Background: We previously reported the techniques for total endoscopic atrial septal defect (ASD) repair on hearts arrested with cardioplegia through three small incisions in the chest wall without aid of a surgical robotic system. The optimal results motivated us to use total thoracoscopic technology for ASD on perfused beating hearts. Methods: From 2010 to 2017, 161 patients with a mean age of 28.31±12.34 years who underwent nonrobotically assisted total thoracoscopic closure for ASD were included in this study, and those patients were also divided into two groups, including group A and group B. In group A, 115 patients underwent the procedure on beating hearts without aorta cross-clamped; in group B, 46 patients underwent the procedure on hearts arrested with cardioplegia with aorta cross-clamped. Cardiopulmonary bypass (CPB) was peripherally achieved as well. Results: Total thoracoscopic ASD closures were successfully performed without in-hospital mortality or other serious complications in all patients of both groups. Dacron or bovine patches were used in 81 and 32 patients in the two groups, respectively. Duration of operation, duration of CPB, aorta cross-clamped time, duration of mechanical ventilation, the length of intensive care unit (ICU) and post-operative hospital stay in group A, were all shorter than those in group B (P<0.05). There was no statistically significant difference in blood transfusion during operation or post-operation thoracic drainage. During follow-up, echocardiograms at 3, 30, 90 and 365, showed no residual shunt or tricuspid regurgitation. Conclusions: Total thoracoscopic closure of ASD without assistance of a surgical robotic system on beating heart is safe and feasible and can be used as a therapeutic option for ASD, and by using the mentioned technique, less injuries are applied to patients.
We estimated seroincidence of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV), and the prevalence of risk behaviors among injection drug users (IDUs) who accepted inpatient detoxification by 14-day methadone tapering treatment in the Shanghai Drug Abuse Treatment Center. We also evaluated the effect of an HIV/AIDS prevention education intervention on those IDUs. Data including demographic characteristics, HIV, HBV and HCV seroincidence, sexual and injection-related risk behaviors were collected from 101 IDUs. All subjects received HIV/AIDS prevention education during inpatient detoxification treatment. An HIV-knowledge questionnaire was used to evaluate the effects of this intervention. We found that risk behaviors, including unsafe sex and unclean injection practices, were common among the subjects. The seroincidence of HBV and HCV infection rates was 56.4% and 46.5%, respectively, but no HIV-infected case was found among the subjects. After participating in the HIV/AIDS prevention intervention, subjects' scores (M+/-SD) on the HIV-knowledge questionnaire were significantly improved from baseline (97.29+/-7.42 vs. 31.1+/-12.1). Our study confirmed that IDUs in Shanghai are a high-risk population for blood borne diseases such as hepatitis B and hepatitis C and HIV. HIV/AIDS prevention education increased HIV knowledge, improved understanding of HIV prevention methods and changed attitudes toward HIV/AIDS. Therefore, HIV/AIDS prevention education should to be an important component of drug treatment.
The comorbidity of autism spectrum disorder and anxiety is common, but the underlying circuitry is poorly understood. Here, Tmem74-/- mice showed autism- and anxiety-like behaviors along with increased excitability of pyramidal neurons (PNs) in the prelimbic cortex (PL), which were reversed by Tmem74 re-expression and chemogenetic inhibition in PNs of the PL. To determine the underlying circuitry, we performed conditional deletion of Tmem74 in the PNs of PL of mice, and we found that alterations in the PL projections to fast-spiking interneurons (FSIs) in the dorsal striatum (dSTR) (PLPNs–dSTRFSIs) mediated the hyperexcitability of FSIs and autism-like behaviors and that alterations in the PL projections to the PNs of the basolateral amygdaloid nucleus (BLA) (PLPNs–BLAPNs) mediated the hyperexcitability of PNs and anxiety-like behaviors. However, the two populations of PNs in the PL had different spatial locations, optogenetic manipulations revealed that alterations in the activity in the PL–dSTR or PL–BLA circuits led to autism- or anxiety-like behaviors, respectively. Collectively, these findings highlight that the hyperactivity of the two populations of PNs in the PL mediates autism and anxiety comorbidity through the PL–dSTR and PL–BLA circuits, which may lead to the development of new therapeutics for the autism and anxiety comorbidity.
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