Left atrial appendage perforation with Watchman device implantation: Strategies for surgical repair

Percutaneous occlusion of the left atrial appendage is increasingly being used as an alternative for stroke prevention in patients with non‐valvular atrial fibrillation at high risk of complications from long term anticoagulation. We describe a case of left atrial appendage perforation during Watchman device implantation requiring emergency repair of the left atrium using sternotomy and cardiopulmonary bypass. Technical considerations for surgical decision making are discussed; in hemodynamically unstable patients as well as those at high risk for embolization.     

Opportunistic Infections After Induction With Alemtuzumab or Basiliximab: A 3-Year Kidney Transplantation Experience

BackgroundAntibody induction immunosuppression is commonly used in kidney transplantation to decrease the risk of early acute rejection. However, infectious complications may arise in patients treated with higher intensity induction immunosuppression. In this study, we compared the rate of opportunistic infections during the 3 years after kidney transplantation in recipients who received either alemtuzumab or basiliximab for induction therapy.MethodsAll renal transplant recipients from our center who received induction with alemtuzumab between 2011 and 2016 were included and matched 1:2 (by age and date of transplant) to renal transplant recipients who received basiliximab. The primary outcome was the rate of opportunistic infections.ResultsTwenty-seven patients received alemtuzumab (mean age = 50.8 years; SD ±12), and 54 received basiliximab (mean age = 50.8 years; SD ±11.8). Infections within 3 years posttransplant were not different between groups: BK viremia (P = .99), BK nephritis (P = .48), cytomegalovirus infection (P = .13), varicella zoster virus (P = .22), and all infections (P = .87). Time to infection (P = .67), patient survival (P = .21), and time to rejection (P = .098) were similar in both groups. There were also no group differences in delayed graft function (P = .76), graft loss (P = .97), or rejection (P = .2).ConclusionThe rate of infection was not significantly increased in recipients receiving lymphocyte-depleting alemtuzumab compared to recipients receiving basiliximab induction therapy, despite receiving similar maintenance immunosuppression. Although the immunologic risks differed between the 2 groups, there was no observable difference in clinical outcomes.     

Recent Developments in the Determination of PM2.5 Chemical Composition

Bulletin of Environmental Contamination and Toxicology - Fine particulate matter (named PM2.5) has become a prominent and dangerous form of air pollution. The chemical composition of PM2.5 mainly...     

Mutation profile and its correlation with clinicopathology in Chinese hepatocellular carcinoma patients

BackgroundHepatocellular carcinoma (HCC) is one of the most common causes of cancer worldwide. Although many studies have focused on oncogene characteristics, the genomic landscape of Chinese HCC patients has not been fully clarified.MethodsA total of 165 HCC patients, including 146 males and 19 females, were enrolled. The median age was 55 years (range, 27–78 years). Corresponding clinical and pathological information was collected for further analysis. A total of 168 tumor tissues from these patients were selected for next-generation sequencing (NGS)-based 450 panel gene sequencing. Genomic alterations including single nucleotide variations (SNV), short and long insertions and deletions (InDels), copy number variations, and gene rearrangements were analyzed. Tumor mutational burden (TMB) was measured by an algorithm developed in-house. The top quartile of HCC was classified as TMB high.ResultsA total of 1,004 genomic alterations were detected from 258 genes in 168 HCC tissues. TMB values were identified in 160 HCC specimens, with a median TMB of 5.4 Muts/Mb (range, 0–28.4 Muts/Mb) and a 75% TMB of 7.7 Muts/Mb. The most commonly mutated genes were TP53, TERT, CTNNB1, AXIN1, RB1, TSC2, CCND1, ARID1A, and FGF19. SNV was the most common mutation type and C:G>T:A and guanine transformation were the most common SNVs. Compared to wild-type patients, the proportion of Edmondson grade III–IV and microvascular invasion was significantly higher in TP53 mutated patients (P<0.05). The proportion of tumors invading the hepatic capsule was significantly higher in TERT mutated patients (P<0.05). The proportion of Edmondson grade I-II, alpha fetoprotein (AFP) <25 µmg/L, and those without a history of hepatitis B was significantly higher in CTNNB1 mutated patients (P<0.05). CTNNB1 mutations were associated with TMB high in HCC patients (P<0.05). Based on correlation analysis, the mutation of TP53 was independently correlated with microvascular invasion (P=0.002, OR =3.096) and Edmondson grade III–IV (P=0.008, OR =2.613). The mutation of TERT was independently correlated with tumor invasion of the liver capsule (P=0.001, OR =3.030), and the mutation of CTNNB1 was independently correlated with AFP (<25 µmg/L) (P=0.009, OR =3.414).ConclusionsThe most frequently mutated genes of HCC patients in China were TP53, TERT, and CTNNB1, which mainly lead to the occurrence and development of HCC by regulating the P53 pathway, Wnt pathway, and telomere repair pathway. There were more patients with microvascular invasion and Edmondson III–IV grade in TP53 mutated patients and more patients with hepatic capsule invasion in TERT mutated patients, while in CTNNB1 mutated patients, there were more patients with Edmondson I–II grade, AFP <25 µmg/L, and a non-hepatitis B background. Also, the TMB values were significantly higher in CTNNB1 mutated patients than in wild type patients.     

溶胶-凝胶法制备纳米羟基磷灰石粉体的研究进展

目的 利用溶胶凝胶法制备纳米羟基磷灰石粉体的方法进行研究。方法综述了溶胶凝胶法的基本原理和分类，介绍了制备纳米羟基磷灰石粉体采用的溶胶-凝胶方法，提出了相关待解决的问题。结果溶胶-凝胶法的研究已取得一定的进展。结论利用该方法有望制备出形状可控、粒度均匀的纳米羟基磷灰石粉体。     

骨纤维结构不良和骨化性纤维瘤的组织病理及免疫组化研究

对140例骨纤维结构不良和70例骨化性纤维瘤的临床资料及组织病理进行了复习,其中对近期病例中各15例的组织。作了6种有关的免疫组化染色进行观察。本文对骨纤维结构不良和骨化性纤维瘤的诊断、鉴别诊断及其病变的性质进行了讨论。还对6种免疫组化染色在显示某些组织成分,特别对骨连结蛋白在显示骨母细胞及新生骨质的意义作了探讨。     

血吸虫病兔肠系膜上动脉夹闭休克时内脏超氧化物歧化酶的变化

本实验在血吸虫病兔肠系膜上动脉夹闭休克(SMAO)模型上,测定内脏SOD活力(n=10),并与正常兔合并SMAO组(n=7)和假手术组(n=6)对照。旨在探讨自由基反应及肝脏在多器官功能衰竭(MOF)中的作用。病理检查提示,血吸虫病兔合并SMAO组内脏有明显损伤。SOD活力测定:血吸虫病兔与正常兔合并SMAO时内脏SOD明显低于假手术组(P<0.01)。血吸虫病兔合并SMAO组肝、肺、胃SOD明显低于正常兔合并SMAO组,分别为2541/2993、1235/1656、1072/1578,(P<0.01),肾无显著性差异(1500/1558)。本研究表明,自由基反应是休克并发MOF的原因之一,合并有血吸虫肝病时更易发生MOF。     

知识模式转换在医学科技创新中的作用

医学科技创新是医院赖以生存与发展的动力,医学科技创新的过程也是医学知识模式不断转换的过程,本文从知识模式转换的视角,探讨知识管理对医学科技创新的意义与作用     

日本血吸虫单克隆抗独特型抗体NP30诱导保护性免疫

作者应用正交设计观察了单克隆抗独特型抗体NP30主动免疫诱导的保护性免疫力。对照组接种SP2/0 腹水。实验结果表明,根据不同的免疫方案,NP30主动免疫可产生22.36％～50.46％的减虫率,并确定了最优化免疫方案。本文提示NP30主动免疫对尾蚴攻击可产生一定的保护力,具有血吸虫疫苗候选分子的潜能。