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BACKGROUND@#Surgical left atrial appendage occlusion (SLAAO) may be associated with a lower risk of thromboembolism in patients with atrial fibrillation undergoing cardiac surgery. However, evidence regarding the effectiveness of SLAAO in patients undergoing mechanical heart valve replacement (MHVR) is lacking. Therefore, we aimed to evaluate the association between SLAAO and the cardiovascular outcomes in patients with atrial fibrillation undergoing MHVR.@*METHODS@#We retrospectively analyzed data for 497 patients with atrial fibrillation; 27.6% of the patients underwent SLAAO, and the remainder of the patients did not (No-SLAAO group). The primary outcome was a composite of ischemic stroke, systemic embolism, and all-cause mortality. Cumulative event-free survival rates were estimated using Kaplan-Meier curves, and we performed multivariate Cox analyses to evaluate the association between SLAAO and outcomes. We used one-to-one propensity score matching to balance patients' baseline characteristics, and analyzed 120 matching pairs.@*RESULTS@#Five patients died within 30 days postoperatively, and there were no significant differences between the two groups regarding in-hospital complications (all P > 0.05). After a median follow-up of 14 months, 14 primary events occurred. Kaplan-Meier curves showed no difference in the cumulative incidence of freedom from the primary outcome (log-rank P = 0.830), hemorrhagic events (log-rank P = 0.870), and the secondary outcome (log-rank P = 0.730), between the two groups. Multivariable Cox proportional hazards regression analysis showed no association between SLAAO and any outcome (all P > 0.05). After propensity score matching, cardiopulmonary bypass time and aortic cross-clamp time, and the postoperative length of stay were significantly longer in the SLAAO group (all P < 0.05); results were similar to the unadjusted analyses.@*CONCLUSIONS@#Concomitant SLAAO and MHVR was associated with longer length of stay, and cardiopulmonary bypass time and aortic cross-clamp time, but was not associated with additional protective effects against thromboembolic events and mortality during the 14-month follow-up.
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Purpose To analyze the Wnt/β-catenin signaling pathway related TCF/LEF binding sites in human mesothelin gene and to identify the core promoter region of the gene in the ovarian cancer cells. Methods The possible TCF/LEF transcription factor binding sites in the promoter region of human meosothelin gene were analyzed by bioinformatics method. The 1764 bp promoter sequence near the 5'end of the human mesothelin gene were cloned. The fragments was truncated differently at the 5' end and cloned into p GL3-basic report gene vector and transfected into human ovarian cancer cell lines SKOV-3 and 3-AO. The activity of diffetent promoter fragmentis was detected by double luciferase reporter gene system. Results There were multiple potential TCF/LEF binding sites in the promoter region of the human mesothelin gene. Three fragments of mesothelin gene promoter region-1456-+ 308、-164-+ 308、+ 47-+ 308 were cloned and amplified successfully, the p GL3 vector was constructed by sequencing. After transfection of SKOV-3 and 3-AO cells, the double luciferase reporter gene system showed that the-1456-+ 308 fragments and-164-+ 308 framents had high promoting activity in both cell lines, and the activity of + 47-+308 fragments was significantly lower than that of the former two cell lines (P<0.01). Conclusion The-164-+ 47 sequence containing TCF/LEF transcription factor binding site is the core promoter region of mesothelin gene in ovarian cancer, which lays a foundation for further study on the regulation mechanism of mesothelin gene expression in ovarian cancer.
ABSTRACT
<p><b>OBJECTIVE</b>To determine the impact of smoking behaviors on long-term outcomes of coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>We conducted this survey in 2541 consecutive patients who underwent CABG in Fu Wai hospital from January 1, 2004 to December 30, 2005. The preoperative and postoperative smoking habits were obtained. The patients were divided into never smokers and ever smokers. The ever smokers were further divided into the current smokers who smoked before and after CABG and former smokers who stopped smoking before CABG, quitters who stopped smoking after CABG. Death, major adverse cardiovascular or cerebrovascular events and angina pectoris were observed. The relative risk of adverse events in different patients were analyzed by univariate and multivariate Cox analysis.</p><p><b>RESULTS</b>The patients were followed up for 4.27 to 6.41 years (average 5.09 years). After CABG, the percentage of persistent smoking patients was 22.1%. After adjusting baseline characteristics, relative risk for tumor related death (RR: 2.38, 95%CI: 1.06 - 5.36), major adverse cardiovascular or cerebrovascular events (RR: 1.26, 95%CI: 1.01 - 1.57) and angina pectoris (RR: 1.29, 95%CI: 1.04 - 1.59) were significantly higher in ever smokers than in never smokers. Similarly, relative risk of death from all causes (RR: 2.60, 95%CI: 1.53 - 4.46), cardiac death (RR: 2.51, 95%CI: 1.32 - 4.78), tumor cause death (RR: 5.12, 95%CI: 2.08 - 12.59), major adverse cardiovascular or cerebrovascular events (RR: 1.83, 95%CI: 1.42 - 2.34) and angina pectoris (RR: 1.69, 95%CI: 1.33 - 2.16) were also significantly higher in current smokers than in never smokers. Outcome was similar between patients who stopped smoking and never smokers (all P > 0.05).</p><p><b>CONCLUSIONS</b>Smoking prevalence is still high in patients after CABG in China. Persistent smoking is associated with higher rates of mortality and morbidity after CABG while smoking cessation is associated with reduction of morbidity and mortality in patients after CABG.</p>