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@#Objective To evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. Results A total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P<0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P<0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P<0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P<0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P<0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.
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Epithelial-mesenchymal transition (EMT) is involved in both physiological and pathological processes. EMT plays an essential role in the invasion, migration and metastasis of tumours. Autophagy has been shown to regulate EMT in a variety of cancers but not in head and neck squamous cell carcinoma (HNSCC). Herein, we investigated whether autophagy also regulates EMT in HNSCC. Analyses of clinical data from three public databases revealed that higher expression of fibronectin-1 (FN1) correlated with poorer prognosis and higher tumour pathological grade in HNSCC. Data from SCC-25 cells demonstrated that rapamycin and Earle's balanced salt solution (EBSS) promoted autophagy, leading to increased FN1 degradation, while 3-methyladenine (3-MA), bafilomycin A1 (Baf A1) and chloroquine (CQ) inhibited autophagy, leading to decreased FN1 degradation. On the other hand, autophagic flux was blocked in BECN1 mutant HNSCC Cal-27 cells, and rapamycin did not promote autophagy in Cal-27 cells; also in addition, FN1 degradation was inhibited. Further, we identified FN1 degradation through the lysosome-dependent degradation pathway using the proteasome inhibitor MG132. Data from immunoprecipitation assays also showed that p62/SQSTM1 participated as an autophagy adapter in the autophagy-lysosome pathway of FN1 degradation. Finally, data from immunoprecipitation assays demonstrated that the interaction between p62 and FN1 was abolished in p62 mutant MCF-7 and A2780 cell lines. These results indicate that autophagy significantly promotes the degradation of FN1. Collectively, our findings clearly suggest that FN1, as a marker of EMT, has adverse effects on HNSCC and elucidate the autophagy-lysosome degradation mechanism of FN1.
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Female , Humans , Autophagy , Cell Line, Tumor , Fibronectins , Lysosomes/metabolism , Ovarian Neoplasms , Sequestosome-1 Protein/metabolism , Squamous Cell Carcinoma of Head and NeckABSTRACT
Objective@#To evaluate the effect of vascular endothelial growth factor (VEGF)-loaded microspheres on dental pulp tissue regeneration and vascularization in vivo.@*Methods@#In vitro release experiment and human umbilical vein endothelial cell migration experiment were conducted with VEGF loaded microspheres. The dental pulp stem cells (DPSC) were co-cultured with VEGF microspheres to observe the compatibility between the cells and the microspheres. DPSC and VEGF loaded microspheres were injected into the root lumen through the apical foramen, which were then transplanted subcutaneously into nude mice. Histological and immunohistochemical features were observed after nine weeks.@*Results@#DPSCs attached and spread on the surface of the microspheres. HE staining showed that the regenerated pulp-like tissue fulfilled the whole apex and middle third of the root. Differentiated odontoblast-like cells aligned with the existing tubular root dentin.@*Conclusions@#VEGF-loaded microspheres promoted the regeneration of pulp-like tissues and formation of blood vessels.
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Objective To investigate the accuracy of the positioning of the prosthesis of the femur and tibia by the individual navigation template assisted Oxford unicompartmental arthroplasty and to evaluate of the value of navigation template in unicompartmental arthroplasty.Methods Twenty cadaveric legs were randomly divided into two groups (n=10),group 1 for navigation template and 2 for conventional method.ACT scan was performed preoperatively on the lower limb for navigational group.Geomagic software was used to process the CT data.A navigational template was constructed as the inverse of the distal femur and proximal tibia surface with an osteotomy gap.Two drills were used to define the rotational alignment of the femur in the computer.The navigational templates were produced using a rapid prototyping (RP) technique to assist UKA.The traditional method group was guided by the tibial extramedullary localization and the femoral intramedullary localization for the osteotomy and prosthesis placement.Both groups were performed according to the same standard.The position of the single condyle was evaluated by the anteroposterior X-ray films of the knee joint.The vertical relationship between the osteotomy surface and its mechanical axis was evaluated by CT.The parallel relationship between the central placement of femoral prosthesis and the posterior femoral cortex was also evaluated.Results The navigation template was close to the femoral condyle and tibial plateau without obvious movement.The mean operative duration of the navigation template group were 50.75 ±2.3 min and the traditional method group were 58.57 ± 1.5 min (P＞0.05).The postoperative femoral prosthesis flip angles of the navigation template group and the traditional group were 2.5° ±-0.65° and-7.8°± 3.26° respectively (P＜0.05).The femoral prosthesis flexion angles were-2.9° ±4.18° and -6.5°±4.25° (P＜0.05),and the tibial prosthesis varus and valgns angles were-1.5°±0.50° and-5.8°±3.15° respectively (P＜0.05).The tibial implant posterior inclination angles were 4.50°±1.55°and 3.05°±3.63° respectively (P＜0.05).The average angles between navigational group distal femoral osteotomy surface and mechanical shaft were 89.5o±2.3° (range 87.5°-91.8°).The average angle between the proximal tibial resected surface and the mechanical axis was 90.3°±0.5° (range 89.4°-90.7°).There were 17 specimens of central column of femoral prosthesis parallel with the posterior femoral cortex.However,the angle of remaining 3 samples were less than 5°.In the traditional method group,the osteotomy surface and its mechanical axis were all angled.The deviation of distal femur distal surface in 7 specimens from the mechanical axis was larger than 10°,while that in 5 specimens was larger than 5°.Conclusion The navigation template can improve the accuracy of the femoral prosthesis localization,orientation and tibial prosthesis implants in the direction of valgus and valgus.However,there was no significant effect on the tibial prosthesis in the direction of posterior inclination.
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Objective To investigate the clinical significance of thoracoscopy combined with beating-heart technique to provide a certain reference for selecting clinical operation mode.Methods Forty patients with chronic rheumatic mitral stenosis receiving thoracoscopic mitral valve replacement surgery in the cardiothoracic surgery department of our hospital from September 2012 to September 2015 were included in this study and divided into the experimental group(beating-heart group,20 cases) and control group(arrested heart group,20 cases).The operative time,CPB time,enzymology indicators,RI and operative complications were analyzed and compared between the two groups.Results One case in each group died of postoperative low cardiac output syndrome.Other cases successfully completed the operation without serious operative complications such as low cardiac output syndrome,serious cardiac arrhythmia and air embolism.Two groups had no statistically significant difference in the operation time and time of CPB (P＞0.05),but the ICU staying duration had statistical difference between the two groups(P＜0.05).The levels of CK-MB,cTnI,LDH,TNF-α,IL-6,IL-8 and RI were significantly increased in two groups(P＜0.05),while the levels in the experimental group were significantly lower than those in the control group(P＜0.05).Conclusion Thoracoscopic mitral valve replacement operation with beating-heart may have better protection effect on heart and lung than thoracoscopic arrested-heart mitral valve replacement operation.
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Objective:To study the antimicrobial properties of CaO/ZnO core-shell nanoparticles.Methods:The CaO/ZnO core-shell nanoparticles were prepared via precipitation method.The pH and calcium ion release from the samples which composed of eugenol and nanoparticles were examined respectively.The form of the particles was observed under electron microscope,the ions were analysed by inductively coupled plasma(ICP).The antibacterial activities against Streptococcus mutans,Enterococcus faecalis,Escherichia coli and Staphylococcus aureus were evaluated by agar diffusion test (ADT).Results:CaO/ZnO core-shell nanoparticles were spherical with core-shell structure and with the diameter of 80-90 nm.The calcium ion release and pH were gradually increasing from the nanoparticles in PBS.The antibacterial activity of CaO/ZnO core-shell nanoparticles-eugenol was significantly greater than that of iRoot SP and zinc oxide-eugenol sealer(P<0.01).Conclusion:CaO/ZnO core-shell nanoparticles possess antibacterial activity.
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Objective To measure the sternal angle corresponded to thoracic plane by three-dimensional reconstruction of spiral CT , and to explore the accurate positioning methods and the preoperative assessment of cervicothoracic junction lesions .Methods Selected 42 cases of normal bone mass , 48 cases with bone loss , and 60 cases of osteoporosis who were diagnosed by dual-energy X-ray absorptiometry , and measured the location of thoracic sternal angle corresponded to the thoracic spine and thoracic kyphosis angle through the volume recon -struction data of the 16-slice spiral CT chest examinations .Results The range of sternal angle corresponded to thoracic plane was measure-ment units ⅢtoⅥ.The measure unit Ⅳwas the most, accounting for about 55%.There was no statistical significance between the position of sternal angle corresponded to thoracic plane and the relationship of bone mass , which required further study .The position of sternal angle corresponded to thoracic plane was associated with the thoracic kyphosis angle .The larger the thoracic kyphosis angle , the lower the corre-sponding position was .Conclusion The thoracic segment corresponded to the sternal angle is not a constant or accurate plane , which is not properly concerned as an accurate positioning mark to the thoracic segment .The measurement of the thoracic sternal angle was corresponded to the thoracic spine location , and its co-relationship evaluation between the thoracic kyphosis angle was vital for the accurately positioning of cervico-thoracic junction area lesions , the pre-assessment methods of surgical treatment , approach selection , and different methods for ster-num and other such contents .This research was of important clinical significance .
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Objective To study the protective effect of normothermic ex vivo perfusion to prevent donor-lung injury.Method After being flushed with perfadex solution through the pulmonary artery and vein,the donor lungs were divided to control group (preserved with 4℃ cold static preservation,n =8) and experimental group (preserved with ex vivo oxygenated blood continuous perfusion,n =8).Pulmonary function indexes,including pulmonary vascular resistance (PVR),lung ventilation resistance(LVR),the left inferior pulmonary vein(LIPV) blood PO2,and lung water content,were evaluated.Lung injury were studied by light microscopic observation and detecting the expression of proimflammatory factor IL-1β was detected.Result (1) Lung function evaluation:in both group,PVR,LVR and lung water content gradually increased,LIPV PO2 gradually declined;But in the same time point PVR and LVR in group were were significantly less than in control group (P＜0.05),LIPV PO2 in experimental group were were significantly more than in control group(P＜0.05).(2)Lung injury evaluation:Lung tissue edema classification in both group were significantly higher than in normal lung(P＜0.05),but classification in experimental group were significantly lower than in control group(P＜0.05).The expression of IL-1β in experimental group (0.422 ± 0.132) were significantly lower than in control group(0.578 ± 0.163,P＜0.05).Conclusion Ex vivo oxygenated blood continuous perfusion without ventilator is a feasible technique for lung preservation.It ameliorates hypothermic time-dependent ischemic injury.But further systems evaluation in complete physiologic condition is necessary.
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Objective To investigate the effectiveness of heart valve replacement in the same period of radiofrequency ablation in the treatment of atrial fibrillation.Methods Eighty-six patients with atrial fibrillation underwent heart valve replacement in the same period of bipolar radiofrequency ablation system according to the maze heart valve replacement operation principle.And optimized the operation method.Results No death occurred during operation.The average ablation time was (23 ± 8) minutes with a range of 16-56 minutes.Sinus rhythm of the heart was restored after surgery in all patients (100％).The long-term success rate was 98.8％ (85/86).Conclusion Our optimization of heart valve replacement in the same period of radiofrequency ablation enhanced the success rate of the operation,simplified the procedures,meanwhile it might need widely application clinically.
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Objective To investigate the feasibility and efficacy of treating atrial fibrillation(AF)in beating heart surgery using bipolar Radiofrequency Ablation(RFA)system. Methods Treating AF in beating heart under normal temperature CBP surgery with bipolar RFA following the circuit of maze operation,2 - 6 times each place,until sinus rhythm appeared,then perform AVR or MVR in the stopped beating heart. Results All 18 cases survived the surgery. Sinus rhythm appeared in all cases. The average treating time was 28 minutes. Conclusions Application of bipolar RFA in the treatment of AF in beating heart is a safe and efficacy method. It is recommended to be applied widely.