Acute Type A Aortic Dissection during Late Pregnancy Period in a Patient with Marfan's Syndrome / 日本心臓血管外科学会雑誌

A 34-year-old female with a gestational age of 38 weeks developed acute type A aortic dissection. Appearance of this patient was typical for Marfan's syndrome, and echocardiography revealed annulo-aortic ectasia with mild aortic regurgitation, but pericardial effusion was absent. As her hemodynamic condition was stable, an emergency Caesarean section was carried out first. After careful observation in the ICU for half a day, she successfully underwent aortic valve reimplantation and replacement of the ascending aorta under deep hypothermic circulatory arrest. Intraoperative heparin use minimally impacted uterine bleeding. Both the mother and the neonate were discharged home 16 days later. We believe a two-stage strategy should be adopted whenever possible.

Expression of mitofusin 2 in IgA1-induced glomerular mesangial cell proliferation and association with a valsartan-induced inhibitory effect on hyperplasia / 中国医师杂志

Objective To observe glomerular mesangial cells (GMCs) proliferation induced by IgA1 and the association with the expression of apoptosis-related proteins-B cell lymphoma-2 (Bcl-2),cysteine aspartic acid protease-3 (Caspase-3),cysteine aspartic acid protease-9 (Caspase-9) and with mitofusin 2 (Mfn2) in rat GMCs,to study the possible mechanism of valsartan inhibiting rat GMCs proliferation,and to provide a new direction for the mechanism of GMCs proliferation and intervention research in IgA nephrology (IgAN).Methods GMCs stimulated with IgA1 were cultured in vitro to detect cellproliferation with the cell counting kit-8 cell activity assay (CCK8).GMCs were divided into three groups:CG,TG and VG.The GMCs proliferation level was detected by the CCK8,using real-time PCR to detect Mfn2 expression and Western blotting to detect protein levels of Mfn2,Bcl-2,Caspase-3,and Caspase-9.Results Rat GMCs proliferated significantly after stimulation with IgA1,and IgA1 could obviously stimulate high expression of Bcl-2 in GMCs and down regulate the expression of Mfn2,Caspase-3,and Caspase-9.Valsartan could inhibit the proliferation of GMCs induced by IgA1 significantly,downregulate the expression of Bcl-2,and upregulate the expression of Mfn2,Caspase-3,and Caspase-9.Conclusions These results showed that the mechanism of action of valsartan in the treatment of lgAN is inhibiting the proliferation of GMCs.This mechanism may be associated with the regulation of apoptosis-related proteins,such as Mfn2,Bcl-2,Caspase-3,and Caspase-9.These findings may provide a new direction for the mechanism of GMCs proliferation and intervention research in IgAN.

Influence of Aae Autotransporter Protein on Adhesion and Biofilm Formation by Aggregatibacter actinomycetemcomitans

Abstract The periodontopathogen Aggregatibacter actinomycetemcomitans colonizes oral cavity by binding to and invading epithelial cells as well as by participating in biofilms formed on hard surfaces. Aae, an autotransporter protein, is implicated in bacterial adhesion to epithelial cells. Due to the multiple functions of bacterial autotransporter proteins, this study aimed to evaluate the role of aae in A. actinomycetemcomitans ability to adhere to both saliva-coated hydroxyapatite (SHA) and biofilm. An aae null mutant was constructed. Its hydrophobic properties as well as its ability to adhere to epithelial cells, SHA and to form biofilm were evaluated and compared with the parental strain, A. actinomycetemcomitans VT1169. The aae null mutant showed reduced hydrophobicity, as well as decreased binding to SHA and biofilm formation compared to the parental strain. These data suggest that aae mediates A. actinomycetemcomitans adhesion to epithelial cells and may be involved in biofilm formation and interaction with adsorbed salivary proteins.

Resumo O peridontopatógeno Aggregatibacter actinomycetemcomitans coloniza a cavidade oral aderindo e invadindo as células epiteliais e participando da formação de biofilme em superfícies duras. Aae, uma proteína autotransportadora está relacionada com a adesão bacteriana às células epiteliais. Devido às múltiplas funções desempenhadas por proteínas bacterianas autotransportadoras, este estudo teve como objetivo avaliar o papel de aae de A. actinomycetemcomitans tanto na capacidade de aderir à hidroxiapatita recoberta por saliva (SHA), quanto a de formar biofilme. Um mutante nulo aae foi construído. Suas propriedades hidrofóbicas, bem como a sia capacidade para aderir às células epiteliais, à SHA e para formar biofilme foram avaliadas e comparadas com a cepa -mãe, A. Actinomycetemcomitans VT1169. O mutante nulo aae apresentou redução de hidrofobicidade, assim como diminuição da adesão à SHA e na formação de biofilme, quando comparado à cepa parental. Estes dados sugerem que aae media a adesão de A. Actinomycetemcomitans às células epiteliais e pode também estar envolvida na formação de biofilme e na interação com proteínas salivares adsorvidas.

Concomitant Repair of Annuloaortic Ectasia, Aortic Regurgitation, and Pectus Excavatum in Marfan Syndrome / 日本心臓血管外科学会雑誌

Marfan syndrome may include cardiovascular disease co-exising with thoracic deformities. A 24 year-old man given a diagnosis of Marfan syndrome and annuloaortic ectasia (AAE), aortic regurgitation (Ar) and pectus excavatum, was referred to our hospital due to the rapid dilatation of a root aneurysm. Chest computed tomography showed a root aneurysm measuring about 60×55 mm in diameter with mild Ar. Moreover, the sternum, which had been displaced in a posterior direction, contacted with the root aneurysm and heart. The heart was deviated to the left, because of compression from the sternum. We performed a concomitant repair of AAE and Ar and pectus excavatum with partial sternal turnover and elevation, and Bentall procedure. First, median skin incision was made, and dissected to the sternum. The ribs and cartilage below the third rib were cut, and the sternum was transected at the two-thirds point. The root aneurysm and heart were visible so it was easier to operate than a post median sternotomy. A cardiopulmonary bypass was established by ascending aortic perfusion, right atrial drainage and pulmonary arterial venting. The Bentall procedure was done using a Carrel patch methods. The removed sternum was formed flat and turned over, and sternum elevation was perfomed using sternal wire, after cutting and removing the excess ribs and costal cartilage. The postoperative course was uneventful with good hemodynamic and respiratory function. Concomitant surgery provides good operative exposure, which can avoid accidental aneurysm laceration, although operation time is longer and operative invasion and bleeding are greater than in staged operations.

One-Staged Operation for Stanford Type A Aortic Dissection, AAE, Mitral Valve Regurgitation and Pectus Excavatum in a Patient with Marfan's Syndrome / 日本心臓血管外科学会雑誌

A 22-year-old man was hospitalized due to severe back pain having being diagnosed as Stanford type A aortic dissection, AAE, mitral regurgitation and pectus excavatum associated with Marfan's syndrome. A single staged operation including ascending aortic replacement, mitral valve replacement and sternal turnover with a rectus muscle pedicle was carried out in order to keep the blood supply to the plastron to reduce the risk of infection during such a long operation. By this approach, it was found that the operative field was excellent and postoperative hemodynamics were stable. However, frail plastron occurred because of difficulties in keeping the patient stabilized because of severe pain thus re-fixation was required. The necessity of strong pain control after such an operation was also recognized.

One-Stage Operation of Annulo Aortic Ectasia Complicated with Acute Aortic Dissection of Stanford Type B / 日本心臓血管外科学会雑誌

A 51-year-old man was admitted with symptoms of sudden back pain and abdominal pain. Echocardiography and aortagraphy demonstrated enlargement of the aortic annulus, aortic regurgitation and Stanford type B aortic dissection. Since an entry of the aortic dissection was located at the root of the left subclavian artery, a one-stage operation consisting of aortic root replacement and total arch replacement was scheduled. The aortic root replacement using Piehler's modification was first performed followed by total arch replacement combining with the closure of the entry in the distal aortic arch was followed under selective cerebral perfusion. All procedures were complished through median sternotomy. The postoperative course was uneventful and aortography showed good reconstruction of the coronary arteries and the cervical arteries and thrombo-exclusion of the false lumen in the descending aorta. This method was useful for in this case of annulo aortic ectasia with Stanford type B aortic dissection.