Acetylcorynoline inhibits microglia activation by regulating EGFR/MAPK signaling to promote functional recovery of injured mouse spinal cord / 南方医科大学学报

OBJECTIVE@#To investigate the effect of acetylcorynoline (Ace) for promoting functional recovery of injured spinal cord in rats and explore the underlying mechanism.@*METHODS@#Rat models of spinal cord injury (SCI) were treated with intraperitoneal injection of different concentrations of Ace, with the sham-operated rats as the control group. After the treatment, the changes in motor function of the rats and the area of spinal cord injury were assessed with BBB score and HE staining, and the changes in pro-inflammatory cytokine levels and microglial activation were determined using PCR, ELISA and immunofluorescence staining. In a lipopolysaccharide (LPS)-treated BV2 cell model, the effects of different concentrations of Ace or DMSO on microglial activation and inflammatory cytokine production were observed. Network pharmacology analysis was performed to predict the target protein and signaling mechanism that mediated the inhibitory effect of Ace on microglia activation, and AutoDock software was used for molecular docking between Ace and the target protein. A signaling pathway blocker (Osimertinib) was used to verify the signaling mechanism in rat models of SCI and LPS-treated BV2 cell model.@*RESULTS@#In rat models of SCI, Ace treatment significantly increased the BBB score, reduced the area of spinal cord injury, and lowered the number of activated microglia cells and the levels of pro-inflammatory cytokines (P < 0.05). The cell experiments showed that Ace treatment significantly lower the level of cell activation and the production of inflammatory cytokines in LPS-treated BV2 cells (P < 0.05). Network pharmacology analysis suggested that EGFR was the main target of Ace, and they bound to each other via hydrogen bonds as shown by molecular docking. Western blotting confirmed that Ace inhibited the activation of the EGFR/MAPK signaling pathway in injured mouse spinal cord tissue and in LPS-treated BV2 cells, and its inhibitory effect was comparable to that of Osimertinib.@*CONCLUSION@#In rat models of SCI, treatment with Ace can inhibit microglia-mediated inflammatory response by regulating the EGFR/MAPK pathway, thus promoting tissue repair and motor function recovery.

HSDL2 overexpression promotes rectal cancer progression by regulating cancer cell cycle and promoting cell proliferation / 南方医科大学学报

OBJECTIVE@#To analyze the expression of hydroxysteroid dehydrogenase like 2 (HSDL2) in rectal cancer tissues and the effect of changes in HSDL2 expression level on proliferation of rectal cancer cells.@*METHODS@#Clinical data and tissue samples of 90 patients with rectal cancer admitted to our hospital from January 2020 to June 2022 were collected from the prospective clinical database and biological specimen database. The expression level of HSDL2 in rectal cancer and adjacent tissues was detected by immunohistochemistry, and based on the median level of HSDL2 expression, the patients were divided into high expression group (n=45) and low expression group (n=45) for analysis the correlation between HSDL2 expression level and the clinicopathological parameters. GO and KEGG enrichment analyses were performed to explore the role of HSDL2 in rectal cancer progression. The effects of changes in HSDL2 expression levels on rectal cancer cell proliferation, cell cycle and protein expressions were investigated in SW480 cells with lentivirus-mediated HSDL2 silencing or HSDL2 overexpression using CCK-8 assay, flow cytometry and Western blotting.@*RESULTS@#The expressions of HSDL2 and Ki67 were significantly higher in rectal cancer tissues than in the adjacent tissues (P < 0.05). Spearman correlation analysis showed that the expression of HSDL2 protein was positively correlated with Ki67, CEA and CA19-9 expressions (P < 0.01). The rectal cancer patients with high HSDL2 expressions had significantly higher likelihood of having CEA ≥5 μg/L, CA19-9 ≥37 kU/L, T3-4 stage, and N2-3 stage than those with a low HSDL2 expression (P < 0.05). GO and KEGG analysis showed that HSDL2 was mainly enriched in DNA replication and cell cycle. In SW480 cells, HSDL2 overexpression significantly promoted cell proliferation, increased cell percentage in S phase, and enhanced the expression levels of CDK6 and cyclinD1 (P < 0.05), and HSDL2 silencing produced the opposite effects (P < 0.05).@*CONCLUSION@#The high expression of HSDL2 in rectal cancer participates in malignant progression of the tumor by promoting the proliferation and cell cycle progress of the cancer cells.

Early and mid-term outcomes of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze the early and mid-term safety and effectiveness of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery. Methods    We retrospectively reviewed the clinical data of 68 patients (28 males and 40 females with a mean age of 38.7±9.3 years) who underwent concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve and tricuspid surgery in the Department of Cardiovascular Surgery of the Second Xiangya Hospital from August 2013 to October 2017. The heart rhythm of the patients after surgery was supervised by 24 hour holter monitoring eletrocardiogram. Results    No death occurred during operation and follow-up. One patient underwent reexploration for bleeding. The rate of sinus rhythm restored at the time of discharge was 95.8%. The rate of sinus rhythm restored at 6 months, 12 months, 24 months, 36 months after surgery was 93.5%, 91.6%, 90.3% and 89.5% respectively. Conclusion    Concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery is quite safe and effective in treatment of rheumatic mitral valve disease and atrial fibrillation in the early and mid-term follow-up.

Systematic review on poly ADP ribose polymerase inhibitors for treating recurrent ovarian cancer / 重庆医学

Objective To evaluate the efficacy and safety of poly ADP ribose polymerase (PARP) inhibitors for treating recurrent ovarian cancer.Methods The databases of Medline,Embase,Central and SinoMed were retrieved with the retrieval time from their establishment to September 2017;in addition the related reference literatures were manually retrieved.The randomized controlled trials (RCTs) of PARP inhibitors for treating recurrent ovarian cancer were included.The meta analysis was performed by using the RevMan 5.3 software.Results A total of 5 RCTs were included,including 1 160 cases in the experimental group and 679 cases in the control group.When compared with placebo,PARP inhibitors significantly improved the progression-free survival [HR=0.34,95％CI(0.30,0.40),P＜0.01] and overall survival [HR=0.73,95％CI(0.55,0.96),P=0.025],and increased objective response rate [RR=2.56,95％CI(1.17,5.59),P=0.020].The addition of PARP inhibitors to chemotherapy reduced the risk of disease progression [HR =0.51,95 ％CI (0.34,0.77),P =0.001].However,there were no statistically significant differences in overall survival [HR=1.17,95％CI(0.79,1.73),P=0.440] and objective response rate [RR=1.11,95％CI(0.86,1.42),P =0.420] between the PARP inhibitors plus chemotherapy group and the chemotherapy alone group.The administration of PARP inhibitors was associated with a significantly increased risk of serious anemia,fatigue,nausea and vomiting.Conclusion PARP inhibitors could improve the progression-free survival outcome in recurrent ovarian cancer.

Evaluation of right ventricular systolic function in patients with primary pulmonary hypertension using real-time three -dimensional echocardiography(RT -3DE)and ultrasonic two -dimensional speckle tracking imaging technology / 中国基层医药

Objective To evaluate the right ventricular(RV)systolic function in patients with primary pulmonary hypertension(PPH)using real -time three -dimensional echocardiography(RT -3DE)and ultrasonic two-dimensional speckle tracking imaging(STI).Methods Patients with PPH were divided into three groups according to pulmonary arterial systolic pressure(PASP),consisted of mild group,moderate group and severe group,with 20 cases in each group.20 healthy cases were included as the control group.The global RV dysfunction,including RV end -diastolic volume(EDV),end -systolic volume(ESV),stroke volume(SV),ejection fraction(EF),tricuspid annular plane systolic excursion(TAPSE),longitudinal peak systolic strain(SL),longitudinal peak systolic strain rate(SRL), longitudinal peak systolic velocity(VL)in RV free wall and interventricular septum for basal,mid and apical segment were detected by using RT -3DE and STI.Results Global RV ESV increased in all groups(t =3.10,7.53,7.72,all P 0.05).Conclusion RT -3DE and STI technology can be useful in assessing RV function every period.

Effect of natural mountain spring on SOD and MDA content in mice aging / 中国比较医学杂志

Objective To observe the effect of Natural mountain spring on oxidative damage of aging mice . Methods Thirty male aging mice were randomly divided into experimental group ( drink Natural mountain spring ) and control group ( drink tap water ) according to the level of MDA .The serum in the two groups was taken for T-SOD activity and MDA content analysis after two months .Results The MDA content in experimental group decreased markedly than that in control group .Conclusion Natural mountain spring could alleviate oxidative damage by free radicals to extent .

Recombinant expression of Schistosoma japonicum fructose-1,6-bisphos-phate aldolase and its expression in different developmental stages of S. ja-ponicum / 中国血吸虫病防治杂志

Objective To clone express and purify Schistosoma japonicum fructose?1 6?bisphosphate aldolase SjFBPA in E. coli and observe its expression in different developmental stages of S. japonicum. Methods FBPA gene was amplified from S. japonicum adult worm cDNA by using PCR. The amplified product was recombined into pET28a plasmid and inducibly expressed with IPTG in E. coli BL21. SDS?PAGE and Western blotting were employed to analyze and identify the recombinant protein SjFBPA rSjFBPA . Then rSjFBPA was purified by chromatographic purification and its purity was analyzed by SDS?PAGE. The protein concentration of rSjFBPA purified was measured by the BCA method. Furthermore SjFBPA mRNA was ana?lyzed in different developmental stages of S. japonicum by RT?PCR. Results SjFBPA was successfully amplified by using PCR and identified by restriction enzyme digestion and sequencing. The Western blotting analysis confirmed that the recombinant pro?tein could specifically reactive to the anti?His?tag monoclonal antibody. The concentration of the purified recombinant protein was about 4 mg/ml. The result of RT?PCR showed that SjFBPA mRNA was expressed in cercaria schistosomulum adult worm and egg of S. japonicum. Conclusion SjFBPA is successfully recombined and expressed in a prokaryotic system and SjFBPA mRNA is expressed in cercaria schistosomulum adult worm and egg of S. japonicum.

The effect on proliferation and invasion after silence c-cbl gene in ovarian cancer SKOV3 cell / 重庆医学

Objective To study the expression of c-cbl protein in ovarian cancer and its effect on proliferation and invasion in ovarian cancer cell .Methods The expression of c-cbl protein in ovarian tissue were detected by immunohistochemical(S-P meth-od) ,the mRNA expression of c-cbl protein in ovarian cancer SKOV3 cells were detected .the proliferation ability and migration in o-varian cancer SKOV3 cells were detected by EdU assay and Transwell assay .Western blot was used to detect the expression of P21 and P53 protein .Results c-cbl was located in the cytoplasm in ovarian cancer tissues .c-cbl showed moderate or strong positive ex-pression in ovarian cancer .In contrast ,it showed weakly positive or negative expression in normal ovarian tissue .c-cbl expressed in-creased significantly in ovarian cancer compared with those of in normal ovarian tissue(P < 0 .05) ;c-cbl expressed was associated with FIGO stage in ovarian cancer(P< 0 .05) ;silence c-cbl expression in ovarian cancer SKOV3 cells decreased the proliferation and invasion(P< 0 .05) .Silence c-cbl expression increased the expression of P21 and P53 protein(P< 0 .05) .Conclusion c-cbl was in-creased expression in ovarian cancer tissues .Silence c-cbl expression may be related to increased expression of P21 and P53 .

Aberrant expression of CyclinE and p27 in laryngeal squamous cell carcinoma and the clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore new hallmarks affecting the prognosis of patients with laryngeal squamous cell carcinoma (LSCC) via investigating the expression of CyclinE and p27 in LSCC tissues.@*METHOD@#The expression of CyclinE and p27 was detected via Elivision immunohistochemical staining in 160 LSCC tissues and 20 normal laryngeal tissues (NLT). The relationship between CyclinE/ p27 and LSCC/ NLT was analyzed via Log-rank analysis. The relationship of CyclinE and p27 protein was statistically analyzed by spearman correlation analysis. The relationship between CyclinE/p27 and clinical-pathology-factors of patients with LSCC, such as age, gender, tumor site, diameter, differentiation, lymph node metastasis and PTNM stage were analyzed by Chi-square test. The relationship between clinical-pathology-factors, CyclinE, p27 and overall survival time of patients with LSCC was analyzed via Cox multiplicity and Kaplan-Meier survival analysis. A significant difference was recognized by P0.05 for all). A negative correlation was found between the expression of CyclinE and p27 protein, r= -0.767(P<0.05). Kaplan-Meier survival analysis showed that the overall survival rate of patients with LSCC was 36.9% (P<0.05). The 5-year survival rate in positive group of CyclinE was 8%, in negative group was 80% (P<0.05). On the contrary, the 5-year survival rate of patients with LSCC in positive group of p27 protein was 77.27%, the rate was 5.32% in negative group (P<0.05). Cox multivariate regression analysis revealed that lymph node metastasis, PTNM stage, CyclinE and p27 were independent risk factors of prognosis for patients with LSCC.@*CONCLUSION@#It is the molecular basis underlying the development and invasion/ metastasis of LSCC that activation of CyclinE gene accompanying inactivation of p27 gene. It is very important of co-detecting CyclinE and p27 protein to predict the prognosis of patients with LSCC.

Construction of pLVX-IRES-ZsGreen1-MIA2 lentiviral expression vector and its expression activity / 重庆医学

Objective To construct an Lentiviral expression vector of pLVX‐IRES‐ZsGreen1‐MIA2 targeting to MIA2 and in‐vestigate its effect on the expression of MIA2 and growth of HCC cell line HepG2 in vitro ,observe MIA2 changes and the influence on apotheosis ,thus to provide preliminary experimental fundament for successive researching on the role of MIA2 in the pathogene‐sis of HCC .Methods The sequence of pLVX‐IRES‐ZsGreen1‐MIA2 was designed and synthesized .The pLVX‐IRES‐ZsGreen1‐MIA2 Lentiviral expression vector was constructed and then transiently transfected into HepG2 HCC cells in vitro .The proportion of pLVX‐IRES‐ZsGreen1‐MIA2 positive cells was observed under the fluorescence microscope .Then ,the expression level of MIA2 was detected by real time PCR .Moreover ,the proliferation of HepG2 cells was observed by MTT assay and colony formation as‐say .Finally ,the migration of HepG2 cells in vitro was also determined by Scratch assay .Results pLVX‐IRES‐ZsGreen1‐MIA2 Lentiviral expression vector was successfully constructed .Compared with control group (NC) ,the expression level of MIA2 was significantly decreased in transfected groups(P<0 .05);MTT assay showed that the proliferation of HepG2 cells was dramatically reduced in pIRES2‐ZsGreen1‐MIA2transfected groups(P< 0 .05);furthermore ,the number of both colony forming and migrating cells were also remarkably reduced in transfected groups(P<0 .05) .Conclusion The pIRES2‐ZsGreen1‐MIA2 can significantly re‐duce the expression level of MIA2 and inhibit the proliferation and migration of the HepG2 HCC cells in vitro .

Clinical analysis for the surgical treatment of 76 cases with complete atrioventricular septal defect / 中国医师杂志

Objective To achieve the best chance and optimize the method of operation,the clinical outcomes of 76 cases with complete atrioventricular septal defect (CAVSD) were summarized.Methods According to the Rastelli classification,there were 57 cases of type A,6 type B,and 13 type C.The repaired procedures included the two-patch technique for atrioventricular septal defect (65 cases),direct closure of ventricular septal defect (7 cases),and the Glenn bidirection shunt (4 cases).Results Two patients died.Of them,one was concomitant with double outlet right ventricle (DORV) and total anomalous pulmonary venous connection (TAPVC),died of low cardiac output syndrome; another was complicated with severe pulmonary hypertension,and the death reason was hypoxaemia and respiratory function failure.The survived patients were followed up,and the follow-up period was varied from one to ten years,mitral valve regurgitation was found in 12 cases,3 were middle and 9 were mild.Conclusions In order to prevent deteriorated condition of these patients and improve the survival rate,CAVSD should be operated as soon as the diagnosis is certain,and the co-exist malformation also should be corrected.

8.5 year-follow-up of combined heart-lung transplantation in a patient / 中南大学学报(医学版)

To summarize the case of combined heart-lung transplantation for a patient who survived for 8.5 years. On September 20, 2003, at Second Xiangya Hospital of Central South University, homologous heartlung transplantation was performed on a male patient who was diagnosed with cardiopulmonary failure secondary to congenital ventricular septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1500 mL modified St.Thomas solution and 3000 mL modified LPD solution. Postoperative immunosuppressive therapies included: methylprednisolone and human anti-lymphocyte globulin protein in the induction period; and combination of ciclosporin A, CellCept and prednisolone in the stable period. In 2007, the treatment was changed to CellCept mg, twice a day+FK506 4 mg, twice a day. The patient lived 8.5 years of normal life with cardiac function of NYHA I-II. Echocardiogram showed left ventricular ejection fraction of 61% to 74%. Heart-lung transplantation proved reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation and proper perioperative treatment are key factors for long-term survival after heart-lung transplantation.

Correlation Analysis between EBV and Hp Infection and Gastric Cancer / 天津医药

Objective To investigate the correlation between Epstein-Barrvirus (EBV) and H.pylori (Hp) infection and gastric cancer. Methods The EBV infection was examined by polymerase chain reaction (PCR) and in situ hybridiza-tion (ISH) in 100 samples of gastric cancer tissue and 82 samples of gastritis tissue. The Hp infection was detected by PCR. The correlation between EBV and Hp infection and clinical and pathological features was analyzed in patients with gastric cancer. Results The positive rates of EBV and Hp were significantly higher in gastric cancer tissues than those in gastritis tissues (9.0%vs 0 and 56.0%vs 40.2%, P＜0.05). There was significantly higher infection rate in EBV in cardia gastric can-cer than that of gastric cancer (16.3%vs 2.0%,P＜0.05). There were significantly higher infection rates in EBV and Hp in poorly differentiated carcinoma than those of well-differentiated carcinoma (15.7%vs 2.0%and 66.7%vs 44.9%, P＜0.05). There were no significant differences in EBV and Hp infection between gender, age, nationality and lymph node metastasis (P>0.05). There was no significant difference in Hp infection between different parts of gastric cancer. There was no correla-tion between EBV and Hp infection in gastric cancer tissues (r=0.137, P>0.05). Conclusion EBV and Hp infection are two independent factors in the development of gastric cancer, and both of them are associated with the malignant evolution of gastric cancer.

Trimethoxystilbene and its effects on the proliferation and apoptosis of PASMCs / 中南大学学报(医学版)

OBJECTIVE@#To synthesize 3, 5, 4' -trimethoxystilbene (TMS) by methylation of resveratrol (Res), a natural compound extracted from polygonum cuspidatum, to identify the chemical structure of TMS, to test its pharmacokinetics, and to determine the effects of TMS on the growth inhibition and apoptosis in pulmonary artery smooth muscle cells (PASMCs).@*METHODS@#The chemical structure of TMS was analyzed by UV- and IR- absorption spectrometry, (1)H-NMR and (13)C-NMR spectroscopy and mass spectrometry. We measured the bioavailability, the characteristics of intestinal absorption, and the distribution of TMS in body and excretions of SD rats after oral administration of TMS. The acute toxicity of TMS in mice was tested. PASMCs were prepared from pulmonary artery of SD rats. The PASMCs were divided into 8 groups. Group of A (control) was cultured without TNF-α, TMS, or Res. Group of B (TNF-α) was cultured with 100 pg/mL TNF-α. Groups of C-E (low-high concentrations of TMS) were cultured with 100 pg/mL TNF-α and 5, 10, 20 μmol/L TMS, respectively. Groups of F-H (low-high concentrations of Res) were cultured with 100 pg/mL TNF-α and 50, 100, 200 μmol/L Res, respectively. The proliferation of PASMCs after treatment was determined by MTT assay. The apoptosis of PASMCs after treatment was determined by flow cytometry.@*RESULTS@#The UV absorption map of TMS showed λmax(MeOH) at 318, 306.2, and 217.8 nm. Analysis of infrared spectrum of TMS showed IRvKBr max /cm at 2999, 2935, 2836, 1591, 1511 and 1456/cm. The (1)H-NMR map showed that the synthetic product contained three hydroxy groups, while (13)C-NMR map showed 17 carbon signals and some symmetrical structural fragments. Electospray ionization mass spectrometry of the productshowed m/z peaks corresponded to 271[M+H](+), 256[M+H-CH(3)](+) and 241[256-CH(3)](+); the implied relative molecular weight is 270 and the implied molecular formula is C17H18O3. These data confirm the product is 3,5,4' - trimethoxystilbene. The absolute bioavailability of TMS was 45.4%. TMS was well absorped in the upper small intestine; it was excreted in stool and bile and distributed into several tissues. The maximal tolerance dose (MTD) of TMS was 5.85 g/kg. MTT assay showed TMS inhibited the proliferation of PASMCs in a dose-dependent manner. The extent of growth inhibition in A-H groups were (4.07±2.12)%, (6.54±4.78)%, (9.35±4.26)%, (16.75±5.34)%, (23.74±7.07)%, (6.78±5.58) %, (8.81±5.16) %, and (17.81±6.03) %, respectively. Flow cytometry showed the extent of apoptosis in PASMCs (after being treated with TMS for 24 h) was significantly higher than that in PASMCs treated only with TNF-α. The apoptosis rates of A-H groups were (2.63±0.74)%, (3.54±0.81)%, (5.77±4.62)%, (11.68±5.35)%, (18.79±4.15)%, (4.11±3.59)%, (6.33±4.8) %, and (12.47±5.06)%, respectively.@*CONCLUSION@#We have confirmed our synthetic product as 3,5,4'-trimethoxystilbene (TMS), with the molecular formula of C17H18O3 and appropriate molecular weight and absorbption and NMR spectra. The bioavailability of TMS was to 45%. It strongly inhibits the proliferation of PASMCs in a dose-dependent manner and induces apoptosis of PASMCs.

Unidirectional valved patch for congenital heart disease with severe pulmonary hypertension / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of unidirectional valved patch (UVP) for congenital heart disease (CHD) with severe pulmonary hypertension (PH).@*METHODS@#We retrospectively analyzed the treatment of 37 CHD patients with severe PH by UVP in the operation, and summarized its short-term to mid-term effect to find an optimum therapeutic regimen.@*RESULTS@#Before the operation, the ECG showed that the mean pulmonary artery pressure (MPAP) ranged 65-72 mmHg, and the cardiac catheterization showed the pulmonary artery pressure ranged 80-120 mmHg, P(P)/P(A) ranged 0.8-1.05,PVR ranged 8.5-19.2 (under oxygen inhalation 6.8-14.6) wood unit.After the operation, P(P)/P(A) ranged 0.4-0.72 on weaning-off CPB. Postoperative ECG showed the MPAP ranged 32-48 mmHg. No pulmonary hypertension crisis occurred and no patient died. Mechanical ventilation time ranged from 32 h to 8 d and the SaO₂ ranged 93%-96% at rest after the extubation.The right-to-left shunt situations by ECG were as follows:22 cases had shunt 5 d after the operation, 11 cases had shunt 1 month after the operation,4 cases 3 months after the operation, and none 1 year after the operation but one patient lost follow-up.However,there were no long-term follow-up data: 12 patients had a 1-year follow-up, 5 patients had a 3-year follow-up, and most patients had just 3-month follow-up.@*CONCLUSION@#UVP can decrease the operative risk in CHD with severe PH at perioperative period. The short-term to mid-term effect is satisfactory, while long-term effect remains uncertain.

Application of laminated anastomosis with absorbable suture in cervical esophagogastrostomy / 中南大学学报(医学版)

OBJECTIVE@#To observe the clinical results of laminated anastomosis using absorbable suture in cervical esophagogastrostomy, and to reduce the incidence of cervical esophagogastric anastomotic stricture.@*METHODS@#A retrospective analysis was carried out on 210 patients who underwent cervical esophagogastrostomy after subtotal esophagectomy from January 2008 to June 2010. Among them, 96 cases were treated with traditional full layer interrupted varus suture (varus group) and the remaining 114 cases were treated with seromuscular layer and mucosal layer laminated anastomosis with absorbable suture (laminated group). Esophageal angiography was performed in 1 week, 1 month, and 3 months after the operation. The diameter of anastomatic stoma was measured on the anteroposterior and lateral angiography image respectively. The area of anastomatic stoma was calculated. The degree of stenosis was assessed according to the patients' dysphagia symptom.@*RESULTS@#There was no operative deaths, no serious pulmonary complications and chylothorax, no sever esophageal reflux in all patients. The ratio of cervical esophagogastric anastomotic leakage was 2.1% (2/96) in the varus group. No anastomotic leakage in the laminated group. Compared with the varus group, the area of the anastomatic stoma in the laminated group was significantly increased in all measured time points (P<0.01). The incidence of obstruction in the laminated group was decreased significantly (P<0.01) in 1 month or in 3 months after operation compared with the varus group.@*CONCLUSION@#Application of the laminated anastomosis with absorbable suture in cervical esophagogastrostomy can significantly reduce the incidence of anastomotic stenosis.

Evaluation of resection of local advanced upper lung cancer through median sternotomy / 中南大学学报(医学版)

OBJECTIVE@#To summarize the resection of local advanced upper lung cancer and radical bilateral mediastinal lymph node dissection through a median sternotomy.@*METHODS@#A total of 31 patients with local advanced upper lung cancer underwent lobectomy and radical complete dissection of bilateral superior mediastinal lymph node through a median sternotomy (the sternotomy group). The sternotomy group consisted of 8 females and 23 males, from 35 to 75 years old (average 57 years). Five patients underwent superior vena caval replacement or partial excision, 21 underwent upper sleeve lobectomy, and 6 patients combined with right pulmonary artery sleeve angioplasty or partial resection and reconstruction. Compared with the 30 patients who were operated through posterolateral incision, the surgery time, complications, and prognosis during the same period (the posterolateral incision group) were recorded.@*RESULTS@#There was no perioperative death. The average operation time in the sternotomy group was (170±30)min, while that in the posterolateral incision group was (140±30) min(P>0.05). Postoperative complications comprised atelectasis, cardiac arrhythmia, and pneumonia. In the sternotomy group it was 6.5%(2/31), 16.1%(5/31), and 6.5% (2/31),and that in the posterolateral incision group 3.3%(1/30), 20%(6/30), 10.0%(3/30),respectively. Postoperative pathological findings demonstrated the rate for pN3 disease in the sternotomy group was 29%(9/31), 2 patients died of brain and liver metastasis respectively 10 or 11 months after the operation. The 3 year survival rate of 9 patients with pN3 diagnosed as cN2 preoperatively was 33.3%(3/9). The total survival rate of 1,3 years in the sternotomy group was 90.3%(28/31) and 41.9%(13/31), in the posterolateral incision group 86.6%(26/30) and 40.0%(12/30),respectively(P>0.05).@*CONCLUSION@#Median sternotomy helps to resect local advanced upper lung cancer completely and to dissect bilateral mediastinal lymph node, and it can also provide more complete postoperative lymph node staging with no significant increase in complications.

Reoperative valve surgery after open-heart valve surgery: a report of 155 cases / 中南大学学报(医学版)

OBJECTIVE@#To summarize the characteristics of reoperative valve surgery after previous open-heart valve surgery.@*METHODS@#From 1996 to 2010, 155 patients who underwent reoperative valve surgery, either valve replacement or tricuspid annuloplasty or the repair of perivalvular leakage were included in the study. The reoperative interval was 1-266 (94.82 ± 85.37) months. All surgeries were carried out with extracorporeal circulation under moderated hypothermia. The cardioplegic solution in cold crystal or blood was used if heart beating was stopped during the surgery.@*RESULTS@#The total in-hospital mortality was 5.81%, while it was 2.75% from 2005 to 2010. The end-diastolic dimension, size of atrium and ventricles were reduced after the reoperation. Ventricular arrhythmia and low cardiac output were the most frequent complications.@*CONCLUSION@#The success rate of reoperative valve surgery can be improved by the distinctive therapeutic strategies based on the clinical characteristics and therapy principles obtained from practice experiences.

Effect of sirolimus on the expression of integrin ανβ3 mRNA in cardiac allograft in rats / 中华器官移植杂志

Objective To investigate the effect of sirolimus (SRL) on the expression of integrin ανβ3 mRNA in vascular smooth muscle cells of cardiac allografts in rats, and the possible mechanism of SRL in the prevention of cardiac allograft vasculopathy. Methods Heterotopic heart transplantation models were established. Hearts from Wistar rats were heterotopically transplanted to SD rats (allograft) or Wistar rats (isograft). All rats were randomly divided into four groups:SRL group, SRL 1.25 mg/kg every day,oral intubation after cardiac transplantation; cyclosporine (CsA) group,CsA 10mg/kg every day, subcutaneous administration ; isograft group, no immunosuppressant administration;control group, normal hearts of Wistar rats. All of the animals were killed at 60 day after transplantation. Angiostenosis degree was analyzed by Mias system 4.1 after the cardiac tissues were stained with Van Gieson stain. Reverse transcription-polymerase chain reaction (RT-PCR) assay was used to detect the expression of integrin ανβ3 mRNA in cardiac allografts. The relationship between the expression of integrin ανβ3 mRNA and the area of vascular stenosis was analyzed. ResultsIn control group, there was no thickened vascular intima and no vascular stenosis. In allograft group,the thickness of vascular intima was slightly increased but no vascular stenosis was detected. In CsA group, the vascular intima was obviously thickened, the lumen was narrowed, and some small arteries had obstruction. In SRL group, vascular intima proliferation and angiostenosis degree were obviously milder than in CsA group. Semiquantitative RT-PCR analysis revealed that the relative expression of integrin ανβ3 mRNA in CsA and SRL groups was increased significantly as compared with control group and isograft group (2.51±0.43 or 1.17±0.12 vs 0.28±0.08 or 0. 38 ± 0. 05, P＜0. 01). The relative expression of integrin ανβ3 mRNA in SRL group was decreased significantly as compared with CsA group (1.17±0.12 vs 2.51±0.43, P＜0.05). A positive correlation was found between vascular stenosis and the expression of integrin ανβ3 mRNA (r = 0. 654, P＜0. 01) in allografts. Conclusion SRL may down-regulate the expression of integrin ανβ3 mRNA in cardiac allografts in rats, which was probably associated with classic cardiac allograft vasculopathy.

Minimally invasive mitral valve surgery via right minithoracotomy / 中南大学学报(医学版)

OBJECTIVE@#To summarize the successful experience of 45 patients with minimally invasive mitral valve surgery via right minithoracotomy.@*METHODS@#Forty-five patients with mitral valve disease were enrolled. A main surgical wound (4-6 cm)was made over the lateral border of the right breast. Cardiopulmonary bypass was established via femoral cannulation. The Chitwood clamp was inserted thlution the 2nd or 3rd intercostal space. After the cross-clamp was placed, cold blood cardioplegic solution was delivered via right minithoracotomy. The procedures of mitral valve replacement were performed via left atrialotomy.@*RESULTS@#All the operations were successful. There was no death. The duration of operation and extracorporeal circulation was 80-291(139±35) min, and 25-110(49±21) min, respectively. The cross-clamped time was 18-77 (33±12) min, the ventilation time was 4.5-45(14.8±10) h, the total chest tube drainage was 50-1 050(262±110) mL, and the postoperative hospital stay was 5-14(7.5±1.8) d.@*CONCLUSION@#Minimally invasive mitral valve surgery via right minithoracotomy is feasible, safe, and less invasive with rapid recovery,and has superior cosmetic results for patients.