Overexpression of sirtuin 1 attenuates calcium oxalate-induced kidney injury by promoting macrophage polarization.

Sirtuin 1 (SIRT1) protein is involved in macrophage differentiation, while NOTCH signaling affects inflammation and macrophage polarization. Inflammation and macrophage infiltration are typical processes that accompany kidney stone formation. However, the role and mechanism of SIRT1 in renal tubular epithelial cell injury caused by calcium oxalate (CaOx) deposition and the relationship between SIRT1 and the NOTCH signaling pathway in this urological disorder are unclear. This study investigated whether SIRT1 promotes macrophage polarization to inhibit CaOx crystal deposition and reduce renal tubular epithelial cell injury. Public single-cell sequencing data, RT-qPCR, immunostaining approaches, and Western blotting showed decreased SIRT1 expression in macrophages treated with CaOx or exposed to kidney stones. Macrophages overexpressing SIRT1 differentiated towards the anti-inflammatory M2 phenotype, significantly inhibiting apoptosis and alleviating injury in the kidneys of mice with hyperoxaluria. Conversely, decreased SIRT1 expression in CaOx-treated macrophages triggered Notch signaling pathway activation, promoting macrophage polarization towards the pro-inflammatory M1 phenotype. Our results suggest that SIRT1 promotes macrophage polarization towards the M2 phenotype by repressing the NOTCH signaling pathway, which reduces CaOx crystal deposition, apoptosis, and damage in the kidney. Therefore, we propose SIRT1 as a potential target for preventing disease progression in patients with kidney stones.

Etiology of 305 cases of refractory hematospermia and therapeutic options by emerging endoscopic technology.

To investigate the surgical outcomes of vesiculoscopy on refractory hematospermia and ejaculatory duct obstruction (EDO), the clinical data (including pelvic magnetic resonance imaging (MRI) examinations and the long-term effects of endoscopic treatment) from 305 patients were analyzed. Four main etiologic groups were found on MRI. We found that 62.0% (189/305) of patients showed abnormal signal intensity in MRI investigations in the seminal vesicle (SV) area. Cystic lesions were observed in 36.7% (112/305) of the patients. The third sign was dilatation or enlargement of unilateral or bilateral SV, which were observed in 32.1% (98/305) of the patients. The fourth sign was stone formation in SV or in an adjacent cyst, which was present in 8.5% (26/305) of the patients. The transurethral endoscopy or seminal vesiculoscopy and the related procedures, including fenestration in prostatic utricle (PU), irrigation, lithotripsy, stone removal, biopsy, electroexcision, fulguration, or transurethral resection/incision of the ejaculatory duct (TURED/TUIED), chosen according to the different situations of individual patients were successfully performed in 296 patients. Fenestrations in PU+ seminal vesiculoscopy were performed in 66.6% (197/296) of cases. Seminal vesiculoscopy via the pathological opening in PU was performed in 10.8% (32/296) of cases. TURED/TUIED + seminal vesiculoscopy was performed in 12.8% (38/296) of cases, and seminal vesiculoscopy by the natural orifices of the ejaculatory duct (ED) was performed in 2.4% (7/296) of cases. Electroexcision and fulguration to the abnormal blood vessels or cavernous hemangioma at posterior urethra were performed in 7.4% (22/296) of cases. Two hundred and seventy-one patients were followed up for 6-72 months. The hematospermia of all the patients disappeared within 2-6 weeks, and 93.0% of the patients showed no further hematospermia during follow-up. No obvious postoperative complications were observed. The transurethral seminal vesiculoscopy technique and related procedures are safe and effective approaches for refractory hematospermia and EDO.

Expression Status of PIWIL1 as a Prognostic Marker of Colorectal Cancer.

The PIWI-like protein 1 (PIWIL1) plays a crucial role in stem cell proliferation, embryogenesis, growth, and development, as well as differentiation and maturation in multiple organisms. The relationships between PIWIL1 expression and clinicopathological features of colorectal cancer (CRC) patients were analyzed by us. Survival analysis was performed using the Kaplan-Meier method and Cox's proportional hazards model. The high expression rate of PIWIL1 in the cancer tissue was obviously higher than that in the corresponding adjacent tissue. The expression of PIWIL1 was closely related to the tumor differentiation degree, infiltration depth, lymphovascular invasion, lymph node metastasis, and TNM stage. The Kaplan-Meier survival model suggested that the survival time of CRC patients in the high PIWIL1 expression group was notably lower than that in the low PIWIL1 expression group. High PIWIL1 expression suggests a poor prognosis for CRC patients, and PIWIL1 can serve as an important molecular marker for predicting the prognosis of CRC patients.

[Effect of A Novel Emodin Derivative on Chronic Myelogenous Leukemia K562 Cells and Imatinib-resistant K562/G01 Cells].

OBJECTIVE: To explore the effect of a novel emodin derivative E19 on proliferation inhibition and apoptosis induction of human chronic myelogenous leukemia (CML) cell line K562 and imatinib-resistant CML cell line (K562/G01), and to clarify the involved mechanisms. METHODS: MTT and colony formation test were used to detect the cell proliferation. Apoptotic induction effects were examined by DAPI staining method and DNA ladder assay. Western blot was performed to detect the changes of P210(Bcr-Abl) protein. RESULTS: The emodin derivative E19 could efficiently inhibit proliferation and induce apoptosis in K562 and K562/G01 cells. IC50 of K562 cells and IC50 of K562/G01 cells were (1.20 ± 0.19) µmol/L and (1.22 ± 0.16) µmol/L, respectively. DNA fragmentation in K562 cells and K562/G01 cells confirmed that the E19 induced apoptosis in dose-dependent manner. Western blot showed that emodin derivative inhibited phosphorylation of P210 protein in K562 cells and K562/G01 cells and down-regulated the expression level of P210 in dose- and time-dependent manners. CONCLUSION: The emodin derivative E19 can efficiently inhibit growth and induce apoptosis of K562 cells and K562/G01 cells, while the inhibition of phosphorylation of P210 protein and down-regulation of P210 protein expression may be involved in these processes.

Transurethral endoscopic treatment of seminal vesicle cysts (report of seven cases).

OBJECTIVE: Seminal vesicle cysts are a rare disorder of the male reproductive system. The goal of this report was to summarize the radiological manifestations and transurethral endoscopic treatment of large seminal vesicle cysts. MATERIALS AND METHODS: The clinical data of seven cases of giant seminal vesicle cysts, including their symptoms, radiological images, transurethral endoscopic treatment, and postoperative follow-up, were retrospectively reviewed. RESULTS: Computerized tomography and magnetic resonance imaging (MRI) demonstrated the cysts behind the bladder, above the prostate, and away from the midline. The lesions ranged in size from 8.26 cm × 7.98 cm × 4.85 cm to 9.27 cm × 8.95 cm × 8.15 cm. Two cases were associated with ipsilateral renal and ureteral agenesis and were classified as congenital malformations. The other five cases were simple seminal vesicle cysts thought to be secondary to acquired ejaculatory duct obstruction. All seven cases were successfully treated using transurethral endoscopic unroofing with cautery of the mucosa. All the seminal vesicle cysts were confirmed by pathologic examination. No malignant disease was found. All preoperative symptoms resolved after surgery. No complications were observed. No patient developed abnormalities of erection, ejaculation, or orgasm. No bladder or rectal injuries were noted. The seminal vesicle cysts were significantly decreased in size or absent 3-6 months after treatment. CONCLUSION: MRI best characterized seminal vesical cysts and their cause. Transurethral unroofing with cautery of the mucosa is an extension of well-accepted cystoscopic techniques. It is safe, easy to perform, and effective. It is the preferred method for the treatment of large seminal vesicle cysts.

Penetrating injury of the vagina, bladder and omentum in a woman with 5 months gestation: case report and review of the literature.

Intra-peritoneal bladder and visceral injuries from impalement of the perineum in women are exceedingly rare. This kind of injury has not been previously reported in a pregnant woman. The evaluation and surgical management of a pregnant woman is a challenging surgical problem. Preoperative evaluation of the uterus and fetus is balanced with minimal use of radiographic studies. Multiple organs can be damaged with this type of injury, necessitating careful evaluation and operative planning. We report a rare case of transvaginal impalement injury with through-and-through bladder rupture and intra-peritoneal injury in a 5 months pregnant woman. We discuss diagnostic and management strategies and review the literature.

[Long-term effects of permanent pacemaker implantation on tricuspid valve regurgitation].

OBJECTIVE: To explore the long-term effects of permanent pacemaker implantation (PPI) on tricuspid valve regurgitation (TR) in Chinese patients so as to determine the incidence and related factors, evaluate its effects on heart structure and function and ascertain the exact mechanism of TR after PPI. METHODS: A total of 430 patients undergoing permanent pacemaker replacement at our hospital between January 2000 and June 2011 were recruited. The patients with isolated atrial lead implantation procedures, significant heart valve disease or chronic obstructive pulmonary disease were excluded. The data of 108 patients who had Doppler echocardiograms performed before the first pacemaker implantation procedure and this pacemaker replacement procedure were obtained and retrospectively analyzed. According to the post-implant grade of TR, the patients were divided into two groups: normal tricuspid (n = 79) and abnormal tricuspid (n = 29). Their clinical characteristics and echocardiographic data between two groups were analyzed and compared. RESULTS: The mean follow-up time (from the first pacemaker implantation) was (13 ± 6) years (range: 4 - 34). Among 108 patients with initially normal tricuspid post-implant, 29 patients (26.9%) developed significant TR during the follow-up. In comparison to those in normal tricuspid group, the patients in abnormal tricuspid group had a longer time from the first pacemaker implantation ((16 ± 7) vs (12 ± 5) years, P = 0.003), more transtricuspid leads (1.31 ± 0.66 vs 1.10 ± 0.30, P = 0.026), larger right atrial size ((38 ± 7) vs (35 ± 4) mm, P = 0.028) and higher prevalence of mild TR and mitral valve regurgitation (MR) pre-implantation (TR: 21% vs 4%, P = 0.015, MR: 28% vs 5%, P = 0.003). The size of right atrium, right ventricle and left atrium in abnormal tricuspid group were more than those in normal tricuspid group. The prevalence of significant MR post-implantation in abnormal tricuspid group was higher than that in normal tricuspid group. The ejection fraction in abnormal tricuspid group was lower than that in normal tricuspid group during the follow-up. CONCLUSIONS: Abnormal TR after PPI during a long-term follow-up is quite common. The related factors include the time interval from the first pacemaker implantation, number of transtricuspid lead, right atrial size, mild TR and MR pre-implantation.

[Early and midterm outcomes of coronary artery bypass grafting in octogenarians].

OBJECTIVE: To investigate the early and midterm postoperative outcomes and analyze risk factors of coronary artery bypass grafting (CABG) in octogenarians. METHODS: Clinical data of 38 patients aged 80 years or greater receiving isolated coronary artery bypass grafting from September 2001 to November 2010 were reviewed. There were 33 male and 5 female patients, aging from 80 to 87 years with a mean of (82.6 ± 1.2) years. Twelve patients underwent conventional (on-pump) CABG and 26 patients underwent off-pump CABG. The number of bypass grafts was 1 to 5 (mean 2.5 ± 1.1). Left internal mammary artery was used in 37 (97.3%) patients. RESULTS: The perioperative mortality was 2.6% (1/38). Postoperative complications included stroke (4 cases), respiratory infection (1 case). The atrial arrhythmias occurred in 25 patients. Intensive care unit and hospital length of stay lasted (3.8 ± 1.4) days and (15 ± 6) days, respectively. Totally 38 patients were followed up for 4 to 70 months. Six patients died during the follow-up period. The 92.6% patients recovered without any cardiac events. CONCLUSIONS: Isolated CABG can be performed safely with acceptable postoperative morbidity and mortality in octogenarians. Appropriate surgical strategy and intensive perioperative treatment must be enhanced in octogenarians who underwent CABG.

[Impact of prior percutaneous coronary intervention on outcome of coronary artery bypass graft surgery].

OBJECTIVE: To determine the impact of prior percutaneous coronary intervention (PCI) on outcome of coronary artery bypass graft (CABG) surgery. METHODS: Perioperative data were collected from 1306 patients undergoing CABG from January 2002 to November 2010, including 117 patients with prior PCI and 1 189 patients without prior PCI. Among 117 patients with prior PCI, 99 patients had a single PCI procedure and 18 had multiple PCI procedures. The surgical outcomes including in-hospital mortality and major adverse cardiac events were compared between two groups. RESULTS: Patients with prior PCI were younger, less likely to have triple vessel and left main stem disease, and less recent myocardial infarction. Interval time between PCI and CABG was (13.39 ± 13.81) months. There were no significant difference in in-hospital mortality (1.7% compared with 0.5 % P=0.156) and major adverse cardiac events (including postoperative myocardial infarction, stroke, and in-hospital death,2.6% compared with 1.1% P=0.167) between two groups. CONCLUSION: There was no association between prior PCI and isolated CABG. Good outcomes can be obtained in the group of patients undergoing CABG who have had previous PCI.

[Acute kidney injury early after cardiac surgery with cardiopulmonary bypass: clinical analysis].

OBJECTIVE: To explore the occurrence of acute kidney injury (AKI) in early stage after cardiac surgery under cardiopulmonary bypass (CPB) and discuss the perioperative risk factors and its impact on clinical outcome. METHODS: Retrospective analysis was performed among 1472 adult patients undergoing cardiac surgery with CPB between January 2008 and April 2011. The postoperative occurrence of AKI following cardiac surgery was stratified according to the RIFLE criteria. And the perioperative risk factors of AKI and its impact on clinical outcome were analyzed. RESULTS: AKI occurred in 437 patients (29.7%) within 72 hours postoperation. Of these, 292 (19.8%) fulfilled AKI-Risk, 110 (7.5%) AKI-Injury and 35 (2.4%) AKI-Failure. Logistic regression analysis showed that age, hypertension, chronic renal insufficiency, reoperation, aortic surgery, CPB duration, intraoperative transfused erythrocyte volume and perioperative use of intra-aortic balloon pump were independent risk factors for AKI. A postoperative elevation of AKI level was associated with a prolonged duration of mechanical ventilation, intensive care unit stay, postoperative hospital stay, delayed extubation, extubation failure and death. Receiver operator characteristic (ROC) curve showed that AKI classification was a postoperative predictor of delayed extubation, extubation failure and death. CONCLUSION: As a common complication after cardiac surgery, AKI is associated with many perioperative risk factors. And the AKI classification is predicator of delayed extubation, extubation failure and death.

Surgical treatment of isolated right-sided infective endocarditis.

We reviewed our department's experience with the perioperative features and surgical treatment of isolated right-sided infective endocarditis. From January 2000 through July 2010, 35 patients underwent surgery for isolated right-sided infective endocarditis in our department. The mean pathologic course was 3.6 months. Preoperative transthoracic echocardiography had revealed intracardiac vegetations in all 35 patients: the tricuspid valve was involved in 28, and preoperative cultures were positive in 31. The median follow-up time was 5.8 years, and the follow-up rate was 85.3%. All the operations were performed with the patients on cardiopulmonary bypass, with or without cardiac arrest. All concomitant congenital heart defects were repaired, and vegetations and foreign materials were removed as part of intensive débridement of the infected area. After vegetation removal, 4 tricuspid valve replacements with tissue valves and 24 tricuspid valve reconstructions were performed. One patient who underwent tricuspid valve replacement died of uncontrollable infection and multiple-organ failure. Two patients required mechanical ventilation for more than 1 week, and 3 needed dialysis for acute renal failure. Of the excised vegetations, 31.4% were positive for microorganisms. Of the patients who underwent tricuspid valvuloplasty, 23 had no valvular incompetence and 11 had mild or moderate regurgitation before discharge from the hospital. During follow-up, no patient needed reoperation because of reinfection, and 1 underwent reoperation for severe tricuspid regurgitation. We conclude that surgery can yield satisfactory immediate and midterm results in the treatment of isolated right-sided infective endocarditis.

[Effects of peri-operative intra-aortic balloon pump support in high EuroSCORE patients undergoing cardiac surgery].

OBJECTIVE: To analyze the effects of perioperative intra-aortic balloon pump (IABP) support in EuroSCORE high-risk patients undergoing cardiac surgery, and evaluate the risk factors associated with mortality and midterm survival. METHODS: Fifty-eight patients with EuroSCORE of no less than 6 underwent cardiac surgery and received peri-operative IABP support, including 29 with preoperative IABP support, 21 with intra-operative IABP support, and 8 with postoperative IABP support. The patients who survived the surgeries were followed up for at least 1 year. RESULTS: Complications related to IABP support occurred in 2 cases (3.45%). The in-hospital mortality was 6.89% (4/58) in this series. Patients with intra-operative IABP had a lower ejection fraction, and those with pre-operative IABP showed more frequent unstable angina and recent myocardial infarction. The number of emergency procedures was also significantly higher in patients with pre-operative IABP support. Patients with intra- or postoperative IABP support had a longer ICU stay. The 1-year follow-up was completed in 54 patients and 4 deaths were recorded, with a 1-year survival of 86.21%. The 1-year survival rate was significantly higher in patients with preo- and intra-operative IABP support than those with post-operative IABP. CONCLUSION: Peri-operative IABP support benefit cardiac support for cardiac surgery, and its preoperative use does not increase the surgical risk. Early prophylactic IABP support according to the EuroSCORE can improve the outcome of the high-risk cardiac surgery.

Effects and mechanisms of non-restrictive external stent for prevention of vein graft restenosis in a rabbit model.

BACKGROUND: Among various treatments preventing vein graft restenosis, external stent is receiving more and more attention. This study aimed to investigate the effect of non-restrictive external stent on the prevention of vein graft restenosis and the potential mechanisms of platelet-derived growth factor (PDGF) in the process of restenosis. METHODS: Thirty-six "New Zealand white rabbits" were randomly divided into two groups, stented group (group S) and control group (non-stented group, group NS). Each rabbit underwent a reversed autologous external jugular vein into common carotid artery bypass grafting. In group S, the vein grafts were surrounded by a non restrictive stent which was 6 mm in diameter (a kind of Dacron vascular prosthesis); and in group NS, there was no stent to support the vein grafts. The grafts were harvested at the first week (1W), second week (2W) and fourth week (4W) after surgery respectively. The dimensions (including the thickness and area of the intima and media, luminal area) were measured by computer-aided image analysis system, and the intimal hyperplasia ratio was defined as the percentage of the area enclosed by the internal elastic lamina occupied by the intima. RESULTS: At 1W, the difference of the thickness and area of the intima between groups S and NS was not significant (P > 0.05); at 2W and 4W, the thickness and area of the intima and the intimal hyperplasia ratio in group S were less significant than those in group NS (P < 0.05); from 1W to 4W, the thickness and area of the media in group S were smaller than those in group NS (P < 0.05). Immunocytochemistry staining of PDGF-B showed that the percentage of positive cells of intima in both two groups was peaked at 2W, and a significantly smaller percentage was detected in group S compared with that in group NS at 2W and 4W (P < 0.05); the percentage of PDGF-B positive cells of media in both two groups was also peaked at 2W, and that in group S was smaller than that in group NS from 1W to 4W (P < 0.05); and the percentage of PDGF-B positive cells of adventitia in group S was peaked at 4W, whereas the percentage of adventitia in group NS peaked at 2W, and the percentage of adventitia in group S was greater than in group NS at 4W (P < 0.05). CONCLUSIONS: Non-restrictive external stenting inhibits the hyperplasia of the intima and media of the vein grafts and reduces the thickness and area of the intima and media; Non-restrictive external stenting inhibits the synthesis of PDGF and changes its distribution, and then inhibits the hyperplasia of the intima.

[Analysis on the risk factors of intracardial thrombus after prosthetic valve replacement: a 1-year follow-up study].

OBJECTIVE: To analysis the risk factors predicting intracardial thrombus after prosthetic valve replacement. METHODS: The clinical data of 29 cases from January 2005 to April 2009 with intracardial thrombus after prosthetic valve replacement during a 1-year follow-up was retrospectively analyzed. There were 11 male and 18 female, aged from 12 to 70 years with a mean of 48 years. The risk factors of intracardial thrombus were examined by univariate and multivariate analysis. RESULTS: Univariate analysis found that bioprosthetic valve replacement, anticoagulation using aspirin, valve replacement at mitral position, atrial fibrillation, preoperative and postoperative internal diameter of left atrium, postoperative fibrinogen were predict factors of intracardial thrombus after prosthetic valve replacement (P < 0.05). Logistic regression analysis showed valve replacement at mitral position (OR = 9.815, P < 0.05), atrial fibrillation (OR = 5.267, P < 0.05), preoperative internal diameter of left atrium (OR = 4.529, P < 0.05) were significant risk factors of intracardial thrombus after prosthetic valve replacement. CONCLUSIONS: Valve replacement at mitral position, atrial fibrillation, and preoperative internal diameter of left atrium are the correlated risk factors of intracardial thrombus after prosthetic valve replacement. Anticoagulation after prosthetic valve (especially bioprosthetic valve) replacement should be standardized to prevent intracardial thrombus formation.

[The empirical study on paracrine communication of bone marrow mesenchymal stem cells].

OBJECTIVE: To study the influence of (60)Co gamma exposure on paracrine effect of marrow mesenchymal stem cells (MSC). To evaluate the function and construction after early stage of acute myocardial infarction (AMI) by injection of supernatant liquid. To discuss the mechanism of prarcrine communication initially. METHODS: MSC were radiated by (60)Co gamma with different dosage. The culture solution was collected peri-irradiation. The changes of Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), Interleuki-1beta (IL-1beta) in supernatant liquid were checked by ELISA. Using a rat model of AMI, the supernatant liquid and control medium were injected intramyocardially and intraperitoneally according to the project. After 4 weeks, the cardiac dimension and functions were assessed, the microvessel density were detected. RESULTS: Three cytokines decreased significantly after irradiation, with the increasing in dosage of irradiation, the secretory volume of cytokines decreased greatly. When compared with the control group (group A 6.6 +/- 0.6) and medium group (group C 5.7 +/- 0.7), the microvessel density in supernatant liquid group (group B 10.8 +/- 2.9) increased obviously, contributing to improvement in cardiac function and dimension. (Left ventricular internal dimension in diastolic (LVDd) postoperation: A 8.1 mm +/- 1.5 mm, B 7.0 mm +/- 1.5 mm, C 7.7 mm +/- 1.1 mm; Eject fraction (EF) postoperation: A 43.8% +/- 8.9%, B 51.5% +/- 7.8%, C 45.6% +/- 8.1%. CONCLUSIONS: (60)Co gamma radiation exposure can degrade MSC' ability of paracrine communication. The paracrine effect which should take important role in improving the cardiac function after AMI. The mechanism of prarcrine is complex, neovascularization is the important link.

[Clinical analyses of cardiovascular operations in patients with severe dilated left ventricle].

OBJECTIVE: To explore the perioperative features of surgical treatment in valvular patients with severe dilated left ventricle and investigate the structural changes of left ventricle and its correlation with cardiac functions. METHODS: A total of 126 patients with severe dilated left ventricle underwent mitral valve and/or aortic valve operation from January 2003 to December 2008, including mitral valve replacement (MVR) (n = 27), mitral valvuloplasty (MVP) (n = 13), aortic valve replacement (AVR) (n = 51), AVR+MVR (n = 25) and AVR + MVP (n = 10). There were 79 males and 47 females with a mean age of (52 ± 13) years old. The mean pathological course was (18 ± 12) years. The pathological changes were mainly of aortic and/or mitral incompetence. The concomitant procedures included Bentall procedure (n = 6), coronary artery bypass grafting (n = 3), tricuspid valvuloplasty (n = 58) and left atrial folding (n = 62). RESULTS: The perioperative mortality was 3.17% (4/126). Two died of multiple organ failure (MOF) secondarily to severe low-output syndrome while another 2 died of sudden ventricular fibrillation. Forty-six (36.5%) patients suffered from ventricular arrhythmia during the earlier postoperative period and they required a venous injection of lidocaine and/or amiodarone. Fourteen (11.1%) patients suffered from severe low-output syndrome. Among them, 4 patients were resuscitated with an intra-aortic balloon pump for another 4 - 6 days. And 26 (20.6%) cases were complicated with multiple organ failure. The echocardiographic examinations showed that left ventricular dimensions decreased significantly at Days 7 - 14 postoperatively and progressively at Months 6 - 12 postoperatively. Left ventricular end-diastolic diameter (LVEDD) was (77 ± 6) mm preoperatively and (63 ± 12) mm (Days 7 - 14), (58 ± 10) mm (Months 6 - 12) postoperatively (P < 0.01). The contractile function of left ventricle temporarily decreased during the early postoperative stage and improved gradually afterwards. But it was not restored to normal range even until 6 - 12 m post-operation. Ejection fraction was 49% ± 12% preoperatively and 42% ± 9% (Days 7 - 14), 51% ± 7% (Months 6 - 12) postoperatively (P < 0.01). Left ventricular fraction shortness was 28% ± 7% preoperatively and 25% ± 4% (Days 7 - 14), 29% ± 5% (Months 6 - 12) postoperatively (P < 0.05). CONCLUSION: For the patients with severe dilated left ventricle, cardiovascular operation can achieve an excellent outcome through a rigorous perioperative regiment. The prevention and treatment of postoperative ventricular arrhythmia should be emphasized. The dimension of left ventricle decreases progressively during the early postoperative period. There is a postoperative decline of cardiac functions.

[Structural and functional changes of postoperative small left ventricle patients].

OBJECTIVE: To explore the perioperative features of surgical treatment in valvular patients with small left ventricle, and investigate the postoperative early structural changes of left ventricle and its correlation with cardiac function. METHODS: A total of 51 patients with small left ventricle underwent mitral valve replacement from January 2003 to August 2008. There were 7 males and 44 females with mean age of (48 +/- 5) years old. The mean pathologic course was (18 +/- 9) years old. The concomitant procedures included aortic valve replacement in 6 cases, coronary artery bypass grafting in 1 case, tricuspid valvular plasty in 48 cases, left atrial thrombi scavenging in 36 cases, and left atrium folding in 42 cases. RESULTS: The perioperative mortality was 3.9% (2/51). Fourteen patients (27.5%) suffered from severe low-output syndrome in the earlier period postoperatively. Among them, 5 patients needed secondary cardiopulmonary bypass (CPB) to assist circulation, with the result of 1 patient died of weaning off CPB unsuccessfully, 1 patient revived with intra-aortic balloon pump assisted for another 2 d after termination of CPB and another 1 patient died of multiple organ failure (MOF) 10 d later. Eleven cases complicated with MOF. Five patients complicated with ventricular arrhythmia. The echocardiographic examinations showed that the left ventricular dimensions didn't expand significantly postoperatively at 7 to 14 d postoperatively. Left ventricular end-diastolic diameter (LVEDD) was (36.5 +/- 3.2) mm preoperatively and (38.6 +/- 5.3) mm postoperatively (P > 0.05). Preoperative LVEDD index (LVEDDI) was (45.9 +/- 3.8) ml/m(2) and postoperative LVEDDI was (48.2 +/- 7.4) ml/m(2) (P > 0.05). The contract function of left ventricle was improved postoperatively but with no statistical significance. Ejection fraction was 48.6% +/- 6.7% preoperatively and 52.8% +/- 8.3% postoperatively. Left ventricular fraction shortness was 25.5% +/- 3.3% preoperatively and 27.1% +/- 1.3% postoperatively. CONCLUSIONS: For the patients with small left ventricle usually, the postoperative emphases should be put on the management of low output syndrome. The decreased dimension of left ventricle doesn't expand in the early period after valvular operation.

[The empirical study in transplantation of bone marrow mesenchymal stem cells for acute myocardial infarction].

OBJECTIVE: To study the effect of (60)Co gamma ray on proliferation and differentiation potency of MSC. To evaluate the function of heart after early stage of acute myocardial infarction (AMI) in rats by transplantation of MSC. METHODS: Irradiated MSC was cultured with the method of adherent culture, the ability of its proliferation was detected by Methyl thiazolyl tetrazolium (MTT) shade selection test. The express of Cardiac troponin T (C-TNT) and beta-myosin heavy chain (beta-MHC) in MSC were detected by Reverse transcriptase-polymerase chain reaction (RT-PCR), which was induced by 5-azacytidine. Using a rat model of AMI, irradiated and unirradiated MSC were transplanted into myocardium after infarction. At 4 weeks, the cardiac dimension and functions were assessed by echocardiography and hemodynamics, the microvessel density were detected after VIII factor immunohistochemistry stain. RESULTS: The ability of proliferation in 4Gy group was depressed. C-TNT and beta-MHC expressed somewhat in unirradiated group. When compared with the control group (6.6 +/- 0.6), the microvessel density in both transplanted groups (12.7 +/- 2.2, 11.5 +/- 2.1) increased, contributing to improvement in cardiac function and dimension. CONCLUSION: MSC with or without differentiation potency can improve cardiac function equally at the early stage of AMI.

[The use of recombinant activated factor VII for blood loss after cardiovascular surgery].

OBJECTIVE: To describe the early experiences with rFVIIa in the management of bleeding after cardiovascular surgery. METHODS: From May 2006 through December 2007, 16 patients received rFVIIa during or after surgery despite conventional medical therapy and transfusion of blood products. There were 15 male patients and 1 female patients, aged from 36 to 77 years old with a mean of 52 years old. The surgical procedures include aortic procedures for 8 cases, valve replacement for 6 cases, pulmonary thromboendarterectomy for 1 case and atrial septal defect repair for 1 case. The data of these patients were reviewed and the safety and efficacy of rFVIIa after cardiovascular surgery were evaluated. RESULTS: rFVIIa was administered as a first dose of 27.6 to 54.5 microg/kg with a mean of 40.2 microg/kg. Six patients achieved hemostasis after the first dose. Nine patients received a second administration within 30 min, with a cumulative dose of 59.3 to 90.9 microg/kg, a mean of 80.3 microg/kg. Eight patients achieved hemostasis and 1 patient went to exploration. One patient received four doses of rFVIIa with a cumulative dose of 203.4 microg/kg and the bleeding stopped. Mean amount of chest drain loss and the amount of red blood cell, fresh frozen plasma, cryoprecipitate, and platelet transfusions decreased significantly after rFVIIa administration. The total amount of chest drain losses, transfusions of red blood cell and cryoprecipitate within 12 h postoperatively was positively correlated with the time from the end of bypass to administration of rFVIIa. No thromboembolic complications and other adverse reactions were noted. CONCLUSIONS: The use of rFVIIa is associated with reduced blood loss, rapid improvement of coagulation variables, and decreased need for blood products. rFVIIa is safe and efficacious in the management of refractory postcardiotomy bleeding.

[Effect of non-restrictive external stent on the expression of platelet-derived growth factor in vein grafts of rabbits].

OBJECTIVE: To investigate the potential mechanism of non-restrictive external stent in preventing re-stenosis of vein grafts. METHODS: Thirty-six rabbits underwent reversed bypass grafting of autologous external jugular vein into common carotid artery and then were randomly divided into two equal groups, stenting group (Group S), with an external stent 6 mm in diameter (Dacron vascular prosthesis) surrounding the vein graft, and control group (Group NS) , without stenting. The vein grafts were harvested 7, 14, and 28 days after the operation respectively. Immunocytochemistry was used to detect the platelet-derived growth factor B (PDGF-B) positive cells. The mRNA expression of PDGF-B was detected with RT-PCR. RESULTS: The PDGF-B positive cell percentages in the intima of Group S 7 and 14 days later were both significantly lower than those of Group NS (15.2% +/- 3.6% vs 21.6% +/- 4.6%, and 6.5% +/- 2.6% vs 12.5% +/- 4.4%, both P < 0.05) . The PDGF-B positive cell percentages in media 7, 14 and 28 days later of Group S were all significantly lower than those of Group NS (13.8% +/- 4.6% vs 25.4% +/- 6.2%, 21.3% +/- 4.4% vs 35.7% +/- 7.3%, and 7.2% +/- 3.2% vs 19.2% +/- 5.4%, all P < 0.01). The PDGF-B positive cell percentage in adventitia peaked 28 days later in Group S and 14 days later in Group NS, and the PDGF-B positive cell percentage in adventitia 28 days later of Group S was significantly higher than that of Group NS (42.5% +/- 8.6% vs 31.9% +/- 4.6%, P < 0.01). RT-PCR analysis revealed that PDGF-B amplification products (457 bp) appeared in both group S and NS from 7 to 28 days, and the PDGF-B mRNA expression levels 7, 14, and 28 days later of Group S were all significantly lower than those of Group NS (31.2% +/- 6.5% vs 45.4% +/- 8.4%, P < 0.05; 42.3% +/- 6.2% vs 65.2% +/- 11.5%, P < 0.01; and 21.3% +/- 5.6% vs 36.2% +/- 9.4%, P < 0.01). CONCLUSION: Non-restrictive external stenting can inhibit the synthesis of PDGF and change its distribution, which may be one of the mechanisms of external stent in preventing re-stenosis of vein grafts.