Treatment of thoracoabdominal aortic aneurysm by prosthetic vessel replacement under left heart bypass / 中南大学学报(医学版)

OBJECTIVES@#Thoracoabdominal aortic aneurysm (TAAA) prosthetic vessel replacement is one of the most complex operations in the field of cardiovascular surgery. The key to success of this operation is to prevent and avoid ischemia of important organs while repairing TAAA. This study aims to summarize and analyze the effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA.@*METHODS@#Data of 15 patients with TAAA who underwent prosthetic vessel replacement under left heart bypass in Xiangya Hospital of Central South University were retrospectively analyzed. According to Crawford classification, there were 2 cases of type I, 8 cases of type II, 3 cases of type III, and 2 cases of type V. There were 14 cases of selective operation and 1 case of emergency operation. All operations were performed under left heart bypass, and cerebrospinal fluid drainage was performed before operation. Left heart bypass was established by intubation of left inferior pulmonary vein and distal abdominal aorta or left femoral artery. The thoracoabdominal aorta was replaced segment by segment. After aortic dissection, the kidneys were perfused with cold crystalloid renal protective solution, and the celiac trunk and superior mesenteric artery were perfused with warm blood.@*RESULTS@#One patient with TAAA after aortic dissection of type A died. During the operation, straight blood vessels were used to repair TAAA, and the celiac artery branches were trimmed into island shape and anastomosed with prosthetic vessels. After the operation, massive bleeding occurred at the anastomotic stoma, then anaphylactic reaction occurred during massive blood transfusion, resulting in death. One patient suffered from paraplegia due to ischemic injury of spinal cord. The other patients recovered well and were discharged. The postoperative ventilation time was (16.5±13.8) h and the postoperative hospital stay was (10±4) d. The amount of red blood cell transfusion was (13±9) U. The patients were followed up for 2 months to 2 years, and the recovery was satisfactory.@*CONCLUSIONS@#The effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA is good, which is worthy of clinical promotion.

Discovery of the anti-angiogenesis effect of eltrombopag in breast cancer through targeting of HuR protein

HuR (human antigen R), an mRNA-binding protein responsible for poor prognosis in nearly all kinds of malignancies, is a potential anti-tumor target for drug development. While screening HuR inhibitors with a fluorescence polarization (FP) based high-throughput screening (HTS) system, the clinically used drug eltrombopag was identified. Activity of eltrombopag on molecular level was verified with FP, electrophoretic mobility shift assay (EMSA), simulation docking and surface plasmon resonance (SPR). Further, we showed that eltrombopag inhibited cell proliferation of multiple cancer cell lines and macrophages, and the anti-tumor activity was also demonstrated in a 4T1 tumor-bearing mouse model. The data showed that eltrombopag was efficient in reducing microvessels in tumor tissues. We then confirmed the HuR-dependent anti-angiogenesis effect of eltrombopag in 4T1 cells and RAW264.7 macrophages with qRT-PCR, HuR-overexpression and HuR-silencing assays, RNA stability assays, RNA immunoprecipitation and luciferase assays. Finally, we analyzed the anti-angiogenesis effect of eltrombopag on human umbilical vein endothelial cells (HUVECs) mediated by macrophages with cell scratch assay and Matrigel angiogenesis assay. With these data, we revealed the HuR-dependent anti-angiogenesis effect of eltrombopag in breast tumor, suggesting that the existing drug eltrombopag may be used as an anti-cancer drug.

Protective effect of right coronary artery ischemic preconditioning on myocardial ischemia reperfusion injury in rabbit heart / 中南大学学报(医学版)

To explore the protective effects of right coronary artery ischemic preconditioning and post-conditioning on myocardial ischemia reperfusion injury in rabbit heart.
 Methods: A total of 30 rabbits were randomly divided into 4 groups: a control group (n=7), an ischemia reperfusion group (IR group, n=8), an ischemic preconditioning group (IPC group, n=8) and an ischemic post-conditioning group (IPO group, n=7). Venous blood samples were taken at pre-operation, 1 and 6 h post-operation, and the concentration of serum creatine kinase isoenzyme (CK-MB) and cardiac troponin-T (cTn-T) were measured. The infarct area of cardiac muscle was calculated.
 Results: Compared with the IR group, the levels of CK-MB and cTn-T at 1 and 6 h post-operation in the IPC group and the IPO group were reduced (all P<0.05). Compared with the IR group, the infarct size in the IPC group and the IPO group was significantly decreased, with significant difference (both P<0.05) .
 Conclusion: Right coronary artery ischemic preconditioning and post-conditioning exert significant protective effects on the myocardial ischemia reperfusion injury in New Zealand rabbits.

Heparin-induced thrombocytopenia in patients undergoing cardiac surgery / 中南大学学报(医学版)

OBJECTIVE@#To investigate the incidence for heparin-induced thrombocytopenia (HIT) in patients undergoing cardiac surgery and to evaluate the risk factors for the generation of HIT-antibody.
@*METHODS@#A total of 315 patients undergoing cardiac surgery in the Department of Cardiothoracic Surgery, Xiangya Hospital between December, 2013 and July, 2014 were enrolled for this study. Among them, 120, 154 and 41 were for surgery of congenital heart defect, valve and coronary artery bypass graft, respectively. There were 170 male patients and 69 patients were under 18 years old. Platelet counts, HIT-antibody and concentration of platelet factor 4 (PF4) were tested before and after the surgery. Diagnosis of HIT was based on "4Ts" (Pretest Clinical Scoring System). 
@*RESULTS@#HIT was diagnosed in 11 patients (3.5%, 11/315). And thromboembolic events occurred in 2 of 11 patients with HIT. The positive ratio for HIT-antibody was 36.5% (115/315). The coronary artery disease patients had a higher incidence of HIT than that of either the valve disease or the congenital heart defect (17.1%, 7/41 versus 1.9%, 3/154 or 0.8%, 1/120; P<0.05). The congenital heart defect patients had a higher positive ratio for HIT-antibody than that of both the valve disease and the coronary artery disease. The valve disease patients had a higher positive ratio for HIT-antibody than that of the coronary artery disease (51.7%, 62/120 versus 30.5%, 47/154 versus 14.6%, 6/41; P<0.05). Major postoperative complications occurred more frequently in HIT patients (36.4%, 4/11 versus 10.5%, 32/304; P<0.05). Age was a risk factor for HIT (P=0.030, OR=1.083, 95% CI 1.008-1.163). Cardiopulmonary bypass (CPB) (P=0.037, OR=3.113, 95% CI 1.071-9.050) and age (P<0.001, OR=0.970, 95% CI 0.959-0.982) were risk factors for HIT-antibody.
@*CONCLUSION@#The incidence of HIT is low during cardiac surgery, but HIT is a highly risk factor for the major postoperative complications. More attentions should be paid to these severe complications and the risk factors for HIT.

REV procedure for complex congenital heart diseases / 中南大学学报(医学版)

OBJECTIVE@#To introduce REV procedure in patients with transposition of the great arteries (TGA) with a ventricular septal defect (VSD) and pulmonary stenosis (PS).@*METHODS@#From May 2012 to June 2012, 4 patients with TGA were admitted for surgery. Two patients with VSD underwent SWITCH operation. REV procedure was used for the other two patients with PS. The Senning procedure was also used for the patient with atrioventricular discordance.@*RESULTS@#There was no in-hospital mortality. Shortest cardiopulmonary bypass time and aortic crossclamp time were found in simple REV procedure patient. Postoperative echocardiography demonstrated physiologic hemodynamics in the left ventricular outflow tract and normal heart function. All the patients were in excellent clinical condition during follow-up.@*CONCLUSION@#REV procedure is a good choice for transposition of great arteries associated with ventricular septal defect and obstruction of the pulmonary outflow tract.

Transplantation of autologous myoblasts transfected with VEGF165 improves heart function after myocardial infarction in rabbits / 中南大学学报(医学版)

OBJECTIVE@#To determine the improvements of post-infarction heart function after transplantation of autologous skeletal myoblasts transfected with VEGF165 in rabbits.@*METHODS@#Myocardium infarction was induced in rabbits by left anterior descending coronary artery ligation. At 2 weeks, 1.75×10(7) autologous skeletal myoblasts transfected with pcDNA3.1-VEGF165 were infused into the region of MI via direct intramuscular injection; pcDNA3.1 served as a control.@*RESULTS@#The DAPI-labeled and Desmin-positive immunostained skeletal myofibers were found throughout the infracted areas and border zones, and the density of blood capillary in the MI region transplanted by myoblasts with VEGF165 was increased (measured 4 weeks later and compared with controls). Heart function was examined by the Buxco system and demonstrated that maximum dp/dt [(1607.23±102.67) mmHg/s vs (1217.77±89.91) mmHg/s] and minimum dp/dt [(-1535.09 ± 81.34) mmHg/s vs (1174.58 ± 91.5) mmHg/s] were improved in the heart transplanted with the transfected myoblasts(P<0.05).@*CONCLUSION@#Autologous skeletal myoblasts transfected with VEGF165 could ameliorate the blood supply in the MI region, and aid recovery of heart function more quickly in post-infarction hearts. This suggests an effective treatment for myocardium infarction.

Telephone follow-up of 1635 post-surgery lung cancer patients and retrospective study of lung cancer prognosis / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the telephone follow-up of surgery patients with lung cancer and to analyze the prognosis factors.@*METHODS@#From October 2011 to January 2012, 1635 post-surgery lung cancer patients from January 2002 to August 2011 were followed up by telephone interview. The data from follow-up and clinical characteristics were collected and analyzed. Among these patients, 116 patients with complete and reliable clinical data were further analyzed to determine the effective factors of lung cancer metastasis and long-term survival.@*RESULTS@#The average response rate in the follow-up was 36.1%, and the response rate was related to the interval time after the operations. The shorter the interval, the higher the response rate. The response rate in female patients was higher than that in male patients (P<0.001).The response rate was higher in patients younger than 40 (56 %) than that in the patients aged between 50-59 and over 60 (39% and 24% respectively, P<0.001). There was no statistical difference between patients from urban and rural areas (P=0.844). In the 116 patients with complete and reliable clinical data, statistical analysis confirmed that the metastasis and high lymph node staging were factors to increase patients' risk of death (with odd ratio 0.212 and 1.818 respectively, P<0.001). The adenocarcinoma grade, high lymph node staging and advanced age were related to the metastasis risk (odds ratio 2.353, 2.181 and 2.908, respectively).@*CONCLUSION@#Time, gender and age are the influencing factors in the telephone follow-up. Metastasis, lymph node metastasis, pathologic type and age are related to the lung cancer prognosis in the small-scale sample.

The effects of recombinant human brain natriuretic peptide on the plasma endotoxin and systemic inflammatory response in patients with cardiac valve replacement during cardiopulmonary bypass / 中华胸心血管外科杂志

Objective To observe the effects of recombinant human brain natriuretic peptide on the plasma endotoxin and systemic inflammatory response in patients undergoing cardiac valve replacement surgery during cardiopulmonary bypass (CPB) and to explore its mechanism.Methods 32 patients with elective heart valve replacement surgery during cardiopulmonary bypass were divided into a control group and a treatment group randomly.The patients of treatment group were recievel rhBN (1.5 μg · kg-1 · min-1 bolus intravenous injection before aortic cross-clamping followed by 0.0075 μg · kg-1 · min-1 for 24 hours),while the patients of control group received the same volume of 0.9％ sodium chloride.The plasma levels of endothelin -1 ( ET-1 ),diamine oxidase(DAO),lipopolysaccharide ( LPS),tumor necrosis factor-α (TNF-α) before skin incision ( T1 ),the end of CPB ( T2 ),4 h after the end of CPB ( T3 ),8 h after the end of CPB (T4),24h after the end of CPB (T5) respectively.Results Before skin incision ( T1 ),plasma ET-1,DAO,LPS,TNF-α of two group patients showed no significant difference ( P ＞ 0.05 ) ; At each time point after the end of CPB ( T2,T3,T4,T5 ) Plasma DAO,LPS,TNF-α levels of two groups patients were significantly higher than before skin incision ( T1 ) levels ( P ＜ 0.01 ).There was no significant difference of the plasma levels of ET-1 between T5 and T1 in treatment group patients ( P =0.24).At each time point after the end of CPB ( T2,T3,T4,T5 ),treatment group patients'plasma ET-1,DAO,LPS,TNF-α levels were significantly lower than the control group respectively (P ＜0.01 ).The increase in blood ET-1 was highly positive correlated with the increase in blood DAO (r=0.51,P ＜0.01 ).The increase in blood DAO was highly positive correlated with the increase in blood LPS (r =0.77,P ＜ 0.01 ).The increase in blood LPS was significantly positive correlated with the increase in blood TNF-α ( r =0.48,P ＜0.01 ).Conclusion Recombinant human brain natriuretic peptide can reduce gastrointestinal vasoconstriction,improve gastrointestinal mucosal perfusion and oxygenation,protect the gastrointestinal mucosal barrier function,preventing intestinal endotoxemia Shift,reduce plasma endotoxin levels and reduce systemic inflammatory response by inhibiting the release of ET-1 during CPB.

Autologous myoblasts transplantation improves heart function after myocardiac infarction / 中南大学学报(医学版)

Objective To determine whether autologous skeletal myoblasts implantation improves the cardiac function after myocardial infarction and the possible mechanism. Methods Myocardial infarction was induced by ligation of the left anterior descending coronary artery in rabbits. At 2 weeks, 1. 34 × 107 to 1.75 × 107 autologous skeletal myoblasts were infused into the lesion via direct intramuscular injection. In the control group, the postinfarction hearts were infused with medium alone. Buxco invasive cardiac function testing and histopathological examination were utilized to evaluate the functional and structural changes in the myocardium 4 weeks later. Results Both maximum rising rate of the left intraventricular pressure [+dp/dtmax,( 1 217.77 +89.91 )mmHg/s vs. (897.83 ±70.04) mmHg/s] and maximum falling rate of the left intraventricular pressure [- dp/dtmax,( -1174.58 ± 91.5 ) mmHg/s vs. ( - 753.67 ± 69.66 ) mmHg/s] were improved in the myoblast transplanted group compared with medium infusion group. The positive desmin immunostaining skeletal myofibers in the myocardium were found throughout the infracted areas and the border zone. Conclusion Autologous skeletal myoblasts can establish muscle tissue when transplanted into postinfarction hearts, and this mucle can treat myocardiac infarction effectively.

Protective effect of aminophylline on cerebral injury during cardiopulmonary bypass in infants / 中南大学学报(医学版)

OBJECTIVE@#To investigate the protective effect of aminophylline on cerebral injury induced by cardiopulmonary bypass (CPB) in infants.@*METHODS@#Forty patients who underwent ventricular septal defect within 3 years old were randomly divided into 2 groups(20 cases in each group).Aminophylline group:aminophylline (5 mg/kg) was injected slowly via the vein after anesthesia and maintained at a dose of 0.5 mg/(kg.h) until the end of CPB.@*CONTROL GROUP@#aminophylline was replaced by Ringer's lactated solution. Samples were obtained at the beginning of CPB (T(1)),the end of CPB (T(2)),6 h (T(3)) and 24 h (T(4)) after the operation to measure S-100 beta protein, NSE, tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and interleukin-10 (IL-10) concentration by ELISA in the 2 groups.@*RESULTS@#Compared with the time point immediately before CPB, the S-100beta protein,NSE, TNF-alpha, and IL-8 concentration in the 2 groups began to increase with the start of CPB, reached a climax at the end of CPB (T(2)),decreased gradually 6 h after the termination of CPB(T(3)) and could not restore to the level before CPB at T(4)(24 h after the termination of CPB).IL-10 in the 2 groups both increased after the CPB. At T(2) and T(3), S-100beta protein,NSE, TNF-alpha, and IL-8 concentrations were significantly lower than those in the aminophylline group (P<0.05 or P<0.01), while IL-10 was just the opposite.@*CONCLUSION@#There is cerebral damage induced by CPB. Aminophylline may play a protective role in cerebral injury by modulating the balance between the pro-inflammatory factor and anti-inflammatory factor to reduce the level of S-100beta protein and NSE during CPB and open cardiac surgeries.

Effects of Xuefu Zhuyu decoction on serum asymmetric dimethylarginine in atherosclerosis rabbits / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of Xuefu Zhuyu decoction on serum asymmetric dimethylarginine (ADMA) level of the atherosclerosis rabbits.</p><p><b>METHOD</b>Twenty-four male rabbits were randomly divided into three groups: control group (n = 8) was fed with normal diet; the model group (n = 8) was fed with high fat/high cholesterol diet; and Xuefu Zhuyu decoction group (n = 8) was fed with high fat/high cholesterol diet and intragastric administrated with Xuefu Zhuyu decoction 7.10 g x kg(-1) x d(-1). Concentrations of serum total cholesterol (TC), total triglyceride (TG), low density lipoprotein (LDL), serum ADMA and serum nitric oxide (NO) were measured after eight weeks. Rabbits' aorta were made into the pathological section to observe the pathology changes degree and atherosclerotic plaqu mean gray value and plaque area were analyzed by OPTIMAS image analysis system.</p><p><b>RESULT</b>1) Compared with the aortic atherosclerotic plaqu mean gray value of Xuefu Zhuyu decoction group 175.56 +/- 12.30, those of the model group 198.91 +/- 5.08 were significant higher (P < 0.01). Significant difference were found between the the aortic atherosclerotic plaque area of the model group (4.80 +/- 0.83) mm2 and Xuefu Zhuyu decoction group (1.96 +/- 0.48) mm2 (P < 0.01). There were no atherosclerotic plaque in the control group rabbits' aorta. 2) The serum TC (23.42 +/- 7.80) mmol x L(-1), TG (2.37 +/- 0.42) mmol x L(-1) and LDL (17.24 +/- 8.29) mmol x L(-1) of the model group were higher than those of Xuefu Zhuyu decoction group (P < 0.01); Compared with control group, the serum TC (15.63 +/- 4.12) mmol x L(-1) and LDL (7.64 +/- 2.36) mmol x L(-1) of the Xuefu Zhuyu decoction group increased significantly, while there were no significant changes between serum TG of control group (1.11 +/- 0.26) mmol x L(-1) and serum TG of Xuefu Zhuyu decoction group (1.43 +/- 0.34) mmol x L(-1). The serum ADMA of the model group (1.57 +/- 0.17) micromol x L(-1) were higher than those of Xuefu Zhuyu decoction group (1.01 +/- 0.13) micromol x L(-1) (P < 0.01), while the serum NO of the model group (8.76 +/- 2.42) micromol x L(-1) were significantly lower than those of Xuefu Zhuyu decoction group (15.90 +/- 2.38) micromol x L(-1) (P < 0.01). There were no significant difference between the serum ADMA of the control group (0.93 +/- 0.11) micromol x L(-1) and Xuefu Zhuyu decoction group. Compared with Xuefu Zhuyu decoction group, the serum NO of the control group (17.88 +/- 3.34) micromol x L(-1) have no significant difference. 3) The serum ADMA of all rabbits negatively correlated to the serum NO (r = -0.773), (P < 0.01).</p><p><b>CONCLUSION</b>Xuefu Zhuyu decoction can decrease the serum ADMA level in atherosclerosis rabbits. The effect of Xuefu Zhuyu decoction on anti-atherosclerosis may be related to the decreased serum ADMA level.</p>

Surgical Treatment and Prognosis in Thymoma Patients with Myasthenia Gravis / 中国医师杂志

Objective To explore the diagnosis, surgical treatment and prognosis of thymoma complicated with myasthenia gravis(MG). Methods A retrospective analysis was performed in 33 thymoma patients with MG, who underwent surgical treatment. Results The total effective rate of operation was 75.8%, and the 5 and 10 years survival rates of the patients after operation were 85% and 78.7%, respectively. According to the Masaoka staging system, the 5 and 10 years survival rates of stages I and II were obviously higher than those of stages III and IV (P

SUDIES ON THE CHEMICAL CONSTITUENTS OF THE DAYAWAN BAY GERM PSEUDOMONAS SP / 中国海洋药物

A red pigmant, procligiosin, have been isolated from the metabolite of germ pseudomonas sp. collected from the Dayawan Bay. Its structure was established on the basis of the spectral method.