The role and mechanism of CXCR4 in renal injury and fibrosis caused by calcium oxalate crystals / 中华泌尿外科杂志

Objective:To investigate the role and mechanism of chemokine receptor type 4 (CXCR4) in renal injury and fibrosis caused by calcium oxalate crystals in mice.Methods:In June 2021, Fifteen male C57/BL6 mice were divided into control group (5 mice), model group (5 mice), and AMD3100 intervention group (5 mice) by random number table method. In model group and AMD3100 intervention group, glyoxylate (100 mg/kg) was injected intraperitoneal for 7 consecutive days for modeling. Meanwhile, the AMD3100 intervention group was also given intraperitoneal injection of AMD3100 (1 mg/kg) for 7 days. The control group was continuously injected with equal volume saline intraperitoneally. After 7 days, peripheral blood was collected from each group to determine the levels of serum urea nitrogen (BUN) and creatinine (Scr) to assess the renal function; HE, Von-Kossa, Picrosirius Red staining was also taken from the left kidney to observe the pathological changes of renal tissue. CXCR4, transforming growth factor β1 (TGF-β1) were detected by immunohistochemistry and western blot. The expression levels of PI3K/AKT pathway-related proteins were detected by western blot.Results:The results of biochemical indexes showed that the serum Scr [(108.03±13.56) μmol/L vs. (39.50±4.48)μmol/L, P<0.01)] and BUN[(5.66±0.48)mmol/L vs. (0.77±0.10)mmol/L, P<0.01) levels were significantly increased in model group compared with the control group. The AMD3100 intervention group was significantly lower than the model group in terms of Scr [(65.77±3.27)μmol/L vs. (108.03±13.56)μmol/L, P<0.05) and BUN [(2.97±0.44)mmol/L vs. (5.66±0.48)mmol/L, P<0.05) levels. The results of kidney pathology in mice showed that renal tubules were significantly dilated with inflammatory cell infiltration in the model group compared with the control group, and a large number of calcium oxalate crystals and collagen fibers were deposited. The extent of kidney damage, calcium oxalate crystals and collagen fibers deposition were significantly reduced in the AMD3100 intervention group compared with the model group. The results of western blotting showed that the relative expression of CXCR4(0.639±0.019 vs. 0.158±0.012, P<0.01) and TGF-β1(0.698+ 0.018 vs. 0.314+ 0.015, P<0.05) was significantly increased in the model group compared with the control group. The relative expression of CXCR4(0.322±0.231) in the AMD3100 intervention group compared with the model group (0.322±0.231 vs. 0.639±0.019, P<0.05) and TGF-β1(0.445+ 0.017 vs. 0.698+ 0.018, P<0.05) were significantly decreased. The results of immunohistochemical staining showed the trend of CXCR4 and TGF-β1 expression in each group consistent with the results of protein blotting assay. Western blotting results showed that the expression of p-PI3K (0.613±0.016 vs. 0.213±0.011, P<0.01) and p-AKT(0.149±0.013 vs. 0.047±0.014, P<0.01) was significantly increased in the model group compared with the control group. The expression of p-PI3K in the AMD3100 intervention group compared with the model group (0.292±0.020 vs. 0.613±0.016, P<0.05) and p-AKT (0.098±0.021 vs. 0.149±0.013, P<0.05)was significantly decreased. Conclusion:CXCR4 inhibits calcium oxalate crystal-induced kidney injury and interstitial fibrosis in mice by targeting the PI3K/AKT pathway.

Relationship between the establishment of percutaneous renal access and injury of the renal blood vessels using different puncture pathways in an animal model / 中华泌尿外科杂志

Objective:To compare the injury of renal blood vessels using different puncture pathways and access sizes.Methods:Between April 2018 and June 2019, eighty fresh pig kidneys were selected to perform percutaneous puncture and dilation, which was used to compare the injury of renal blood vessels with different puncture pathways and access sizes. The puncture pathway included the centerline of the normal renal pyramid (A), centreline of one side pyramid of the fused renal pyramid (FRP) (B), midline of the entire FRP (C) and midline of the renal column (D). The access size included F8, F12, F16, F20, F24 and F30. Histopathological methods were used to analyze the injury of renal blood vessels.Results:The puncture through paths A and B mainly caused injury to the grade Ⅴ and Ⅵ arteries in renal cortex. The puncture often directly injures the grade Ⅳ artery in path C. The puncture often simultaneously injures the grade Ⅲ-Ⅵ arteries in path D. Grade Ⅲ artery injury began to occur when paths A, B, C, and D were dilated to F30, F24, F16, and F12, respectively. The degree of arterial injury among the four different puncture pathways was significantly different in F8, F12, F16, F20, F24 and F30 ( P<0.05). Statistical differences were found between paths A and D in F12, F16, F20, F24 and F30 ( P<0.05), and between paths A and C in F16, F20 and F24 ( P<0.05). No significant difference was found between paths A and B in all access sizes ( P>0.05). Compared with F8, the degree of arterial injury of the F30 in path A and the F24 and F30 in path B were increased significantly ( P<0.05). Conclusions:Vascular injury in path D was the most serious followed by that in path C. Relatively little vascular injury can be achieved in paths A and B. The vascular injury increased when the path B was dilated to F24, while the path A needed to be dilated to F30.

Logistic regression analysis of death risk factors of patients with severe and critical coronavirus disease 2019 and their predictive value / 中华危重病急救医学

Objective:To analyze the risk factors of death in patients with severe and critical coronavirus disease 2019 (COVID-19) and their predictive value.Methods:Using the clinical and epidemiological database of Yangtze River Shipping General Hospital in Wuhan, the clinical and epidemiological data of 105 patients with severe and critical COVID-19 from January to March in 2020 were collected. Multivariate unconditional Logistic regression method was used to analyze the death risk factors of patients during hospitalization. The receiver operating characteristic (ROC) curve was drawn according to the multivariate analysis results to construct a death prediction model; the prediction value of the model was analyzed.Results:The 105 patients with severe and critical COVID-19 were enrolled with 66 males (62.9%) and 39 females (37.1%). The age was (58.2±14.4) years old. Forty-two patients died in hospital and 63 survived. Among the dead patients, 69.0% (29/42) were male, and 78.6% (33/42) were over 60 years old. Compared with survival patients, the non-survival patients were older (years old: 59.2±12.5 vs. 51.2±11.4), and had more comorbidities, including coronary heart disease, hypertension, myocardial damage and thrombocytopenia (coronary heart disease: 33.3% vs. 11.1%, hypertension: 28.6% vs. 9.5%, myocardial damage: 73.8% vs. 11.1%, thrombocytopenia: 61.9% vs. 14.3%), and received more mechanical ventilation (92.9% vs. 44.4%), with significant differences (all P < 0.01). The variables of gender, age, basic diseases, mechanical ventilation and complications were included in the unconditional Logistic regression analysis, which showed that gender [odds ratio ( OR) = 2.852, 95% confidence interval (95% CI) was 0.122-66.694], age ( OR = 3.257, 95% CI was 0.466-18.584), coronary heart disease ( OR = 7.337, 95% CI was 0.227-87.021), hypertension ( OR = 5.517, 95% CI was 0.258-65.024) and concurrent myocardial damage ( OR = 7.322, 95% CI was 0.278-95.020) and thrombocytopenia ( OR = 3.968, 95% CI was 0.325-35.549) were independent risk factors for death in patients with severe and critical COVID-19 during hospitalization. According to the risk factors, the death prediction model was constructed and ROC curve was analyzed, which showed that the area under ROC curve (AUC) of death prediction model for predicting the mortality of patients with severe and critical COVID-19 during hospitalization was 0.804, the sensitivity was 83.8%, and the specificity was 82.3%. Conclusions:Various risk factors are associated with the death of severe or critical COVID-19 patients, such as gender, age, basic diseases and complications. The death prediction model is constructed by gender, age, basic diseases with coronary heart disease and hypertension, concurrent myocardial damage and thrombocytopenia, which has certain predictive value for the death of patients with severe or critical COVID-19.

Emergency coronary artery bypass grafting for acute coronary syndrome: mid-term follow-up results / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the experience with emergency coronary artery bypass grafting (ECABG) for management of acute coronary syndrome and analyze the mid-term follow-up results.</p><p><b>METHODS</b>Forty-five ECABG surgeries were performed in 34 male and 11 female patients (aged 65.6∓5.8 years) for cardiogenic shock (5 cases), acute heart failure (6 cases) and refractory unstable angina (34 cases). Twenty patients received the operation within one week after acute myocardial infarction (AMI) and 18 were preoperatively supported by intra-aortic balloon pumping (IABP). All patients had triple-vessel disease and 15 had left main stenosis. Ten patients experienced two myocardial infarctions and 6 had chronic renal dysfunction including two requiring hemodialysis. On-pump operations were performed in all cases with a mean CPB time of 104.2∓29.7 min and cross clamping time of 69.0∓21.3 min. Cold blood or HTK cardioplegia was used for myocardial protection. The left internal mammary artery (LIMA) was routinely anastomosed to the left anterior descending artery (LAD), and the great saphenous vein (GSV) to other target vessels. The mean number of grafts was 2.9∓0.6.</p><p><b>RESULTS</b>Forty-one patients were cured and discharged and 4 patients died with an in-hospital mortality of 8.9%, including one associated with cardiac event (2.2%). IABP was weaned off within 28.5∓10.6 h after surgery except for one patient who died of multiple organ and system failure (MOSF). Thirty-eight patients (92.7%) were followed up for a mean of 37.3∓16.7 months, during which 2 patients died with a mid-term survival rate of 94.7%. Thirty-five (92.1%) patients had New York Heart Association (NYHA) class I and II. The freedom from cardiac event was 90.5%. Follow-up echocardiography showed significantly improved left ventricular dimension and ejection fraction in these cases (P<0.05), and graft patency was 95.8% for the LIMA and 90.5% for the GSV.</p><p><b>CONCLUSION</b>Despite a slight increase of the in-hospital mortality, ECABG can improve the mid-term survival, freedom from cardiac event, and cardiac function when the indications and timing for surgery are well controlled with optimal perioperative management.</p>

Surgical treatment of aortic paravalvular abscess by infective endocarditis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical features, pathology and surgical treatment experiences in the patients with aortic paravalvular abscess by infective endocarditis.</p><p><b>METHODS</b>The study consisted of a retrospective analysis of 29 cases with aortic paravalvular abscess by infective endocarditis underwent surgical treatment between January 2001 and June 2013. Among the 29 patients, 22 were male and 7 were female, and the mean age was (37 ± 16) years (range from 11 to 63 years). The primary cardiac disease was congenital aortic valve malformation in 16 patients. There were 15 patients with a history of severe heart failure. Of 29 cases, 8 abscess cavities, 13 pseudoaneurysms and 6 fistulas were found, and complete aortoventricular discontinuity was present in 5 patients with serious infections. Of them, the abscess was above the annulus in 14 patients and below the annulus in 10 patients, and simultaneously involved the annulus above and below in 5 patients. 19 patients were culture positive either positive preoperative blood cultures or positive cultures of surgical specimens, including 9 patients with Staphylococcus infection. The paravalvular defect was repaired by patch in 19 cases, and by local closure in 10 cases. The valvular annulus was reconstructed simultaneously in 16 patients. Aortic valve replacement was performed in 26 patients, and Bentall procedure in 2 patients, including 23 with prosthetic mechanical valve and 5 with biological valve.</p><p><b>RESULTS</b>Of the total 29 patients, 28 patients were recovered, and 1 patient was died of sepsis. During 3 months to 13 years postoperative follow-up (average 4.5 years), one was died of non-cardiac cause, and no patient had recurrent endocarditis and paravalvular leakage.</p><p><b>CONCLUSIONS</b>Aortic paravalvular abscess by infective endocarditis is not uncommon, prone to heart failure. According to the different pathological manifestations, the appropriate surgical approach and strategy can achieve satisfactory outcomes.</p>

Early results of left atrial appendage closure in cerebral ischemic stroke reduction in patients with mitral valve replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the role of left atrial appendage (LAA) closure for cerebral ischemic stroke prevention following mitral valve replacement.</p><p><b>METHODS</b>Retrospective data on 860 consecutive adult patients undergoing mitral valve replacement between January 2008 and January 2013 were analyzed. There were 414 male and 446 female patients, with a mean age of (53 ± 12) years. The patients were divided into two groups according to whether the left atrial appendage was closed during operation: LAA closure group (n = 521) and non-LAA closure group (n = 339).Early mortality, postoperative cerebral ischemic stroke and the risk factors for cerebral ischemic stroke were assessed. Multivariate analysis was performed using logistic regression analysis.</p><p><b>RESULTS</b>Compared with non-LAA closure group, LAA closure group had higher proportion of female gender, higher percentage of patients with cardiac insufficiency, pulmonary hypertension and left atrial thrombus, higher incidence of mechanical valve implantation and concurrent tricuspid surgery, and larger preoperative diameter of left atrium, but lower proportion of hypertension and patients undergoing coronary artery bypass surgery, and shorter aorta cross clamping time (χ² = 6.807 to 122.576, t = -2.818 and 3.756, all P < 0.05). There were no differences in exploratory thoracotomy for bleeding and in-hospital mortality between the two groups. Postoperative cerebral ischemic stroke occurred in 12 patients (1.4%). The incidence of cerebral ischemic stroke in LAA closure group was significantly lower than in non-LAA closure group (0.6% vs.2.7%, χ² = 6.452, P = 0.011).Logistic regression analysis showed that LAA closure was a significant protective factor for postoperative cerebral ischemic stroke (OR = 0.189, 95% CI: 0.039 to 0.902, P = 0.037) while history of cerebrovascular disease (OR = 4.326, 95% CI:1.074 to 17.418, P = 0.039) and preoperative diameter of left atrium (OR = 1.509, 95% CI: 1.022 to 1.098, P = 0.002) being the independent risk factors for postoperative cerebral ischemic stroke. The subgroup analysis showed that, for atrial fibrillation patients, LAA closure was a strong protective factor (OR = 0.064, 95% CI: 0.006 to 0.705, P = 0.025), but LAA closure was not a significant predictive factor (OR = 1.902, 95% CI: 0.171 to 21.191, P = 0.601) in non-atrial fibrillation patients.</p><p><b>CONCLUSION</b>Concurrent LAA closure during mitral valve replacement is safe and effective to reduce the early postoperative risk of cerebral ischemic stroke in atrial fibrillation patients.</p>

Efficacy of oral bosentan for treatment of congenital heart disease-associated pulmonary arterial hypertension / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of oral bosentan in the treatment of congenital heart disease-associated pulmonary arterial hypertension.</p><p><b>METHODS</b>24 patients with congenital heart disease-associated pulmonary arterial hypertension, including 4 receiving heart surgery and 20 with surgical contraindications, were enrolled in this study. All the patients were given oral bosentan and followed up regularly for analyzing the outcomes and side effects.</p><p><b>RESULTS</b>One patient was lost to follow up and one patient died. Systolic pulmonary artery pressure showed no significant changes at 2 (93.6 ± 17.2 mmHg) and 4 months (85.7 ± 25.5 mmHg) of bosentan treatment compared to that before the medication (97.8 ± 14.9 mmHg) (P=0.096), but decreased significantly after a 6-month therapy (80.9 ± 25.0 mmHg, P=0.029). The 6-minute walking distance increased significantly after a 2, 4, and 6-month therapy [(488 ± 98.8, 496.3 ± 89.0, and 491.3 ± 114.2 m, respectively; P=0.004, 0.003, and 0.004 vs the distance before medication (317.0 ± 134.1)]. The New York heart functional classification was improved significantly after a 2, 4, and 6-month therapy [(2.0 ± 0.5, 1.8 ± 0.4, and 1.7 ± 0.5, respectively; P<0.001 vs pre-medication score (2.9 ± 0.5)). Hepatic and renal function remained normal, and ALT and AST showed no significant variations during the medication (P>0.05).</p><p><b>CONCLUSION</b>Oral bosentan can effectively relieve the symptoms, decrease pulmonary artery hypertension, and improve exercise tolerance and cardiac function classification in patients with pulmonary artery hypertension associated with congenital heart disease with good safety and mild side effects.</p>

Clinical study on the treatment of primary premature ejaculation with paroxetine hydrochloride and tamsalosin / 重庆医学

Objective To evaluate the therapeutic effects and adverse events on treatment of primary premature ejaculation (PE) with paroxetine hydrochloride and/or tamsalosin .Methods 225 cases of healthy men ,a history of lifelong PE and an intravaginal e‐jaculation latency time(IELT) < 120 sec were included in this study .The patients were divided into three groups(with 75 cases in each group) .Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks ;group B were given tamsalosin 0 .2 mg/d for 8 weeks ;group C were given paroxetine hydrochloride and tamsalosin for 8 weeks .The effects and adverse events were evaluated by the overall change and fold increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP) .Results The reliable data from 198 patients were achieved .The mean IELT after treatment were significantly improved in all groups than that of before treatment (P<0 .05) .The mean IELT in group C was increased for 8 .15 min after treatment .The in‐creased folds of mean IELT in group C (8 .02 folds) was significantly higher than that in group B (1 .98 folds)and group A (6 .92 folds)(P<0 .01) .The mean PEP scores that include measures of perceived control over ejaculation ,satisfaction with sexual inter‐course ,ejaculation‐related personal distress ,ejaculation‐related interpersonal difficulty were significantly improved in all groups after treatment .The mean PEP scores in group C had more significant improvements than that in group A and B .The prevalence of ad‐verse events in group A ,B ,C were 10 cases(13 .3% ) ,2 cases(2 .6% ) and 9 cases(12 .0% ) ,respectively .Conclusion Paroxetine hydrochloride combined with tamsalosin lead to better therapeutic effects and could be a priority selection for the treatment of pri‐mary PE .

Analysis of blood flow in sequential and individual saphenous vein grafts in off-pump coronary artery bypass grafting / 中南大学学报(医学版)

OBJECTIVE@#To compare the blood flow in sequential and individual saphenous vein grafts (SVGs) and to analyze the influence of the location of the target vessel in off-pump coronary artery bypass grafting (OPCAB).@*METHODS@#A total of 464 SVGs in 412 patients receiving OPCAB were nested into individual SVG (n=206), double (n=241) or triple sequential SVG (n=15), and analyzed.@*RESULTS@#The blood flow in double and triple SVGs was significantly higher than in individual SVGs [(43.4±22.5), (43.7±19.2) and (28.9±18.7) mL/min, respectively, P<0.001, P=0.047]. There were no differences between flow in double and triple SVGs (P=0.96). Pulsatility index (PI) of the three groups were similar (2.6±1.2, 2.5±1.6, 2.8±0.9, respectively, P=0.49, P=0.49). In individual SVGs to right coronary artery, the blood flow was higher than in the posterior descending branch (PDA) (P=0.047) and posterior branch of left ventricle (PBLV), the flow-time in systole period was longer than diagonals (P=0.003), obtuse marginal (OM) (P=0.013) and PDA (P=0.002), PI was significantly lower than PDA (P=0.033) and PBLV (P=0.032). The blood flow in individual SVGs to diagonals was significantly lower than in other target vessels except for PBLV (P<0.05). Flow in double SVGs to PDA-PBLV was significantly lower than in PDA-OM.@*CONCLUSION@#The mean blood flow in double and triple sequential SVGs is about 1.5 times higher than in individual SVGs. Individual, double, and triple SVGs have similar pI. Flow in individual SVGs to diagonals was significantly lower than in other target vessels except for PBLV.

Surgery in patients of severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction / 中华胸心血管外科杂志

Objective To assess the result of aortic valve replacement(AVR) for patients of severe aortic stenosis(AS)with low transvalvular gradients(TVG) and severe left ventricular dysfunction,and try to identify the determinants of survival,functional status and change in left ventricular ejection fraction(LNEF) during follow-up.Methods From 2005 to 2011,35patients with aortic valve area(AVA) ＜ 1 cm2,LN EF ＜ 0.40 and mean TVG ＜ 30 mm Hg underwent AVR in our hospital.The average age of the patients was 58 yeats old,and 88.6％ of the patients were in New York Heart Association (NYHA) functional class Ⅲ/IV at admission to the hospital.The AVA was (0.70 ± 0.09) cm2,LVEF was 0.276 ± 0.020,TVG was (26.0 ± 2.3) mm Hg,and left ventricular end-diastolic diameter (LNEDD) was (6.3 ±0.4) cm respectively.35 prosthetic valves were implanted,including 20 mechanical prostheses and 15 biological prostheses with the mean sizs of (23 ± 1) mm.Concomitant procedures included mitral valvularplasty in 5.tricuspid valve repair in 3 and coronary artery bypass grafting in 4.Results The perioperative mortaiity was 8.6％.Follow-up period was 3 to 60 monthes.The survival rates were:1-year 78％,2-year 68％,5-year 60％.LVEF increased significantly to 0.358 ± 0.047 one week postoperatively (P =0.008) and 0.426 ± 0.031 six months later (P ＜ 0.01)).LNEDD decreased to (5.7 ± 0.4) cm one week later(P =0.062) and (5.3 ±0.3)cm 6 months postoperatiwely (P ＜ 0.01).NYHA functional class improved from 88.6％ in class Ⅲ/Ⅳ to 35％ (P ＜0.01).Compared with those who surviwd during follow-up,the patients who died during follow-up were older in the year of operation[(63 ± 10) vs (54 ± 11),P =0.017],their NYHA functional class was higher[(3.9 ±0.2) vs (2.9 ±0.3),P =0.003]and the LVEDD for them in one week postoperatively was larger[(6.0 ± 1.0) cm vs (5.5 ± 0.3) cm,P =0.031].Conclusion The left ventricle contractile reserve seems to play an essential role for surgery in patients of severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction.AVR can be performed for them with acceptable results.

Good outcomes from cardiac valve surgery in the elderly over 70 years / 中华胸心血管外科杂志

ObjectiveTo evaluate the outcomes for elderly( ＞70 years) patients undergoing valvular heart surgery and determine the early mortality and major morbidity associated with cardiac valve surgery in the elderly.MethodsBetween 2005and 2011,1366 patients underwent cardiac valve surgery in our department.115 patients(65 males,50 females) were 70 or older [aged (74.3 ± 3.1 ) years].Rheumatic valvular disease presented in 68 ( 59.1％ ),degenerative valvular disease in 33(28.7 ％),congenital heart disease in 6 (5.2 ％) and the others in 8 (7.0％).20 cases( 17.4％ ) had hypertention,17 cases( 15.8 ％ ) had diabetes mellitus,18 (15.7％) had coronary heart disease.Chronic obstructive pulmonary disease was found in 25 cases(21.7 ％ ),and renal insufficiency was found in 9(7.8 ％ ).6 patients(5.2％ ) had the history of cerebrovascular disease.72 (62.6 ％) had atral fibrillation and 11 cases(9.6％ ) had the history of cardiac valve surgery previously.75(65.2 ％ ) cases were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ.Left ventricular ejection fraction (LVEF) was 0.28-0.72 (0.53 ± 0.01 ).All the patients receieved coronary angiography preoperatively.All the operations were performed on cardiac-pulmonary bypass (CPB) with moderate hypothermia.During CPB,the perfusional pressure was maintained between 60-70 mm Hg and the oxygen saturation for mixed venous blood was kept above 0.70.Artificial ultrafilitration was performed for all the patients during the time of CPB.55 ( 47.8 ％ ) patients had mitral valve replacement ( MVR),3 (2.6％) had mitral valve repair( MVP),33 (28.7 ％) had aortic valve replacement (AVR),16 ( 13.9 ％ ) had AVR +MVR,5(4.3％ ) had AVR + MVP,and 3 had tricuspid replacement.The concomitant procedures included left atrial thrombus scavenging in 18( 15.7％ ),tricuspid valvularplasty in 71 (61.7 ％ ),bental procedure in 6 (5.2 ％ ),and coronary artery bypass grafting(CABG) in 15 ( 13.0 ％).ResultsThe early mortality was 0.87 ％.The major complications included sever low cardiac output syndrome in 6 patients,transient atrial fibrillation in 17,acute renal failure requiring dialysis in 3,delayed ventilation assistance in 12,and stroke in 3.112 (97.4％) patients survived during 6 months period of follow-up,in whom only 8(7.14％) were in NYHA functional class Ⅲ-Ⅳ which was lower significantly compared with that preoperatively.ConclusionHeart valve surgery for elderly patients can get satisfactory result and early mortality and major mortality is low for them.Concerns over the risk of cardiac valve surgery in the elderly should not prevent referral,and elderly patients can do well.

Economic outcome of coronary artery bypass surgery: a comparative study between on-pump and off-pump surgery / 中华胸心血管外科杂志

Objective To compare the economic outcome between on-pump and off-pump coronary artery bypass grafting (CABG). Methods Six hundred seventy-nine patients were divided into on-pump and off-pump groups. Twelve variables with respect to costs were obtained for each group during hospital stay. Results There was no significant difference in total mean cost between two groups. For off-pump patient, the costs of medication, operation, blood transfusion, bed occupancy, and nursery were significantly less than those of on-pump CABG surgery was (P0.05). Conclusion Costs of OPCAB are not significantly lower than on-pump CABG due to higher material costs.

Clinical study on the pulsatility index for Chinese CABG patients / 中华胸心血管外科杂志

0.05). Accordingly, statistics shows that the mean value of PI is 2.56?2.35. Conclusion: The referential range of PI for Chinese CABG patients is 2.56?2.35.

Intraoperative comparison of left internal mammary artery blood flow: immediately after implantation versus before sternum closure / 中华胸心血管外科杂志

Objective: The study was to analyze hemodynamic changes of blood flow of left internal mammary artery (LIMA) in off-pump coronary bypass surgery (OPCAB). Methods: From January 2002 to August 2002, a total of 65 patients received intraoperative hemodynamic assessment of their bypass grafts by transit-time flowmeter(TTFM) during OPCAB. All operations and flow measurements were performed by the same surgeon (GCQ). The mean age of patients was (64.3?0.94) years(range 47 to 75 years), There were 50 men and 15 women. One-vessel disease was in 7 patients, two-vessel disease in 26, three-vessel disease in 32, and left main stem disease (isolated or associated) in 22. Left anterior descending artery (LAD) was routinely bypassed with LIMA. The blood flow of LIMA was measured immediately after completion of the anastomosis to LAD (early phase) and before sternum closure (late phase) using transit-time flowmeter. Results: The mean flow significantly decreased from (29.91?3.32) ml/min in early phase to (25.12?2.56) ml/min, P

Comparison of perioperative myocardial injury between off-pump coronary artery bypass grafting and conventional coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the perioperative release levels of cardiac troponin I (cTnI) between off-pump coronary artery bypass grafting (OPCAB) or conventional coronary artery bypass grafting (CCABG) in an attempt to detect myocardial injury.</p><p><b>METHODS</b>Fifty-nine patients with instable angina underwent coronary artery bypass grafting by OPCAB in 34 patients aged (59.15 +/- 1.71) years or CCABG in 25 patients, aged (54.46 +/- 1.81) years.</p><p><b>RESULTS</b>Baseline characteristics were similar. The number of grafts was similar (OPCAB, mean 2.90; CCABG, mean 3.2), and no patient died. Postoperative myocardial serum enzyme measures were significantly lower in OPCAB, suggesting less myocardial injury. OPCAB patients did not receive blood transfusion, and had higher hematocrit at discharge. Most of OPCAB patients were extubated in 4 hours.</p><p><b>CONCLUSIONS</b>Compared with CCABG, OPCAB may achieve similar outcomes; it reduces transfusion volume and creates less myocardial injury.</p>

Expression, purification and diagnostic application of EBV TK kinase / 中华实验和临床病毒学杂志

<p><b>BACKGROUND</b>To find a rapid and sensitive method for early diagnosis of nasopharyngeal carcinoma by using EBV TK kinase.</p><p><b>METHODS</b>Prokaryotic expression plasmid pRSETTK was constructed. EBV TK kinase was highly expressed in E.coil BL21 (DE3). The authors identified specificity of TK kinase by Western blot, then used purified TK kinase in ELISA to detect the IgG antibody in the serum of NPC patients.</p><p><b>RESULTS</b>Specific IgG antibody against TK kinase was found in the serum of NPC patients. The specificity and sensitivity of TK kinase were both 100% in Western blot and were 98.0% and 93.4% respectively in ELISA.</p><p><b>CONCLUSIONS</b>The EBV TK kinase showed high specificity and sensitivity in ELISA, therefore it can be used for early diagnosis of NPC</p>

Clinical experiences in radical surgery for tetralogy of Fallot in infancy:a report of 128 cases / 解放军医学杂志

Objective To sum up the experiences in radical surgery for tetralogy of Fallot(TOF) in infancy.Methods One hundred and twenty-two infants(82 males and 46 females,6 months to 2 years old) suffered from TOF were treated with radical surgery from January 1996 to December 2007.Median sternotomy was routinely performed in all patients,and a longitudinal incision of right ventricular outflow tract was made to widen the conduit adequately,the ventricular septal defect was closed with polyfluortetraethylene patch,and the outflow conduit was reconstructed by autologous pericardial patch.Modified ultrafiltration technique was adopted routinely before cardiopulmonary bypass termination.Results Seven of the 128 infants died after operation with the early mortality of 5.5%.The death causes were: severe low cardiac output syndrome(n=2),severe pulmonary complications(n=4) and multiple organ failure(n=1).The major post-operative complications included 12 cases of low cardiac output syndrome,5 cases of atelectasis and 6 cases of perfusion lung.Conclusions The preferable operative age of radical surgery for TOF is about 1 year old,and the clinical outcome could be satisfactory.Low cardiac output syndrome and severe respiratory complications are the major problems after radical surgery for TOF in infants.

Comparative studies on perioperative hemodynamics in coronary artery bypass with or without cardiopulmonary bypass / 解放军医学杂志

Objective To analyze the hemodynamic changes during coronary artery bypass grafting with or without cardiopulmonary bypass.Methods Thirty patients undergone coronary artery bypass grafting from January to June,2006 were retrospectively analyzed.Among them,12 patients were operated on with cardiopulmonary bypass(CCABG)and 18 without cardiopulmonary bypass(OPCAB).The stabilizator(type Octops III)was used to fix target vessels in OPCAB group.In CCBAG group,the extracorporeal circulation was used routinely,and internal mammary artery and saphenous vein were used to anastomose with target branches of coronary artery.The hemodynamic changes at different time points during and after operation were monitored,and the relevant parameters were also recorded.Results The anaesthesia time,intraoperative blood loss and fluid input,and ventilating time after operation in CCABG group were significantly higher than those in OPCAB group,and the postoperative haematocrit(HCT)was significantly lower in CCABG group than that in OPCAB group(P

Surgical treatment of left ventricular outflow tract obstruction due to accessory mitral valve: case report and review of literature / 解放军医学杂志

Objective To study the clinical characteristics and surgical treatment of left ventricular outflow tract obstruction (LVOTO) caused by congenital accessory mitral valve (AMV) tissue. Methods Two cases were treated in our department. Pre-operatively, case 1 was diagnosed as congenital heart disease with severe LVOTO and anterior mitral valve cleft; case 2 was diagnosed as congenital atrial septal defect combined with AMV and mild LVOTO as well as mild mitral valve regurgitation. Both patients were operated on under CPB. In case 1, LVOTO was caused by AMV which belonged to Type I (fixed type). In case 2, the AMV was type II (mobile type). Results Both AMV tissues were resected through atrial septum, and combined cardiac disorders were repaired simultaneously. The operations were successful and the patients were discharged with good results. Echocardiography revealed that the LVOTO almost disappeared. Conclusions LVOTO caused by AMV is a rare congenital heart disorder. AMV may be removed with acceptable postoperative outcome. Prophylactic removal of AMV tissue should not be attempted in patients with no or mild LVOTO and no other associated heart defects. These patients should be followed and observed periodically by Doppler echocardiography to identify any progression in LVOTO.

Clinical analysis of 1120 cases of coronary artery bypass grafting / 解放军医学杂志

Objectives To analyze retrospectively 1120 patients who underwent coronary artery bypass grafting surgery (CABG) in order to evaluate surgical techniques and clinical outcome. Methods From 1997 through April of 2005, data of 597 patients who underwent conventional coronary artery bypass surgery on pump (CCABG) and 523 patients who underwent off-pump CABG (OPCAB) all performed by the same surgeon were collected and analyzed retrospectively. Eight hundred and fifty-two patients had unstable angina, 640 patients were over 60 years old (57.1%) and 862 patients had concomitant diseases involving valves, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect, stroke, COPD, renal failure and cancer. A hundred and seventy-six patients had LIMS stenosis and 738 patients with triple-vessel disease. Results Total mortality was 0.36% (4-case death), and morbidity of 1.6% (sternal dehiscence, stroke and mediastinitis). The grafts per patient with CCABG and OPCAB were 3.3?0.6 vs. 2.5?0.4. Left internal mammary artery (LIMA) was used in 94% of the patients, and IABP was given in 31 patients early postoperatively. Follow-up period was 4 months to 7 years. Conclusions Rational and appropriate surgical strategies, excellent surgical techniques, improvement in anesthesia, and CPB significantly lower mortality and morbidity of CABG, which has become safe and effective in patients with coronary artery disease.