冉君
中国医学科学院阜外医院
BACKGROUND:Stem cell therapy (SCT) has emerged as a potential therapeutic avenue, with various cell types being explored for their efficacy in treating DCM. However, the safety and efficacy of these therapies have been the subject of numerous systematic reviews. This umbrella review aims to consolidate the existing evidence on stem cell interventions for DCM, providing a comprehensive overview of the current research landscape.METHODS:This review was conducted following the JBI and PRISMA guidelines. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) evaluating the safety and efficacy of SCT for DCM were included. Outcomes such as 6MWT, LVEDD, LVEF, MACE, NYHA, and QoL, among others, were considered. A literature search was executed across databases like PubMed, Embase, Web of Science, and Cochrane Database up to October 07, 2023. The quality of the included reviews was assessed using the JBI Checklist for Systematic Reviews and Research Syntheses. Data synthesis was carried out in both narrative and tabular formats, with the GRADE criteria guiding the determination of evidence certainty.RESULTS:Nine systematic reviews met the inclusion criteria. LVEF found to be significantly improved with SCT. LVEDD and LVEDV assessments yielded mixed results, with some reviews observing significant changes. LVESV showed consistent reductions across multiple studies. BNP concentrations post-interventions were explored in several studies, with mixed findings. Health-related quality of life (HRQL) showed varied results, with some studies noting improvements and others finding no significant differences. NYHA classifications and 6-MWT results indicated potential benefits from stem cell treatments. SCT was observed to be generally safe. The certainty of evidence was low or very low for most of outcomes.CONCLUSION:SCT showed has shown promise in treating DCM, with many studies highlighting its safety and potential benefits. Nonetheless, the existing data has its limitations due to biases in the RCTs studies. To truly establish the benefits of SCT for DCM, future high quality RCTS, are crucial.
International journal of surgery (London, England) 2024
A 56-year-old Chinese woman with previous disseminated mycobacterium avium complex infection and recurrent cervical abscesses from Burkholderia cepacia complex visited our hospital. She was diagnosed with adult-onset immunodeficiency (AOID) and tested positive for interferon-γ-neutralizing autoantibody. Ceftazidime was administered as the initial antimicrobial treatment, which was later combined with sulfamethoxazole-trimethoprim (SMZ-TMP). She developed drug rash with eosinophilia and systemic symptoms (DRESS) syndrome after SMZ-TMP administration and improved after withdrawal of the culprit antibiotic and systemic glucocorticoids treatment. Her cervical infection was eventually cured after combined therapy of long-term antibiotics and anti-IFN-γ autoantibodies (AIGA) titer-lowering treatments including glucocorticoids, rituximab, and plasmapheresis. This is the first case of DRESS syndrome in the setting of AIGA-induced AOID and is worthy of notice.
Frontiers in immunology 2022
Cardiac fibroma is a rare benign primary tumour of the heart. In the paediatric population, it has been reported as the second most common benign cardiac tumour following rhabdomyoma. However, the prevalence of cardiac fibroma is rarely reported in the adult population. Signs and symptoms are nonspecific, including palpitations, cardiac murmur, arrhythmias, dyspnoea, cyanosis, chest pain, and sudden mortality, whereas, a number of patients with cardiac fibroma are asymptomatic. Surgical resection should be considered as the best option in symptomatic patients. This study reported four surgical cases of adults with cardiac fibroma arising from the left ventricle and a literature review regarding the clinical and pathological features, diagnostic modalities, therapeutic aspects, and prognosis of this rare entity.
Cardiology in the young 2020
BACKGROUND:To compare the clinical outcomes, quality of saphenous vein (SV) grafts, and wound complications between endoscopic vein harvesting (EVH) technique and open vein harvesting (OVH) technique in patients with coronary artery bypass graft (CABG) surgery.METHODS:We reviewed one hundred patients with multi-vessel coronary artery disease who underwent elective CABG and agreed to preserve their SV specimens for study. Fifty patients (OVH group) underwent OVH, and the remaining (EVH group) underwent EVH. The median follow-up time was 12 months. Clinical outcomes, 1-year graft patency rates, endothelium integrity of SV grafts and wound complications were assessed.RESULTS:The follow-up time was 12 [12-13] months. Recurrence of angina was observed in 5 patients, with 3 (6.1%) in EVH group and 2 (4%) in OVH group (P=0.68). The endothelium integrity of specimens before distension was similar in both the groups (EVH: 81.1%±6.11% vs. OVH: 80.8%±6.58%, P=0.83). After distension, the endothelium integrity was still similar (EVH: 70.7%±9.73%; OVH: 68.3%±9.60%; P=0.22). Grafts of 5 (11.6%) patients in EVH group were classified as occluded, and 4 (9.8%) patients in OVH group showed occlusion of SV grafts (P=1.0). After day 7, the postoperative leg pain was significantly milder in EVH group than OVH group (1.16±0.76 vs. 2.50±0.91, P<0.01).CONCLUSIONS:These findings suggest that EVH is not associated with worse clinical outcomes or conduit quality. However, it may have advantage in wound healing.
Journal of thoracic disease 2020
INTRODUCTION:An initial retrospective study suggested that tranexamic acid (TXA) administration increased the incidence of seizures in paediatric patients undergoing cardiac surgery. However, the efficacy of TXA in paediatric cardiac surgery remains unclear owing to the small sample sizes of the studies. Therefore, this study will investigate the efficacy and safety of TXA in paediatric patients undergoing cardiac surgery. We hypothesised that TXA may increase the incidence of postoperative seizures with no effect on postoperative allogeneic transfusion in paediatric patients undergoing cardiac surgery. The pragmatic study will provide important implications for paediatric cardiac surgery.METHODS AND ANALYSIS:This will be a single-centre prospective, double-blind randomised controlled trial. The plan is to enrol in the study 2090 paediatric patients aged 31 days to 7 years who will be undergoing cardiac surgery with cardiopulmonary bypass (CPB). All eligible participants will be randomly assigned to either the TXA or placebo group by using a Web-based randomisation service in a 1:1 ratio. The primary safety end point will be postoperative seizures until hospital discharge, and the primary efficacy end point will be the volume of allogeneic red blood cell transfusion after termination of CPB. All patients will be followed up for 1 year postdischarge. All data will be analysed in accordance with the intention-to-treat principle.ETHICS AND DISSEMINATION:This study was approved by the institutional review board of Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (No 20191195). Written informed consent will be obtained from the parents/legal guardian of each patient because all participants will be <18 years of age. The results of the trial will be published in an international peer-reviewed journal.TRIAL REGISTRATION NUMBER:Chinese Clinical Trial Register (ChiCTR1900024131).
BMJ open 2019
OBJECTIVES:Surgical strategies for patients with midventricular obstruction remain underappreciated. We sought to assess clinical and haemodynamic results, summarize the surgical technique of extended myectomy and provide reliable pre- and intraoperative methods of evaluating patients with midventricular obstruction.METHODS:The preoperative evaluation process, intraoperative surgical strategy and early outcomes were thoroughly reviewed in 40 patients with midventricular obstruction.RESULTS:Isolated transaortic myectomy was conducted in 38 (95.0%) patients, and 2 (5.0%) other patients with an apical aneurysm were treated with a combined transaortic and transapical myectomy. The median resection length of the removed muscle was 50 mm (45-55 mm), approximately 5 mm more than the obstruction length measured using preoperative transthoracic echocardiography. There were no early or late deaths, complete heart blocks or iatrogenic septal perforations in our study series with a median follow-up time of 19 months (13-54 months). Instantaneous pressure gradients at the subaortic level decreased from 70.5 mmHg (51-89.5 mmHg) preoperatively to 7.7 mmHg (6-11 mmHg) (P < 0.001) at the most recent evaluation and at the midventricular level from 61.0 mmHg (42.8-85.5 mmHg) to 8.5 mmHg (6.3-11.8 mmHg) (P < 0.001). In all patients, the New York Heart Association functional classifications improved, with a better haemodynamic status.CONCLUSIONS:Transaortic myectomy can be extended to the midventricular level, improving haemodynamic status and yielding satisfactory early outcomes in selected patients. Additional transapical myectomy should be considered in patients with a long obstruction, limited exposure of the midventricular area or a concomitant apical aneurysm.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2018
The indications for a concomitant mitral valve (MV) procedure remain controversial for patients with hypertrophic obstructive cardiomyopathy (HOCM). According to previous studies, a concomitant MV surgery was required in 11-20% of inpatient operations. Thus, we aimed to study the outcomes of an extended Morrow procedure without a concomitant MV procedure for HOCM patients who had no intrinsic abnormalities of the MV apparatus. We retrospectively reviewed 232 consecutive HOCM patients who underwent extended Morrow procedures from January 2010 to October 2014. Only 10 (4.31%) patients with intrinsic MV diseases underwent concomitant MV procedures. Of the 232 patients, 230 had no to mild mitral regurgitation (MR) postoperatively. We separated the 232 patients into two groups according to preoperative MR degree. One group is mild MR, and the other is moderate or severe MR. The three-month, one-year, and three-year composite end-point event-free survival rates had no difference between two groups (p = 0.820). When we separated the patients to postoperative no or trace MR group and mild MR group, there was also no difference on survival rates (p = 0.830). In conclusion, concomitant mitral valve procedures are not necessary for HOCM patients with MR caused by systolic anterior motion, even moderate to severe extent.
Scientific reports 2016
