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Minisci-type dehydrogenative coupling of C(sp3)-H and N-heteroaromatics was performed with N-hydroxysuccinimide as a hydrogen atom transfer catalyst in a photoelectrochemical cell composed of a mesoporous BiVO4 photoanode and a Pt electrode. In the absence of metal catalysts and chemical oxidants, a range of N-heteroarenes (e.g., quinolines, isoquinolines, and quinoxaline) can undergo coupling with various C(sp3)-H partners to form the corresponding products in excellent yields.
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The Minisci-type dehydrogenative coupling of N-heteroaromatic rings with inert C-H or Si-H partners via visible-light-catalyzed hydrogen atom transfer has been reported. This methodology allows the coupling reactions to be carried out in water as a solvent under air atmospheric conditions with visible-light illumination. A wide range of inert C-H and Si-H partners could be directly coupled with various N-aromatic heterocycles to deliver products in good to excellent yields.
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A nephrometry scoring system is a key standard to evaluate the feasibility of partial nephrectomy (PN). Whether based on two-dimensional or three-dimensional images, simplicity, effectiveness, and practicality are the keys to the nephrometric scoring system. Since the emergence of RENAL score in 2009, numerous scoring systems based on different anatomical parameters are established to seek accurately and few parameters to assess the risk of PN and complications. This study aimed to achieve a three-game winning streak in PN more easily and efficiently (negative resection margin, maximum preservation of normal nephron function, and avoiding short-term and long-term complications). Using PubMed, we counted 28 kinds of nephrometric scoring systems. We considered only English literatures published and excluded editorials, commentaries, and meeting abstracts. To the best of our knowledge, this is to date and most comprehensive summary as well as an outlook of the nephrometric scoring system.
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Neoplasias Renales , Humanos , Neoplasias Renales/cirugía , Nefrectomía/métodos , Nefronas , Riñón/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: To identify the immune-related genes of bladder cancer (BLCA) based on immunological characteristics and explore their correlation with the prognosis. METHODS: We downloaded the gene and clinical data of BLCA from the Cancer Genome Atlas (TCGA) as the training group, and obtained immune-related genes from the Immport database. We downloaded GSE31684 and GSE39281 from the Gene Expression Omnibus (GEO) as the external validation group. R (version 4.0.5) and Perl were used to analyze all data. RESULT: Univariate Cox regression analysis and Lasso regression analysis revealed that 9 prognosis-related immunity genes (PIMGs) of differentially expressed immune genes (DEIGs) were significantly associated with the survival of BLCA patients (p < 0.01), of which 5 genes, including NPR2, PDGFRA, VIM, RBP1, RBP1 and TNC, increased the risk of the prognosis, while the rest, including CD3D, GNLY, LCK, and ZAP70, decreased the risk of the prognosis. Then, we used these genes to establish a prognostic model. We drew receiver operator characteristic (ROC) curves in the training group, and estimated the area under the curve (AUC) of 1-, 3- and 5-year survival for this model, which were 0.688, 0.719, and 0.706, respectively. The accuracy of the prognostic model was verified by the calibration chart. Combining clinical factors, we established a nomogram. The ROC curve in the external validation group showed that the nomogram had a good predictive ability for the survival rate, with a high accuracy, and the AUC values of 1-, 3-, and 5-year survival were 0.744, 0.770, and 0.782, respectively. The calibration chart indicated that the nomogram performed similarly with the ideal model. CONCLUSION: We had identified nine genes, including PDGFRA, VIM, RBP1, RBP1, TNC, CD3D, GNLY, LCK, and ZAP70, which played important roles in the occurrence and development of BLCA. The prognostic model based on these genes had good accuracy in predicting the OS of patients and might be promising candidates of therapeutic targets. This study may provide a new insight for the diagnosis, treatment and prognosis of BLCA from the perspective of immunology. However, further experimental studies are necessary to reveal the underlying mechanisms by which these genes mediate the progression of BLCA.
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In this work, FeCr-based films with different Y2O3 contents were fabricated using radio frequency (RF) magnetron sputtering. The effects of Y2O3 content on their microstructure and mechanical properties were investigated through scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), inductive coupled plasma emission spectrometer (ICP) and a nanoindenter. It was found that the Y2O3-doped FeCr films exhibited a nanocomposite structure with nanosized Y2O3 particles uniformly distributed into a FeCr matrix. With the increase of Y2O3 content from 0 to 1.97 wt.%, the average grain size of the FeCr films decreased from 12.65 nm to 7.34 nm, demonstrating a grain refining effect of Y2O3. Furthermore, the hardness of the Y2O3-doped FeCr films showed an increasing trend with Y2O3 concentration, owing to the synergetic effect of dispersion strengthening and grain refinement strengthening. This work provides a beneficial guidance on the development and research of composite materials of nanocrystalline metal with a rare earth oxide dispersion phase.
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To the flexible tripod platform tren (tris(2-aminoethyl)amine), a Rhodamine and two naphthalene fluorophores were introduced. The resulting fluorescence probe named TRN was fully characterized and employed in cell imaging. Probe TRN exhibited high selectivity and excellent sensitivity for the simultaneous fluorescence detection of Zn2+/Hg2+/Al3+/Cu2+. The significant changes in the fluorescence color make naked-eye detection possible. Furthermore, fluorescence imaging experiments of Zn2+/Hg2+/Al3+/Cu2+ in living PC3 cells demonstrated its value for practical applications in biological systems.
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Colorantes Fluorescentes , Mercurio , Cationes , Rodaminas , Espectrometría de FluorescenciaRESUMEN
WRKY transcription factors constitute one of the largest transcription factor families in plants, and play crucial roles in plant growth and development, defense regulation and stress responses. However, knowledge about this family in maize is limited. In the present study, we identified a drought-induced WRKY gene, ZmWRKY106, based on the maize drought de novo transcriptome sequencing data. ZmWRKY106 was identified as part of the WRKYII group, and a phylogenetic tree analysis showed that ZmWRKY106 was closer to OsWRKY13. The subcellular localization of ZmWRKY106 was only observed in the nucleus. The promoter region of ZmWRKY106 included the C-repeat/dehydration responsive element (DRE), low-temperature responsive element (LTR), MBS, and TCA-elements, which possibly participate in drought, cold, and salicylic acid (SA) stress responses. The expression of ZmWRKY106 was induced significantly by drought, high temperature, and exogenous abscisic acid (ABA), but was weakly induced by salt. Overexpression of ZmWRKY106 improved the tolerance to drought and heat in transgenic Arabidopsis by regulating stress-related genes through the ABA-signaling pathway, and the reactive oxygen species (ROS) content in transgenic lines was reduced by enhancing the activities of superoxide dismutase (SOD), peroxide dismutase (POD), and catalase (CAT) under drought stress. This suggested that ZmWRKY106 was involved in multiple abiotic stress response pathways and acted as a positive factor under drought and heat stress.
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Adaptación Biológica , Sequías , Respuesta al Choque Térmico , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Zea mays/genética , Zea mays/metabolismo , Secuencia de Aminoácidos , Arabidopsis/genética , Arabidopsis/metabolismo , Núcleo Celular/metabolismo , Perfilación de la Expresión Génica , Regulación Enzimológica de la Expresión Génica , Secuenciación de Nucleótidos de Alto Rendimiento , Fenotipo , Filogenia , Plantas Modificadas Genéticamente , Regiones Promotoras Genéticas , Transporte de Proteínas , Especies Reactivas de Oxígeno/metabolismo , Elementos de Respuesta , Estrés Fisiológico , Factores de Transcripción/química , Transcriptoma , Zea mays/clasificaciónRESUMEN
Abiotic stresses restrict the growth and yield of crops. Plants have developed a number of regulatory mechanisms to respond to these stresses. WRKY transcription factors (TFs) are plant-specific transcription factors that play essential roles in multiple plant processes, including abiotic stress response. At present, little information regarding drought-related WRKY genes in maize is available. In this study, we identified a WRKY transcription factor gene from maize, named ZmWRKY40. ZmWRKY40 is a member of WRKY group II, localized in the nucleus of mesophyll protoplasts. Several stress-related transcriptional regulatory elements existed in the promoter region of ZmWRKY40. ZmWRKY40 was induced by drought, high salinity, high temperature, and abscisic acid (ABA). ZmWRKY40 could rapidly respond to drought with peak levels (more than 10-fold) at 1 h after treatment. Overexpression of ZmWRKY40 improved drought tolerance in transgenic Arabidopsis by regulating stress-related genes, and the reactive oxygen species (ROS) content in transgenic lines was reduced by enhancing the activities of peroxide dismutase (POD) and catalase (CAT) under drought stress. According to the results, the present study may provide a candidate gene involved in the drought stress response and a theoretical basis to understand the mechanisms of ZmWRKY40 in response to abiotic stresses in maize.
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Arabidopsis/crecimiento & desarrollo , Estrés Fisiológico , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Zea mays/genética , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Núcleo Celular/metabolismo , Sequías , Evolución Molecular , Perfilación de la Expresión Génica , Regulación de la Expresión Génica de las Plantas , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismo , Plantas Modificadas Genéticamente/crecimiento & desarrollo , Regiones Promotoras Genéticas , Protoplastos/metabolismo , Zea mays/crecimiento & desarrollo , Zea mays/metabolismoRESUMEN
OBJECTIVE: To study the effects of Jisuikang (Chinese characters) on Nogo-NgR gene expression, and to explore the protective effects and mechanism of Jisuikang (Chinese characters) on spinal cord injury in rats. METHODS: One hundred eighty female rats were randomly assigned to 6 groups(30 rats per group). Sham group: T10 lamina was resected only and spinal cord was untreated. Model group: spine cord injury (SCI) was created with a modified impinger of Allen's by impacting on the T10 spinal cord. Prednisolone group: Prednisolone (0.06 g/kg) was given by intragastric administration at a time interval of 24 hours after operation. The Jisuikang (Chinese characters) high, moderate and low dose groups: Jisuikang (Chinese characters) was supplied with different dose (50 g/kg, 25 g/kg, 12.5 g/kg) by intragastric administration in rats after operation,for the first time at 30 min after surgery. Animals were killed 3, 7, 14 days after surgery. The expression levels of Nogo-A and NgR were observed by Western Blot and Real-time PCR. RESULTS: The expression of Nogo-A and NgR was at the basic level at all time points in sham group. Compared with model group, the protein expression levels of Nogo-A and NgR in sham, prednisolone, Jisuikang (Chinese characters) moderate dose groups were statistically significant at all time points (P < 0.05). No difference was found in Jisuikang (Chinese characters) high and low dose groups (P > 0.05). Three days after surgery, the mRNA levels of Nogo-A and NgR in treatment group were significantly lower than that in model group (P < 0.01); 7 days after surgery,Nogo-A and NgR mRNA expression were dramatically upregulated and peaked; 14 days after operation, the expression was decreased, but still significantly higher than that in other treatment groups (P < 0.01). Prednisolone and Jisuikang (Chinese characters) moderate dose groups showed the most significant effects among all groups,but there was no statistically significant difference between two groups (P > 0.05). CONCLUSION: The decoction Jisuikang (Chinese characters) can promote the nerve cell regeneration by regulating Nogo-A and NgR gene expression, activating Nogo- NgR signaling pathways after acute spinal cord injury.
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Medicina Tradicional China , Proteínas de la Mielina/genética , Receptores de Superficie Celular/genética , Traumatismos de la Médula Espinal/tratamiento farmacológico , Animales , Femenino , Proteínas Ligadas a GPI/análisis , Proteínas Ligadas a GPI/genética , Proteínas Ligadas a GPI/fisiología , Proteínas de la Mielina/análisis , Proteínas de la Mielina/fisiología , Regeneración Nerviosa/efectos de los fármacos , Proteínas Nogo , Receptor Nogo 1 , Ratas , Ratas Sprague-Dawley , Receptores de Superficie Celular/análisis , Receptores de Superficie Celular/fisiología , Transducción de Señal/efectos de los fármacos , Traumatismos de la Médula Espinal/metabolismoRESUMEN
The mechanism involved in neural regeneration after spinal cord injury is unclear. The myelin-derived protein Nogo-A, which is specific to the central nervous system, has been identified to negatively affect the cytoskeleton and growth program of axotomized neurons. Studies have shown that Nogo-A exerts immediate and chronic inhibitory effects on neurite outgrowth. In vivo, inhibitors of Nogo-A have been shown to lead to a marked enhancement of regenerative axon extension. We established a spinal cord injury model in rats using a free-falling weight drop device to subsequently investigate Nogo-A expression. Nogo-A mRNA and protein expression and immunoreactivity were detected in spinal cord tissue using real-time quantitative PCR, immunohistochemistry and western blot analysis. At 24 hours after spinal cord injury, Nogo-A protein and mRNA expression was low in the injured group compared with control and sham-operated groups. The levels then continued to drop further and were at their lowest at 3 days, rapidly rose to a peak after 7 days, and then gradually declined again after 14 days. These changes were observed at both the mRNA and protein level. The transient decrease observed early after injury followed by high levels for a few days indicates Nogo-A expression is time dependent. This may contribute to the lack of regeneration in the central nervous system after spinal cord injury. The dynamic variation of Nogo-A should be taken into account in the treatment of spinal cord injury.
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OBJECTIVES: The aim of the study was to detect whether the systolic dyssynchrony index (SDI) assessed by real-time 3D echocardiography (RT3DE) could predict clinical outcomes of patients with ventricular aneurysm in response to surgical ventricular reconstruction (SVR). METHODS: In total, 120 individuals underwent RT3DE, including 30 healthy volunteers and 90 patients with ventricular aneurysm. All patients underwent clinical and echocardiographic assessments at baseline and at 12 months after SVR. The SDI was defined as the SD of time to minimum systolic volume of the 16 left ventricular (LV) segments, expressed in percent RR duration. SVR responder was defined as a >15% decrease in LV end-systolic volume, reduction in NYHA functional class or 20% relative increase in the LV ejection fraction (LVEF). RESULTS: The SDI was significantly higher in patients with aneurysm, at 14.3% compared with 2.0% in healthy volunteers (P <0.047). The SDI was negatively correlated with the LVEF. After SVR, 86 patients were responders. In this patient subgroup, the SDI exhibited an immediate significant decrease (to 7.7%; P <0.034) and a progressive decrease during 12 months of follow-up (to 4.9%; P <0.044). The SDI can discriminate SVR responders. Receiver-operating characteristic curve analysis yielded cut-off values of SDI 14.3% best associated with SVR response; area under the curve was 0.79 with reduction in NYHA class, 0.86 with increase in EF and 0.66 with decrease in the end-systolic volume. CONCLUSIONS: RT3DE can be used to assess LV mechanical dyssynchrony in patients with aneurysm. SVR produces a mechanical intraventricular resynchronization and SDI can predict improvement following SVR.
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Procedimientos Quirúrgicos Cardíacos , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/cirugía , Procedimientos de Cirugía Plástica , Disfunción Ventricular Izquierda/cirugía , Función Ventricular Izquierda , Anciano , Estudios de Casos y Controles , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Proyectos Piloto , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recuperación de la Función , Reproducibilidad de los Resultados , Volumen Sistólico , Sístole , Factores de Tiempo , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
OBJECTIVE: To observe the dynamic changes of sciatic nerve conduction velocity of Toxoplasma gondii-infected rats at different time points. METHODS: Twenty SD rats were randomly divided into control group and Toxoplasma gondii infection group. Rats in T. gondii infection group were intraperitoneal injected with 4x10(7) T. gondii tachyzoites, while those in control group were given equivalent normal saline. Motor and sensory nerve conduction velocities (MNCV, SNCV) in sciatic nerve were measured by Medtronic Keypoint4 Workstation electromyography at pre-infection, and 2, 4, 8, 12 months post-infection. RESULTS: Within two months after infection, there was no difference in SNCV and MNCV between control group and infection group (P>0.05). From 4 months after T. gondii injection, infected rats began to show the slowness of SNCV and MNCV, which progressed with the course of infection. At 4, 8, and 12 months after infection, SNCV and MNCV of infection group were (35.26±3.02) and (25.94±3.20) m/s, (33.57±2.27) and (22.75±2.31) m/s, and (32.38±2.38) and (22.03±2.08) m/s, respectively. Compared with control group, SNCV and MNCV of infection group reduced by (7.47±2.11)% and (12.57±1.89)%, (8.92±2.64)% and (13.72±2.65)%, and (12.18±1.94)% and (15.46±2.37)%, respectively (P<0.05). CONCLUSION: From 4 months after infection, Toxoplasma gondii-infected rats show a slowness of motor and sensory nerve conduction velocities in sciatic nerve.
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Nervio Ciático , Toxoplasma , Toxoplasmosis , Animales , Conducción Nerviosa , Ratas , Ratas Sprague-DawleyRESUMEN
OBJECTIVE: To explore the effects of entacapone on the plasma level of homocysteine (Hcy) in Parkinson's disease (PD) patients on levodopa. METHODS: This cross-sectional study was made up of 4 groups, i.e. 'L + E' group (primary PD patients on levodopa and entacapone), 'L' group (primary PD patients on levodopa alone), 'L(-)' group (primary PD patients never on levodopa) and control group (people without PD or any other nervous system diseases). They were randomly selected from the PD patient database of our department in September 2012. At the beginning, 60 cases were selected for each group. The C677T genotypes of methylenetetrahydrofolate reductase (MTHFR) were identified and the plasma concentrations of Hcy, folic acid and vitamin B12 detected in each subject. Then group t test, single factor analysis of variance and χ(2) test were used for statistical analysis by SPSS 11.5 software. RESULTS: Among 240 early subjects, 98 cases with CC genotype at 677 site of MTHFR gene were finally recruited. Statistical analysis revealed no differences in age, gender, plasma concentrations of folic acid and vitamin B12 among the groups. The PD duration of 'L + E' group (96 ± 21 months) were the longest among 3 groups, followed by those of 'L' group (51 ± 17 months) and 'L(-)' group (21 ± 6 months). The treatment duration and daily dose of levodopa in 'L + E' group (77 ± 22 months, 765 ± 110 mg) were all higher than those in 'L' group (42 ± 14 months, 673 ± 73 mg). The plasma Hcy concentrations of 'L + E' group (15.1 ± 3.1 µmol/L) were lower than those of 'L' group (20.4 ± 4.7 µmol/L), but still higher than those of 'L(-)' group (12.2 ± 2.4 µmol/L) and control group (9.1 ± 2.2 µmol/L). The Hcy concentrations of 'L(-)' group were also higher than those of control group. CONCLUSION: Entacapone increases the bioavailability of levodopa and simultaneously alleviates partially its resulting hyperhomocysteinemia.
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Catecoles/uso terapéutico , Homocisteína/sangre , Levodopa/uso terapéutico , Nitrilos/uso terapéutico , Enfermedad de Parkinson/sangre , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Persona de Mediana Edad , Enfermedad de Parkinson/tratamiento farmacológicoRESUMEN
BACKGROUND: In patients with coronary disease and aneurysm, ventricular reconstruction with revascularization is a surgical option. Details of patient selection and optimal surgical technique are still debated. We report our results with off-pump aneurysm plication after ventricular aneurysm with relative wall thinning. METHODS: We retrospectively reviewed the records of 248 patients who had an operation for postinfarction left ventricular aneurysm. Reconstruction was accomplished by off-pump anteroapical aneurysm plication. The following variables were recorded: preoperative clinical, angiographic and echocardiographic findings and operative procedures. Outcomes were early mortality, long-term survival and poor 5-year result, defined as the need for transplantation or repeated hospitalization for congestive heart failure. Risk factors were pinpointed using the t test and survival curves. Independent risk factors were identified using Cox regression methods. RESULTS: Hospital mortality was low (2.0%). Mean follow-up was 5.8 (standard deviation [SD] 3.8) years. Actuarial survival at 1 and 5 years was 94% and 84%. Among the 232 survivors, 200 were in functional class I or II, and the average increase in ejection fraction was 14.0% (SD 3.1%). As determined by multivariable analysis, factors predicting poor outcome were advanced age, ejection fraction less than 0.35, conicity index less than 1, end-systolic volume index greater than 80 mL/m2, advanced New York Heart Association functional class and congestive heart failure. CONCLUSION: Using wall thinning as a criterion for patient selection, the technique of off-pump anteroapical aneurysm plication can be performed with low operative mortality and provides good symptomatic relief and long-term survival.
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Aneurisma Cardíaco/cirugía , Anciano , Procedimientos Quirúrgicos Cardíacos , Puente de Arteria Coronaria Off-Pump , Femenino , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/patología , Ventrículos Cardíacos , Mortalidad Hospitalaria , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Volumen Sistólico , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim was to evaluate the early outcome of off-pump coronary artery bypass grafting (OPCABG) with a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. MATERIALS AND METHODS: From October 2002 to December 2008, 208 patients (196 male and 12 female patients) underwent OPCABG by only using a BIMA Y configuration graft. The average age of the patients was 56.5±11.3 years, with the age range being 33-78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semiskeletonization skill was used to harvest the two IMAs, and then the free right internal mammary artery was anastomosed end-to-side to the in situ left internal mammary artery to composite a Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery for the patients. Graft patency was assessed by using the HT311 transit time flowmeter (USA Transonic Systems Inc.), intraoperatively. RESULTS: We performed distal anastomoses of the grafts in 728 patients, the average being 3.5±1.3 per person. No one died and got recurrent angina within 30 days after operation. CONCLUSION: OPCABG by using the BIMA Y graft was safe and effective to achieve total arterial revascularization, and avoid surgical operation on the ascending aorta, and other incisions.
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OBJECTIVE: To evaluate the outcome of off-pump coronary artery bypass grafting (OPCABG) using a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. METHODS: From October 2002 to December 2008, 208 patients (196 males and 12 females) underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33-78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries (IMAs), and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery (LIMA) in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intra-operatively with the HT311 transit time flowmeter. RESULTS: A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5 ± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. CONCLUSIONS: OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions.
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BACKGROUND: The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair. METHODS: From March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed. RESULTS: Early mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90 ± 0.59 to 1.65 ± 0.54 among the mid-term survivors (P < 0.001), with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction (EF) < 0.35 (OR = 7.9, 95%CI 1.6 - 40.0); congestive heart failure (CHF) (OR = 4.4, 95%CI 1.0 - 19.0); end-systolic volume index (ESVI) > 80 ml/m(2) (OR = 3.7, 95%CI 1.0 - 14.0); and advanced age > 70 years (OR = 2.4, 95%CI 1.0 - 12.0). CONCLUSIONS: The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.
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Procedimientos Quirúrgicos Cardíacos/métodos , Aneurisma Cardíaco/cirugía , Infarto del Miocardio/cirugía , Anciano , Puente de Arteria Coronaria , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Left ventricular (LV) dyssynchrony has been described to occur in patients with myocardial infarction. Dyssynchrony of left ventricular mechanical contraction produces adverse hemodynamic consequences. This study aimed to test the capacity of geometric rebuilding by aneurysm plication to restore a more synchronous contractile pattern after a mechanical, rather than electrical, intervention. METHODS: A total of sixty patients with anterior myocardial infarction, QRS duration < 120 ms, electively undergoing operation between January 2008 and January 2010 were included for analysis. Real-time 3-dimensional echocardiography was performed to assess LV function, LV systolic and diastolic dyssynchrony by measuring ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR) and LV dyssynchrony. LV dyssynchrony was defined as the systolic dyssynchrony of the time to reach the minimum systolic volume for 16 LV segments, expressed in percent cardiac cycle, systolic dyssynchrony index (SDI). We compared changes of LV dyssynchrony at different interval times. RESULTS: LV contraction was significantly asynchronous because preoperative SDI was higher, EF, PER and PFR were lowered. Compared with function after operation, LV mechanical intraventricular resynchronization was improved with decreased SDI ((8.7 ± 0.5)% vs. (14.3 ± 1.6)%, P = 0.01); LV function was improved with EF increasing ((43 ± 9)% vs. (37 ± 7)%, P = 0.001), and LV systolic and diastolic dyssynchrony was improved with more rapid PFR (199.4 ± 15.6 vs. 148.4 ± 21.2, P = 0.002) and PER (212.4 ± 14.5 vs. 156.3 ± 26.2, P = 0.001). CONCLUSIONS: Systolic and diastolic dyssynchrony was highly prevalent in patients with aneurysm, irrespective of QRS duration. Aneurysm plication produces a mechanical intraventricular resynchronization.
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Aneurisma/cirugía , Infarto del Miocardio/cirugía , Anciano , Ecocardiografía Tridimensional , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , RadiografíaRESUMEN
BACKGROUND: Off-pump coronary artery bypass surgery (OPCAB) has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB. METHODS: From April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out. RESULTS: Off-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 (P < 0.05). In both groups, the mean New York Heart Association (NYHA) class and ejection fraction increased significantly (P < 0.001) and the mean left ventricular end-diastolic diameter decreased significantly (P < 0.05). Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein. CONCLUSIONS: Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.