Efficacy comparison between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect.</p><p><b>METHODS</b>Two hundred and twenty patients with simple ventricular septal defect (except subarterial ventricular septal defect) were randomly divided into micro invasive group (n = 116) and traditional cardiopulmonary bypass surgery group (n = 104). Clinical data were collected and compared at baseline and at 3, 30 and 180 days after surgery.</p><p><b>RESULTS</b>Age, gender, body weight and ventricular septal defect type were similar between the two groups (all P > 0.05). Operation time and hospitalization duration were significantly shorter in the micro invasive group than the traditional cardiopulmonary bypass surgery group (all P < 0.05). The proportion of blood transfusion was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [2.59% (3/116) vs. 72.12% (75/104), P < 0.01]. Three days after surgery, incidence of mild and above tricuspid insufficiency was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [0.86% (1/116) vs. 2.88% (3/104), P < 0.05]. There was one patient developed mild pericardial effusion at 30 days post surgery in micro invasive group. There was no intracardiac infection in the two groups during follow-up. At 30 and 180 days post surgery, incidence of residual shunt was also less in micro invasive group than the traditional cardiopulmonary bypass surgery group [1.72% (2/116) vs. 7.69 (8/104) and 0(0/116) vs. 7.69(8/104), all P < 0.05]. After surgery for 3, 30 and 180 days, transthoracic echocardiography derived chamber size, left ventricular end-diastolic volume index and left ventricular ejection fraction were similar between the two groups (all P > 0.05).</p><p><b>CONCLUSIONS</b>The efficacy is similar for patients with simple ventricular septal defect (except subarterial ventricular septal defect) using micro invasive occlusion therapy or extracorporeal circulation surgery. Micro invasive occlusion procedure can shorten operation and hospitalization time, and reduce the need for blood transfusion and risk of developing procedural-related tricuspid insufficiency and post-procedural residual shunt.</p>

1,25(OH)(2)D(3) influences endothelial cell proliferation, apoptosis and endothelial nitric oxide synthase expression of aorta in apolipoprotein E-deficient mice / 中华儿科杂志

<p><b>OBJECTIVE</b>To study possible influences of 1,25(OH)(2)D(3) on endothelial cell proliferation, apoptosis and endothelial nitric oxide synthase (eNOS) expression of aorta in apolipoprotein E-deficient (apoE(-/-)) mice and to explore the relationship between vitamin D and atherosclerosis.</p><p><b>METHOD</b>Endothelial cell of aorta in apoE(-/-) mice were isolated and cultured, and the influence of 1,25(OH)(2)D(3) on endothelial cell proliferation were observed by MTT, apoptosis of cells were quantitated by terminal deoxynucleotidyl transferase mediated dUTP nick end labelling, Bcl-2 mRNA, fas mRNA and eNOS mRNA was detected by reverse transcription-polymerase chain reaction.</p><p><b>RESULT</b>Endothelial cell proliferation rate of aorta did not significantly change in the two control groups (0.162 ± 0.031 vs. 0.158 ± 0.006, P > 0.05). Compared with control groups, 1,25(OH)(2)D(3) stimulated endothelial cell proliferation of aorta (P < 0.05), but endothelial cell proliferation rate did not significantly change in different 1,25(OH)(2)D(3) concentration groups [1,25(OH)(2)D(3) concentration: 10(-4)mol/L, 10(-5) mol/L, 10(-6) mol/L, 10(-7) mol/L, 10(-8) mol/L, endothelial cell proliferation rate: 0.189 ± 0.013 vs. 0.285 ± 0.011 vs. 0.296 ± 0.026 vs. 0.284 ± 0.017 vs. 0.233 ± 0.010, P > 0.05]. 1,25(OH)(2)D(3) research concentration as chosen as 10(-6) mol/L. In 1,25(OH)(2)D(3) 10(-6) mol/L group, the expression of Bcl-2, eNOS mRNA was significantly increased (0.78 ± 0.16 vs. 0.46 ± 0.21 vs. 0.42 ± 0.17, 0.56 ± 0.16 vs. 0.39 ± 0.13 vs. 0.35 ± 0.11, 0.46 ± 0.2 vs. 10.42 ± 0.17 vs. 0.78 ± 0.16, 0.79 ± 0.21 vs. 0.81 ± 0.20 vs. 0.43 ± 0.12), apoptotic index, Fas mRNA was significantly decreased (15.14 ± 3.19 vs. 18.94 ± 4.22 vs. 19.27 ± 4.58, 0.43 ± 0.12 vs.0.79 ± 0.21 vs. 0.81 ± 0.20)(P < 0.05). The quantity of eNOS gene expression was inversely associated with apoptosis index and Fas mRNA, was positively associated with Bcl-2 mRNA (r = -0.676, -0.758, 0.762, P < 0.01).</p><p><b>CONCLUSION</b>1,25(OH)(2)D(3) stimulated endothelial cell proliferation, inhibited apoptosis and increased eNOS expression of aorta in apoE(-/-) mice. These results may deepen understanding of the pathogenesis of atherosclerosis.</p>

CT angiography-based simulation of the surgical approach in early operation for ruptured aneurysm / 南方医科大学学报

<p><b>OBJECTIVE</b>To simulate the surgical approaches for intracranial aneurysms using three-dimensional CT angiography (3D-CTA) and assess the value of 3D-CTA in early microneurosurgery for ruptured intracranial aneurysms.</p><p><b>METHODS</b>Forty-eight patients with spontaneous subarachnoid hemorrhage due to ruptured intracranial aneurysm were confirmed by early operation. All the patients were classified according to Hunt-Hess, including 11 of grade I, 29 of grade II, and 8 of grade III. CTA was performed before the operation and surgical simulation was conducted. The preoperative findings on CTA and the intraoperative findings were compared and the clinical value of cerebral 3D-CTA was analyzed.</p><p><b>RESULTS</b>Pre-operative 3D-CTA clearly displayed the location, size and shape of the aneurysms, the axis direction of the aneurysm apex and the width of aneurysm neck. The spatial relation between the parent aneutysm artery, the aneurysm, the peripheral vessels and the bony structures were also demonstrated. These findings were basically consistent with the intraoperative findings. The Glasgow outcome score was 5 in 41 patients, 4 in 4 patients, 3 in 2 patients, and 2 in 1 patient upon discharge from the hospital.</p><p><b>CONCLUSIONS</b>Preoperative 3D-CTA examination can simulate the surgery for ruptured aneurysms to help improve the surgical success rate.</p>

Early surgical treatment for infants with large atrial septal defects or ventricular septal defects complicated by pneumonia: experience of 39 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>This research reported the experience of early surgical treatment for infants with large atrial septal defects (ASD) or ventricular septal defects (VSD) complicated by pneumonia.</p><p><b>METHODS</b>Between January 2003 and January 2008, 39 infants with large ASD or VSD complicated by pneumonia were admitted to the Second Xiangya Hospital. Thirty-six patients underwent surgical repair within 7-10 days after pneumonia had been controlled. Mean age was 5.4+/-3.4 months and mean weight was 4.7+/-1.6 kg in the 36 patients. Three patients received conservative treatment due to uncontrolled lung infections.</p><p><b>RESULTS</b>Of the 36 patients, 33 had successful surgery and 3 (8.3%) died of serious low cardiac output (n=1) or respiratory failure due to congenital tracheostenosis (n=2). The 33 survivors showed normal growth and development in a 6 month-5 year follow-up. Of the 3 patients receiving conservative treatment, 1 died of cardiopulmonary failure and 2 were discharged after the symptoms had been improved.</p><p><b>CONCLUSIONS</b>With increasing medical experience and technique, early surgical operation may be performed with good outcomes in infants with large ASD or VSD complicated by pneumonia.</p>

Retrospective study on clinical application of biovalves in 52 cases / 中南大学学报(医学版)

OBJECTIVE@#To summarize the clinical application of bioprosthetic valve replacement.@*METHODS@#Fifty two patients, aged 13-73(52.4+/-14.0) years, underwent cardiac valve replacement with biovalves from June 2002 to June 2006 in our hospital. Fifty three tissue valve replacements combined with 8 mechanical valve replacements were performed. Other procedures were also carried out if appropriate, including bidirectional Glenn shunt in 1 patient with double outlet of right ventricle and pulmonary artery stenosis; interruption of accessory pathway in 1 patient with Wolff-Parkinson-White syndrome; coronary artery bypass graft in 5 with severe coronary artery disease; and atrial or ventricular repair in 4 with congenital septum defects.@*RESULTS@#One patient died in hospital due to multiple organ failure. The hospital mortality rate was 1.9%. The mean follow-up was 25 months. Two patients lost follow-up and the follow-up rate was 96%. Forty one patients returned to NYHA class I, 9 to class II, and 1 to class III. Echocardiography showed the implanted bioprosthesis functioned well without stenosis or regurgitation. There was no structural deterioration with freedom from thromboembolism and anticoagulant hemorrhage in all patients.@*CONCLUSION@#The efficacy of biovalves in heart valve replacement is satisfactory.

Mechanical ventilation treatment on acute respiratory distress syndrome in operations by cardiopulmonary bypass / 中南大学学报(医学版)

OBJECTIVE@#To explore the early diagnosis of acute respiratory distress syndrome (ARDS) and the mechanical ventilation treatment in operations of cardiopulmonary bypass.@*METHODS@#Thirty-four patients with acute respiratory distress syndrome were divided into the traditional ventilation strategy plus positive end expiratory pressure (PEEP) group (n=13) and the protective ventilation strategy group (n=21), and their diagnosis and treatment were reviewed.@*RESULTS@#The average ventilator-carrying time in the protective ventilation strategy group and the traditional ventilation strategy plus PEEP group was (4.8+/-2.1) and (7.2+/-3.6) days,and the mortality was 23.8% and 61.5% respectively. There was statistical significance in the 2 groups (P<0.05).@*CONCLUSION@#The key to ARDS is the early diagnosis and ventilation strategy. Protective ventilation strategy in treating ARDS is more effective than the traditional ventilation strategy plus PEEP, and it can obviously shorten the ventilator-carrying time and reduce the mortality of ARDS.

Surgical treatment of total anomalous pulmonary venous connection / 中南大学学报(医学版)

OBJECTIVE@#To summarize the surgical treatment of total anomalous pulmonary venous connection (TAPVC).@*METHODS@#We retrospectively analyzed 49 patients with TAPVC as follows: 37 patients with supra-cardiac type in which 35 received anastomoses between the rear wall of the left atrium and the common pulmonary vein and the other 2 received anastomoses between the rear edge of the left atrium roof and the common pulmonary vein; another 12 patients with cardiac type who were incised the upper edge of coronary sinus, connected the common junction of pulmonary veins with the left atrium to form a new left atrium, and repaired the atrial septal defect with a pericardial patch.@*RESULTS@#Forty-six patients recovered and 3 patients died. Thirty-eight patients were followed-up from 3 months to 8 years. The rest patients got fluent pulmonary vein drainage and their heart function resumed to NYHA I.@*CONCLUSION@#TAPVC patients should be operated on immediately at definite diagnosis. The fluency of the common pulmonary vein-left atrium anastomoses and proper postoperative care can ensure a satisfactory outcome.

Angiogenic effect of bone marrow mesenchymal stem cells transfected with human VEGF gene on myocardial infarcts in rats / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the angiogenic effect of the bone marrow mesenchymal stem cells (MSCs) transfected with human vascular endothelial growth factor (VEGF(165)) gene on myocardial infarcts in rats.@*METHODS@#The animal model of heart ischemic was established by ligating the left anterior descending coronary artery in Wistar rats. The ligated rats were divided into 4 groups (n=12 each), and 2 weeks later they were injected hVEGF-transfected MSC at the heart infarct zone (Group A), MSC (Group B), liposome-hVEGF gene plasmid (Group C), and medium (Group D). Four weeks after the injection, the capillary density of the infracted zone and the expression of human VEGF in vivo were examined.@*RESULTS@#Four weeks after the transplantation,the capillary density was significantly greater in Group A than that in Group B and Group D, slightly greater than that in Group C. The highest expression of hVEGF was Group A, and followed by Group C, Group B, and Group D.@*CONCLUSION@#MSC is helpful for the stable expression of hVEGF gene, and is an ideal cellular vehicle for VEGF genes.

Transfection of human VEGF165 gene into bone marrow mesenchymal stem cells in rats / 中南大学学报(医学版)

OBJECTIVE@#To create a method for transfecting human vascular endothelial growth factor165 (hVEGF165) gene into bone marrow mesenchymal stem cells (MSCs) in rats.@*METHODS@#MSCs of Wistar rats were isolated by density gradient centrifugation and purified based on their ability of adhesion to plastic. Detections of cell surface antigens, including CD34, CD45, CD44, and SH3, were performed using flow cytometry. MSCs' potential of differentiating into osteoblast and lipoblast in vitro was tested. The vector pcDNA(3.1)-hVEGF165 was transfected into MSCs with the liposome mediated method. The expression of hVEGF165 in the transfected cells was detected by enzyme linked immunosorbent assay (ELISA), reverse transcription-polymerase chain reaction (RT-PCR), and Western blot analysis.@*RESULTS@#The cultured MSCs were CD34-, CD45-, CD44+ , and SH+, which were differentiated into osteoblasts and lipocytes successfully. The expressed hVEGF165 in the transfected rat MSCs was demonstrated.@*CONCLUSION@#The vector pcDNA(3.1)-hVEGF165 is successfully expressed in MSCs.

Experimental study on establishing eukaryotic expression vector pcDNA3.1(+) TPA and its expressing activity in human skin fibroblists / 中南大学学报(医学版)

OBJECTIVE@#To establish a cell line stably expressing the tissue plasminogen activator (TPA) in human skin fibroblasts so as to develop the function analysis and gene therapy of TPA in ischemic heart diseases.@*METHODS@#Eukaryotic expression vector pcDNA3.1(+) TPA was constructed and transferred into human skin fibroblasts. After G418 selection, the exogenous expression and activity of TPA were observed subsequently by reverse transcription-polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA), and chromogenic substrate assay.@*RESULTS@#Eukaryotic expression vector pcDNA3.1(+) TPA was expressed effectively in human skin fibroblasts. Quantitative ELISA showed that the expression of TPA protein of the experiment group was much higher than that of the control group (643.5 ng/10(6) cells per 24 hours vs. 19.2 ng/10(6) cells per 24 hours). And the chromogenic substrate assay showed that the exogenous TPA activity of the experimental group was also much higher than that of the control group (122.6 U/10(6) cells per 24 hours vs. 5.8 U/10(6) cells per 24 hours).@*CONCLUSION@#The exogenous TPA gene can be expressed effectively after pcDNA3.1(+)TPA was transferred into human skin fibroblasts, suggesting that the cell model will become an important tool in the further study of TPA function and gene therapy in ischemic heart diseases.

Myocardial protective effects of pretreatment with captopril on ischemia-reperfusion myocardium in rabbits / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of pretreatment with captopril on myocardium ischemia-reperfusion injury in atherosclerotic rabbits.@*METHODS@#Thirty-two New Zealand white rabbits were assigned randomly to the normally feed group, cholesterol-feed (CF) group, and cholesterol food plus captopril group (cap-feed group), which were fed for 10 weeks. We examined the changes in the size of the infarct and changes in the myocardium ultrastructure resulting from coronary ischemia/reperfusion. Levels of endothelin (ET) and nitic oxide (NO) were measured in the different experiment stages.@*RESULTS@#The ET levels significantly increased and the content of NO significantly decreased in the CF group compared with those of the cap-feed group. The ultrastructure of myocardium cell was slightly destroyed and the infarct size was significantly smaller in the cap-feed group than the normally feed rabbits and CF rabbits.@*CONCLUSION@#The long-term captopril treatment can lighten the severity of myocardial injury produced by coronary ischemia/reperfusion.

Diagnosis and surgical treatment of 102 cases of ventricular septal defect with patent ductus arteriosus / 中南大学学报(医学版)

OBJECTIVE@#To summarize the experience of diagnosis and surgical treatment of ventricular septal defect with patent ductus arteriosus.@*METHODS@#We retrospectively analyzed the clinical data of 102 cases of ventricular septal defect combined with patent ductus arteriosus who underwent surgical treatment. Preoperative ultrasonic cardiogram (UCG) showed ventricular septal defect combined with patent ductus arteriosus in 82 cases and ventricular septal defect in 20 cases.@*RESULTS@#The hospital mortality was 4.9% (5/102). The reasons for death included low cardiac output syndrome (1 case), pulmonary hypertension crisis (2 cases) and respiratory failure (2 cases). In the remaining patients,the perioperative complications included lung infection (7 cases), pulmonary atelectasis (5 cases), hydrothorax (1 case), and pulmonary hypertension crisis (2 cases); and all the 15 patients recovered lastly. The pulmonary hypertension of all living patients decreased to some degree. The therapeutical effectiveness was satisfactory.@*CONCLUSION@#Ventricular septal defect with patent ductus arteriosus is easy to be confused with ventricular septal defect clinically. At the same time,it is diffcult to form a correct diagnosis in some patients by UCG preoperatively. To prevent the occurrence of perfusive lung, it is important to reinforce preoperative diagnosis and exploration during operation. Because pulmonary hypertension in patients with ventricular septal defect with patent ductus arteriosus emerges early and develops quickly, it tends to result in organic pulmonary hypertension which can make patients lose operation chances and influence the long-term therapeutical effect. Surgical operation should be performed as soon as possible. Optimal operative timing and proper perioperative management play important roles in surgical results.

Surgical treatment of partial atrioventricular septal defect / 中南大学学报(医学版)

OBJECTIVE@#To summarize the experience of surgical treatments of partial atrioventricular septal defect in 60 patients.@*METHODS@#From April 1999 to April 2004, 60 patients of partial atrioventricular septal defect were operated. Fifty-eight patients were performed with suture of the cleft of mitral valve and the other 2 were given mitral valve replacement; For closure of primum ASD, 53 patients with pericardial patches and 7 with Dacron patches. Coronary sinus was baffled to left atrium with kirklin procedure in 35 cases and baffled to right atrium with McGoon procedure in other 25 cases. Correct the accompanying cardiac deformity at the same time.@*RESULTS@#The hospital mortality was 3.3% (2/60) due to low cardic output syndrome. The incidence rate of complete atrioventricular block was 8.00% (2/ 35) in the group with Kirklin procedure and 6.06% (2/25) in the group with McGoon procedure. There was no statistical significance between the 2 groups (P > 0.05). The follow-up was from 1 month to 5 years, and there was no late death. All cardiac function were improved except middle mitral regurgitation in 1 patient.@*CONCLUSION@#Reasonable operative design, refined procedures, avoiding damage to conducting bundles and proper perioperative management are the key points in improving theraeutic effect.

Apolipoprotein E gene expression in peripheral blood monocyte in children with obesity / 中华儿科杂志

<p><b>OBJECTIVE</b>Coronary heart disease (CHD) is one of the most common causes of death in the world. Some studies suggested that CHD begins in childhood. Obesity and dyslipidemia are important risk factors of coronary heart disease. Apolipoprotein (apo)E gene associated with dyslipidemia and coronary heart disease. The present study was designed to investigate the expression status of apoE gene in peripheral blood monocyte and association of apoE gene expression with lipids in children with obesity.</p><p><b>METHODS</b>Among 32 children with obesity and 32 healthy children without obesity or overweight, ApoE gene expressions were determined by competitive reverse transcription-polymerase chain reaction in peripheral blood monocyte. The concentrations of plasma triglyceride, total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, lipoprotein(a), apoA I, apoB(100) and apoE were measured.</p><p><b>RESULTS</b>Expression of apoE gene was detected in peripheral blood monocyte. Expression of apoE gene was significantly reduced in children with obesity as compared with control group (0.29 +/- 0.14 moles/mole GAPDH mRNA vs. 0.36 +/- 0.10 moles/mole GAPDH mRNA, t = 2.15, P < 0.05). The more severe was the degree of obesity, the more significantly reduced the expression of apoE gene; the degree of obesity was negatively correlated with the levels of expression of apoE gene (correlation coefficient = -0.40, P < 0.05). Compared with control group, the levels of triglyceride, total cholesterol, low density lipoprotein-cholesterol, and apoB(100) were higher, and those of high density lipoprotein-cholesterol, apoA I and apoE were lower in children with obesity [(1.68 +/- 0.50) mmol/L vs. (0.99 +/- 0.54) mmol/L, (4.47 +/- 0.91) mmol/L vs. (3.33 +/- 0.90) mmol/L, (2.23 +/- 0.71) mmol/L vs. (1.13 +/- 0.96) mmol/L, (94.48 +/- 9.97) mg/dl vs. (83.81 +/- 15.64) mg/dl, (1.47 +/- 0.39) mmol/L vs. (1.73 +/- 0.36) mmol/L, (112.71 +/- 27.86) mg/dl vs. (134.80 +/- 45.36) mg/dl, (24.50 +/- 10.92) mg/L vs.(35.07 +/- 9.79) mg/L, respectively, P < 0.05]. ApoE gene expression was associated with plasma lipids metabolism in children with obesity. The quantity of apoE gene expression was inversely associated with low density lipoprotein-cholesterol, positively correlated with apoE (correlation coefficient = -0.33, 0.35, respectively, P < 0.05). The quantity of apoE gene expression was not associated with total cholesterol, triglyceride, high density lipoprotein-cholesterol, lipoprotein(a), apoA I, and apoB(100) (correlation coefficient = -0.19, -0.11, 0.16, 0.09, 0.18, 0.22, P > 0.05).</p><p><b>CONCLUSION</b>Expression of apoE gene was significantly reduced in peripheral blood monocyte in children with obesity. The quantity of apoE gene expression was associated with degree of obesity and abnormality of blood lipids.</p>