Study on the coronary endarterectomy combined with electrocautery in the treatment of diffuse coronary artery disease / 中华胸心血管外科杂志

Objective:To explore the outcomes and mechanisms of coronary endarterectomy combined with electrocautery in patients with diffused coronary artery disease undergoing coronary artery bypass grafting (CABG).Methods:From January 2017 to September 2018, 300 patients undergoing CABG with left anterior descending artery endarterectomy were randomly divided into two groups, after fully informed the risks and other related issues regarding the operations. All the patients in the two groups were treated with CABG. In the study group, patients underwent electrocautery immediately after endarterectomy, whereas in the control group, patients underwent endarterectomy only. The electrocardiogram and serological examination (TNI, IL-6 and TNF-a) were performed at 2 h, 24 h, 72 h and 120 h after operation. The follow-up duration was 1 year.Results:Nine patients in the study group, and 25 patients in the control group had ST segment elevation. The levels of TNI, IL-6 and TNF-a were continuously increased in both groups, and reached the peak at 24 h, then decreased slowly. The levels of TNF-a were significantly lower at 2 h postoperatively in the study group ( P=0.01). There was no significant difference in the levels of TNI and IL-6 between the two groups. The levels of TNI, TNF-a and IL-6 were significantly lower in the electrocautery group at 24 h, 72 h, and 120 h after operation( P<0.05). One year after operation, incidences of ST segment elevation in the study group were significantly lower than that in the control group, and there was no significant difference in restenosis rate and myocardial infarction rate. Conclusion:Endarterectomy combined with electrocautery may prevent the restenosis of the lumen and blood turbulence, smooth the inner wall of the vessel, slow down the release of inflammatory factors in the peripheral blood, inhibit the expression of inflammatory factors in the vessels, and reduce the myocardial damage. The short-term effect was satisfactory; the long-term anti-inflammatory and antithrombotic effect still need further investigations.

Matrix metalloproteinase-8 inhibitors mitigate sepsis-induced myocardial injury in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sepsis-induced myocardial injury (SIMI) is caused by a variety of mechanisms. The aim of the study is to investigate the effects of metalloproteinase-8 (MMP-8) on SIMI and its mechanisms in rats.</p><p><b>METHODS</b>Forty male Sprague Dawley rats were randomly divided into four groups: MMP-8 inhibitor (M8I), dexamethasone (DEX), sepsis, and sham groups. The sepsis model was established by cecal ligation and puncture (CLP). Rats in the M8I group immediately received an intraperitoneal injection of M8I (0.1 mg/kg) after CLP. Rats in the DEX group immediately received an intraperitoneal (IP) injection of DEX (2 mg/kg). Rats in the sepsis and sham groups received intraperitoneal injections of normal saline. Rats were sacrificed 12 hours after CLP. Paraffin sections were stained with hematoxylin and eosin to observe the myocardium. The myocardial ultrastructure was observed with transmission electron microscopy. MMP-8, tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β) were detected by immunohistochemistry. The expression of MMP-8 was measured by Western blotting. TNF-α and IL-1β levels in serum and myocardial tissue were determined by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>Compared with the sham group, the myocardium in the sepsis group was seriously injured. MMP-8, TNF-α and IL-1β expression was higher in the sepsis group than in the sham group. Treatment with M8I or DEX, however, attenuated sepsis induced histopathological changes in the heart, and was associated with significant reductions in serum and myocardial levels of TNF-α and IL-1β (P < 0.05). M8I significantly inhibited MMP-8 expression in myocardial tissue (P < 0.05). In addition, treatment with DEX was not associated with a change in myocardial levels of MMP-8 (P > 0.05).</p><p><b>CONCLUSION</b>MMP-8 inhibitor attenuated myocardial injury in septic rats, which might be related to reduced expression of TNF-α and IL-1β.</p>

Primary cardiac schwannoma-a case report and literature review / 中华胸心血管外科杂志

Objective: To report one case of primary cardiac schwannoma (PCS) with review of literature. Methods: One patient with primary malignant cardiac schwannoma (PMCS) was treated surgically in our hospital and relevant data of 18 cases were collected from international literature. Clinical features, diagnosis and surgical treatment of PCS were discussed. Results: 17 cases were PMCS and 2 cases were primary benign cardiac schwannoma (PBCS). Operation was performed in 11 cases. The locations of mass were both superior vena cava and right atrium in 2 cases, inferior vena cava and right atrium in 1, pulmonary vein and left atrium in 1, right atrium in 1, left atrium in 3, right ventricular outflow tract in 2, and intrapericardial in 1. The long-term results for resected PCS were excellent, but for PMCS were very poor. Conclusion: PCS is an extremely rare disease. The diagnosis dependents on clinical features, M-mode and two-dimensional echocardiography, magnetic resonance imaging, and histopathological and immunohistochemical findings. It is concluded that most PBCS can be resected completely with good results. PMCS can not be resected completely either because of the extent spread and invasion or frequent distant metastasis. The prognosis is dismal and early cardiac transplantation probably offers the only hope for patients with PMCS.