Objective:To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR).Methods:This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results:In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ2=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ2=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts ( χ2=5.24, P=0.155). Conclusion:The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Objective:To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR).Methods:This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results:In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ2=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ2=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts ( χ2=5.24, P=0.155). Conclusion:The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

To explore the value of portable oto-endoscopy system in clinical teaching of otolaryngology residents.

The postgraduate students serving as resident doctors in the Department of Otolaryngology of Peking Union Medical College Hospital from February to March 2022 and from February to March 2023 were selected as the research objects. Random number table method was used to divide them into experimental group and control group. The control group was first taught by theoretical explanation + electrooto-endoscopy system, and the experimental group was first taught by theoretical explanation + portable oto-endoscopy system. After one month, the two groups interchanged their teaching methodologies. The results of theoretical assessment, self-evaluation at the end of the first month of clinical learning and satisfaction with teaching effectiveness at the end of two months of clinical learning were compared between the two groups.

A total of 36 residents were included in this study, with 18 in each group. After one month of clinical study, the theoretical test scores of the experimental group were significantly higher than those of the control group[(93.17±4.16) points vs. (82.28±4.46) points, P=0.000]. The results of the questionnaire survey showed that the self-evaluation scores of the test group in the five dimensions of ear disease learning, clinical learning efficiency, clinical data collection, doctor-patient communication and equipment use were significantly higher than those of the control group(all P < 0.05). After two months of ear rotation, the satisfaction of the 36 students on portable ear endoscopy teaching was significantly higher than that of electric ear endoscopy (57.9% vs. 47.4%, P=0.040).

The portable oto-endoscopy system can display the anatomy and diseases of otolaryngology more vividly and intuitively in the clinical teaching of otolaryngology, facilitate the management of clinical data, increase the learning interest of residents, fully mobilize the image thinking of medical students, and improve the post competence of residents more efficiently.

To explore the value of portable oto-endoscopy system in clinical teaching of otolaryngology residents.

The postgraduate students serving as resident doctors in the Department of Otolaryngology of Peking Union Medical College Hospital from February to March 2022 and from February to March 2023 were selected as the research objects. Random number table method was used to divide them into experimental group and control group. The control group was first taught by theoretical explanation + electrooto-endoscopy system, and the experimental group was first taught by theoretical explanation + portable oto-endoscopy system. After one month, the two groups interchanged their teaching methodologies. The results of theoretical assessment, self-evaluation at the end of the first month of clinical learning and satisfaction with teaching effectiveness at the end of two months of clinical learning were compared between the two groups.

A total of 36 residents were included in this study, with 18 in each group. After one month of clinical study, the theoretical test scores of the experimental group were significantly higher than those of the control group[(93.17±4.16) points vs. (82.28±4.46) points, P=0.000]. The results of the questionnaire survey showed that the self-evaluation scores of the test group in the five dimensions of ear disease learning, clinical learning efficiency, clinical data collection, doctor-patient communication and equipment use were significantly higher than those of the control group(all P < 0.05). After two months of ear rotation, the satisfaction of the 36 students on portable ear endoscopy teaching was significantly higher than that of electric ear endoscopy (57.9% vs. 47.4%, P=0.040).

The portable oto-endoscopy system can display the anatomy and diseases of otolaryngology more vividly and intuitively in the clinical teaching of otolaryngology, facilitate the management of clinical data, increase the learning interest of residents, fully mobilize the image thinking of medical students, and improve the post competence of residents more efficiently.

Objective: To investigate an effect on speech recognition after bilateral cochlear implants(CI) simultaneously. Methods: Nine subjects who underwent bilateral CI operation simultaneously in Peking Union Hospital in 2007 were assigned as bilateral group, another 9 subjects with unilateral CI were chosen as unilateral group according to the age, gender, duration of deafness. Hearing threshold, speech recognition of phrases, disyllabic words, single word in quiet and noise environment were calculated, respectively. Three different sound source positions were set up to simulate the three effects of binaural hearing (head shadow, binaural redundancy and binaural squelch) in noise environment. The speech signal intensity was 70 dBSPL, the signal to noise ratio (SNR) was 0 dB, + 4 dB, + 8 dB, and the speech recognition of phrases were examined in bilateral CI group. All the data was analyzed by SPSS 19.0 software. Results: In quiet environment, the average aid-hearing threshold was significantly reduced as (7.2±3.0)dB in bilateral CI group compared to unilateral CI group(P<0.05). However, the speech recognition of phrases, disyllabic words, and single word in quiet and noise environment did not show significant differences between bilateral CI and unilateral CI groups (P>0.05). In the testing under noise environment, the speech recognition of bilateral CI group was significantly higher than that of unilateral CI group (P<0.05). In the estimation of noise environment (SNR=+ 8), the phrase test and speech recognition of head shadow model in bilateral groups were significantly better than that of unilateral group (P<0.01). Further, bilateral CI group showed statistical significances in binaural redundancy and binaural squelch models(P<0.01), there was statistically significant were also found difference between two groups (P<0.01); Bilateral CI group did not reveal significant difference compared with unbilateral CI group in binaural squelch model(P>0.05). Under different signal-to-noise ratio (SNR=+ 8, + 4) noise environment, all the three given models in bilateral CI group show higher signal-to-noise ratio, higher speech recognition rate (Independent-Samples t test, P<0.01). In addition, head shadow model presented negative influences on speech recognition rate compared with binaural redundancy and binaural squelch model by SNR(P<0.05). SNR influences on binaural redundancy and binaural squelch model were almost identical, F=0.371, P=0.549. Conclusion The subjects who underwent simultaneous bilateral cochlear implantation could significantly reduce aid-hearing threshold, and greatly improve the speech recognition of phrases, disyllabic words, and single word under noise environment.

Objective Analysis of the outcome of the electric brain stem auditory response (EABR) before cochlear implantation (CI) and the mapping parameters after CI in 187 cases,to explore the significance of EABR before CI.Methods From February,2008 to December,2014,EABR were performed in 187 patients with normal cochlear structures before CI with Nucleus 24R multi-channel cochlear.Including 105 cases of male,82 cases of female;152 cases of no residual hearing,35 cases of residual hearing.Self-design electrical stimulator and US Bio-logic auditory evoked potential were taken,EABR were performed under general anesthesia before CI,recording EABR waveforms,measuring the latency of Ⅱ,Ⅲ,Ⅳ,Ⅴ wave and the Ⅲ-Ⅴ interval,Ⅴ-wave amplitude,Ⅴ-wave threshold and I/O curve slope.Data were analysis by SPSS19.0.Results EABR waveforms were recorded in all 187 patients.The Ⅱ,Ⅲ,Ⅳ,Ⅴ waves are similar with the acoustic evoked ABR,the waveforms differentiation were different in ages,but no significant difference in gender.At 50 μs pulse electrical stimulation,the average threshold of V-wave was (156.37 ± 21.44) CL,the average dynamic range was (36.33-± 8.63) CL.20 CL above the threshold,average latency of wave Ⅱ,Ⅲ,Ⅴ was (1.54 ± 0.12) ms,(2.06 ± 0.23) ms and (4.14 ± 0.25) ms,the Ⅲ-Ⅴ interval was (2.08 ± 0.24) ms,the average amplitude of Ⅴ-wave was (0.35-0.07) μⅤ.One month later,the 187 patients achieved different degrees of hearing,the average C value of mapping was (163.55 ± 27.43)CL,significantly correlated with EABR threshold(r =0.915,P =0.013).The EABR threshold in 35 cases of no residual hearing value was (163.82 ± 16.21)CL and V-wave I/O curve slope was 0.035 227 ± 0.013 918,and the threshold was (148.41 ± 15.38)CL,the slope was 0.041 364 ±0.013 623 in paired group of 35 residual hearing patients,there was a statistically significant difference between two groups(t =15.838 and 4.328,P ＜ 0.05).Conclusions The EABR detection method is reliable,extraction rate is high.EABR can be used to evaluate the auditory pathway before inserting electrode,which could provide the help for the screening operative indications of CI.

Objective To investigate the effects of Epigallocatechin gallate(EGCG)on IL-1βinduced MIN6 cells apoptosis. M.Methods The experiment group was divided into control group,IL-1β group,IL-1β+ EGCG low concentration group and IL-1β+EGCG high concentration group.Cell activity was detected by CCK8.Insulin secretion was detected by ELISA.cell apoptosis was detected by flow cytometry.The mitochondrial membrane potential was detected by flow cytometry.ATP content and cell ac-tivity of ROS were detected by colorimetry and chemiluminescence method.Results Compared with normal group,IL-1β group showed much lower cell activity,insulin secretion,cell mitochondrial membrane potential and ATP content,and at the same time IL-1βgroup had significantly higher cell apoptosis and ROS activities.After given EGCG,both low concentration group and high con-centration group had higher cell activity,insulin secretion,cell mitochondrial membrane potential and ATP content,at the same time lower cell apoptosis and ROS activities was showed.And the IL-1β+EGCG high concentration group worked more powerful.Con-clusion EGCG has protective effects on IL-1βinduced MIN6 cells apoptosis.Its mechanism may be related to increasing the content of the ATP and mitochondrial membrane potential and protecting mitochondrial function as well reducing the activity of ROS.

OBJECTIVE: To investigate cochlear implantation surgical techniques and postoperative results in patients with cochlear ossification. METHOD: Twenty-nine cochlear ossification patients with cochlear implantation in our department were retrospectively studied during 1997-2011. Preoperative imaging and electrophysiological assessment were done to classify the cochlear ossification of all the patients. Categories of auditory performance and speech intelligibility rating were detected to assess the outcome of cochlear implant postoperatively. RESULT: Among 29 cases with cochlear ossification, 19 cases were grade II, 4 cases were grade I, 4 cases were grade III, and 2 cases were apical turn ossification. Among 23 patients with cochlear ossification grade I and II, 17 cases were totally cochlear array insertion, and 6 cases were partial cochlear array insertion. Patients with cochlear ossification grade III were all partial cochlear array insertion. Most patients achieved good hearing and language ability after cochlear implantation. CONCLUSION Cochlear implantation can be successfully performed on the basis of systematic preoperative assessment and some patients can achieve good postoperative results in patients with cochlear ossification. Intraoperative electrical stimulation of the auditory evoked response provides a good method to assess the residual spiral nerve function.
Adolescent ; Adult ; Child ; Child, Preschool ; Cochlea ; pathology ; Cochlear Implantation ; methods ; Female ; Follow-Up Studies ; Hearing Loss, Sensorineural ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; complications ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVE: The aim of this study was to evaluate the clinical features of cochlear reimplantation. To review our experience of cochlear reimplant surgery. METHOD: Retrospective analysis of all 25 cochlear reimplant surgeries between 2002 and 2012. Causes of revision operations, number of electrode channels inserted, surgical findings and postoperative speech performances were analyzed. RESULT: Causes of reimplantation were eight hard failures; eight poor implanted electrodes position, four poor outcome, three skin flap infection lead to implant device exposure, one postoperative symptoms of facial nerve stimulation, one postoperative temporal bone lesions. All cochlear reimplantations were successfully performed in our hospital, audiologic performances were stable or improved following reimplantation in most of cases. CONCLUSION Cochlear implant surgeons should have a good knowledge of how to diagnose cochlear implant failures and how to deal with medical complications related to cochlear implantation. Medical and audiologic outcomes are generally excellent. Cochlear reimplantation appears to be a safe and effective.
Cochlea ; Cochlear Implantation ; Cochlear Implants ; Electrodes ; Electrodes, Implanted ; Facial Nerve ; Humans ; Postoperative Period ; Reoperation ; Retrospective Studies ; Speech ; Speech Perception ; Surgical Flaps ; Temporal Bone

OBJECTIVETo analyze the characteristics of autopsies in medical dispute.

METHODSThe data of 202 autopsy cases in medical disputes performed by the Department of Pathology of Jiangxi Medical College from January 2001 to December 2010 were retrospectively analyzed.

RESULTSThe number of autopsy in medical disputes increased year by year. Neonatal, infant and 30 ≊ 60y were more common age groups in dispute; the gender ratio of male to female was 2:1 and more cases were from hospitals in rural areas. Most medical disputes came from in departments of pediatric, obstetrics and gynecology and general surgery. Death caused by cardiovascular diseases ranked at the first place.

CONCLUSIONAutopsy is important in medical disputes to define the cause of death and to preserve evidence.

Adolescent ; Adult ; Aged ; Autopsy ; statistics & numerical data ; Cardiovascular Diseases ; mortality ; Cause of Death ; Child ; Child, Preschool ; Dissent and Disputes ; Female ; Hospital Departments ; statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Malpractice ; Middle Aged ; Retrospective Studies ; Sex Ratio ; Young Adult