ablation.Methods Eighteen patients (16 males) with persistent atrial fibrillation were enrolled in this study.All patients underwent circumferential pulmonary vein ablation guided by a Carto three-dimensional mapping systen.In addition,linear ablation at the top of the left atrium and the isthmus of mitral valves and complex fractionated atrial electrogram (CAFE) ablation were performed.All patients were still in either atrial fibrillation or atrial flutter after ablation,the patients were treated with l mg intravenous ibutilide injection within 10 minutes after unsuccessful ablation.Intravenous injection was stopped in case of sinus rhythm (SR) restoration or occurrence of severe adverse reactions such as ventricular tachycardia.Cardioversion rate within 30 min and adverse reactions within 4 h were observed.Patients were divided into either conversion group or nonconversion group according to whether AF was converted to sinus rhythm within 30 minutes after injection.Results Eleven patients (61.11％ ) converted to SR after ibutilide injection.There were no significant differences in gender,age,body mass index,left atrium and left ventricular function between conversion group and non-conversion groups.The average conversion time was ( 13.80 + 7.64 ) min,left atrium scar area ratio was significantly larger in non-conversion group ( 12.40 + 11.03 ) ％ than in conversion group (5.12 ±3.83)％,P ＜0.05.Ibutilide significantly prolonged the average wavelength of the AF wave ( 171.8 + 29.5 ) ms vs.(242.0 ± 40.0) ms at baseline,P ＜ 0.01.The QT interval at 30 min after ibutilide injection (0.39 ± 0.21 ) s was significantly longer than before injection (0.51 ± 0.08 ) s,P ＜ 0.05.There was no serious arrhythmias or other adverse reactions post ibutilide injection.Conclusions Ibutilide is highly effective and safe agent for cardioversion in patients underwent unsuccessful ablation.Left atrium scar area ratio is an important determinant for the conversion rate in this cohort.

Objective To compare the clinical efficacy and safety of insulin glulisine (GLU) and insulin aspam(ASP) combined with insulin glargine (GLA) in type 2 diabetes patients (T2DM) with secondary failure to oral hypoglycemic agents.Methods One hundred and twenty cases of T2DM with secondary failure to oral hypoglycemia agents were randomly divided into control group (n =60 cases) and treatment group (n =60 cases).The control group received subcutaneous injection of ASP before 0-10 min three meals daily,and the treatment group received subcutaneous injection of GLU before 0-10min three meals daily.The two groups were treated with subcutaneous injection of GLA,once daily.The initial dose of ASP and GLU were 0.8 U · kg-1 · d-1,and the initial dose of GLA was 0.2 U · kg-1 · d-1.Two groups of patients were hospitalized for 2 weeks.The changes of blood glucose,cases and days of blood glucose of achieving target were compared after treatment of hospitalization.The improvement of HbAlc and the frequency of hypoglycemia were observed after treatment of 12 weeks.Results The days of 2-hour postprandial blood glucose(2 h PG) of achieving target in the treatment group and the control group were (10.01 ± 1.99)d and (10.93 ± 1.52)d with 57 cases and 47 cases,and the days of fasting plasma glucose,postprandial blood glucose and 2 h PG of achieving target were (10.31 ± 1.04) d and (11.03 ± 1.38) d with 48 cases and 40 cases(all P ＜ 0.05).After treatment 12 weeks,the HbAlc in treatment and control groups were (6.78 ±0.59)％ and (7.07 ±0.49)％ without significant difference (P ＞ 0.05).During treatment of 12 weeks,the adverse drug reactions in the two groups were mainly hypoglycemic events,the incidence of hypoglycemia in the treatment group was 30.00％,and 25.00％ in the control group,the difference was not statistically significant (P ＞ 0.05).Conclusion Both GLU combined with GLA or ASP combined with GLA have similar efficacy and safety for T2DM with secondary failure to oral hypoglycemic agents.GLU combined with GLA is more rapid in controlling 2 h PG of these patients.

Objective Electrical restitution was believed to be a determinant responsible for the stability of heart rhythm. Although numerous studies focused on the role of action potential duration restitution (APDR) in the initiation and maintenance of ventricular fibrillation (VF), the relationship between atrial APDR and atrial fibrillation (AF) has not been fully understood. This study aims to investigate the characteristics of APDR of left atrium (LA) and right atrium (RA) in canines and the relevance to induction of AF. Methods Monophasic action potential (MAP) was recorded from LA and RA in 14 canines using the MAP recording-pacing combination catheter. APDR, plotted as action potential duration (APD) on the preceding diastolic interval (DI), was assessed by use of programmed stimulation with a single extrastimulus (S_1S_2) at LA and RA. Episodes of AF were recorded and analyzed. Results APD_(90) was significantly shorter in the LA than that in the RA [( 157.4 ± 43.5 ) ms vs. ( 170. 9 ± 37. 9)ms, P < 0. 05]. The mean slope of the APDR curve by S_1S_2 in the LA was significantly greater than that in the RA ( 1.3 ±0. 4 vs. 0. 9 ± 0. 3, P < 0. 05 ). The incidence of induced AF was significantly higher in the LA than in the RA (11/18 vs. 7/18, P < 0. 05). Conclusions The APDR and MAP characteristics are not uniform between atriums, which may be one of the important mechanisms responsible for the initiation of AF. Heterogeneity of APDR between LA and RA might create critical gradients or a dispersion of repolarization and subatrate for re-entrant arrhythmias and vulnerability to AF.

BACKGROUNDAblation of complex fractionated atrial electrograms (CFAE) is an important adjunctive therapy in atrial fibrillation (AF). The present study was to elucidate the substrate underlying CFAE.

METHODSNine adult mongrel dogs were involved in the present study. AF was induced through rapid atrial pacing with vagosympathetic nerve stimulation. CFAE was recorded during AF. Ablation was performed at CFAE sites. Based on the location of the ablation scar, the atrial specimens were divided into CFAE and non-CFAE sites. Serial sections of the atrium were stained respectively with hematoxylin-eosin (HE) and the general neural marker protein gene product 9.5 (PGP9.5). We compared the characteristics of the myocardium and the ganglionated plexus (GPs) distribution between the CFAE and non-CFAE sites.

RESULTSThe myocardium of non-CFAE sites was well-organized with little intercellular substance. However, the myocardium in the CFAE site was disorganized with more interstitial tissue ((61.7 ± 24.3)% vs. (34.1 ± 9.2)%, P < 0.01). GPs in the CFAE site were more abundant than in non-CFAE sites ((34.45 ± 37.46) bundles/cm(2) vs. (6.73 ± 8.22) bundles/cm(2), P < 0.01).

CONCLUSIONThe heterogeneity of the myocardium and GPs distribution may account for the substrate of CFAE and serve as a potential target of ablation.

Animals ; Atrial Fibrillation ; pathology ; Dogs ; Electrophysiologic Techniques, Cardiac ; methods ; Myocardium ; pathology

BACKGROUND: Pulmonary vein (PV) occlusion generally depends on repetitive contrast agent injection when cryoballoon ablation for atrial fibrillation (AF). The present study was to compare the effect of cryoballoon ablation for AF guided by transesophageal echocardiography (TEE) vs. contrast agent injection. METHODS: Eighty patients with paroxysmal AF (PAF) were enrolled in the study. About 40 patients underwent cryoballoon ablation without TEE (non-TEE group) and the other 40 underwent cryoballoon ablation with TEE for PV occlusion (TEE group). In the TEE group during the procedure, PVs were displayed in 3-dimensional images to guide the balloon to achieve PV occlusion. The patients were followed up at regularly scheduled visits every 2 months. RESULTS: No differences were identified between the groups in regard to the procedure time and cryoablation time for each PV. The fluoroscopy time (6.7 ± 4.2 min vs. 17.9 ± 5.9 min, P < 0.05) and the amount of contrast agent (3.0 ± 5.1 mL vs.18.1 ± 3.4 mL, P < 0.05) in the TEE group were both less than the non-TEE group. At a mean of 13.0 ± 3.3 mon follow-up, success rates were similar between the TEE group and non-TEE group (77.5% vs. 80.0%, P = 0.88). CONCLUSIONS Cryoballoon ablation with TEE for occlusion of the PV is both safe and effective. Less fluoroscopy time and a lower contrast agent load can be achieved with the help of TEE for PV occlusion during procedure.
Aged ; Atrial Fibrillation ; diagnostic imaging ; surgery ; Contrast Media ; Cryosurgery ; methods ; Echocardiography, Three-Dimensional ; methods ; Echocardiography, Transesophageal ; methods ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Veins ; diagnostic imaging ; surgery ; Treatment Outcome

Objective To determine the predictive value of HATCH score on recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).Methods The data of 123 consecutive AF patients (74 paroxysmal and 49 persistent AF) who underwent RFCA between April 2009 and December 2010 in our department were retrospectively analyzed.Of theses patients,65 (52.9％) patients had HATCH score =0,41 (33.3％) patients had HATCH score =1,and 17 (13.8％) patients had HATCH score ≥2 (HATCH =2 in 11 patients,HATCH =3 in 5 patients,HATCH =4 in 1 patient).The recurrence was defined as atrial tachyarrhythmia lasting more than 30 seconds after 3 months post RFCA.The patients were divided into recurrence group and no recurrence group.Relationship between HATCH score and recurrence was observed.Results There were 43 cases in recurrence group and 80 cases in no recurrence group.After 12 months follow-up,HATCH score was significant higher in recurrence group than in nonrecurrence group[(0.91 ±0.94) score vs.(0.53 ± 0.80) score,P ＜ 0.05].The ratio of patients with HATCH≥2 in recurrence group was higher than in non-recurrence group [23.3％ (10/43) vs.8.8％ (7/80),P ＜ 0.01].The sensitivity and specificity of HATCH ≥ 2 to define the risk of recurrence was 25.0％,92.4％ respectively.Cumulative non-recurrence rate of patients with HATCH score≥2 was lower than patients with HATCH score =0 and 1 (P ＜ 0.05).Conclusion Higher HATCH score is associated with increased risk of AF recurrence post RFCA.

OBJECTIVETo analyze the number of myeloid-derived suppressor cells(MDSC) and the level of prostaglandin E2(PGE2) in the bone marrow of adult ITP patients, and to explore their possible mechanisms involved in the pathogenesis of this disease.

METHODSTwenty-five patients of newly diagnosed ITP, 25 patients of complete remission group and 15 patients of control group were selected. The number of MDSC in the bone marrow between 3 groups was detect by flow cytometry (FCM). The serum level of prostaglandin E2 (PGE2) in 3 groups was determined by enzyme linked immunosorbent assay (ELISA). The relative expression of IFN-γ mRNA in bone marrow mononuclear cells was measured by real time fluorescence quantitative polymerase chain reaction (RT-qPCR) in each groups.

RESULTSThe number of MDSC in the complete remission group was significantly higher than that in the control group (P<0.05); the number of MDSC in the newly diagnosed group was higher than that in the control group; the number of MDSC in the complete remission group was higher than that in the newly diagnosed group. The serum level of PGE2 in bone marrow of ITP patients in the newly diagnosed group was higher than that of the control group（P<0.05）. The serum level of PGE2 in the bone marrow of ITP patients of the complete remission group was higher than that of the control group (P<0.05）. The level of PGE2 in bone marrow serum of ITP patients of the newly diagnosed group was lower than that in the complete remission group(P<0.05）. The relative expression level of IFN-gamma in bone marrow mononuclear cells of the ITP patients in newly diagnosed group was higher than that in the control group and the complete remission group（P<0.001）. The relative quantification (RQ) of IFN-γ in bone marrow mononuclear cells was 2.60 between the newly diagnosed group and the complete remission group.

CONCLUSIONWhen adult ITP disease is remitted, the number of MDSC rises and correlates with the therapeutic response and PGE2 level in the bone marrow.

Adult ; Bone Marrow ; Flow Cytometry ; Humans ; Myeloid-Derived Suppressor Cells ; Purpura, Thrombocytopenic, Idiopathic ; RNA, Messenger