Intraoperative autologous based blood conservation strategies in mitral valve replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate whether intraoperative autologous donation (IAD) can reduce perioperative blood transfusion for patients underwent mitral valve replacement (MVR).</p><p><b>METHODS</b>A total of 318 patients received implementation of IAD from January 2011 to December 2013 were analyzed retrospectively, and compared with 517 patients of the previous 36-month period (from January 2008 to December 2012). The method of small-volume retrograde autologous priming, strict blood transfusion standard along with IAD together constituted a progressive blood-saving strategy. Statistical methods including Students' t-test, Pearson's χ(2) test, Kruskal-Wallis analysis and multivariate Logistic regression model were used for comparisons of the data.</p><p><b>RESULTS</b>There were no significant difference between IAD group and non-IAD group considering preoperative patient demographics, characteristics and preoperative comorbidities. However, IAD group significantly reduced number of patients transfused with intra/post-operative packed red-blood cell (PRBC) (55(17.0%) vs. 215 (42.1%), χ(2)=53.0, P=0.000), and had significantly reduced postoperative chest tube output (150(380) ml vs. 700(660) ml, H=195.648, P=0.000), length of stay ((16±6) d vs. (20±8)d, t=9.60, P=0.000). But hematocrit were lower in IAD group (30%±5% vs.33%±4% at end of operation, t=7.76, P=0.000; 30%±4% vs. 32%±5% at discharge, P=0.000, t=3.86). Multivariate logistic aggression analysis revealed that age, IAD and smoking history were factors influencing the probability of intra or postoperative blood transfusion.</p><p><b>CONCLUSION</b>Implementation of blood conservation strategies based on intraoperative autologous donation in mitral valve replacement surgery can significantly reduce intra/postoperative blood transfusion as well as postoperative complications.</p>

Preconditioning with 3-nitropropionic acid reduces myocardial apoptosis induced by ischemia-reperfusion injury / 中华急诊医学杂志

Objective To investigate the effects of preconditioning with 3-nitropropionie acid on myocardial apoptosis induced by ischemia-reperfusion injury.Method Twenty-four rabbits were randomly divided into control group(group C,n=8),precondition group(group 3-NPA,n=8)and 5-HD group(group 5-HD,n=8).The group 5-HD was treated intravenously with 5 mg·kg-1 5-HD(ATP-sensitive potassium channels blocker),group C and group 3-NPA received normal saline instead of 5-HD.Ten minutes later,5-HD group and 3-NPA group were injected with 3-NPA(3 mg·kg-1)and the group C was injected with normal saline.Twenty-four hours later,the left anterior descending coronary artery was ligated for 30 min and then unclamped for 120 min to estabhsh ischemi-a-reperfitsion injury model.After reperfusion,the infarct sizes of ventricular myocardium,apoptotic myocardial cells and the expressions of Bcl-2 and Bax protein were measured.Results Infarct sizes and apoptotic myocardial cells in group 3-NPA were less than those in the others(P＜0.01).The expressions of Bcl-2 in group 3-NPA.in-creased as compared with group C(P＜0.05)and group 5-HD(P＜0.05),whereas the expressions of Bax in group 3-NPA decreased as compared with group C(P＜0.05)and group 5-HD(P＜0.05).Conclusions Preconditioning with 3-nitmpropionie acid reduces myocardial apoptosis induced by isehemia-reporfusion injury which is attributed to the opening of mitochondrial KATP channels.

Apico-thoracic retro-aortic anastomosis in radical operation for esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the result of surgical treatment of the middle and upper-middle esophageal carcinoma with a new operation, performing the anastomosis posterior to the aortic arch at the apex of the thoracic cavity.</p><p><b>METHODS</b>From April 1996 to May. 2000, 179 patients with esophageal carcinoma were treated. Sixty-eight of these patients (49 in the middle and 19 in the upper-middle segment) were treated by esophogogastrostomy at the top of the chest, posterior to the aortic arch. There were squamous cell carcinoma 50, adenocarcinoma 16, undifferentiated carcinoma 2, including 8 double-primaries. The lesions were stage I 9 and stage II-III 59.</p><p><b>RESULTS</b>All patients have been alive after follow-up of 2 months to 3 years. Without any positive margins, anastomotic leak or perioperative death, this new method has merits: 1. Length of esophagus resected was maximal through one single incision. It would be especially useful for some of the upper-middle lesions. 2. This new method requires a shorter transposed stomach than that required by the combined triple cervico-thoraco-abdominal approach. 3. As the site of thoracic stomach was on the bed of esophagus, there was less chance of post-operative embarrassment in respiration due to the dilatation of the transpositioned stomach and pylorostenosis, etc. 4. There would be less chance of reflux esophagitis because of the "blocking" by the aortic arch, thereby, the patients life is improved.</p><p><b>CONCLUSION</b>This radical operation for esophageal carcinoma with anastomosis at top of the thoracic cavity posterior to the aortic arch, being a newly designed surgical method, is especially useful for carcinoma in the middle and upper-middle esophageal segment.</p>

Experimental Study of ex vivo Liposome-mediated Gene Transfer in Orthotopic Rat Left Lung Transplantation / 中国医师杂志

Objective To determine the feasibility of ex vivo liposome-mediated gene transfer ( Lac-Z gene ) to lung isografts and to get expression. Methods An orthotopic rat left lung transplant model was developed with the use of a modification of the “cuff” technique. 18 SD rats were divided into three groups randomly. Gene transfer group ( group 1 ): PSV-?-gal/ liposome ( Lipofectin R○ ) complex was transfered into the donor left lung via the left pulmonary vein route at the time of lung harvesting. Liposome group ( group 2 ) and Control group ( group 3 ) : Grafts underwent the same procedure but received liposome and 0 9% saline solution respectively. Donor lungs were harvested one day after transplantation. The transgene expression of Lac-Z gene was detected by histochemical staining. Results Transgene expression of ?-gal in group 1 was detected in bronchial epithelial cells and alveolar epithelial cells. But no expression of ?-gal was found in groups 2 and 3. Conclusion Ex vivo plasmid vector/liposome complex-mediated gene transfer to lung isografts via the left pulmonary vein route is feasible. This study provides the scientific proof to the feasibility of functional gene therapy of complications such as ischemia-reperfusion injury, rejection and infection after rat lung transplantation.

Experimental study on ex vivo gene transfer intracoronarily to donor heart / 中华器官移植杂志

ObjectiveTo study the feasibility of ex vivo gene transfer to donor heart by delivering i ntracoronarily a reporter gene (Lac-Z gene) to donor heart at the time of trans plantation.MethodsThe model of heterotopic heart transplantation in murine was established and the method of perfusing intracoronarily was performed. Twelve male BALB/c mice were divided into 2 groups randomly: gene-transfer group (group 1) and control grou p (group 2). In group 1, plasmid vector (PSV-?-gal containing Lac-Z gene)/li posome (DOSPER) was perfused intracoronarily into each donor heart at the time o f transplantation. In group 2, normal saline was perfused. Donor hearts were har vested 3 days after transplantation. Freezing sections were made for detection o f the transfer and expression of Lac-Z gene by histochemical staining (X-gal). ResultsThe expression of Lac-Z gene was detected in the donor hearts of group 1. In tw o donor hearts, the expression of Lac-Z gene was detectable in the myocardial c ells in the mid-layer of ventriculus; In one donor heart the expression was fou nd in the myocardial cells under epicardium. But no expression of Lac-Z gene wa s detected in donor hearts of group 2.ConclusionEx vivo gene transfer intracoronarily to donor heart in the form of plasmid vector /liposome complex at the time of transplant ation is feasible.