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@#Objective To search for the key microRNAs (miRNAs) involved in myocardial fibrosis in hypertrophic cardiomyopathy, and to further explore the mechanisms involved in the regulation of myocardial fibrosis. Methods Forty-two patients with hypertrophic cardiomyopathy diagnosed and treated surgically in West China Hospital of Sichuan University from January 2014 to June 2018 were selected, including 29 males and 13 females, with a median age of 46 (15-69) years. In the myocardial tissue of patients with hypertrophic cardiomyopathy with different degrees of fibrosis, miRNAs with significantly different expression were screened and further verified at the cellular level. By regulating the expression of the target miRNAs, the expressions of fibrosis-related proteins and target genes were detected respectively. Finally, the target-binding relationship was verified by dual-luciferase reporter gene detection. Results miR-484 was up-regulated in severely fibrotic myocardial tissue and activated cardiac fibroblasts. After cardiac fibroblasts were activated by TGF-β1, the expression of miR-484 was significantly up-regulated, the expression of fibrosis-related proteins (CollagenⅠ, α-SMA) increased, and the expression of the target gene HIPK1 decreased (P<0.05). After inhibiting the expression of miR-484 by transfection of miR-484 antagomir, the expression of fibrosis-related proteins decreased, while expression of HIPK1 was up-regulated (P<0.05). The detection of dual luciferase reporter gene showed that the luciferase activity of the transfected WT-miRNA-484 mimics group was lower than that of the control group (P<0.05). Conclusion miR-484 is a pro-fibrotic miRNA that participates in the process of myocardial fibrosis by negatively regulating the expression of HIPK1. It can be used as a regulatory target to provide a therapeutic strategy for myocardial fibrosis.
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Objective:To retrospectively evaluate the clinical effect of mitral valve repair for rheumatic mitral stenosis.Methods:We retropectively analyze the clinical datd of 50 rheumatic mitral disease patients undergoing mitral valve repair from January 2016 to March 2019, the clinical outcome was compaired with those of patients undergoing mitral valve replacement. The operation time, cardiopulmonary bypass time, blood loss, ICU time, hospital stay, and postoperative cardiac function were analyzed, and followed up for 2 years to assess mitral regurgitation, cardiac function, and complication rates.Results:The time of cardiopulmonary bypass and ascending aorta occlusion in the valve repair group were longer than those in the valve replacement group ( P<0.05), and the postoperative ventilator assistance time, ICU stay time, and hospital stay were shorter than those in the valve replacement group ( P<0.05). After 2 years of follow-up, no patients died in the two groups. The rehospitalization rate in the valve repair group was lower than that in the replacement group ( P<0.05), and there was no significant difference in the reoperation rate between the groups ( P>0.05); There was 1 case (2%) of moderate mitral valve regurgitation in the mitral valve repair group, no moderate or severe mitral valve stenosis, no paravalvular leakage in the mitral valve replacement group, and no significant difference between the two groups ( P>0.05). The left ventricular end-diastolic diameter and left ventricular ejection fraction in the mitral valve repair group were significantly better than those in the mitral valve replacement group ( P<0.05). Conclusion:Mitral valve repair is effective in treating rheumatic mitral stenosis. It is beneficial to protect heart function, reduce postoperative anticoagulation complications, and does not increase the rate of reoperation. It is a safe, effective and feasible treatment.
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Objective To investigate the feasibility and superiority of local anaesthesia video-assisted thoracoscopic surgery (LA-VATS) in diagnosis and treatment of open thoracic trauma (OTT).Methods Seventy-eight patients with OTT emergently admitted from February 2007 and June 2012 were randomized into LA-VATS group (n =37) and conventional treatment group (n =41) by the toss of a coin.In the LA-VATS group,further treatment was determined following LA-VATS.Volume of chest tube drainage,duration of chest tube placement,average length of hospital stay,and postoperative complications were measured and compared between groups.Results In the LA-VATS group,23 patients completed LA-VATS and 14 were transferred for simple VATS-assisted mini-thoracotomy under general anesthesia.In the conventional treatment group,24 cases completed debridement and chest drainage and 17 cases were transferred for thoracotomy under general anesthesia.Volume of chest tube drainage [(195.0 ± 150.8) ml/d∶ (480.0 ±212.3)ml/d] (t =-2.675,P ＜0.05),duration of chest tube placement [(2.6 ± 1.4) d∶ (3.8 ± 1.9) d] (t =-2.318,P ＜ 0.05),average length of hospital stay [(6.4 ±2.3) d ∶ (10.9 ± 3.3) d] (t =-2.471,P ＜ 0.05),and incidence rate of postoperative complications (10.8％ ∶22.0％) (x2 =4.132,P ＜0.05) were all significantly different between LA-VATS and conventional treatment groups.Conclusion LA-VATS is safe and feasible for diagnostic exploration and simple treatment of OTT.
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Objective To explore the modified of methods and techniques to establish a rat model of or thotopic liver transplantion effectively by a single operator, and improve the stability. Methods On the basis of two-cuff technique of Kamada, we improved the techniques of perfusing, shearing, triming donor liver, the suturation of the superior and inferior eaval veins, and so on. Operation was performed in 80 rats with modified techniques (experiment group) and conventional techniques (control group), respectively, compare the survival rates of 48 h, 1 week, lmonth were compared between the two groups. Results In contrast to conventional teehniques, the modified techniques reduced the average time of donor operation, recipient operation and anhepatie phase (P < 0. 05), elevated 1-week, 1-month survival rates, remarkably (P < 0. 05 ).Between the Iwo groups, the survival rate of 48 hour had no statistical significance (P > 0. 05). Conclusions The modified techniques may reduce the operation time of donor and receptor effectively raise the quality of donor liver, elevated the survival rate of receptor. II is a stable, reliable and effective method to establish the rat urthotopic liver transplantation model.
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Objective To evaluate Caspofungin for the treatment of fungous infection liver transplant patients. Methods From 2003 to 2008 clinical data of 27 cases of liver transplant patients with fungal infections were reviewed retrospectively. Before 2005 (control group) fungal infections were treated with amphotericin B or Fluconazole in 13 cases. After 2005, the infection was treated with Caspofungin (observation group) in 14 cases. Liver function (AST, ALT, TBIL) and renal function (BUN, Scr) were evaluated at one and two weeks respectively. Result of treatment was evaluated 7 ～ 14 d after the treatment as for the clinical cure rate, with or without acute rejection. Result The liver function of the observation group compared with that of the control group at one week was as AST(t =8. 03 ,P <0. 01), ALT(t =9. 09, P<0.01), TBIL(t =6.01,P<0.01), and at 2 week as AST(t=5.59,P<0.01), ALT(t =6.60,P< 0. 01), TBIL(t = 8.45,P <0. 01). The renal function of the observation group compared with that of the control group after one week as for BUN(t =6. 51 ,P <0. 01), Scr(t =5.66,P <0. 01). At 2 week,as BUN (t =7.61,P <0.01), Scr(t =6.91,P <0.01). The clinical cure rate of the control group was 7/13 (53%), that of the observation group was 12/14(86%) ; Two cases in the observation group and one in the control group had acute rejection which was successfully managed by methylprednisolone pulse therapy. Conclusion Caspofungin is an ideal alternative therapy for fungal infection after fiver transplantation.
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Objective:To improve the surgical technique to establish the arterialized orthotopic liver transplantion in rat.Methods:On the basis of two-cuff technique of Kamada,we improved the techniques of separaring,perfusing donor liver,the anastomosis of the suprahepatic inferior vena cava,and so on.And used the modified "stent" method to reestablish the hepatic artery.Results:80 cases of operation were completed.The time of donor operation,recipient operation and anhepatic time were(40?3) min,(50?5)min,and(16?2)min,respectively.The time of reestablishing suprahepatic inferior vena cava and hepatic artery were(6~9) min,(2~3) min,respectively.The survival rate at 48 h,1 week and 1 month were 96.3%,93.7%,and 87.5%,respectively.Conclusion:The modified method can enhance the stability and survival rate,which is an ideal method for establishing the arterialized orthotopic liver transplantation model in rat.
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Objective To improve the method of orthotopic liver transplantation model in mice.Methods On the basis of "Qian SG" mothod,the techniques of perfusion,harvesting,and trimming of donor's liver,as well as the anastomosis of superior and inferior caval veins were improved.Operations were performed in 70 mice with improved technique(experiment group) and in 70 mice with conventional technique(control group),respectively.The operation time in both donors and recipients,and the survival rates of 48h,1 week and 1 month after operation were compared between the two groups.Results The operation time for both donors and recipients and the time of anhepatic phase were 37?2min,45?2min and 16?2min,respectively in experiment group,while they were 45?2min,54?2min and 23?2min,respectively,in control group,so that the average time for each procedure was significantly shorter(P0.05).Conclusions The improved technique may shorten the operation time and raise the survival rate,and is an ideal method for the establishment of orthotopic liver transplantation model in mice.
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Objective To study the surgical technique of construction of orthopic liver transplantation model in mice by a single operator.Methods On the basis of two-cuff technique,running suture was used to reestablish the suprahepatic vena cava(SHVC),"two-cuff"technology to reestablish the portal vein(PV)and infrahepatic vena cava(IHVC),and"stent"to reestablish the bile duct.Operation was performed in 70 mice,the 24 h,1 week,1M postoperative survival rate were noted,and hepatic function and pathological change were observed.Results The 24 h,1 week and 1M survival rate was 95.7%,90.9%,85.1%,respectively.The ALT increased gradually in the first postoperative week,and dropped to normal level in the first month.Pathology showed the structure of liver tissue was fine.Conclusions The method is an ideal mothod to establish the orthotopic liver transplantation model in mice,because it has high survival rate,good stability and is easily replicated.