Efficiency of different annuloplasty in treating functional tricuspid regurgitation and risk factors for recurrence

AbstractBackgroundFunctional tricuspid regurgitation (FTR) is frequent in patients with mitral valve disease. Untreated tricuspid regurgitation (TR) may cause poor clinical outcomes. The surgical factors involved in annuloplasty for FTR remain controversial. Our objective was to compare effectiveness of different tricuspid annuloplasty (TVP), and reveal the risk factors of recurrence.MethodsWe analyzed the clinical details of 399 consecutive patients who underwent mitral surgery with concomitant TVP, from 2006 to 2011, in two Chinese single-centers. Three methods were used for TVP: De Vega surgery was completed in 242 patients; annuloplasty using a flexible band was completed in 98 patients; and surgery with a rigid ring was performed in 59 patients.ResultsThe operative mortality rate was 2.3%. After surgery, the TR grade of all patients decreased significantly. At three years postoperatively, 13.7% of patients were diagnosed with recurrent FTR. At the three year time point, severe TR in the De Vega group was 18%, which was higher than those in the flexible (8.4%) and rigid planner ring groups (5.2%). During follow-up, the recurrent rates in the rigid group were significantly lower than in the flexible group. Multivariate analysis revealed that pre-operative atrial fibrillation, severe TR, large left atrial, ejection fraction (EF)<40%, De Vega annuloplasty, and postoperative permanent pacemaker installation were independent risk factors for severe recurrent TR.ConclusionsRigid ring annuloplasty efficaciously improved post-operative tricuspid valve function in patients with FTR. Atrial fibrillation, a large left atrium, low EF and postoperative permanent pacemaker installation were independent risk factors for severe recurrent TR

A nomogram for predicting postoperative overall survival of patients with lung squamous cell carcinoma: A SEER-based study

BackgroundLung squamous cell carcinoma (LSCC) is a common subtype of non-small cell lung cancer. Our study aimed to construct and validate a nomogram for predicting overall survival (OS) for postoperative LSCC patients.MethodsA total of 8,078 patients eligible for recruitment between 2010 and 2015 were selected from the Surveillance, Epidemiology, and End Results database. Study outcomes were 1-, 2- and 3-year OS. Analyses performed included univariate and multivariate Cox regression, receiver operating characteristic (ROC) curve construction, calibration plotting, decision curve analysis (DCA) and Kaplan–Meier survival plotting.ResultsSeven variables were selected to establish our predictive nomogram. Areas under the ROC curves were 0.658, 0.651 and 0.647 for the training cohort and 0.673, 0.667 and 0.658 for the validation cohort at 1-, 2- and 3-year time-points, respectively. Calibration curves confirmed satisfactory consistencies between nomogram-predicted and observed survival probabilities, while DCA confirmed significant clinical usefulness of our model. For risk stratification, patients were divided into three risk groups with significant differences in OS on Kaplan–Meier analysis (P &lt; 0.001).ConclusionHere, we designed and validated a prognostic nomogram for OS in postoperative LSCC patients. Application of our model in the clinical setting may assist clinicians in evaluating patient prognosis and providing highly individualized therapy

Case report: Resection of a giant right ventricular myxoma

Myxoma constitutes the main subtype of all benign cardiac tumors, tending to be more common in women and occurring mostly in the left and right atria. Its classic clinical presentations are intracardiac obstruction, embolization, and systemic or constitutional symptoms, such as fever, in decreasing order. Several imaging techniques such as echocardiography, computed tomography, and angiocardiography contribute to the diagnosis of myxoma, ruling out significant coronary diseases, and assessment of myocardial invasion and tumor involvement of adjacent structures. Surgical resection is the only effective therapeutic option for patients with cardiac myxoma. Here, we report a unique case of a middle-aged man who presented with a giant myxoma and a 3-day history of chest tightness and shortness of breath after physical activity. Subsequently, transthoracic echocardiography revealed a mass of solid echodensity located within the right ventricle, complicated by abnormal hemodynamics. A cardiac computed tomographic angiography showed a large homogeneous density filling defect consuming most parts of the right ventricle and protruding from beat to beat. A surgical resection and histological study later successfully confirmed the diagnosis, and the patient's postoperative recovery course was found to be uneventful

The potential biomarkers in predicting pathologic response of breast cancer to three different chemotherapy regimens: a case control study

<p>Abstract</p> <p>Background</p> <p>Preoperative chemotherapy (PCT) has become the standard of care in locally advanced breast cancer. The identification of patient-specific tumor characteristics that can improve the ability to predict response to therapy would help optimize treatment, improve treatment outcomes, and avoid unnecessary exposure to potential toxicities. This study is to determine whether selected biomarkers could predict pathologic response (PR) of breast tumors to three different PCT regimens, and to identify a subset of patients who would benefit from a given type of treatment.</p> <p>Methods</p> <p>118 patients with primary breast tumor were identified and three PCT regimens including DEC (docetaxel+epirubicin+cyclophosphamide), VFC (vinorelbine/vincristine+5-fluorouracil+cyclophosphamide) and EFC (epirubicin+5-fluorouracil+cyclophosphamide) were investigated. Expression of steroid receptors, HER2, P-gp, MRP, GST-pi and Topo-II was evaluated by immunohistochemical scoring on tumor tissues obtained before and after PCT. The PR of breast carcinoma was graded according to Sataloff's classification. Chi square test, logistic regression and Cochran-Mantel-Haenszel assay were performed to determine the association between biomarkers and PR, as well as the effectiveness of each regimen on induction of PR.</p> <p>Results</p> <p>There was a clear-cut correlation between the expression of ER and decreased PR to PCT in all three different regimens (<it>p </it>< 0.05). HER2 expression is significantly associated with increased PR in DEC regimen (<it>p </it>< 0.05), but not predictive for PR in EFC and VFC groups. No significant correlation was found between biomarkers PgR, Topo-II, P-gp, MRP or GST-pi and PR to any tested PCT regimen. After adjusted by a stratification variable of ER or HER2, DEC regimen was more effective in inducing PR in comparison with VFC and EFC regimens.</p> <p>Conclusion</p> <p>ER is an independent predictive factor for PR to PCT regimens including DEC, VFC and EFC in primary breast tumors, while HER2 is only predictive for DEC regimen. Expression of PgR, Topo-II, P-gp, MRP and GST-pi are not predictive for PR to any PCT regimens investigated. Results obtained in this clinical study may be helpful for the selection of appropriate treatments for breast cancer patients.</p

A SVDD and K-Means Based Early Warning Method for Dual-Rotor Equipment under Time-Varying Operating Conditions

Under frequently time-varying operating conditions, equipment with dual rotors like gas turbines is influenced by two rotors with different rotating speeds. Alarm methods of fixed threshold are unable to consider the influences of time-varying operating conditions. Hence, those methods are not suitable for monitoring dual-rotor equipment. An early warning method for dual-rotor equipment under time-varying operating conditions is proposed in this paper. The influences of time-varying rotating speeds of dual rotors on alarm thresholds have been considered. Firstly, the operating conditions are divided into several limited intervals according to rotating speeds of dual rotors. Secondly, the train data within each interval is processed by SVDD and the allowable ranges (i.e., the alarm threshold) of the vibration are determined. The alarm threshold of each interval of operating conditions is obtained. The alarm threshold can be expressed as a sphere, whose controlling parameters are the coordinate of the center and the radius. Then, the cluster center of the test data, whose alarm state is to be judged, can be extracted through K-means. Finally, the alarm state can be obtained by comparing the cluster center with the corresponding sphere. Experiments are conducted to validate the proposed method

Time Synchronous Averaging Based on Cross-power Spectrum

Abstract Periodic components are of great significance for fault diagnosis and health monitoring of rotating machinery. Time synchronous averaging is an effective and convenient technique for extracting those components. However, the performance of time synchronous averaging is seriously limited when the separate segments are poorly synchronized. This paper proposes a new averaging method capable of extracting periodic components without external reference and an accurate period to solve this problem. With this approach, phase detection and compensation eliminate all segments' phase differences, which enables the segments to be well synchronized. The effectiveness of the proposed method is validated by numerical and experimental signals