Clinical features and treatment options for mitral regurgitation in elderly inpatients

Objective To summarize clinical characteristics and treatment strategy of Chinese elderly mitral regurgitation （MR） inpatients under the current guidelines, and to identify factors related to treatment options in them. Methods A single center retrospective study was conducted in which patients hospitalized in Fuwai hospital from May ist of 2014 to April 30 of 2015 with moderate to severe MR assessed by transthoraeic echocardiography were enrolled consecutively （n = 1741）. Patients 〉 60 years old were grouped as elderly group （n = 680） and patients 〈 60 years were grouped as control group （n = 1061）. The elderly group was categorized into two subgroups based on surgical status. Results The mean age of the elderly group was 66.98 i 5.94 years. The most common reason of MR in elderly group was degenerative MR （41.18%）. Atherosclerotic risk factors such as hypertension, diabetes or hyperlipidaemia were more commonly observed in elderly group than the control group （45.44% vs. 25.17%, P 〈 0.001; 19.56% vs. 8.48%, P 〈 0.001; 35.29% vs. 19.51%, P 〈 0.001）. Elderly group had higher Enroscore Ⅱ score （5.54 ± 2.42 vs. 3.15 ± 1.66）, greater left ventricular end diastolic diameter （LVEDD） （57.72±12.3 vs. 57.33 ± 10.19 ram） and a lower surgery rate （54.71% vs. 63.91%）; P 〈 0.05. Age, left ventricular ejection fraction （LVEF）, regurgitation grade, Eu- roScore-Ⅱ high risk stratification and having diabetes were identified as factors associated with therapy decisions in elderly MR patients. Conclusions Valve surgery was denied in 45.29% of elderly MR inpatients. Older age, impaired LVEF, lower regurgitation grade, Euro- Score-Ⅱ high risk stratification, and having diabetes were factors most significantly associated with surgery denial among elderly Chinese inpatients with MR.

Facial microcystic adnexal carcinoma-treatment with a “jigsaw puzzle” advancement flap and immediate esthetic reconstruction: A case report

BACKGROUND Microcystic adnexal carcinoma(MAC)is a rare malignant tumor of the skin that is commonly found on the face.It grows slowly and has a low mortality rate.However,for various reasons,including strong histological invasiveness,clinical inexperience and inadequate procedure design,immediate or permanent facial deformity may occur after surgical operations.CASE SUMMARY This article describes a middle-aged female artist who was diagnosed with MAC on the left upper lip.She declined the recommended treatment plan,which included two-stage reconstruction,skin grafting,or surgery that could have resulted in obvious facial dysfunction or esthetic deformity.We accurately designed a personalized procedure involving a“jigsaw puzzle advancement flap”for the patient based on the lesion location and the estimated area of skin loss.The procedure was successful;both pathological R0 resection and immediate and long-term esthetic reconstruction effects were achieved.CONCLUSION This study suggests that when treating facial MAC or other skin malignancies,a surgical team should have sufficient plastic surgery-related knowledge and skills.An optimal surgical plan for an individual is needed to achieve good facial esthetics and functional recovery and shorten the treatment course.

Effect of hydrogen intervention on refractory wounds after radiotherapy:A case report

BACKGROUND Patients with keloids who receive radiotherapy(RT)after surgery can develop refractory wounds that cannot be healed by the patient's own repair system.Such chronic wounds are uneven and complex due to persistent abscess and ulceration.Without external intervention,they can easily result in local tissue necrosis or,in severe cases,large area tissue resection,amputation,and even death.CASE SUMMARY This article describes the use of hydrogen to treat a 42-year-old female patient with a chronic wound on her left shoulder.The patient had a skin graft that involved implanting a dilator under the skin of her left shoulder,and then transferring excess skin from her shoulder onto scar tissue on her chest.The skin grafting was followed by two rounds of RT,after which the shoulder wound had difficulty healing.For six months,the patient was treated with 2 h of hydrogen inhalation(HI)therapy per day,in addition to application of sterile gauze on the wound and periodic debridement.We also performed one deep,large,sharp debridement to enlarge the wound area.The wound healed completely within 6 mo of beginning the HI treatment.CONCLUSION After HI therapy,the patient showed superior progress in reepithelialization and wound repair,with eventual wound closure in 6 mo,in comparison with the previous failures of hyperbaric oxygen and recombinant bovine basic fibroblast growth factor therapies.Our work showed that HI therapy could be a new strategy for wound healing that is cleaner,more convenient,and less expensive than other therapies,as well as easily accessible for further application in clinical wound care.

Chinese medical students’interest in COVID-19 pandemic

BACKGROUND The outbreak of coronavirus disease 2019(COVID-19)happened in early December and it has affected China in more ways than one.The societal response to the pandemic restricted medical students to their homes.Although students cannot learn about COVID-19 through clinical practice,they can still pay attention to news of COVID-19 through various channels.Although,as suggested by previous studies,some medical students have already volunteered to serve during the COVID-19 pandemic,the overall willingness of Chinese medical students to volunteer for such has not been systematically examined.AIM To study Chinese medical students’interest in the relevant knowledge on COVID-19 and what roles they want to play in the pandemic.METHODS Medical students at Peking Union Medical College were surveyed via a webbased questionnaire to obtain data on the extent of interest in the relevant knowledge on COVID-19,attitude towards volunteerism in the pandemic,and career preference.Logistic regression modeling was used to investigate possible factors that could encourage volunteerism among this group in a pandemic.RESULTS A total of 552 medical students responded.Most medical students showed a huge interest in COVID-19.The extent of students’interest in COVID-19 varied among different student-classes(P<0.05).Senior students had higher scores than the other two classes.The number of people who were‘glad to volunteer’in COVID-19 represented 85.6%of the respondents.What these students expressed willingness to undertake involved direct,indirect,and administrative job activities.Logistic regression analysis identified two factors that negatively influenced volunteering in the pandemic:Student-class and hazards of the voluntary job.Factors that positively influenced volunteering were time to watch COVID-19 news,predictable impact on China,and moral responsibility.CONCLUSION More innovative methods can be explored to increase Chinese medical students’interest in reading about the relevant knowledge on COVID-19 and doing voluntary jobs during the pandemic.

IgG4 and IgE co-positive group found in idiopathic orbital inflammatory disease

AIM： To reveal the cytokines involved in idiopathic orbital inflammatory disease（IOID） and the relationship between Th17 cells, IgE and IOID pathogenesis.METHODS： Whole blood samples were processed immediately after collection and serological IgG4, IgG, and IgE antibodies were tested using ELISA. IOID and orbital cavernous hemangioma（CH） tissue samples underwent Bio-Plex multiplex cytokine detection. Hematoxylin-Eosin（HE） staining of all paraffin samples suggested the histological features of IOIDs, and expressions of IgG4 and IL-17 A in affected tissues were detected by immunohistochemistry. RESULTS： Among 40 IOID plasma samples, 52.5%（21/40） were positive for IgG4 and 25%（10/40） were positive for IgE. Overlapped IgG4 or IgE positive samples accounted for 22.5%（9/40）. Therefore, IOID samples were separated into three groups. The IgE＋/IgG4＋ group had a relevantly lower level of pro-inflammatory cytokine expression. IL-4（Th2 cell related）, IL-10 and TGF-β1（Treg cell immunity related） were elevated in all three groups. Some of the Th17 cell related cytokines（i.e. IL-17 A/F, IL-25, IL-23, and IL-33） displayed higher expression levels in the IgE-/IgG4-group compared to the other two groups.CONCLUSION： We discovered an IgG4-IgE co-positive group as well as Th17 cell immune involvement in IgG4-IgE co-negative subgtroup in IOID for the first time. The pathogenesis of IOID could differ from different subgroups according to the IgG4 and IgE detection. Therefore, we recommend that, Treatment stratagy should be made according to the clinical assessment of IgG4-IgE and Th17 profile detection.

Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate

Objective： Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue fol- lowing an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy （HBOT） to reduce the keloid recurrence rate after surgical excision and radiotherapy. Methods： （1） A total of 240 patients were randomly divided into two groups. Patients in the HBOT group （O group） received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy （K group）. （2） Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin （H＆E） staining was used to observe keloid morphology. Certain inflammatory factors （interleukin-6 （IL-6）, hypoxia-inducible factor-1α （HIF-1α）, tumor necrosis factor-α （TNF-α）, nuclear factor KB （NF-κB）, and vascular endothelial growth factor （VEGF）） were measured using immunohistochemical staining. Results： （1） The recurrence rate of the O group （5.97%） was significantly lower than that of the K group （14.15%）, P〈0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group （P〈0.05）. （2） Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group. Conclusions： Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.

Necroptosis was found in a rat ischemia/reperfusion injury flap model

Background:Necroptosis is a new form of cell death that has been identified as a third pathway causing cell death.In this study,necrostatin-1 (Nec-1) was used to determine whether necroptosis exists in a rat ischaemia/reperfusion injury flap model.Methods:In this study,twenty male Sprague-Dawley rats were divided randomly into two groups:a control group (CTL group) and a Nec-1 group.Each abdominal skin flap underwent 3 h of ischaemia and then reperfusion.Fifteen minutes before and after reperfusion,phosphate buffer saline (PBS) was administered intraperitoneally to the CTL group,while Nec-1 was administered intraperitoneally to the Nec-1 group.Twenty-four hours after reperfusion,the whole flap was divided equally into 54 sections.Flap blood perfusion was measured.One sample was taken randomly from each row.Morphological changes,apoptosis,receptor-interacting protein-1 (RIP-1) expression and caspase-3 activity were observed and detected.The measurements between the two groups were compared with the independentt-test,and aPvalue of <0.05 was considered statistically significant.Results:Compared to flaps in the CTL group,flaps in the Nec-1 group showed longer survival rates,better blood perfusion and less inflammatory infiltration.The total flap area considered to have survived was 70.88 ± 10.28% in the CTL group,whereas 80.56 ± 5.40% of the area was found to be living in the Nec-1 group (Nec-1 vs.CTL,t= –2.624,P<0.05).For some rows,there were significant differences in cell apoptosis between the two groups,the apoptosis index (AI) in rows "9 cm","7 cm","6 cm" and "5 cm" was significantly lower in the Nec-1 group than that in the CTL group (Nec-1 vs.CTL,P<0.05).RIP-1 expression was much lower in the Nec-1 group than that in the CTL group in rows "5 cm" to "9 cm" (Nec-1 vs.CTL,P<0.05).No significant differences in caspase-3 activity were found.Conclusion:According to the results,necroptosis was present in a rat abdominal ischaemia/reperfusion injury flap model.

Synergistic effect of hyperbaric oxygen preconditioning and hydrogen-rich saline in ameliorating rat flap ischemia/reperfusion injury

Aim:This study was conducted to evaluate the synergistic effects of hyperbaric oxygen(HBO)preconditioning and hydrogen-rich saline(HRS)treatment on skin flap survival and apoptosis in a rat ischemia/reperfusion(IR)skin flap model.Methods:Male Sprague-Dawley rats were randomly divided into five groups:one sham surgery group(sham group)and four surgery groups(IR group,HBO group,HRS group,and HBO+HRS group).An extended epigastric adipocutaneous flap(6 cm×9 cm)was raised over the abdomen in each animal of all five groups.The last four groups underwent 6 h of IR management and were treated,respectively,with normal saline,HBO,HRS(HRS,0.8 mmol/L),or a combined approach(HBO and HRS).On the 3rd postoperative day,flap survival rate and perfusion condition,apoptotic index,caspase-3 activity,protein expression of pASK1 and Bcl-2/Bax ratio,and Bcl-2 messenger RNA(mRNA)expression were assessed.Results:Prior studies have shown the protective effects of HBO and HRS,both of which have been associated with an increase in flap survival.Compared to the IR group,the flaps in the HBO,HRS,and HBO+HRS groups showed better perfusion and a larger survival area with a low number of apoptotic cells,low caspase-3 activity and pASK1 expression,and a high Bcl-2/Bax ratio and Bcl-2 mRNA expression.Of these groups,the HBO+HRS group showed the best flap survival.Conclusion:Both HBO and HRS treatments increase the rate of flap survival,while the synergistic application of HBO and HRS showed a higher survival rate as compared to individual treatments of each.The potential regulation of apoptosis with the use of these two modalities may improve skin flap survival.