Oblique branch of anterolateral thigh flap: Understand it and issues to handle / 中华显微外科杂志

Objective:To summarize the oblique branches found in the transfer of anterolateral thigh flap (ALTF) and to handle the issues of oblique branch.Methods:Thirty patients who require surgery of ALTF transfer from May, 2017 to October, 2019 were enrolled. CTA examination was perfected prior surgery and the origin of ALTF vessels was preliminarily determined. During the surgery, Three-longitudinal-and-five-transverse methods were used to locate and design the flap. The ALTF was taken according to the flap design. Attention should be paid to the location of the oblique branch and the separation of the vessels of oblique branch to avoid a damage as much as possible. The vessels of oblique branch should be completely explored and separated. One or 2 vascular pedicles were cut according to whether the oblique branch vessels and the descending branch vessels were joined together during surgery. Clamping tests were carried out on the 2 vascular pedicles to determine an arterial blood supply. Super drainage of vascular pedicle veins according to the situation of blood circulation. After the surgery, routine treatment was carried out. Blood supply, skin temperature, swelling degree, exudation and survival of the flap were closely observed and regular follow-up was carried out.Results:Among the 30 ALTF examined by CTA, 13 patients were identified with oblique branch vessels before operation. During operation, 11 oblique branch vessels (The occurrencce rate was 36.6%)were found to enter the flap, and were completely preserved. Of the 11 identified oblique branch vessels, 8 had 2 vascular pedicles taken and the vascular pedicles were treated by venous super drainage technique. The postoperative blood supply of the flap was good; The skin temperature was closed to surrounding normal skin; Swelling of flap was minor and there was little seepage. The flaps all survived after surgery with stage one healing. Followed-up time was 3-32 (average 16.1) months. The recipient site healing was good, and the function and appearance were satisfactory. The joint movement at the donor site was normal, and there was no obvious loss of local sensation.Conclusion:More than one third of the oblique branches appear in this group. The oblique branch vessels should be preserved as much as possible to avoid issues in relation to the oblique branch. Reasonable handling of oblique branch is the key to the success of the surgery.

Research of the correlation between α1-antitrypsin and acute kidney injury after cardiopulmonary bypass / 中华胸心血管外科杂志

Objective:To figure out variety of the plasma level of Alpha-1-Antitrypsin(α1-AT) in patients who undergo AKI following cardiopulmonary bypass(CPB), and whether this biomarker serve as a competent predictor.Methods:We recruited 75 patients undergoing cardiac surgery with CPB from January 2018 to January 2019. Patients were categorized into two groups according to the development of AKI. The relationship between plasma concentration of α1-AT and renal injury in two groups was analyzed.Results:27 patients in the AKI group were aged (54.3±12.2)years old, including 15 males and 12 females, the time of cardiopulmonary bypass was(133.5±34.7)min. In the non-AKI group, 48 cases were aged(47.7±11.3)years old, including 26 males and 22 females, and the time of cardiopulmonary bypass was(133.5±34.7)min. α1-AT was significantly decreased in AKI group at 1 h after operation[(0.53±0.53)g/L vs. (1.46±0.91)g/L, P<0.05]compared with the non-AKI group. The sensitivity and specificity of α1-antitrypsin level at 1h after operation was the highest when α1-AT was 0.675 g/L. CPB time ( OR=5.890, 95% CI: 1.078-32.173) and age ( OR=4.427, 95% CI: 1.113-17.614) were independent risk factors for AKI after surgery, and α1-AT at 1h after CPB ( OR=0.084, 95% CI: 0.021-0.333) were protective factors after operation. Conclusion:Increased concentration of α1-AT after cardiopulmonary bypass at early time is a protective factor for AKI and the concentration of α1-AT in plasma could be used as an early biomarker of AKI after CPB.

Analysis on the diagnosis and treatment of necrotizing fasciitis complicated with sepsis / 中华危重病急救医学

Objective:To recognize the characteristics of necrotizing fasciitis patients complicated with sepsis and summarize the experience the treatment.Methods:A retrospective study was conducted. The clinical data of 57 patients with necrotizing fasciitis complicated with sepsis admitted to Guangdong Provincial People's Hospital from July 2009 to December 2019 was analyzed by collecting such factors as gender, age, complications, infection sites, pathogens, surgery information, treatment options and outcome. The patients were divided into debridement group ( n = 14) and control group ( n = 43) according to whether the debridement was completed within 48 hours of admission, and the mortality during hospitalization between the two groups was compared. A telephone follow-up had been done to record the long-term outcome of these patients. Results:Among 57 patients with necrotizing fasciitis complicated with sepsis, there were 43 males and 14 females with the average age of (57.9±12.1) years old. Most of the underlying diseases were diabetes mellitus (70.17%), other diseases included hypertension (8.77%), tumor chemotherapy (7.02%), liver disease (hepatitis, cirrhosis, 7.02%), coronary artery heart disease (3.51%), systemic lupus erythematosus (3.51%), etc. Most of the infection site was lower limbs (71.93%). There were 78 pathogens cultured in 57 patients, in which 52 were non-drug resistant bacteria (66.67%), and 26 were drug resistant bacteria (33.33%). There were 40 Gram positive (G +) bacteria (51.28%), 29 Gram negative (G -) bacteria (37.18%), 8 fungi (10.26%) and 1 mixed bacteria (1.28%). Finally, of 57 patients, 46 patients were cured, and 11 patients died with hospital mortality of 19.30%. Among 57 patients, the hospital mortality in the debridement group was significantly lower than that in the control group [0% (0/14) vs. 25.58% (11/43), P < 0.05]. Among the 46 cured patients, 11 had accepted amputations, accounting for 23.91%. In December 2020, 43 patients who were cured (3 patients were lost to follow-up) were followed up by telephone. Twenty-three patients were completely self-care, 9 patients were partly self-care, 8 patients were completely unable to take care of themselves, and 3 patients died. Conclusions:Necrotizing fasciitis with sepsis mostly occurs in people with weakened immunity, and has a high mortality and disability rate. Early identification and active surgical debridement may be the key to improve the treatment effect.

Surgical treatment for patients aged above 5-month with heterotaxy with functional single ventricle and total anomalous pulmonary venous connection / 中华胸心血管外科杂志

Objective:To review the surgical outcomes for patients above 5-month old with heterotaxy syndrome with heterotaxy with functional single ventricle and total anomalous pulmonary venous connection(TAPVC) in a single center.Methods:From September 2008 to December 2018, there were 34 patients with heterotaxy syndrome with heterotaxy with functional single ventricle and TAPVC underwent cardiac operations at Guangzhou Women and Children Medical Center. 29 patients are aged above 5-month. The median age and body weight at surgery were 440 days(159 to 3 718 years) and 8.5 kg(4.9 to 19.2 kg). The type of TAPVC was supracardiac in 29 patients. All patients were diagnosed with complex cardiac anomaly, including complete atrioventricular canal defect 22 cases, tricuspid atresia 1 cases, mitral atresia 1 cases, atrioventricular valve regurgitation ≥moderate 6 cases, pulmonary venous stenosis 5 cases.Results:There were 4 died after initial operation. The causes of dead were pulmonary hypertension and low cardiac output syndrome. The follow-up duration was 11 to 130 months. 3 patients died of low cardiac output syndrome, protein-losing enteropathy and pulmonary venous stenosis respectively. Kaplan- Meier estimated survival at 1 and 5 years were 79.3% and 75.7%, respectively. 13 patients proceeded to a modified Fontan operation. Fontan completion was 44.8%(13/29). The mortality for patients with pulmonary venous stenosis(PVO) was 60%(3/5). Cox multivariate regression analysis indicated that preoperative PVO was the only risk factor for mortality. Conclusion:Delayed surgical treatment outcomes for patients with heterotaxy syndrome and TAPVC have improved significantly. Fontan completion was higher. However, preoperative PVO was the only risk factor for mortality, and outcomes for patients with PVO were still not promising. The outcomes could be better if these patients underwent initial operation at an early time. Early diagnosis and early intervention are still the principle strategy of surgical treatment of congenital heart disease.

Application of venous super drainage technique in free flaps transfer / 中华显微外科杂志

To investigate the effect of venous super drainage applying in free flaps. Methods From June, 2017 to December, 2018, 7 cases who had severe soft tissue injuries were treated with free flap. Cause of injury: 1 electric injuries, 2 tumor-related wounds, 1 deep burns, 2 mechanical trauma, and 1 necrotizing fasciitis. All patients were underwent free flap transplantation. There were 5 cases of anterolateral thigh artery perforator flap, 1 case of superficial circumflex iliac artery perforator flap, and 1 case of first dorsal metatarsal artery perforator flap.The application of venous super-drainage technology was carried out according to needs and specific conditions. Two sets of venous passages were prepared in both recipient and donor site to form a double set of venous reflux super-drainage mode. Blood supply, swelling, exudation, secondary exploration and survival rate of the flap were observed after operation, and regularly followed-up. Results All 7 flaps survived. Venous super drainage technique was ap-plied in 7 cases. No arteriovenous crisis occurred after the operation. The flaps had good blood circulation, slight swelling, less exudation, rapid edema regression and no secondary surgical exploration. Followed-up for 2-18 (average 10.5) months, there was no infection recurred. Flaps survived well, and the donor sites healed well without sensory loss.The flexion and extension function of joint was normal. Conclusion The technique of venous super-drainage prepares 2 sets of venous systems for the free flap in the treatment of vascular pedicle in the free flap repair operation, which is conducive to reducing the venous crisis after flap surgery, reducing flap edema, reducing exudation, reducing secondary surgical exploration and improving the survival rate of the flap.

Effects of allogeneic bone marrow mesenchymal stem cells on polarization of peritoneal macrophages in rats with sepsis / 中华烧伤杂志

Objective@#To explore the effects of allogeneic bone marrow mesenchymal stem cells (BMSCs) on polarization of peritoneal macrophages isolated from rats with sepsis induced by endotoxin/lipopolysaccharide (LPS).@*Methods@#(1) BMSCs were isolated, cultured and purified from 5 SD rats with whole bone marrow adherent method. The third passage of cells were collected for morphologic observation, detection of expressions of stem cell surface markers CD29, CD44, CD45, and CD90 with flow cytometer, and identification of osteogenic and adipogenic differentiation. (2) Another 45 SD rats were divided into sham injury group (SI, n=5), LPS control group (LC, n=20), and BMSCs-treated group (BT, n=20) according to the random number table. Rats in groups LC and BT were injected with LPS (5 mg/kg) via tail vein to induce sepsis; rats in group SI were injected with the same amount of normal saline to simulate the damage. At post injury hour (PIH) 1, rats in group BT were given 1 mL BMSCs (2×106/mL) via tail vein injection; rats in another two groups were injected with equal volume of phosphate buffer saline. Five rats in group SI at PIH 24 and in groups LC and BT at PIH 6, 12, 24, and 48 were sacrificed to harvest lung tissue for pathological observation with HE staining. In addition, rats in group SI at PIH 24 and in groups LC and BT at PIH 24 and 48 were simultaneously performed with intraperitoneal injection of low-glucose DMEM. Then peritoneal fluid was harvested to culture peritoneal macrophages. Flow cytometer was used to assess the positive expression of cell makers of macrophages including CD68 (making gate), CD11c, and CD206 in group SI at PIH 24 and in groups LC and BT at PIH 24 and 48. Data were processed with one-way analysis of variance and LSD test.@*Results@#(1) The third passage of cells showed uniform fiber-like shape similar to fibroblasts. These cells showed positive expressions of CD29, CD44, CD90 and weak positive expression of CD45. They were able to differentiate into osteoblasts and adipocytes. These cells were identified as BMSCs. (2) At PIH 24, the structure of pulmonary alveoli of rats in group SI was clear and complete with no congestion or inflammatory cell infiltration. At PIH 6, the structure of pulmonary alveoli of rats in groups LC and BT was clear with a small amount of inflammatory cell infiltration, slight congestion and pulmonary interstitial thickening. At PIH 12, the inflammatory responses in lung tissue of rats in group LC were more severe than those in group BT with a large amount of inflammatory cell infiltration, serious congestion, and obvious pulmonary interstitial thickening. The pathological results of rats in group BT at PIH 12 was consistent with the results at PIH 6. At PIH 24, the pathological results of rats in groups LC and BT were similar to the results at PIH 12. At PIH 48, the structure of pulmonary alveoli tissue of rats in group LC was still severely disrupted, with a large number of inflammatory cell infiltration and congestion in lung tissue, but pulmonary interstitial thickening was slightly alleviated than before. The condition of rats in group BT nearly recovered to that in group SI. (3) At PIH 24, the positive expression rate of CD11c in peritoneal macrophages of rats in group LC [(83±10)%] was close to that in group BT [(87±7)%, P>0.05], and they were both significantly higher than the rate in group SI [(55±12)%, with P values below 0.01]. The positive expression rate of CD11c in peritoneal macrophages of rats in group LC [(59±11)%] at PIH 48 was close to that in group SI at PIH 24 (P>0.05), and they were both significantly higher than the rate in group BT [(20±11)%] at PIH 48 (with P values below 0.01). At PIH 24, the positive expression percentages of CD206 in peritoneal macrophages of rats were similar among the three groups (with P values above 0.05). The positive expression percentage of CD206 in peritoneal macrophages of rats in group SI at PIH 24 was close to that in group BT at PIH 48 (P>0.05), and they were both significantly lower than the percentage in group LC at PIH 48 (with P values below 0.01).@*Conclusions@#BMSCs can reduce the pathological inflammatory responses in the lung of rats with sepsis and inhibit peritoneal macrophages from polarizing into M1 phenotype, whereas they can not promote macrophages to polarize into M2 phenotype.

Protective effects of valproic acid on gut barrier function after major burn injury and its mechanism / 中华危重病急救医学

Objective To investigate the potential protective effects of valproic acid (VPA) on gut barrier function after major burn injury in rats and its mechanism.Methods Forty male Sprague-Dawley (SD) rats were divided into sham + normal saline (NS),sham + VPA,scald + NS,and scald + VPA groups,with 10 rats in each group.Rat with 55％ total body surface area (TBSA) third-degree severe-bums model was reproduced by immersing into 80 ℃ water,and the rats in sham groups were given sham-bums by immersing into 37 ℃ water.The rats after severebums were immediately treated with 0.25 mL of 300 mg/kg VPA or NS by subcutaneous injection.Rats were sacrificed at 2 hours and 6 hours after injury,and abdominal aortic blood and ileal tissue were harvested.The levels of vascular endothelial growth factor (VEGF) were determined by enzyme-linked immunosorbent assay (ELISA).The intestinal permeability was evaluated by fluorescein isothiocyanate-dextran (FITC-dextran) determination.The histomorphological changes in gut barrier were evaluated by Chiu grading system.Levels of acetylated lysine at the ninth position of histone 3 protein (Ac-H3K9),hypoxia-inducible factor 1α (HIF-1α),zona occludens 1 (ZO-1) and myosin light chain kinase (MLCK) were determined by immunofluorescence staining and Western Blot.Results Compared with sham + NS group,rats in scald + NS group showed intestinal mucosal damage 2 hours after bum injury,as well as increased mucosal permeability,protein expression levels of HIF-1 α,VEGF,MLCK,and lowered levels of AC-H3K9 and ZO-1.These changes were much more prominent at 6 hours after injury.VPA treatment significantly attenuated the bum-induced intestinal damage.Compared with scald + NS group,the protective effects in scald + VPA group was not evident at 2 hours after injury;however,intestinal damage was much less severe at 6 hours after injury (Chiu score:2.03 ± 0.27 vs.3.12 ± 0.15),intestinal permeability was significantly decreased [FITC-dextran (μg/L):709 ± 76 vs.1138 ± 75],histone acetylation was enhanced [Ac-H3K9 (gray value):1.55 ± 0.12 vs.0.48±0.12],ZO-1 degradation was significantly inhibited (gray value:0.69 ± 0.12 vs.0.43 ± 0.16),the protein expression levels of VEGF and MLCK were significantly down-regulated [VEGF (ng/mg):51.7±3.7 vs.71.2±4.3,MLCK (gray value):1.98±0.20 vs.2.80±0.24],while the HIF-1 α protein expression levels were significantly reduced at both 2 hours and 6 hours after injury (gray value:2.50±0.39 vs.3.88±0.42 at 2 hours,1.83±0.42 vs.4.42±0.41 at 6 hours,all P ＜ 0.05).Conclusions Severe bum injury can induce histone deacetylation,ZO-1 degradation and intestinal barrier dysfunction.VPA can improve the levels of histone acetylation and ZO-1,and protect intestinal epithelial barrier function.These may probably be mediated through inhibiting HIF-1α and its downstream gene VEGF and MLCK.

Myocardial preservation of the isolated heart / 中华胸心血管外科杂志

Although the surgical techniques has already improved in heart transplantation, heart preservation is still the biggest obstacle to the surgery.At present, heart preservation effective time is only 4-6 hour.How to extent the time of heart preservation is a major research direction.Comparison of available preservations for heart transplantation based on its mechanism and the prospect of its Clinical application.

Autophagy and cardiocyte apoptosis after heterotopic transplantation of the mouse heart preserved in high-pressured mixed gas / 医学研究生学报

Objective Heart transplantation is an effective treatment of end-stage heart diseases and extending the time of donor heart preservation helps to make up for the shortage of donor hearts. This study was to investigate whether high-pressured mixed gas ( HPMG) of carbon monoxide and oxygen could prolong the time of donor heart preservation and its mechanisms. Methods Forty-eight C57BL/6 male mice aged 4-6 weeks were randomly divided in-to four groups of equal number:control ( the donor heart isolated but not transplanted) , immediate transplantation ( the donor heart transplanted right after isolated) , HTK-preservation ( the donor heart preserved in histidine-tryptophan-ketoglutarate solution for 24 hours after isolated, and HPMG preservation ( the donor heart preserved in an HPMG chamber with the oxygen partial pressure of 3200 hPa and carbon monoxide partial pressure of 800 hPa for 24 hours after isolated) .Another 36 recipient mice aged 6-8 weeks were randomly assigned to receive the donor heart immediately after harvested (n=12), preserved in HTK solution (n=12), or preserved in HPMG (n=12).At 2 hours after transplantation, the status of heart re-beating and cardiac function were compared among different groups of recipient mice.At 24 hours, tissues were taken from the transplanted hearts for examination of pathologic changes by HE stai-ning, detection of the apoptosis of cardiac cells by TUNEL, and determination of the expressions of microtubule-associated protein 1 light chain 3 -Ⅱ(LC3-Ⅱ) and B cell lymphoma/leukemia-2 (Bcl-2) by Western blot. Resul ts The re-beating rates of the imme-diately transplanted and HPMG-preserved hearts were significantly higher than that of the HTK-preserved ones (P<0.05).At 2 hours after transplantation, the cardiac function scores were 2.5 (2.0-2.9), 0.8 (0.5-1.0), and 4.5 (4.0-4.5) in the immediate implantation, HPMG-preservation and HTK-preservation groups respectively, with statistically significant differences between any two groups (P<0.05).The expressions of LC3-Ⅱand Bcl-2 were 2.06 ±0.29 and 0.87 ±0.18 in the HPMG-preserved heart recipients and 1.24 ±0.20 and 2.07 ±0.32 in the immediately transplanted heart recipients, both higher than 0.13 ±0.03 and 0.19 ±0.02 in the controls and 0.16 ±0.06 and 0.26 ±0.08 in the HTK-preserved heart recipients (P<0.05), the Bcl-2 higher in the HTK-pre-served heart recipients than in the controls (P<0.05), and the LC3-Ⅱ expression higher in the HPMG-preserved heart recipients than in the immediately transplanted heart recipients (P<0.05).HE staining showed that cell edema and inflammatory cell infiltration were more obvious in the HPMG-preserved heart recipients than in the controls and immediately transplanted heart recipients but less obvious than in the HTK-preserved heart recipients.The rate of cell apoptosis was dramatically increased in the HPMG-and HTK-pre-served heart recipients ([5.04 ±1.77]%and [26.72 ±5.23]%) in comparison with the controls ([1.08 ±0.56]%) (P<0.01) and immediately transplanted heart recipients ([2.13 ±1.71]%) (P<0.01) but decreased in the HPMG as compared with the HTK-preserved heart recipients (P<0.01). Conclusion High-pressured mixed gas preservation can reduce cold ischemia-reperfu-sion injury of the donor heart, which may be associated with its promotion of autophagy, provision of energy to cells, and apoptosis of cardiocytes in the donor heart.

Analysis of liver damage and reactivation of hepatitis B virus in hepatitis B surface antigen positive patients after extremely severe burn injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the development of liver damage and reactivation of hepatitis B virus (HBV) during the treatment of extremely severe burn injury in HBsAg positive patients, in order to provide reference for prevention and treatment of liver damage in patients with HBV infection after extremely severe burn.</p><p><b>METHODS</b>Medical records of 54 HBsAg positive patients after extremely severe burn injury admitted from January 2004 to December 2014 were retrospectively analyzed. Development of liver damage and HBV reactivation of these patients during the treatment were analyzed according to the classification of their gender, results of hepatitis B e antigen (HBeAg) and HBV DNA examinations on admission, and development of sepsis in the process of treatment. Data were processed with chi-square test.</p><p><b>RESULTS</b>(1) The incidence of liver damage in the process of treatment of these patients was 85.2% (46/54). Among all the patients, the proportion of liver damage was 35/38 in male, which was significantly higher than that in female (11/16, χ² = 4.867, P<0.05). Liver damage was found in all of 26 patients who were HBeAg positive on admission, 34 patients who were HBV DNA positive on admission, and 36 patients who developed sepsis in the process of treatment; the proportions were significantly higher than those in patients who were HBeAg negative on admission (20/28), patients who were HBV DNA negative on admission (12/20), and patients who did not develop sepsis in the process of treatment (10/18), with χ² values respectively 11.801, 18.384, and 20.574, P values below 0.01. (2) The incidence of HBV reactivation in these patients was 29.6% (16/54). Among all the patients, the proportion of HBV reactivation was 13/38 in male and 3/16 in female, with no statistically significant difference between them (χ² = 0.656, P>0.05). The proportions of HBV reactivation in patients who were HBeAg positive on admission, patients who were HBV DNA positive on admission, and patients who developed sepsis in the process of treatment were respectively 13/26, 16/34, and 15/36, and they were significantly higher than those in patients who were HBeAg negative on admission (3/28), patients who were HBV DNA negative on admission (0/20), and patients who did not develop sepsis in the process of treatment (1/18), with χ² values respectively 9.979, 18.615, and 5.873, P<0.05 or P<0.01.</p><p><b>CONCLUSIONS</b>Patients who are HBsAg positive, HBeAg positive, HBV DNA positive on admission, and develop sepsis in the process of treatment of extremely severe burn injury are more likely to develop liver damage and HBV reactivation. It is necessary to dynamically monitor the changes in HBV DNA and liver function, in order to identity the reactivation of virus.</p>

Protective effect of adenosine preconditioning against spinal cord ischemia-reperfusion injury in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of adenosine preconditioning on cell apoptosis and expressions of glucose-regulated protein (GRP-78) and cysteinyl aspartate-specific protease 12 (caspase-12) in rats with spinal cord ischemia-reperfusion injury.</p><p><b>METHODS</b>Twenty-seven rats were randomized into 3 equal groups and subjected to sham operation (group A), spinal cord ischemia-reperfusion injury (group B), or ischemia-reperfusion injury with adenosine treatment. Spinal cord ischemia-reperfusion injury was induced by cross-clamping of the abdominal aorta inferior to the left renal artery. The spinal cord function was assessed using the Modified Tarlov Scale at 6, 12, and 24 h after reperfusion. At 24 h after reperfusion, histological analysis was carried out with HE staining; cell apoptosis and viability were determined with TUNEL staining, and the expressions of GRP-78 and caspase-12 proteins were determined with Western blotting.</p><p><b>RESULTS</b>HE staining of the spinal cord showed extensive spinal cord injury such as cell edema in group B as compared with group C. Compared with group A, group B showed a significantly increased number of apoptotic cells; the number of apoptotic cells in group B was greater than that in group C. Compared with group B, group C showed significantly increased GRP-78 expression (P<0.01) and decreased caspase-12 expression (P<0.01).</p><p><b>CONCLUSION</b>Adenosine can up-regulate GRP-78 expression and down-regulate caspase-12 expression, and protects the spinal cord against ischemia-reperfusion injury by inhibiting cell apoptosis.</p>

Effect of bone marrow mesenchymal stem cells on lipopolysacharide-induced secretion of inflammatory cytokines in rat macrophages in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of bone marrow mesenchymal stem cells (BMSCs) on secretion of inflammatory cytokines in macrophages stimulated by lipopolysacharide (LPS).</p><p><b>METHODS</b>Rat BMSCs and macrophages were isolated, cultured, and identified. The BMSCs and macrophages, cultured alone or in co-culture, were treated with LPS or PBS or without treatment and tested for interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) concentrations in the supernatants at 1, 3, 5, 7, 12, and 24 h after the treatment using enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>Exposure to LPS caused significantly increased IL-10 and TNF-α concentrations in the supernatant of cultured macrophages but not in BMSC culture. Macrophages co-cultured with BMSCs showed significantly lowered IL-10 and TNF-α secretions in response to LPS exposure as compared with the macrophages cultured alone.</p><p><b>CONCLUSION</b>BMSCs can reduce LPS-induced secretion of inflammatory cytokines by the macrophages to ameliorate inflammatory reactions.</p>

In vivo safety of self-filling osmotic tissue expander / 中国组织工程研究

BACKGROUND:The osmotic tissue expander is a self-fil ing device consisting of an osmotic active hydrogel which is made of vinylpyrrolidone and mehtylmethacrylate. It can absorb body fluids and swel up gradual y after embedded. OBJECTIVE:To explore the short-term and long-term regular patterns as wel as histocompatibility of the osmotic tissue expander in vivo. METHODS:A self-control design was carried out in Wistar rats by embedding the osmotic tissue expander and high-density polyethylene into each side of their spinal column subcutaneously. Wound healing, tissue expansion and inflammatory reaction were detected and compared at different periods after operation. RESULTS AND CONCLUSION:Al the wounds got primary healing. The device expanded fastest at week 1 after the implantation. After being enlarged to about nine times that of the initial size at week 4, the expander slowed down its swel ing. It reached its ultimate volume at week 12 which was about 10 times as big as that of the initial one. Then it remained almost the same size until the end of our design. Pathological sections showed that the inflammatory reaction of osmotic-tissue-expander-group had no significant difference from that of the control group (P>0.05). These findings suggest that osmotic tissue expander has a slow-lasting swel ing ability and good histocompatibility.

The surgical methods and efficacy of 70 cases over 65 years old patients with aortic dissection / 中华胸心血管外科杂志

Objective To retrospectively analyze the surgical methods and efficacy in 70 cases of type A aortic dissection patients over 65 years old.Methods From January 2005 to May 2012,70 type A aortic dissection patients over 65 years old received surgical treatment.Among them,there were 47 males aged 65 to 78 years old with mean 71,23 females,aged 65 to 72 years old with mean 68.55 cases were acute onset,while 15 cases were chronically onset.Different surgical methods were selected depend on patients' situations.We followed up all patients after discharged from hospital to continue to observe their health situation and evaluate the therapeutic effects.Results After surgery,eight patients died in the hospital,62 patients were recovered and discharged from the hospital.The mortality rate is 11.4％.During the follow up period from 3 to 72 months,there were no dead,aneurysm rupture and others severe complications.9 cases received endovascular graft exclusion within 6 months after discharged from hospital.The survival patients were satisfactory healed with their daily living activity resumed.Conclusion For over 65 years old patients with aortic dissection,the accurate and rapid selection of surgical method could improve the survival rate and the quality of life with a lower occurrence rate of complications.

Surgical correction of tetralogy of Fallot in adults over 40 years of age / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the experience with surgical correction of tetralogy of Fallot in adults over 40 years of age.</p><p><b>METHODS</b>From November 1985 to July 2008, 9 male and 11 female patients aged 41-53 years (mean 46.3±3.5 years) underwent total surgical correction for tetralogy of Fallot. Twelve patients had preoperative NYHA class III cardiac function. The common comorbidities included infective endocarditis, cerebral abscess, cerebral infarction, renal dysfunction, and tricuspid insufficiency. Surgical corrections were carried out at the anatomical or physiological level.</p><p><b>RESULTS</b>Nineteen patients received right ventriculotomy to relieve right ventricular outflow obstruction and for ventricular septal defect closure, and 1 patient had Fontan operation. Two patients died after the surgery for heart failure and ventricular fibrillation. The average cardiopulmonary bypass time, aortic clamp time, and postoperative ventilation time was 142.9±36.3 min, 89.9±25.1 min, and 72.0±17.5 h, respectively. Postoperative low cardiac output syndrome occurred in 5 cases, septic shock in 1 case, secondary renal failure in 1 case, and bleeding in 2 cases. Echocardiography showed a significant postoperative reduction of the mean right ventricular outflow tract velocity from 4.29±1.36 m/s to 2.13±0.83 m/s (P<0.01); the right ventricular longitudinal dimension exhibited no significant changes postoperatively (57.1±6.7 mm vs 55.1±7.0 mm, P=0.65).</p><p><b>CONCLUSIONS</b>Surgical correction of the tetralogy of Fallot in patients over 40 years is highly risky and requires appropriate management of cardiac failure, careful myocardial protection, and thorough intracardiac lesion correction to decrease surgical complications.</p>

The effect of different ablation lines in left atrium on modified cardiac Cox maze procedure / 中华胸心血管外科杂志

Objective Background and objective The Cox maze Ⅲ procedure has been considered the gold standard for the surgical treatment of atrial fibrillation (AF) and the modified Cox maze use bipolar radiofrequency ablation instead of the cut-and-sew technique,while also reducing the connecting lines in left atrium.This study was to understand whether completely isolation the posterior left atrium by increasing left atrium ablation lines can enhance the survival after modified Cox maze procedure.Methods From Jan 2009 to Dec 2009,all the patients underwent the Cox maze procedure,following the same examination,were divided into two groups (case-control): box lesion group (n =60),which is means the right and lefi pulmonary vein lesions were connected inferiorly by adding ablation lines,thereby completely isolating the posterior left atrium and the non-box lesion group (n =60).Similar interventions were given during the perioperative periods.Comparing the risk factors before surgeries,then follow-up was 100％ complete,and the mean follow-up was 9 ± 8.4 months.Results Except the box lesion had long time of extracorporeal circulation,the characteristics of the 2 groups were similar because there were no differences in age,AF duration,left atrial diameter,left ventricular ejection fraction or homochronous operation between the groups and there was no operative death.No patient was lost to follow-up.In the mean follow-up duration,a patient was died of intracerebral hemorrhage at 2 months postoperationly in the box lesion group and a patient suffered from stroke at 12 months postoperationly in the non-box lesion.The overall freedom from AF recurrence was higher in the box lesion group at 1 (70％ vs 51.2％,P =0.039) and 3 (78.3％ vs 60％,P =0.030) months.While it was 80％ vs 71.7％ (P =0.286) at 6 months.Eight patients wrere readmitted because of the recurrence of AF,4 and 2 patients underwent catheter ablation in box and non-box group respectively,one patient in each group underwent electrical conversion.After treatment,all of the patients were recovered to sinus rhythm and continued to take cordarone.Conclusion Compared to the single connecting between right and left pulmonary vein,isolating the entire posterior left atrium by creating a box lesion showed higher freedom from AF in the earlier months (1-3months).However,half a year after the surgery,there were no significant differences between the two groups.

Surgical treatment of congenital bicuspid aortic valve in 73 patients aged over 50 years / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the clinical characteristics, surgical management and postoperative complications in patients with congenital bicuspid aortic valve (CBAV) over 50 years of age.</p><p><b>METHODS</b>From January 2009 to September 2011, 73 CBAV patients aged 51-76 years (mean 61.8∓0.73 years) were treated in our center. Except for 1 patient who underwent Bentall surgery and another having Wheat surgery, all the patients received aortic valve replacement (AVR), including 7 with double (mitral and aortic) valve replacement (DVR), 6 with mitral valvular plasty, 11 with tricuspid valvular plasty, 8 with coronary artery bypass graft implantation, 1 with aortic-left ventricular tunnel repair, 1 with atrial maze ablation, and 1 with left atrial thrombosis removal.</p><p><b>RESULTS</b>Two patients died after the surgery, with a perioperative mortality rate of 2.7%. The cardiopulmonary bypass time was 78-217 min (mean 131.9 ∓6.0 min) with an aortic blocking time of 56-158 min (mean 88.2 ∓4.8 min) and total postoperative ICU time of 23.0-647.4 h (mean 97.9∓10.5 h). The postoperative complications included low heart output syndrome in 5 cases, bleeding in 4 cases, wound debridement in 4 cases, and hemodialysis due to acute renal failure in 1 case. The left ventricular end diastolic diameter reduced significantly after the surgery (52.6∓1.7 vs 43.2∓1.0, P=0.001). No significant changes were detected in the left ventricular ejection fraction (62.3∓2.5 vs 65.5∓1.3, P=0.257).</p><p><b>CONCLUSION</b>Thorough preoperative examination, preoperative risk factor assessment, timely perioperative interventions, careful evaluation of patients' tolerance of surgery, and prevention of surgical complications are essential to decrease the perioperative mortality in elderly patients with CBAV.</p>

Validation of the Chinese system for cardiac operative risk evaluation (SinoSCORE): the experience from Guangdong Cardiovascular Institute / 中华胸心血管外科杂志

Objective To validate of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in Cantonese surgery patients. Methods Data from Guangdong Cardiovascular Institute in the period January 2004 through December 2008 were analyzed on 2462 Cantonese heart surgery patients. First, compared risk factors of this series and database of SinoSCORE, and then calculated the additive score of each patients and evaluate the discrimination and calibration of sinoSCORE in Cantonese patients. Results There were some differences between the risk factors of patients from two groups. The gender,smoking, diabetes, hyperlipemia, hypertension, chronic pulmonary diseases, stroke, cardiovascular surgery history, left main disease, atrial fibrillation/atrial flutter, pulmonary arterial hypertension, concomitant coronary surgery and concomitant valve surgery in Cantonese patients were different between two groups. However, The SinoSCORE was able to predict the in-hospital mortality of senior patients with good discrimination ( Hosmer-Lemeshow test, P = 0. 34 ) and calibration ( the area under the receiver operating characteristic curve, 0.84, P ＜ 0.01 ). Conclusion SinoSCORE was able to predict the in-hospital mortality of Cantonese heart surgery patients.

Mitral, aortic and tricuspid valve replacement for severe rheumatic disease / 中华胸心血管外科杂志

Objective: To evaluate the mitral, aortic and tricuspid valve replacement for rheumatic heart disease. Methods: From June 1990 to June 2001, 941 patients underwent valve replacement. Among them, 24 patients underwent simultaneously mitral, aortic and tricuspid valve replacement. There were 17 females and 7 males, with mean age of 36 years (ranged from 18 to 59 years). Eight patients had previous closed mitral valvotomy. Eleven patients complicated with left atrium thrombus, 16 with hapotomeglia, and 8 with ascites. The X ray results showed that the C/T ratio was 0.66 to 0.91. The heart function (NYHA) was class III in 9, and class IV in 15. All patients had combined mitral, aortic valve lesions associated with severe tricuspid valve regurgitation. Results: One patient died postoperatively with an operative mortality of 4.2%. 23 patients followed up from 20 to 36 months (mean, 26.4 months). There was no thrombolism and anticoagulant related hemorrhage. The echocardiography demonstrated the diameter of left atrium right ventricle, and LVDd significantly decreased after operation. The heart function was also significantly improved. Conclusion: The combination of mitral, aortic and tricuspid valve replacement could achieve a satisfactory result with low mortality and better recovery of heart function.