Clinical application of autologous platelet separation in different time courses of cardiovascular surgery / 中国医师杂志

Objective:To investigate the clinical significance of autologous platelet separation (APS) in different time courses of cardiovascular surgery.Methods:The relevant data of 75 patients with cardiovascular surgery from September 2019 to August 2021 in Hunan Provincial Peoples′ Hospital were collected retrospectively. They were divided into two groups according to whether APS was used during the operation: group A used APS (37 cases) and group B did not use APS (38 cases). The two groups were divided into subgroups according to the length of cardiopulmonary bypass (CPB): A1 and B1 were medium and short-term groups (CPB bypass time ≤200 min), and A2 and B2 were long-term groups (CPB bypass time >200 min). Blood routine, postoperative drainage volume, postoperative blood product infusion volume and thromboelastogram at different time points were recorded and compared.Results:The postoperative drainage volume, red blood cell infusion volume and ventilator assisted time in group A were less than those in group B (all P<0.05); The postoperative drainage volume [(645.79±205.25)ml vs (886.67±360.96)ml, P=0.006], erythrocyte infusion volume [(3.24±2.53)U vs (4.77±1.97)U, P=0.016], platelet infusion volume [0.00(0.00, 0.00)U vs 1.00(0.125, 2.00)U, P=0.002] and thromboelastogram coagulation reaction time [(7.38±1.74)min vs (9.09±3.57)min, P=0.047] in group A2 were significantly better than those in group B2 (all P<0.05); There were no significant difference in the above indexes between A1 and B1 group (all P>0.05). Conclusions:APS can improve the coagulation function of patients undergoing cardiopulmonary bypass and reduce the amount of bleeding and blood products. Its protective effect is more prominent in high-risk cardiovascular surgery with long cardiopulmonary bypass and complex operation.

Myocardial protection using del Nido cardioplegia solution in severe valvular surgery / 中国医师杂志

Objective:To discuss the safety and effectiveness of del Nido cardioplegia solution in severe valvular surgery.Methods:A retrospective analysis of 138 patients of severe valvular disease underwent valve replacement or valvuloplasty in Hunan Provincial People′s Hospital between July 2019 and December 2020 was performed. According to the different cardioplegic solution used, patients were separated in two groups: the del Nido cardioplegia group (D group, n=73) and the St. Thomas cardioplegia group (C group, n=65). The perioperative clinical results of the two groups were compared to evaluate the safety and effectiveness of del Nido cardioplegia in the operation of severe valvular disease. Results:Preoperative characteristics were similar between the two groups, including gender, age, body weight, ejection fraction, and myocardial markers ( P>0.05). No statistical differences were noted in cardiopulmonary bypass time, clamp time, mechanical ventilation time, vasoactive drug use time, ICU and hospital stay time, and ejection fraction before discharge ( P>0.05). However, the times of cardioplegia perfusion [(1.33±0.47)times vs (4.08±0.48)times] and the total perfusion time [(3.96±1.41)min vs (13.15±1.46)min] in group D were lower than those in group C, while the automatic rebound rate (90.41% vs 76.92%) was higher than that in group C ( P<0.05). Both groups successfully completed the operation. There were no serious complications of important organs such as low cardiac output, brain, liver and kidney during and after the operation. There were no deaths during hospitalization, and all patients were cured and discharged. Conclusions:There was no significant difference in myocardial protection between del Nido and St. Thomas cardioplegia solution in severe valvular surgery. The application of del Nido cardioplegia could reduce the frequency of perfusions and total perfusion time.

Effect of room temperature irrigating fluid in the perioperative period of transurethral resection of prostate / 中国基层医药

Objective To compare the effects of the different temperature of lavage fluid on the vital signs of the patients during the perioperative period of transurethral resection of prostate (TURP). Methods From June 2016 to June 2017,56 patients received TURP treatment in the First People's Hospital of Linhai were randomly selected. The patients were divided into the observation group and the control group by the random number method, with 28 cases in each group. All patients underwent TURP under continuous epidural anesthesia. The lavage fluid of the observation group was heated and kept at 37℃ . In the control group,the lavage fluid was not heated,the temperature was about 21℃ . The related indicators between the two groups were compared. The changes of 30min,45min and 60min mean arterial pressure (MAP),heart rate (HP),body temperature (T) and blood oxygen saturation (SaO2) in the two groups were observed before and during operation,and the hypothermia in two groups was compared. Results There were no statistically significant differences in the operation time,dosage of lavage fluid,weight of the resection of prostate tissue and amount of bleeding during the operation between the two groups(all P > 0. 05). At preoperation and intraoperative 30min,there were no statistically significant differences in MAP,HP,T,SaO2 between the two groups. At intraoperative 45min,60min,MAP levels in the observation group were (92. 14 ± 8. 63) mmHg, (92. 06 ± 8. 19) mmHg,respectively,which were significantly higher than those in the control group [(85. 33 ± 9. 01)mmHg,(79. 26 ± 9. 84)mmHg] (P < 0. 05). At intraoperative 45min,60min,the HR in the observation group were (79. 45 ± 8. 64) / min,(79. 50 ± 9. 06) / min,respectively,which were significantly higher than those in the control group [(72. 47 ± 8. 21) / min,(65. 44 ± 7. 10) / min] (all P < 0. 05). At intraoperative 45min,60min,T in the observation group were (36. 42 ± 0. 16)℃ ,(36. 12 ± 0. 20)℃ ,respectively,which were significantly higher than those in the control group [(36. 40 ± 0. 14)℃ ,(35. 84 ± 0. 23)℃ ] (P < 0. 05),but SaO2 had no statistically signif-icant difference between the two groups(P > 0. 05). The incidence rates of low temperature,induced arrhythmia in the observation group were 3. 57％ ,0. 00％ ,respectively,which were significantly lower than those in the control group (35. 71％ ,25. 00％ )(χ2 = 7. 240,P = 0. 007;χ2 = 5. 878,P = 0. 015). The incidence rates of low temperature, induced arrhythmia of patients over 75 years old in the observation group were 5. 26％ ,0. 00％ ,respectively,which were significantly lower than those in the control group(44. 44％ ,33. 33％ ) (χ2 = 4. 766,P = 0. 029,χ2 = 4. 667, P = 0. 031). Conclusion The irrigating solution maintained at room temperature can significantly improve the vital signs,reduce hypothermia and induced arrhythmia in patients.

Poorly differentiated endocardial sarcoma: a case report / 临床儿科杂志

Objective To explore the diagnosis and treatment of poorly differentiated endocardial sarcoma. Method The clinical data of a child with poorly differentiated endocardial sarcoma was retrospectively analyzed. Results One-year-old girl was admitted for diarrhea, polypnea, cyanosis, and cough. Abnormal heart sound was found by auscultation. Leads Ⅱ, Ⅲ, and aVF of ECG showed high peaked P wave. The diagnosis of poorly differentiated endocardial sarcoma was confirmed by echocardiography and pathology after cardiac operation. Three months after discharge from the hospital, the patient suddenly came into coma and died. Conclusion The diagnosis of poorly differentiated endocardial sarcoma is mainly based on clinical manifestations, echocardiography and pathology. Surgical resection is the first choice and chemotherapy and radiotherapy play a supporting role. However, there is no cure for it currently.

Study on the risk factors that are related to gastroesophageal reflux disease / 中国医师杂志

Objective To investigate the pathogenesis of gastroesophageal reflux (GERD) diseaserelated risk factors.Methods A questionnaire survey of 1213 patients in our hospital gastroenterology clinic visits was conducted,including irregular feeding time,eating too full,eating before going to bed,like greasy food,spicy food and alcohol consumption,and smoking.The results of the investigation were rated;95 patients were selected as the observation group,another 30 healthy volunteers were selected as the control group.Esophageal and gastric pressures were measured on the observation group and control subjects,respectively.Results Multivariate logistic regression analysis showed that often eating to satiety (OR =11.5322,P =0.0135),before going to bed eating (OR =14.6537,P =0.0005),like greasy food (OR =11.6547,P =0.0089),spicy food (OR =12.5674,P =0.0031),heavy drinking (OR =10.9874,P =0.0003),and smoking (OR =10.3846,P =0.0013) were important factors affecting the incidence of GERD; length of lower esophageal sphincter (LESL) mean of the observation group was (3.27 ±0.29)cm,intragastric pressure (GP) mean (1.63 ± 1.12) kPa,lower esophageal sphincter pressure/intragastric pressure (LESP/GP) =0.55 ±0.41,LESP-GP mean (-0.33 ±0.34) kPa,with the control group [(3.90 ± 0.42) cm,(1.12 ± 0.94) kPa,1.72 ± 0.82,(0.88 ± 0.41) kPa] were statistically significant (t' =8.99,P ＜0.05,t =2.43,P ＜0.05,t' =8.18,P ＜0.05,t =7.91,P ＜0.01).Conclusions Eating too full,eating before going to bed,like greasy food,spicy food,heavy drinking,smoking,and other bad diet and lifestyle were important risk factors of GERD.The lower esophageal sphincter dysfunction and esophageal clearance capacity play important role in the pathogenesis of gastroesophageal reflux disease.

The use of pulmonary valve biorifice to reconstruct right ventricular outflow tract in tetralogy of Fallot / 中国医师杂志

ObjectiveTo introduce a new technique to create a pulmonary valve biorifice for reconstruction of right ventricular outflow tract in tetralogy of Fallot (TOF),and to summarize its initial clinical experience and therapeutic effect.MethodsThe new technique regarding reconstruction of right ventricular outflow tract with a pulmonary valve biorifice was used in a total of 53 TOF cases (the observation group).The conventional technique regarding reconstruction of right ventricular outflow tract was used in other 50 TOF cases (the control group).The clinical dates of all cases were reviewed retrospectively.ResultsThe ages,weights,cardiopulmonary bypass time,cardiac arrest time,as well as the post operation ventilation support time were not different significantly between two groups.Compared with the contrul group,patients from the observation group had shorter duration of ICU stay.After operation,in the observation group,only 2 cases had large amount of pleural effusion,1 case meddle,and 8 cases little amount of pleural effusion; whereas,in the control group,the corresponding numbers were 1,5 and 17,respectively.At the time point of 1 week after operation,all patients were rechecked by echocardiography,no pulmonary valve stenosis was found.Moderate pulmonary valve regurgitation was found in 8 cases,mild regurgitation in 15 cases from the observation group; and severe regurgitation in 3 cases,moderate regurgitation in 17 cases,and mild regurgitation in 16 cases from the control group.A total of 33 cases from the observation group were rechecked at the time point of half year after operation,and moderate - mild pulmonary regurgitation were found in 3 cases.A total of 18 cases of them were rechecked 1 - year latter,no pulmonary regurgitation was found.ConclusionsThe new technique to create pulmonary valve biorifice can reduce the pulmonary valve regurgitation and postoperative pleural effusion,and improve the early outcomc.

Changes of plasma corticotrophin releasing factor levels in the young rats with hypoxic-ischemic brain damage / 中国小儿急救医学

Objective To explore the changes of plasma corticotrophin releasing factor (CRF) levels in the young rats with hypoxic-ischemic brain damage.Methods Two hundred and forty young rats were randomly divided into three groups:hypoxic-ischemic brain damage group ( model group,n =80),sham-operated group ( n =80),and normal control group ( n =80).The plasma CRF levels of rats in three groups were detected at 1 h,3 h,6 h,12 h,l d,3 d,5 d and 18 d after hypoxia-ischemia,per ten rats for each time point.Plasma CRF levels were measured by radioimmunoassay.Results Plasma CRF levels of model group,shamoperated group and normal control group showed no significant difference in the young rats after 1 h,3 h,6 h,12 h of hypoxia-ischemia ( P ＞ 0.05 ).But plasma CRF levels in the model group were respectively significantly lower than those of sham-operated group and normal control group after 1 d and 3 d of hypoxia-ischemia ( P ＜0.001 ),and then recovered to the control group levels after 5 d and 18 d of hypoxia-ischemia ( P ＞0.05 ).Conclusion Hypoxia-ischemia affects plasma CRF levels in the young rats,which is related with the duration after hypoxia-ischemia.

Limb ischemic preconditioning reduce myocardial ischemia reperfusion injury for infants undergoing cardiac operation / 中国医师杂志

Objective To study the feasibility and safety of limb remote ischemic preconditioning (RIPC) in infants and explore the protective effect on myecardium ischemia reperfusion injury for infants undergoing cardiac operation under cardiopulmonary bypass. Methods 60 infants weight less than 7 kilograms with ventricular septal defect were enrolled into the study. 30 of them (RIPC group) were ischemic preconditioned two times (24 hours and 1 hour preoperatively) by three cycles of iscbemia (5 minutes for each) and reperfusion on the left upper arm using a blood pressure cuff. Serum lactate dehydrogenase (LDH), creatine kinase (CK) and its isoenzyme (CK-MB), and tro-ponin I (TnI) ; malondialdehyde (MDA) and superoxide dismutase (SOD) was preoperatively detected. The expression of heat shock pro-tein 70 (HSP 70) in cardiomyocytes was determined by western blot analysis. The surgical outcome including limb movement and sensory function was also recorded. Results No limb disability or sensory disturbance or no other surgical complications was found in all infants. LDH, CK, TnI at the beginning of operation in RIPC group was higher than those in control group. After operation, leakage of heart enzymes were attenuated in RIPC group, and the serum concentration of enzymes were lower than those in the control group. The RIPC group had low coronary sinus venous concentration of MDA but high SOD. The expression of HSP70 was upregulated in cardiomyocytes of RIPC group. Conclusion The limb RIPC can be done easily and safety in infants, and BIPC can reduce the leakage of myocardial enzymes and upregu-late the expression of HSP, which possess protective effect on myocardial IRI.

Effects of bone marrow mesenchymal stem cell transplantation transfected with vascular endothelial growth factor gene on angiogenesis in rat myocardial infarcted area / 中国组织工程研究

BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) as a genetic carrier are beneficial to keep a genetic stability of exogenous gene. BMSCs can transfer human vascular endothelial growth factor (hVEGF) gene into the myocardial infarcted area. It is possible to obtain a cooperation of gene and cell therapy. OBJECTIVE: To investigate the angiogenesis at myocardial infarcted area of rats undergoing the transplantation of BMSCs transfected with hVEGF gene and in vivo expression of VEGF gene. DESIGN, TIME AND SETTING: A randomized control experiment was performed at the Institute of Paediatrics of Hunan Children's Hospital and Central Laboratory of Xiangya Second Hospital of Central South University from 2004 to 2007. MATERIALS: Male clean inbred strain Wistar rats were selected in the study. Rat models of myocardial infarction were established by ligation of coronary artery. METHODS: BMSCs were harvested from rats by density gradient centrifugation and adherent culture. Plasmid PeDNA3. 1-hVEGF 165 were transfected at 80%-90% cell confluence. Rat models of myocardial infarction, constructed by ligation of the left anterior descending coronary artery, were randomly divided into 4 groups. 2 weeks after the ligation,BMSCs transfected with hVEGF gene were injected into rat models in the combination group at the myocardial infarction zone. BMSCs were injected into cell group. Liposome-pcDNA3.1-VEGF165 DNA compound was injected into gene group. Culture medium was injected into control group. MAIN OUTCOME MEASURES: Capillary density and VEGF gene expression in the myocardial infarcted area of rats in each group four weeks after injection. RESULTS: Capillary density was the highest at rat myocardial infarcted area in the combination and gene groups, followed by the cell group (P=0.001, 0.029) and the control group (P=0.028).Reverse transcriptase-polymerase chain reaction (RT-PCR) showed that the hVEGF165 gene was expressed in the combination, gene, cell and control groups from higher level to lower level in order. CONCLUSION: BMSCs as the vector of VEGF gene are beneficial to its stable expression.Transplantation of BMSCs transfected with hVEGF gene is helpful for angiogenesis at myocardial infarcted area of rats. Its outcome is better than gene or cell therapy alone.

Optimization of enzymatic resolution technique of glycidyl butyrate via response surface methodology / 生物工程学报

Our previous work has indicated that enzymatic resolution of glycidyl butyrate are strongly affected by many factors, including concentration of substrate, amount of lipase, the temperature, pH, shaking speed and reaction time. In this study, Plackett-Burman design was undertaken to evaluate the effects of the six factors. By regression analysis, concentration of substrate, amount of lipase and the temperature were found to be important for enzymatic resolution of glycidyl butyrate. In the second phase of the optimization process, a response surfacemethodology (RSM) was used to optimize the above critical factors, and to find out the optimal concentration levels and the relationships between these factors. By solving the quadratic regression model equation using appropriate statistic methods, the optimal parameter of the variables were determined as: 0.499 mol/L glycidyl butyrate, 30.23 mg/g lipase and 29.68 degrees C. In the optimum condition, the value of enantiomeric excess(ee%) was 93.28%. Compared to 84.65% which was the maximum ee% under the non-optimized condition, this study has a significant advancement. The experimental data under various conditions have validated the theoretical values.

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 pcDNA3.1-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 pcDNA3.1-hVEGF165 is successfully expressed in MSCs.

Experimental study on establishing eukaryotic expression vector pcDNA3.1(+)TPA and its expressing activity in human skin fibroblasts / 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 hours). And the chromogenic substrate assay showed that the exogenous TPA activity of the experimental group was also much higher than that of the 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.

Experience of Operation for Complicated Patent Ductus Arteriosus / 中国医师杂志

Objective To investigate the operative procedure for complicated patent ductus arteriosus.Methods 87 cases of complicated patent ductus arteriosus who received operation from Oct 1993 to Aug 2001 were studied retrospectively.Results Operations supported by cardiopulmonary bypass for closure of complicated patent ductus arteriosus and other concomitant cardiothoracic procedures were performed on the all patients at the same time. There were 5 cases of deaths, with dead rate of 5 7%, which mainly caused by heart failure. 82 survivals were followed up at mean period of 3 years and 7 months, and no operative complications occurred.Conclusions Closure for complicated patent ductus arteriosus with correction of concomitant cardiothoracic malformation supported by cardiopulmonary bypasss is a effective treatment of complicated patent ductus arteriosus.