Preoperative Serum Fibrinogen is Associated With Acute Kidney Injury after Cardiac Valve Replacement Surgery.

Acute kidney injury (AKI) after open cardiac surgery is associated with a longer hospital stay and higher risk of mortality. We aimed to explore the association between preoperative serum fibrinogen level and risk of postoperative AKI in patients with open cardiac surgery. 3459 patients who underwent cardiac valve replacement surgery from January 2011 to September 2015 were recruited. The primary outcome was AKI, defined as AKI stage-1 or higher based on the Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines. Synthetic Minority Oversampling Technique (SMOTE) was used to subsample minority groups to eliminate classification bias. 510 (14.74%) patients developed postoperative AKI. Serum fibrinogen was independently associated with AKI (OR = 1.211, 95% CI 1.080 to 1.358, p = 0.001) after adjustment of covariates. The receiver operator characteristic (ROC) curve for the outcome of AKI, after the addition of serum fibrinogen, had a c-statistic increasing from 0.72 to 0.73 (p < 0.001). This translated to a substantially improved AKI risk classification with a net reclassification index of 0.178 (p < 0.001). After SMOTE subsampling, serum fibrinogen was still independently associated with AKI grade 1 or higher (OR = 1.212, 95% CI 1.1089 to 1.347, p = 0.003). Preoperative serum fibrinogen levels were associated with the risk of postoperative AKI after cardiac valve replacement surgery.

Efficacy of pemetrexed plus platinum doublet chemotherapy as first-line treatment for advanced nonsquamous non-small-cell-lung cancer: a systematic review and meta-analysis.

PURPOSE: To assess the efficacy of pemetrexed plus platinum doublet chemotherapy as first-line treatment for advanced nonsquamous non-small-cell lung cancer (NSCLC) through a trial-level meta-analysis. METHODS: Trials published between 1990 and 2015 were identified by an electronic search of public databases (Medline, Embase, and Cochrane Library). All clinical studies were independently identified by two authors. Demographic data, treatment regimens, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were extracted and analyzed using comprehensive meta-analysis software (version 2.0). RESULTS: A total of 2,551 patients with advanced nonsquamous NSCLC from ten trials were included for analysis: 1,565 patients were treated with pemetrexed plus platinum doublet chemotherapy and 986 with platinum plus other first-line chemotherapy. Pooled ORR for pemetrexed plus platinum chemotherapy was 37.8% (95% confidence interval [CI]: 31.7%-44.3%), with median PFS and OS of 5.7 and 16.05 months, respectively. When compared to other platinum-based doublet chemotherapies, the use of pemetrexed plus platinum chemotherapy significantly improved OS (hazard ratio [HR] =0.86, 95% CI: 0.77-0.97, P=0.01) but not PFS (HR =0.90, 95% CI: 0.80-1.01, P=0.084) in advanced nonsquamous NSCLC patients. CONCLUSION: Pemetrexed plus platinum doublet regimen is an efficacious treatment for advanced nonsquamous NSCLC patients. Our findings support the use of pemetrexed plus platinum doublet regimen as first-line treatment in advanced nonsquamous NSCLC patients because of its potential survival benefits.

Efficacy and potential microRNA mechanism for computed tomography-guided percutaneous radiofrequency ablation of primary lung cancer and lung metastasis from liver cancer.

BACKGROUND: The aim of this study was to evaluate comparatively the effectiveness of computed tomography-guided percutaneous radiofrequency ablation (CT-PRFA) for primary non-small cell lung cancer (NSCLC) and lung metastases from hepatocellular carcinoma (HCC) and to explore the potential miRNA mechanisms for the efficacy of CT-PRFA. METHODS: 14 patients pathologically diagnosed with NSCLC and 12 patients with lung metastases from HCC were enrolled in the study and underwent CT-PRFA. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease. Real-time RT-PCR was used to quantify the selected miRNAs known to be play key roles in lung cancer. RESULTS: A total of 21 tumors were treated with umbrella-tip electrodes and spiral-tip electrodes were used for the remaining 8 tumors. The median follow-up was 13.5 months (range, 3-30 months) and no patient was lost to follow-up. The rate of technique efficacy for primary tumors was ∼93% (13 of 14). Treatment was successful in 11 out of 12 (91.7%) lung metastases patients. Overall survival rate was 80.8% at 2 years, and cancer-specific survival rate was 100% at 2 years. The tumor-free survival was 69.2% at 1 year and 26.9% at 2 years. Before PRFA, tumor suppressor let-7a and miR-34a were downregulated whereas oncomiR miR-21 was upregulated in primary tumors, and let-7a and miR-126 levels were downregulated whereas oncomiRs miR-21, miR-155 and miR-17-5p/miR-20b levels were upregulated in secondary tumors. This abnormal expression was normalized by CT-PRFA. Most notably, CT-PRFA failed to normalize the deregulated miRNAs in the non-survivors. CONCLUSIONS: CT-PRFA is a effective treatment for primary NSCLCs and secondary lung tumors from HCC and the efficacy may be related to its ability to normalize deregulated expression of miRNAs: upregulating tumor suppressor miRNAs and downregulating oncomiRs.

Submitral left ventricular aneurysm: a rare disease in xanthoderm.

Submitral aneurysm is a rare cardiac disease, predominantly being diagnosed among the black Africans. A Chinese adult was admitted as submitral aneurysm of the left ventricle in our department recently. We present this case for its rarity among Xanthoderm.

Long-term outcome of correction of tetralogy of Fallot in 56 adult patients.

BACKGROUND: Although most patients with tetralogy of Fallot undergo radical repair during infancy and childhood, patients that remain undiagnosed and untreated until adulthood can still be treated. This study aimed to evaluate longterm outcomes of adult patients with tetralogy of Fallot who were treated surgically, and to determine the predictors of postoperative pulmonary regurgitation. METHODS: Fifty-six adult patients underwent complete surgical repair. Forty-three patients (76.8%) required a transannular patch. Systolic, diastolic, and mean pressure in the main pulmonary artery were measured after repair. RESULTS: The early mortality rate was 3.6%. The 16-year survival rate was (84.4 ± 11.5)%. Late echocardiography revealed 41 patients with transannular patch who had pulmonary regurgitation, consisting of mild pulmonary regurgitation in 28 patients, moderate in eight, and severe regurgitation in five patients. In addition, there was right ventricular outflow tract stenosis in nine patients, moderate/severe tricuspid valve regurgitation in seven, and residual ventricular septal defect in five. Logistic regression analysis demonstrated that the mean pulmonary pressure measured just after repair predicted late pulmonary regurgitation. CONCLUSIONS: The long-term survival of surgically treated adult patients with tetralogy of Fallot is acceptable. The mean pressure >20 mmHg in the main pulmonary artery measured right after surgical repair may be a feasible reference to time the reconstruction of the pulmonary valve.

MicroRNA-214 provokes cardiac hypertrophy via repression of EZH2.

Micro RNAs are small, non-coding RNA molecules that regulate gene expression via either translational inhibition or mRNA degredation. Enhancer of zeste homolog 2 (EZH2)-mediated hypertrophic signaling is a major regulatory response to hypertrophic stimuli. In this study, we constructed AAC rat models and PE-induced hypertrophic cardiomyocytes. We demonstrated that miR-214 relative levels were upregulated, whereas EZH2 was downregulated in both vivo and vitro models. Further, one conserved base-pairing site in the EZH2 3'-untranslated region (UTR) was verified. Mutation of the site in the EZH2 3'-UTR completely blocked the negative effect of miR-214 on EZH2, suggesting that EZH2 is a direct target for miR-214 regulation. Using a gain-of-function approach, incorporating the lentivirus constructed miR-214 and its sponge, we demonstrated that miR-214 significantly regulated endogenous levels of EZH2 gene expression; whereas, changes in the expression of the Sine oculis homeobox homolog gene were induced by an adrenergic receptor agonist in the AAC rat model. Having made this study it is possible to conclude that the negative regulation of EZH2 expression contributed to miR-214-mediated cardiac hypertrophy.

Intracardiac leiomyomatosis: a comprehensive analysis of 194 cases.

Intracardiac leiomyomatosis is rare but has been increasingly reported in recent years. Owing to its rarity, intracardiac leiomyomatosis has been reported only as isolated case reports and case series. This disorder is thought to be underestimated and easily overlooked in the clinic, while it is dangerous owing to the risk of sudden death caused by total outflow tract obstruction. We performed an electronic literature search for intracardiac leiomyomatosis and identified 194 cases that were reported in English from 1974 (the first reported case) to September 2012. Our aim is to provide a detailed and comprehensive review of the clinical presentation, diagnosis, histopathological characterization, treatment and prognosis of this disorder. According to our analysis, intracardiac leiomyomatosis is most common in the fifth decade, and the mean age of detection is ~50 years. Most patients had undergone previous hysterectomy/myomectomy or had a coexisting uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, syncope, oedema of the lower extremities and palpitation. Transoesophageal echocardiography, computed tomography and magnetic resonance imaging are helpful in the preoperative diagnosis and to guide the surgical management. Complete removal guarantees an excellent outcome, with no recurrence or postoperative death, while incomplete removal leads to recurrence in one-third of patients. Anti-oestrogen therapy is not imperative after incomplete removal owing to its inability to prevent recurrence.

One-stage complete removal of intracardiac leiomyomatosis without cardiac arrest.

We present here a woman with an intracardiac leiomyoma originating from uterine leiomyomatosis. The tumor was completely removed in a one-stage procedure using cardiopulmonary bypass without cardiac arrest. Most one-stage operations were performed with total circulation arrest; however, using of on-pump beating-heart technique when removing the intracardiac mass has seldom been reported in detail. The patient was asymptomatic with no evidence of recurrence on 13-month follow-up.

Elevated intraoperative expression of ventricular myosin light chain predicts heart failure after valve replacement surgery.

BACKGROUND: It can be difficult to predict which patients will survive and recover cardiac function after valve replacement surgery. We hypothesized that the expression levels of ventricular myosin light chain (MLCv) might reflect the severity of disease or the extent of irreversible myocardial damage and might be useful for predicting the postoperative course. Thus, the aim of this study was to explore the relationship between MLCv expression in specimens obtained during valve replacement surgery and the postoperative New York Heart Association (NYHA) class. METHODS: The levels of expression of the regulatory MLCv (MLC-2v) and MLC-1v in papillary muscle specimens from 80 patients who underwent valve replacement surgery for rheumatic valvular disease were evaluated by Western blot analysis. RESULTS: The patients were similar with regard to the intraoperative expression of MLC-1v, regardless of postoperative NYHA class. The preoperative NYHA class, the end-systolic left ventricular internal dimension, and the intraoperative expression of MLC-2v emerged as independent risks factors for a NYHA class status of III/IV at 6 months after surgery, with an area under the receiver operating characteristic curve of 0.862. CONCLUSION: The intraoperative level of MLC-2v expression was predictive of the patients' NYHA class after valve replacement surgery. This result suggests that future studies evaluating the use of preoperative specimens (such as biopsy or peripheral blood samples) for measurement of MLC-2v levels could lead to a valuable preoperative tool for the assessment of candidates for valve replacement.

[Effects of angiotensin converting enzyme inhibitor on the expression of angiotensin converting enzyme 2 in atrium of patients with atrial fibrillation].

OBJECTIVE: To investigate the expression of angiotensin converting enzyme 2 (ACE2) and the changes treated with angiotensin converting enzyme inhibitor (ACEI), and its signal transduction pathway. METHODS: Atrial tissues were obtained from 47 patients with RHD undergoing cardiac surgery. The mRNA of ACE2 and ACE were semi-qualified by RT-PCR and normalized to the gene beta-actin. Western blot analysis was employed to examine the expressions of ACE2, ACE, ERK1/2 and phosphorylated ERK (pERK1/2). The atrial tissue angiotensin II (Ang II) content was determined by radioimmunoassay detection. RESULTS: The expression of ACE2 was significantly decreased (P < 0.05), the expression of ACE and pERK1/2 were significantly increased (P < 0.05), and the level of atrial tissue Ang II was significantly increased in patients with chronic atrial fibrillation group (CAF) compared with sinus rhythm group (SR) (P < 0.05). Compared with CAF patients treated without ACEI, the expression of ACE2 significantly increased (P < 0.01), and the relative activity of ERK1/2 significantly decreased (P < 0.05), whereas the expression of ACE and the level of atrial tissue Ang II remained unchanged in CAF patients treated with ACEI. CONCLUSIONS: The study suggested that the dysequilibrium of ACE/ACE2 might play an important role in the process of atrial fibrillation, which may be related to the activation of ERK1/2 pathway. The clinical effect of long-term treatment of ACEI maybe associated with elevated ACE2 expression but not ACE expression.

Diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue lymphoma.

BACKGROUND: Primary non-Hodgkin's lymphoma in lung is very rare, and the most common among them is mucosa-associated lymphoid tissue lymphoma (MALToma), whose clinical features and laboratory characteristics are poorly defined, making diagnosis difficult. The purpose of this study was to study the diagnosis and treatment of pulmonary MALToma. METHODS: The clinical data of 12 patients treated for MALToma between August 1992 and December 2005 were analyzed. RESULTS: No specific symptoms or signs, or results of bronchoscopy, ultrasonagraphy or bone marrow examination could be found in the 12 patients. Only radiography was useful in diagnosis, though the final diagnosis of all the patients was based on histology and immunohistochemistry. Two patients also had gastric MALToma. Operations were performed on 6 patients, including 5 radical operations and 1 partial resection: 4 patients also received adjuvant chemotherapy. One patient experienced recurrence 152 months after the operation, while the other 5 patients have survived disease-free. Four patients were treated with chemotherapy alone, two of whom experienced complete remission and the others partial remission. The final 2 patients received no treatment and had survived for 7 and 27 months respectively. All the patients were still alive at the most recent follow-up, 7 to 160 months (mean 71.3 months). CONCLUSIONS: Except radiography, no specific clinical manifestations could be identified for pulmonary MALToma. The final diagnosis should be based on histology and immunohistochemistry. Several treatment methods can be used to achieve good outcomes.

Disseminated intravascular coagulopathy caused by intracardiac mesothelioma.

We report a case of intracardiac mesothelioma complicated by chronic disseminated intravascular coagulopathy in a 50-year-old woman. Her symptoms were completely relieved by emergency resection of the tumor. Primary resection of the intracardiac mesothelioma is adequate treatment for this complicated surgical problem.

[Surgical treatment of tricuspid valve disease combined with cardiac cachexia syndrome].

OBJECTIVE: To evaluate the surgical treatment of tricuspid valve disease combined with cardiac cachexia. METHODS: Seven patients with heavy tricuspid valve disease combined with cardiac cachexia underwent tricuspid valve replacement. Heart function and nutrition status were improved in the perioperative period. RESULT: All operations were performed successfully, but one patient died of heavy heart failure postoperatively. The mean follow-up length was 32 months, all patients had good heart function except one with minor right heart function failure. CONCLUSION: Prosthetic heart valve replacement is an effective treatment for patients with serious tricuspid valve disease combined with cardiac cachexia. The perioperative nutrition support and heart function improvement are important in the treatment process.

[Diagnosis and treatment of primary pulmonary mucosa-associated lymphoid tissue lymphoma].

OBJECTIVE: To study the diagnosis and treatment for primary pulmonary mucosa-associated lymphoid tissue lymphoma. METHODS: The clinical data of 12 patients with primary pulmonary mucosa-associated lymphoid tissue lymphoma from August 1992 to May 2005 were analyzed. RESULTS: All the patients survived during the follow-up periods of 6 to 164 months (mean 70.3 months). Gastric mucosa-associated lymphoid tissue lymphoma was found to coexist in 2 patients. No specific symptoms or signs, or specific results of bronchoscopy, ultrasonography or bone marrow examination were found in these patients, except that radiography showed nodules with blurred margins with characteristic air bronchogram. The final diagnosis was based on histology and immunohistochemistry. Surgical resection was performed for 6 patients, including 5 radical operations and 1 partial resection, among which 4 patients received adjuvant chemotherapy. Recurrence occurred in 1 patient 12.7 years after the operation, while the other 5 patients got disease free survival. Chemotherapy alone was administered for 4 patients, among whom 2 patients got complete remission and the others got partial remission. The other 2 patients received no treatment and had survived for 6 and 26 months respectively. CONCLUSIONS: Except for the radiographic findings, there were no specific clinical manifestations for primary pulmonary mucosa-associated lymphoid tissue lymphoma. The final diagnosis should be made by histology and immunohistochemistry. Surgery and chemotherapy can be adopted for the patients with good outcomes.