Objective To analyze the outcomes of catheter ablation for persistent atrial fibrillation(AF)and the independent risk factors for its recurrence in the elderly.Methods A total of 194 patients with persistent AF who underwent catheter ablation at our department from January 2019 to December 2021 were enrolled in this study.They were divided into elderly group(≥60 years old,99 cases)and non-elderly group(＜60 years old,95 cases).Their surgical characteris-tics,postoperative complications and recurrence were compared between the two groups,and the independent risk factors for postoperative recurrence were analyzed in the elderly group.Results Advanced age,higher B-type natriuretic peptide,larger proportions of hypertension and coronary heart disease,and increased CHA2DS2-VASc and HAS-BLED scores,while lower male ratio and estimated glomerular filtration rate were observed in the elderly group than the non-elderly group(P＜0.05,P＜0.01).The elderly group had a higher proportion of left atrial fibrosis than the non-elderly group(30.3％vs 8.4％,P=0.001).Postoperative complications in the elderly group in-cluded 1 case of pericardial effusion and 2 cases of hematoma at the puncture site,and all of these were improved after treatment.There were no significant differences in the 1-year success rate(71.7％vs 69.5％,P=0.763)or recurrence rate during blanking period(21.2％vs 21.1％,P=0.981)between the elderly and non-elderly groups.AF duration(HR=1.020,95％CI:1.007-1.032,P=0.002)and recurrence during blanking period(HR=6.781,95％CI:3.078-14.935,P=0.001)were independent risk factors for postoperative recurrence in the elderly group.Conclu-sion Catheter ablation is safe and effective in the treatment of persistent AF in the elderly.The elderly patients with long duration of AF and recurrences during blanking period are more likely to experience recurrences within 1 year after ablation.

Objective: To explore the clinical application of subpectoral silicone implant associated with autologous fat grafting after tissue expansion, for breast reconstructions. Methods: From Jan 2013 to Dec 2016, a total of 15 female patients were admitted to the plastic surgery department of the First Affiliated hospital of Fujian Medical University. They were after or were prepared to unilateral modified radical mastectomy. Patients were aged 18-50 years old, with the average of 33.5 years. There were 8 cases of T₁N₀M_O (T_1micN₀M_O, n=1), 3 cases of T₂N₀M_O, 1 case of T₂N₁M_O, 1 case of T₁N₂M_O, 1 case of T₂N₂M_O and 1 case of T₃N₃M_O. A tissue expander was inserted beneath the posterior pectoralis major in first surgery. The cavity stripped range is greater than the expander around 1cm. The lowest position of the expander was determined according to the IMF of the other breast. The tissue expander was gradually filled intraoperatively and postoperatively periodically, until the expander exceeds 30%-50% of the volume of the other breast. Three months later, as the soft tissue over the breast area has stretched enough, the expander was removed in a second operation and a permanent implant was inserted. Meanwhile, the autologous fat particles, harvested from thigh or abdomen, was centrifuged at 800×g for 3 minutes. Then it was injected into the subcutaneous and posterior pectoralis major space. And the other breast may be adjusted if necessary for symmetry. Results: Fifteen patients was included in this study (immediately tissue expander implanted, n=8; delayed tissue expander implanted, n=7). All the expanders are round in shape. The interval between the two operations was 6-12 months, with an average of 7.4 months. The total salt-water solution injected was 310-450 ml per patient, with an average of 365 ml. The volume of breast implants was 180-280 ml. The injection volume of autologous fat was 65-230 ml, 122.7 ml on average. All incisions healed well. The follow-up period was 1-3 years, with an average of 2 years. The reconstructed breasts were in a natural shape, with a slight drop and bilateral symmetry. According to Harris breast shape evaluation criteria, all reconstructed breasts were graded as excellent. Conclusions The permanent implant associated with autologous fat grafting after tissue expansion is alternative for breast reconstruction.

Objective To explore the role of electrocardiogram (ECG) in predicting cardiac resynchronization therapy (CRT) response.Methods This study retrospectively analyzed ECG of 92 CRT patients,who received CRT therapy from 2001 to 2013 in our center and were followed up for 6 months.The patients were divided into responder group (n =64) and non-responder group (n =28).The baseline and 6-month data including QRS width,heart rhythm and axis variation were analyzed.The definition of responder is left ventricular end systolic volume (LVESV) reduction ≥ 15％ within 6 months after CRT.After CRT therapy,the ventricular activation was changed as left to right (frontal plane),posterior to anterior and axis changed in a clockwise direction.The change in more than two directions was defined as prominent axis change.Logistic analysis was performed to analyze the role of ECG in predicting CRT response.Results (1) Baseline parameter comparison between the two groups:the proportion of female and LBBB is significantly higher (P ＜ 0.01;P =0.04),while the proportion of atrial fibrillation/flutter (Af/AF) is significantly lower (P ＜ 0.01) in responder group than in non-responder group.The pre-CRT average QRS duration is much wider in responder group than in non-responder group (P =0.01).(2) Comparison of follow-up with baseline results in two groups:NYHA heart function level,6 minutes walking distance,QRS duration,LVEF,LVESV improved significantly (P ＜0.01) post-CRT in responder group.In non-responder group,the QRS duration and LVESV deteriorated significantly (P =0.02,P ＜ 0.01),while post-CRT NYHA heart function level improved significantly.In responder group,pre-CRT ECG axis of 53 patients (82.8％) pointed to left and 58 patients (90.6％) pointed to posterior;post-CRT ECG axis of 49 patients (76.6％) pointed to right and 30 patients (40.6％) pointed to anterior.In non-responder group,pre-CRT ECG axis of 25 patients (89.3％) pointed to left and 24 patients (85.7％) pointed to posterior;post-CRT ECG axis of 17 patients (60.7％) pointed to right and 12 patients (42.9％) pointed to anterior.Post-CRT,the proportion of ECG axis prominent change was significantly higher in responder than in non-responder group (62.5％ (40/64) vs.32.1％ (9/28),P =0.007).(3) Predicting value:pre-CRT QRS width ≥140 ms (OR =4.97,95 ％ CI 1.53 to 16.13,P =0.008) and post-CRT prominent axis change (OR =5.1,95 ％CI 1.67 to 15.5,P =0.004) were found to be independent predictors of CRT responders.Af/AF pre-CRT was associated with reduced CRT response (OR =0.25,95 ％ CI0.08 to 0.80,P =0.02).Conclusions ECG may play a role in predicting CRT response.QRS width and Af/AF before CRT and ECG axis change post-CRT could be used to predict CRT response.

OBJECTIVETo analyze HOXD13 gene in polydactyly in dispersion type of Fujian Han population in order to know whether there is mutation in HOXD13.

METHODSAll members were evaluated physically and radlologically. Genomic DNA was extracted from peripheral blood of the patients who were treated from Dec. 2012 to Apr. 2013, their parents, grandparents, and normal volunteers from our department. The polymerase chain reaction ( PCR) , agarose gel electrophoresis and DNA sequence analysis were adopted to analyze HOXD13 from six cases with polydactyly and forty normal volunteers.

RESULTSAll patients had no family history. A heterozygous synonymous mutation, c. 291 C > T( p. A60A), was detected in exon 1 of the HOXD13 Gene in five of the polydactyly patients. Similar mutation was not detected in one brachy dactyly patient and the forty normal volunteers.

CONCLUSIONA heterozygous synonymous mutation, c.291C > T (p. A60A), of the HOXD13 gene may be related with polydactyly in dispersion type of Chinese han population.

China ; Exons ; Heterozygote ; Homeodomain Proteins ; genetics ; Humans ; Mutation ; Polydactyly ; genetics ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Transcription Factors ; genetics

Objective: To explore the guiding significance of transpulmonary thermodilution pulse-indicated continuous cardiac output (PiCCO) in treatment for patients with acute inferior wall myocardial infarction (AIMI). Methods: A total of 26 AIMI patients in intensive care unit of cardiology department in our hospital from Jul 2012 to Jan 2014 received PiCCO and ultrasonic cardiography (UCG) to monitor cardiac output (CO) and cardiac index (CI), and their correlation analysis. Results: When PiCCO placement and after placement 72h， PiCCO monitoring CI were （2.77±0.77）L•min-1•m-2, (3.17±0.39) L•min-1•m-2 respectively, there was significant difference（P＜0.01）, UCG measured CI were (2.49±0.64）L•min-1•m-2, (2.63±0.24) L•min-1•m-2, there was no significant difference（P＞0.05）; PiCCO monitoring CO were（4.78±1.06）L/min, (5.08±1.53) L/min respectively, there was significant difference（P＜0.05）, UCG measured CO were（4.51± 0.86）L/min, (4.57±0.91) L/min, there was no significant difference（P＞0.05）; and CI，CO measured by PiCCO were significantly higher than those of UCG group (P＜0.01 both) after PiCCO placement 72h. Conclusion: Pulse-indicated continuous cardiac output can offer more sensitive hemodynamic indexes compared with UCG, which possesses important treatment guiding significance in patients with acute inferior wall myocardial infarction and unstable hemodynamics.

Objective To investigate the impact of cardiac resynchronization therapy (CRT) on left ventricular systolic function evaluated by velocity vector imaging (VVI) in refractory heart failure patients and the predictive value of VVI on CRT responses.Methods This study included 38 patients with medically refractory heart failure (HF) patients underwent CRT in our department from May 2007 to April 2011.Left ventricular long axis dyssynchrony indexes including time to peak of systolic velocity (Ts max-min),standard deviation of the time to peak of systolic velocity (Ts-SD) before and at 3-6 months post CRT.CRT response was defined as 15％ decrease in left ventricular end-systolic volume.ROC curve and the area under the curve (AUC) were calculated.Results Twenty-four patients were defined as responder.No significant difference was observed between responders and non-responders in medical therapy.When using Ts max-min to predict response,the AUC of ROC curves was 0.76 ± 0.07.The sensitivity and specifity was 70.8％ and 77.8％ respectively with Ts max-min≥124.0 ms.When using Ts-SD to predict response,the AUC of ROC curves was 0.82 ±0.07.The sensitivity and specifity was 79.2％ and 71.2％ respectively with Ts-SD≥40.5.Conclusion Ts-SD is a useful index to predict CRT response in refractory HF patients.

Objective: To analyze the current condition and inlfuencing factors for clinical compliance in patients with permanent pacemaker implantation and to improve the follow-up condition in relevant patients. Methods: A total of 817 patients with permanent pacemaker implantation in our hospital from 2006-01 to 2013-01 were retrospectively studied. The clinical compliance condition and inlfuencing factors were accessed for 1 year period. Results: There were 26/817 (3.18%) patients lost contact and 1 patient died. A total of 790 (96.7%) patients finished the followed-up study by 2 groups: Clinical visit group,n=440 (55.70%) and Telephone visit group,n=350 (44.30%). The education level, medical cost, residency, comprehension of arrhythmia and accompany personnel were different between 2 groups,P<0.05. The patients were with high school education or above, reimbursed medical cost, local residency, comprehension of arrhythmia and accompany personnel had the higher clinical visit rate. The overall 1 year occurrence rate of complication was 1.8% without severe event. There were 59.5% of patients optimized the pacemaker parameters during clinical visit. Conclusion: The patients with permanent pacemaker implantation had the lower rate of clinical follow-up visit which should be improved in several issues.

OBJECTIVETo investigate the application of medpor and split-thickness skin graft in formation of cranioauricular sulcus during auricular reconstruction with Nagata method.

METHODSThe first stage operation was fulfilled according to the Nagata two-stage method which involves fabrication and grafting of the costal cartilage framework. The second-stage ear elevation operation was undertaken 6 months later to form the cranioauricular sulcus. Split-thickness skin was taken from temporal and accipital area. After releasing the auricular framework and transplanting C shaped medpor at the rear side of framework, the temporaparietal fascia flap was transferred to cover postauricular medpor and framework. Then the split-thickness skin graft was implant on the fascia surface.

RESULTSFrom July 2010 to August 2012, 20 cases (22 ears) were treated. Partial necrosis of temporaparietal fascia flap and framework exposure happened in 1 case. Successful ear reconstruction was achieved in other cases with satisfactory cranioauricular sulcus during the follow-up period of 6-18 months (average, 13 months).

CONCLUSIONSThe application of medpor and split-thickness skin graft in the ear elevation of Nagata method for auricular reconstruction for microtia can achieve satisfactory results. It not only avoids the obvious scar in the donor site due to harvesting full-thickness and intermediate-thickness skin, but also reduces chest trauma due to harvesting costal cartilage.

Costal Cartilage ; transplantation ; Dermatologic Surgical Procedures ; methods ; Ear Auricle ; surgery ; Fascia ; Humans ; Polyethylenes ; therapeutic use ; Skin Transplantation ; Surgical Flaps ; transplantation

BackgroundPocket hematoma is one of the major complications associated with cardiovascular implantable electronic devices (CIEDs) implantation. The aim of this study is to evaluate the impact of body mass index (BMI) on the occurrence of pocket hematoma after CIEDs implantation.MethodsThe study is a retrospective review of 972 patients receiving CIEDs implantation between 2008 and 2012 in a tertiary hospital.ResultsTwenty two patients (2.2%) developed severe pocket hematoma requiring re-intervention. The hematoma rate (4.6%,n = 15) of patients with a BMI of < 23 kg/m2 was significantly higher compared with that of patients with a BMI of≥23 kg/m2 (1.1%, n = 7,P< 0.001). In multivariate regression analysis, a BMI < 23.0 kg/m2 may be associated with the development of severe pocket hema-toma. An increase of 1.0 kg/m2 in BMI was associated with lower incidence of hematoma formation (OR: 0.84; 95% CI: 0.74-0.95;P = 0.006).ConclusionBMI < 23 kg/m2 was associated with a higher incidence of pocket hematoma, requiring re-intervention. The data sup-port that great care must be taken when patients were with a lower BMI received CIEDs implantation.

Objective To investigate the effect of a step-wise diversified teaching mode on cardiac electrophysiology (EP) education. Methods 64 young doctors (male:36, female:28) who studied in EP sub-specialty were enrolled. The atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) were selected as teaching content. All the doctors were randomly divided into traditional teaching group (TT) and step-wise diversified teaching group (DT) according to cross-over design protocol. In TT group, only teaching and answering the questions by teachers were given to students, for the DT group, in different stages of teaching, multiple teach-ing strategy were combined to complete teaching. T test and Chi square test were used to compare the effect of two teaching methods. Results There was no difference of basic features and time of self-studying between the two groups. In examinations, the students in DT group got higher score than TT group[DT:(92.3±9.8) and (93.1±7.8),TT:(88.3±8.6) and (87.1±10.0),P<0.05], and had better perfor-mance of learning interest, initiative, ability of finding and resolving problems, teamwork spirit and so on. Conclusion The step-wise diversified teaching mode contributes improving the quality of instruction of cardiac EP, moreover, arousing learning interest and initiative, enhancing ability of find-ing and resolving problems, teamwork spirit and so on, which is worthy of wide-popularizing in cardiac EP training.