Treatment strategy of mechanical hemolysis after mitral valve repair / 医学研究生学报

Objective　In recent yaers, mitral valve repair has been widely used in the surgical treatment of congenital and secondary mitral valve lesions. To investigate the mechanism and treatment strategy of mechanical hemolysis after mitral valve repair.　Methods　A total of 451 consecutive patients registrated in general hospital of southern theatre command who underwent mitral valve repair surgery between August 2010 and June 2018,of whom 16(3.5%) had complicated mechanical hemolysis(hemoglobinuria, jaundice, anemia), were retrospectively analyzed. Echocardiographic examination showed that there were 3 cases of mild mitral regurgitation(MR), 9 cases of moderate MR and 4 cases of severe MR, among which 75% of mitral regurgitation flow were rapid regurgitant jets (Vmax>4m/s). According to the treatment strategy,all cases were divided into two groups: the aggressive reoperation group（n=10）,patients received re-repair procedures within 1 week after hemolysis diagnosis. The conservative treatment group(n=6), patients received symptomatic treatment of hemodialysis, blood transfusion, diuresis, alkalization of urine, liver protection and oral metoprolol et al. All patients were followed up for 2 to 36 months, with an average (16±7.5) months, and the postoperative echocardiographic results, hemolysis symptom improvement and cardiac function were compared.　Results　No death occurred in the two groups after operation. The symptoms of patients in the aggressive reoperation group receded rapidly and discharged from hospital. 4 patients in the conservative treatment group received reoperation 3~11 weeks after surgery due to poor treatment effect (1 patient underwent re-repair and 3 patients underwent replacement), the other 2 patients received long-term conservative treatment. The cardiac function of the patients undergoing reoperation was maintained at level I~II. Echocardiographic examination showed that mild MR(n=10), mild~moderate MR(n=3), and no recurrence of mechanical hemolysis. Two patients with long-term conservative treatment, mild~moderate anemia, urinogen +~++, moderate MR, cardiac function at level II, were in a subclinical hemolytic state.　Conclusion　Mechanical hemolysis frequently occurs immediately or soon after mitral valve repair. Hemoglobinuria, jaundice, anemia and postoper echocardiography found the mitral regurgitant flow with high-shear stress, these helpful to the diagnosis. Surgery is an important factor affecting hemolysis. Hemolysis can be a sign of surgical failure, re-repair operation is the best treatment as soon as possible after the hemolysis has been diagnosed.Conservative treatment is not the priority choice.

Sedative Effect of Dexmedetomidine in Patients With Type Ⅰ Aortic Dissection After Total Arch Replacement Surgery / 中国循环杂志

Objectives: To evaluate the sedative effect of dexmedetomidine (DEX) in patients with type I aortic dissection (AD) after total arch replacement surgery. Methods: A total of 237 AD patients with arch involvement received total arch replacement were enrolled; there were 199 (84.0%) male and the patient's mean age was (48.79±12.65) years. Based on post-operative application of sedatives during ICU stay, the patients were divided into 2 groups: DEX group, patients received load dose DEX 1μg/kg by slow intravenous injection, then (0.2-0.7) μg/(kg·h ) by continuous infusion, n=126 and Midazolam (MDZ) group, patients received load dose MDZ 0.05μg/kg by slow intravenous injection, then (0.02-0.1) mg/(kg·h ) by continuous infusion, n=111. Same surgical method was used in both groups, the mechanical ventilation time, incidence of delirium and other relevant indexes were compared between 2 groups. Results: Compared with MDZ group, DEX group had reduced mechanical ventilation time (3.97±1.28) d vs (4.99±1.58) d and ICU stay time (6.63±1.71) vs (7.24±2.56) d, less incidences of delirium (8.7% vs 18.9%) and permanent dysneuria (5.65% vs 13.5%), all P<0.05. Conclusions: Compared with MDZ, DEX may effectively reduce mechanical ventilation time, ICU stay time and the incidence of dysneuria in type I AD patients after total arch replacement surgery; it had positive role for patient's recovery.

Coarctation of the aorta with hypoplastic aortic arch :Analysis of midterm and longterm outcomes with autologous pulmonary patch aortoplasty / 医学研究生学报

Objective Previously we have reported the early and midterm benifit of autologous pulmonary patch in repairing aortic coarctation of hypoplastic aortic arch.This study aimed to assess its reliability and midterm and longterm outcomes.Methods We retrospectivly analyzed 42 pediatric patients with coarctation of the aorta (CoA) with hypoplastic aortic arch undergoing surgical repair with autologous pulmonary patch from May 2009 to May 2017 in General Hospital of Guangzhou Military Command of PLA.All the patients were allocated into either senior group (＞ 1 years) or junior group (≤1 years) according to the age of operation.The trans-coarctation gradient,pulmonary pressure and aortic Z value change were compared between two groups before and after the repair.Results There were 8 cases had early postoperative complications.However,no death had been reported during the postoperative time and the followed up period ranged from 4 months to 106 months (40.0± 15.5) months).The average pressure gradient of coarctation segment for all the patients was (11.9±6.4) mmHg,including 5 cases more than 25 mmHg.The pressure gradient and mean pulmonary arterial pressure after operation were significantly lower than those before operation (P＜0.05),The postoperative aortic arch Z value was greater than the preoperative value (P＜0.05).Compared with the preoperative period,the Z value of proximal transverse arch increased significantly(-0.64±0.44) vs (1.27±0.66),P＜0.05.Compared with junior group,the senior group had higher preoperative and postoperative pulmonary artery pressure (P＜0.05),and longer CPB time,aortic block time,ventilation time,ICU time and hospital stay time (P＜0.05).However,patients in the junior group had a higher pressure gradient through the aorta arch(P＜0.05) and a smaller Z value transverse arch aortic proximal and isthmus(P＜0.05) during the long-term period.The time of selective cerebral perfusion had no statistical difference between the two groups (P＞ 0.05).Conclusion Early surgery for coarctation of aorta with hypoplastic aortic arch,autologous pulmonary patch aortoplasty is a relatively ideal option with better midterm and longterm outcomes.

Protective effects of high-dose ulinastatin on vital organs in patients receiving total arch replacement for type A aortic dissection / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the protective effects of high-dose ulinastatin on the vital organs in patients undergoing total arch replacement for type A aortic dissection.</p><p><b>METHODS</b>Between September 2014 and March 2016, 66 patients with type A aortic dissection underwent total arch replacement at our center. Thirty-six of the patients received ulinastatin treatment at 300 000 U/8 h from admission to 3 days postoperatively and at 300 000 U/2 h during cardiopulmonary bypass surgery (UTI group), and the other 30 patients did not receive perioperative ulinastatin treatment (control group). The surgical data and blood biochemistry profiles on days 1, 3, and 5 postoperatively were compared between the two groups, and the postoperative ICU stay, re-operation for bleeding, ventilation for over 7 days, ultrafiltration for postoperative renal failure, tracheotomy, incidences of pulmonary and neurological complications and hospital death were also compared.</p><p><b>RESULTS</b>s The operating time, cardiopulmonary bypass time, ACP time, cardiac arrest time, the lowest rectal temperature and frequency of bilateral and unilateral antegrade selective cerebral perfusion were similar between the two groups (P>0.05). Compared with those in the control group, patients in UTI group had lower lactate, S-100 and neuron specific enolase levels on the first postoperative day and higher OI on the 1st, 3rd, and 5th postoperative days (P<0.05), but serum creatinine, blood urea nitrogen, total bilirubin, and alanine aminotransferase levels were comparable between the two groups (P>0.05). No significant differences were found in the frequency of re-operation for bleeding, ultrafiltration for renal failure, tracheotomy, neurological complications or hospital death after the operation between the two groups, but the patients in UTI group had a shorter ICU time, a less frequent long-term ventilation and a lower incidence of pulmonary infection (P<0.05).</p><p><b>CONCLUSION</b>High-dose ulinastatin offers protection on pulmonary function and lowers the specific brain injury markers in patients with type A aortic dissection after total arch replacement, but its protective effects on brain is uncertain.</p>

Case-control study on midterm follow-up effects of the extended release of posterior clearance in total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the midterm follow-up results of extended release of posterior clearance in total knee arthroplasty.</p><p><b>METHODS</b>A total of 120 patients with knee osteoarthritis were equally randomly assigned to the experimental group and control group, and underwent unilateral TKA from March 2010 to March 2012. In experimental group, there were 21 males and 39 females with an average age of (62.2±10.9) years old. In the control group, there were 25 males and 35 females with an average age of (64.9±11.4) years old. All the patients were performed using the anterior knee approach. During operation, after osteotomy of the tibia and the femoral condyle, extended release of the posterior knee clearance were taken in experimental group, while only the clearance of osteophyte in the posterior condyle were performed in the control group. The KSS scores including knee functional score and knee clinical score,as well as the range of motion (ROM) of patients, were compared between the two groups at midterm follow-up.</p><p><b>RESULTS</b>Totally 49 patients in the experimental group and 54 patients in the control group were followed up, and the median follow-up time was 46 months. The knee functional score of patients in the experimental group was 91.3±3.4, which was better than 86.4±3.9 of patients in the control group; initiative ROM of flexion of patients in the experimental group was (133.2±5.9)°, which was better than (126.9±7.4)° of patients in the control group. There were no significant difference of knee clinical score between 86.9±4.6 of patients in the experimental group and 85.7±5.1 of patients in the control group, and the initiative ROM of extension between (0.5±1.1)° and (0.3±1.2)°.</p><p><b>CONCLUSION</b>Extended release of the posterior knee clearance contributes to the knee function and initiative flexion ROM during a midterm follow-up and patients benefit.</p>

Clinical analysis of complications in endovenous laser treatment for patients with varicose veins of the lower extremities / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the causes and therapies for the complications induced by endovenous laser treatment (EVLT) in patients with varicose vein of lower limbs.</p><p><b>METHODS</b>From December 2003 to October 2009, 283 cases (totally 361 lower limbs) treated by the endovenous laser treatment or combined with other treatment were analyzed retrospectively. There were 108 male and 175 female patients, with a mean age of 52 years (ranging from 17 to 83 years). The varicose vein occurred in left limb for 112 cases, right limbs for 93 cases and both limbs for 78 cases.</p><p><b>RESULTS</b>The patients were followed up for average 18 months, during which 142 limbs showed skin bruises and/or hematoma, 47 limbs showed skin burns, 7 limbs showed phlebitis; all of these cases were cured. In addition 91 limbs appeared abnormal skin sensation, 87 of them were recovered and 4 improved. Two limbs were found with deep vein thrombosis in this series, after treatment one case was obviously improved and other was alleviated.</p><p><b>CONCLUSIONS</b>EVLT is a effective therapy for varicose vein of lower limbs. But it may lead to some complications without right manipulations.</p>

Surgical treatment of DeBakey type II aortic dissection combined with true aneurysm in the distal aortic arch: a case report / 南方医科大学学报

DeBakey type II aortic dissection combined with true aneurysm in the distal aortic arch is a very rare condition, and due to the complicated pathology, its surgical intervention can be difficult and risky. We report a case with this pathology in a 23-year-old man, who received a previous open heart surgery for ventricular septal defect at the age of 6 years. Aortic valve, ascending aorta and total aortic arch replacements were performed. Cardiopulmonary bypass (CPB) including deep hypothermic circulatory arrest with selective antegrade cerebral perfusion was used. No postoperative complications occurred, and the follow-up examination at 6 months after the operation showed good therapeutic results.

Thoracic aortic replacement with concomitant endoluminal stent grafting for DeBakey type I aortic dissection / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect and safety of thoracic aortic replacement with concomitant endoluminal stent grafting in the treatment of DeBakey type I aortic dissection.</p><p><b>METHODS</b>From September 2007 to January 2010, 6 patients with DeBakey type I aortic dissection (including one with aortic dissection relapse) received ascending aortic (or Bentall) and total aortic arch replacement and simultaneous stent graft implantation into the descending aorta. Multi-slice spiral CT scans (MSCT) were performed in each patient regularly after the surgery. Cardio-pulmonary bypass including deep hypothermic circulatory arrest with selective antegrade cerebral perfusion were used during the surgery.</p><p><b>RESULTS</b>All the patients recovered smoothly after the surgical procedure without serious complications. The time of cardiopulmonary bypass ranged from 208 to 291 min (mean 242 min), arrest time of the ascending aortic was 112-194 min (mean 145 min), and selective cerebral perfusion time was 63-102 min (mean 76 min). The patients were followed up for 4-32 months (mean 15.5 months), and MSCT revealed smooth blood flow in the prosthesis, complete thrombus formation in the false lumen in the perigraft space and shrinkage of the distal false lumen without internal fistula or stent dislocation.</p><p><b>CONCLUSION</b>Thoracic aortic replacement with concomitant endoluminal stent grafting is a safe and effective treatment of DeBakey type I dissection.</p>

Effect of electromagnetic pulse exposure on brain micro vascular permeability in rats / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To observe the effect of electromagnetic pulse (EMP) exposure on cerebral micro vascular permeability in rats.</p><p><b>METHODS</b>The whole-body of male Sprague-Dawley rats were exposed or sham exposed to 200 pulses or 400 pulses (1 Hz) of EMP at 200 kV/m. At 0.5, 1, 3, 6, and 12 h after EMP exposure, the permeability of cerebral micro vascular was detected by transmission electron microscopy and immunohistochemistry using lanthanum nitrate and endogenous albumin as vascular tracers, respectively.</p><p><b>RESULTS</b>The lanthanum nitrate tracer was limited to the micro vascular lumen with no lanthanum nitrate or albumin tracer extravasation in control rat brain. After EMP exposure, the lanthanum nitrate ions reached the tight junction, basal lamina and pericapillary tissue. Similarly, the albumin immunopositive staining was identified in pericapillary tissue. The changes in brain micro vascular permeability were transient, the leakage of micro vascular vessels appeared at 1 h, and reached its peak at 3 h, and nearly recovered at 12 h, after EMP exposure. In addition, the leakage of micro vascular was more obvious after exposure of EMP at 400 pulses than after exposure of EMP at 200 pulses.</p><p><b>CONCLUSION</b>Exposure to 200 and 400 pulses (1 Hz) of EMP at 200 kV/m can increase cerebral micro vascular permeability in rats, which is recoverable.</p>

Comparison of Hsps expression after radio-frequency field exposure in three human glioma cell lines / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate and compare the effect of radio-frequency (RF) field exposure on expression of heat shock proteins (Hsps) in three human glioma cell lines (MO54, A172, and T98).</p><p><b>METHODS</b>Cells were exposed to sham or 1950 MHz continuous-wave for 1 h. Specific absorption rates (SARs) were 1 and 10 W/kg. Localization and expression of Hsp27 and phosphorylated Hsp27 ((78) Ser) (p-Hsp27) were examined by immunocytochemistry. Expression levels of Hsp27, p-Hs27, and Hsp70 were determined by Western blotting.</p><p><b>RESULTS</b>The Hsp27 was primarily located within the cytoplasm, p-Hsp27 in both cytoplasm and nuclei of MO54, A172, and T98 cells. RF field exposure did not affect the distribution or expression of Hsp27. In addition, Western blotting showed no significant differences in protein expression of Hsp27 or Hsp70 between sham- and RF field-exposed cells at a SAR of 1 W/kg and 10 W/kg for 1 h in three cells lines. Exposure to RF field at a SAR of 10 W/kg for 1 h slightly decreased the protein level of phosphorylated Hsp27 in MO54 cells.</p><p><b>CONCLUSION</b>The 1950 MHz RF field has only little or no apparent effect on Hsp70 and Hsp27 expression in MO54, A172, and T98 cells.</p>

Effects of electromagnetic pulse on blood-brain barrier permeability and tight junction proteins in rats / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the effect of electromagnetic pulse (EMP) on the permeability of blood-brain barrier, tight junction (TJ)-associated protein expression and localization in rats.</p><p><b>METHODS</b>66 male SD rats, weighing (200 approximately 250) g, were sham or whole-body exposed to EMP at 200 kV/m for 200 pulses. The repetition rate was 1 Hz. The permeability of the blood-brain barrier in rats was assessed by albumin immunohistochemistry. The expression of typical tight junction protein ZO-1 and occludin in both cerebral cortex homogenate and cerebral cortex microvessel homogenate was analyzed by the Western blotting and the distribution of ZO-1 and occludin was examined by immunofluorescence microscopy.</p><p><b>RESULTS</b>In the sham exposure rats, no brain capillaries showed albumin leakage, at 0.5 h after 200 kV/m EMP exposure for 200 pulses; a few brain capillaries with extravasated serum albumin was found, with the time extended, the number of brain capillaries with extravasated serum albumin increased, and reached the peak at 3 h, then began to recover at 6 h. In addition, no change in the distribution of the occludin was found after EMP exposure. Total occludin expression had no significant change compared with the control. However, the expression level of ZO-1 significantly decreased at 1 h and 3 h after EMP exposure in both cerebral cortex homogenate and cerebral cortex microvessel homogenate. Furthermore, immunofluorescence studies also showed alterations in ZO-1 protein localization in cerebral cortex microvessel.</p><p><b>CONCLUSION</b>The EMP exposure (200 kV/m, 200 pulses) could increase blood-brain barrier permeability in rat, and this change is associated with specific alterations in tight junction protein ZO-1.</p>

Risk factors for early postoperative death after total correction of tetralogy of Fallot: analysis of 20 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To identify the risk factors of early postoperative death after total correction of tetralogy of Fallot (TOF).</p><p><b>METHODS</b>A retrospective analysis was conducted among 356 patients undergoing total correction of TOF by opening heart surgery and cardiopulmonary bypass. Of these patients, 20 died in the early postoperative period, and the possible risk factors for early postoperative death were analyzed in view of the surgical indication, surgical approaches, myocardial protection and postoperative management.</p><p><b>RESULTS</b>Of the 20 fatal cases, death occurred due to low cardiac output syndrome in 11 cases, respiratory failure in 4 cases, kidney failure or multiple organ failure in 3 cases, acute left heart failure in 1 case, and cerebrovascular accident in 1 case.</p><p><b>CONCLUSION</b>Young age at repair and poor development of the pulmonary vessels and left ventricle are high risk factors for postoperative low cardiac output syndrome. Postoperative death following surgical correction of TOF is associated mainly with the surgical skills and approaches. Appropriate cardiopulmonary bypass and effective measures for myocardial protection are critical to ensure the surgical success, and proper postoperative management and close monitoring may help reduce postoperative death in surgical patients with TOF.</p>

Time course change in the high mobility group box-1 after myocardial infarction in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the time course change in myocardial high mobility group box-1 (HMGB1) after myocardial infarction in rats.</p><p><b>METHODS</b>Myocardial infarction (MI) was induced in SD rats by ligation of the anterior descending coronary artery. At 1, 2, 4, and 8 weeks after MI, the cardiac function of the rats was examined, and the expressions of HMGB1 at mRNA and protein levels in the myocardium were detected using real-time RT-PCR and Western blotting, respectively.</p><p><b>RESULTS</b>Cardiac function test confirmed that the MI model was successfully induced. The expression of HMGB1 mRNA was increased in early stage (1 week) after MI, while significantly down-regulated in later stage (4-8 weeks after MI). HMGB1 protein showed a similar biphasic pattern of changes, and was up-regulated early (1-2 weeks) after MI (P<0.05) and decreased markedly (P<0.01) at 8 weeks.</p><p><b>CONCLUSIONS</b>As an inflammatory regulator, HMGB1 can modulate inflammatory response early time after MI and functions later as a transcriptional modulator, thus contributing to the myocardial repair after MI. Interventions targeting HMGB1 in different stages after MI may prove helpful in reducing the complications, improving the prognosis and promoting long-term survival.</p>

Effect of electromagnetic pulse exposure on permeability of blood-testicle barrier in mice / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the effect of electromagnetic pulse (EMP) exposure on the permeability of blood-testicle barrier (BTB) in mice.</p><p><b>METHODS</b>Adult male BALB/c mice were exposed to EMP at 200 kV/m for 200 pulses with 2 seconds interval. The mice were injected with 2% Evans Blue solution through caudal vein at different time points after exposure, and the permeability of BTB was monitored using a fluorescence microscope. The testis sample for the transmission electron microscopy was prepared at 2 h after EMP exposure. The permeability of BTB in mice was observed by using Evans Blue tracer and lanthanum nitrate tracer.</p><p><b>RESULTS</b>After exposure, cloudy Evans Blue was found in the testicle convoluted seminiferous tubule of mice. Lanthanum nitrate was observed not only between testicle spermatogonia near seminiferous tubule wall and sertoli cells, but also between sertoli cells and primary spermatocyte or secondary spermatocyte. In contrast, lanthanum nitrate in control group was only found in the testicle sertoli cells between seminiferous tubule and near seminiferous tubule wall.</p><p><b>CONCLUSION</b>EMP exposure could increase the permeability of BTB in the mice.</p>

Gene cloning and expression analysis of a male sterility related gene BoDHAR from broccoli / 生物工程学报

A differentially expressed cDNA fragment obtained from a cDNA-AFLP analysis, which performed on floral buds of male sterile and fertile lines of cabbage, was used as a querying probe to blast the Genbank and Arabidopsis databases. Based on the assembled homologous cDNA sequences, a full-length cDNA of 633 bp for BoDHAR was cloned by RT-PCR. Furthermore, we have experimentally cloned and sequenced the 5' flanking sequence of gene BoDHAR by genomic walking method based on ligation-mediated PCR. The full length DNA sequence with 1486bp, containing two introns, was achieved. Homologous analysis shows that gene has 82.3% identity at nucleotide level, and 79.6% identity at amino acid level with Arabidopsis dehydroascorbate reductase (DHAR) gene AT1 G19570.1. Structurally, BoDHAR encodes a polypeptide of 210 amino acids, which contains a GST-c-DHAR domain highly conserved among other members of the DHAR superfamily and has multiple phosphorylation sites. Promoter predictions software indicated that the 5' upstream region contained putative transcription signals and conserved sequences, one CAAT-box, one G-box and four TGAC-like motifs. To advance our understanding of gene BoDHAR, tissue expression pattern were analyzed by semi-quantitative RT-PCR. The results indicate that expression level of gene BoDHAR is higher in fertile buds than that in sterile buds, and expressed intensively in the anther.

Rapid Characterization of Recombination Clone by PCR Screening of Individual Bacterial Colonies / 微生物学通报

The recombination clones contained CFP, LTB-ST foreign gene were screening by PCR using individual bacterial colonies as template, the aimed band was amplified from positive clones, the result was as well as plasmid PCR. The selecting of agrobacterium transformed with recombination plasmid could also use this method of PCR screening of individual bacterial colonies. The result of individual bacterial colonies PCR was as well as that of PCR using bacterial solution as template. It showed that the method individual bacterial colonies PCR was an efficient, easy one that characterized recombination clones.