Association of red blood cell distribution width with post-operative new-onset atrial fibrillation following cardiac valve replacement surgery: a retrospective study.

PURPOSE: The aim of this study was to evaluate the impact of preoperative red blood cell distribution width (RDW) values on the risk of post-operative new-onset atrial fibrillation (PNAF) during hospitalization following cardiac valve replacement surgery. MATERIALS AND METHODS: The clinical data of 148 patients with preoperative sinus rhythm who underwent cardiac valve replacement surgery at The First Affiliated Hospital of Anhui Medical University from September 2017 to June 2018 were retrospectively analysed. Univariate and multivariate logistic regression analyses were used to determine the relationship between preoperative RDW values and the development of PNAF. RESULTS: Forty-nine of the 148 patients (33.1%) developed PNAF. The median preoperative RDW was 13.1 (12.6-17.2), while the median RDW value was significantly higher in patients with PNAF than in those without PNAF [14.1 (13.2-15.0) vs. 12.9 (12.4-13.5), p < 0.001]. Multivariate logistic regression analysis showed that preoperative RDW values were significantly correlated with the occurrence of PNAF (odds ratio: 1.940, 95% confidence interval: 1.377-2.731, p < 0.001). CONCLUSIONS: Preoperative RDW is an independent risk factor for PNAF during hospitalization following cardiac valve replacement surgery. This finding suggests that preoperative RDW measurement may be used to stratify the risk for PNAF development in patients undergoing cardiac surgery.

Early outcome of transapical transcatheter aortic valve replacement for aortic insufficiency / 中国胸心血管外科临床杂志

@#Objective    To assess the early outcome of transapical transcatheter aortic valve replacement (TAVR) for patients with aortic insufficiency. Methods    The patients with aortic valvular disease who underwent transapical TAVR from October 2020 to October 2022 in the Department of Cardiac and Vascular Surgery, the First Affiliated Hospital of Anhui Medical University were enrolled in the current retrospective study. The patients with aortic stenosis were assembled in a group A, and the patients with aortic insufficiency were assembled in a group B. The improvements of heart function and complications were assessed for the two groups. Results    A total of 56 patients were enrolled, including 32 males and 24 females with an average age of 73.34±5.10 years. There were 31 patients in the group A and 25 patients in the group B. There was no statistical difference between the two groups in the age, gender, height, weight, hypertension, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, renal disorder or classification of heart function (P>0.05). Also, there was still no statistical difference in the rate of permanent peacemaker implants, emergent open surgery, valve re-implants, or perivalvular leakage (P>0.05). After TAVR, the left ventricular diastolic diameter, left ventricular ejection fraction, complicated moderated mitral and tricuspid regurgitation were significantly improved in both groups compared with preoperative findings (P<0.05); however, there was no statistical difference in these parameters between groups (P>0.05). Conclusion    Interventional valve (J-Valve) in the treatment of patients with aortic insufficiency through transapical TAVR significantly improves cardiac function and reduces functional valve regurgitation.

Independent risk factors related to acute respiratory distress syndrome after acute type A aortic dissection surgery: A retrospective analysis / 中国胸心血管外科临床杂志

@#Objective    To investigate the independent risk factors associated with postoperative acute respiratory distress syndrome in patients undergoing type A aortic dissection surgery. Methods    The clinical data of 147 patients who underwent acute type A aortic dissection surgery in the First Affiliated Hospital of Anhui Medical University from 2015 to 2019 were retrospectively analyzed. There were 110 males at age of 51.9±10.1 years and 37 females at age of 54.3±11.1 years. According to whether the patients developed ARDS after surgery, all of the patients were divided into a ARDS group or a non-ARDS group. Logistic regress analysis was utilized to establish the predictive mode to identify the independent risk factors related to ARDS. Results    Of the patients, 25 developed postoperative ARDS. Among them, 5 patients were mild ARDS, 13 patients were moderate, and 7 patients were severe ARDS. Multivariate logistic regression analysis showed that deep hypothermic circulatory arrest time [odds ratio (OR)=1.067, 95% confidence interval (CI) 1.014-1.124, P=0.013], cardiopulmonary bypass time (OR=1.012, 95%CI 1.001-1.022, P=0.027) and perioperative plasma input (OR=1.001, 95%CI 1.000-1.002, P=0.011) were independently associated with ARDS in patients undergoing acute A aortic dissection surgery. Receiver operating characteristic (ROC) curve analysis demonstrated a good discrimination ability of the logistic regression model, with an area under the curve of 0.835 (95%CI 0.740-0.929, P=0.000). Conclusion    Duration of deep hypothermic circulatory arrest, cardiopulmonary bypass time and perioperative plasma are independent risk factors for postoperative ARDS in patients undergoing type A aortic dissection surgery.

Robotic versus sternotomy approach for closure of atrial septal defect / 中国胸心血管外科临床杂志

@#Objective    To compare the short-term outcomes of surgical repair for atrial septal defect (ASD) with a robotic (da Vinci Si) approach versus a conventional open procedure. Methods    Clinical data of 140 patients undergoing ASD closure in the First Affiliated Hospital of Anhui Medical University from January 2016 to May 2020 were retrospectively analyzed. The patients were divided into a robotic group and a sternotomy group according to different surgical methods. In the robotic group, there were 67 patients including 20 males and 47 females at a median age of 40.0 (25.0) years, and in the sternotomy group there were 73 patients including 23 males and 50 females at a median age of 41.0 (29.0) years. Multivariate linear regressions were used to produce risk-adjusted analysis of pertinent clinical characteristics. Kaplan-Meier analysis was performed to compare the speed of sternotomy versus robotic group returning to exercise or daily life. Results    Robotic-assisted surgery was associated with significantly shorter 24 h postoperative drainage volume [220.0 (210.0) mL vs. 345.0 (265.0) mL, P<0.001], mechanical ventilation [6.0 (11.0) h vs. 8.0 (11.0) h, P=0.024], intensive care unit length of stay (LOS) [19.0 (19.0) h vs. 22.0 (25.0) h, P=0.005], postoperative hospital LOS [9.0 (5.0) d vs. 10.0(6.0) d, P=0.003], and a lower rate of perioperative blood transfusion (28.36% vs. 84.93%, P<0.001). After controlling for patient comorbidity in the multiple regression model, there remained a trend toward decreased 24 h postoperative drainage volume (β=–115.30, 95%CI–170.78 to –59.82, P<0.001), mechanical ventilation (β=–4.96, 95%CI –8.33 to –1.59, P=0.004) and postoperative hospital LOS (β=–2.31, 95%CI –3.98 to –0.63, P=0.007) in the robotic group. Kaplan-Meier analysis revealed that patients returned to exercise or daily life earlier in the robotic group [35.0 (32.0) d vs. 90.0 (75.0) d, P<0.001]. Conclusion    Closure of ASD can be performed safely and effectively via robotic approach. And the minimally invasive technique is beneficial to postoperative recovery.

Effect of pulmonary hypertension on clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation patients with valvular heart disease: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To explore the effect of pulmonary hypertension on the clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation (AF) patients with valvular heart disease. Methods    The clinical data of 84 patients who received cardiac valve replacement and Cox Maze Ⅳ ablation in our hospital from July 2017 to January 2020 were retrospectively analyzed. According to the estimation of pulmonary artery pressure (PAP) by ultrasound, the patients were divided into two groups: a group A (PAP<45 mm Hg, 20 males, 26 females with an average age of 59.1±7.8 years) and a group B (PAP≥45 mm Hg, 15 males and 23 females with an average age of 58.5±8.5 years). The PAP was less than 70 mm Hg in all patients. A systematic follow-up review was performed for 6 months after operation. The recovery and recurrence rate of sinus rhythm after surgical ablation were compared between the two groups, and the efficacy was analyzed. Results    (1) All the patients completed the operation successfully, and there was no statistical difference in the ablation time between the two groups (P>0.05); no patients died of pulmonary infection after the operation, and one patient underwent implantation of a permanent pacemaker due to conduction block. (2) At the end of the operation and 3 months after the operation, the conversion rate of AF in the group A was 91.3% (42 patients) and 82.6% (38 patients), respectively, and in the group B was 89.5% (34 patients) and 73.7% (28 patients), respectively (P>0.05). The conversion rate of AF was 82.6% (38 patients) in the group A and 63.2% (24 patients) in the group B at 6 months after operation (P=0.043). Binary logistic regression analysis showed that PAP≥45 mm Hg had a significant effect on the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease [P=0.014, OR=5.661, 95%CI (1.429, 22.432)]. Conclusion    PAP may be an influencing factor for the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease. Although the long-term recurrence rate of AF in the moderate pulmonary hypertension group is higher than that in the group A, the overall effect is still safe and effective; therefore it is still worth promoting in clinical application.

The role of SPARCL1 in atherosclerotic plaque formation / 安徽医科大学学报

Objective @#To investigate the effect of cysteine rich acidic secretory protein like protein 1 (SPARCL1) on atherosclerosis (AS) plaque formation .@*Methods @#A case control study design was used , 394 patients with con firmed AS were selected as the case group , and 394 healthy medical examiners matched for age and gender were se lected as the control group . The expression level of serum SPARCL1 was determined by enzyme linked immunosor bent assay; immunohistochemistry was used to assess the expression level and localization of SPARCL1 protein in the AS plaque region , and the expression of SPARCL1 protein was also detected in the neutrophils and monocytes of peripheral blood of AS patients and normal controls; SPARCL1 overexpressing and the recombinant adenoviral vec tors were constructed to inhibit SPARCL1 overexpression and expression , and the effects of SPARCL1 on cell mi gration were ob served in the cell scratch assay using mouse macrophage cells (J774A.1) as target cells .@*Results@#Serum SPARCL1 levels in the AS patient group were lower than those in the healthy group ( P < 0.05 ) ; high SPARCL1 expression was detected in AS plaques and was mainly expressed in the cytoplasm of foamy cells; SPARCL1 expression levels in peripheral blood neutrophils and monocytes were lower than those in normal controls in AS patients (P < 0.05) ; recombinant SPARCL1 overexpression and inhibition of expression of adenovirus was successfully constructed; the cell migration rate was decreased in J774A.1 cells that inhibited SPARCL1 expression and increased in J774A.1 cells that overexpressed SPARCL1 ( P < 0.05) .@*Conclusion @#SPARCL1 is highly expressed in foam cells at the site of AS lesions , which may result from compensatory recruitment of peripheral blood monocytes and neutrophils , and SPARCL1 may be involved as a protective factors for blood vessels in inhibiting the development of AS plaques .

The study of expression and significance of GBE1 in hypoxic lung cancer based on GEO database / 安徽医科大学学报

Objective To investigate the expression of glucogen branching enzyme 1 (GBE1) in hypoxic lung cancer tissues and cells, to evaluate its significance for hypoxia tolerance in lung cancer and to explore its mechanism of apoptosis of lung cancer. Methods Data of 20 patients with hypoxic lung cancer and normoxia lung cancer tissue microarray were downloaded through the GEO database, GCBI was used to screen the differential genes for GO and KEGG pathway analysis. In vitro culture of A549 cells was cultured and transfected with siGEBl for knock down or GBE1 for overexpression. After hypoxia treatment, cell viability was analyzed using MTT assay. Western blot and real-time PCR were used to detect the expression of apoptosis-related genes. Results The data from 20 cases of lung cancer specimens showed that 206 genes displayed differences, and the GBE1 was the most significant, GO and KEGG pathway analysis found that the differential gene involved in cell cycle, cell metabolism and other multiple access. The expression of GBE1 in A549 cells after hypoxia treatment was significantly increased, and GBE1 could significantly enhance the expression of apoptosis-related genes in A549 cells after hypoxia treatment. Over-expression of GBE1 could inhibit the expression of apoptosis-related genes. Conclusion GBE1 may be a potential marker of hypoxia tolerance in lung cancer, this study provide a reference for further study of hypoxia tolerance mechanism of lung cancer.

Comparison of uniportal and three portal video-assisted thoracic surgery in benign pulmonary diseases / 实用医学杂志

Objective To compare the advantages and disadvantages of uniportal video-assisted thoracic surgery(uniportal-VATS)and three portal VATS in treatment of benign pulmonary diseases. Methods The clinical data of 66 patients with benign pulmonary disease treated by VAST from June 2015 to October 2016 were retrospec-tively analyzed. The patients were divided into two groups according to the specific operation. There were 32 patients (18 males and 14 females)in uniportal-VATS group. There were 34 patients(18 males and 16 females)in three portal VATS group. The operative time ,intraoperative blood loss ,thoracic drainage volume at 24 h after opera-tion,incision length,and the time of postoperative drainage of thoracic cavity,postoperative third day pain score and complication rate were compared between the two groups. Results The patients in the experimental and the control groups were successfully operated according to the scheduled protocol. No thoracotomy was performed. There was no statistical difference in the volume of blood loss,the volume of pleural drainage after 24 hours,the time of postoperative drainage of thoracic cavity ,the length of hospital stays and postoperative complications in uni-portal-VATS group and three portal VATS group(P>0.05). The pain score and postoperative third day pain score of the uniportal-VATS group was better than that of the three portal VATS group(P<0.05),but the operation time of the uniportal-VATS group was longer than that of the three portal VATS group(P<0.05). Conclusion Uniportal-VATS is safe and feasible for the treatment of benign lung diseases. It is more minimally invasive and beautiful than traditional three-hole thoracoscopic surgery. It is worthy of promotion and has broad prospects.

Selection of perfusion flow in cardiopulmonary bypass surgery for adult patients with valvular heart disease / 实用医学杂志

Objective To investigate the effect of flow rate on pH,urine volume and cerebral oxygen saturation during cardiopulmonary bypass (CPB) in patients with valvular heart disease.Methods 40 with valvular heart disease were divided into the high flow group (n =20) and the low flow group (n =20).The cerebral oxygen saturation value,lactic acid,BE value and the amount of urine between the two groups after induction of anesthesia (T1),at the beginning of CPB (T2),5 min after declamping shock (T3),5 min after recovery temperature (T4),5 min after aortic opening (T5),5 min after the end of aortic bypass (T6) were compared.Results (1) The cerebral oxygen saturation at the beginning of T2 was slightly lower than that of T1 after anesthesia induction.(2) The cerebral oxygen saturation was slightly higher and the absolute value of lactic acid and BE was slightly lower at T4 than that of T3.(3) The cerebral oxygen saturation was higher and the absolute value of BE was lower at T5 than that of T4.(4) The cerebral oxygen saturation of high flow group at T3,T4 and T5 was higher than that of the low flow group,while the absolute value of lactic acid and BE was lower than that of the low flow group.Conclusion High flow rate can increase cerebral oxygen saturation,reduce blood lactic acid,maintain the balance of pH,and increase renal blood perfusion.

The lung protective effect of levosimendan during cardiopulmonary bypass in canine model / 中华胸心血管外科杂志

Objective To explore lung protection effect of levosimendan(LS) during cardiopulmonary bypass in canine model by ratio between dry and wet (W/D) lung tissue,concentrations of malonaldehyde (MDA) and superoxide dismutase (SOD) and alterations of histology.Methods A total of 32 canines were divided into 4 groups at random with the procedure of myocardial blocking for 1 hour and then recovering for 2 hours.Animals in 4 groups were handled as following:No any special treatment after myocardial blocking in control group(group C).Lung perfusion was performaned with cold oxygenated blood after myocardial blocking in experiment 1 group(group P).LS(65 μg/kg) was injected intravenously before thoracotomy in experiment 2 group(group LSIV) and remaining procedure was same to the control one.Combined with LS (65 μg/kg),lungperfusion was performaned with cold oxygenated blood after myocardial blocking in experiment 3 group(group LSP).Right lung tissue of canines was taken immediately after the study for observing pathological alterations and measuring the concentrations of MDA and SOD through corresponding procedure.Results Compared with group C,the ratios of W/D and the concentrations of MDA were lower significantly,while those of SOD were higher significantly(P ＜ 0.05).Compared with group P and LSIV,the concentration of MDA was lower significantly,while that of SOD was higher significantly(P ＜ 0.05).There was no significant difference between group P and LSIV(P ＞0.05).Less impairment of lung tissue was found after LS intervention by light and electric microscope.Conclusion LS plays an important role in protecting lung tissue,based on founding in canine model,with decreasing ration of W/D and concentration of MDA and increasing that of SOD by both intravenous injection and lung perfusion.

Levosimendan Reduces Lung Injury in a Canine Model of Cardiopulmonary Bypass

BACKGROUND AND OBJECTIVES: To explore the lung-protective effect of levosimendan (LS) during cardiopulmonary bypass in a canine model by determining the wet/dry weight (W/D) ratio of lung tissue, malonaldehyde (MDA) and superoxide dismutase (SOD) concentrations, and performing a histological evaluation. MATERIALS AND METHODS: Thirty-two canines were divided randomly into four groups and underwent a routine aortic cross-clamping cardiopulmonary bypass procedure for 1 h, followed by recovery for 2 h. Animals were handled as follows: group C (means control group), no special treatment after aortic cross clamping; group P (means pulmonary artery perfusion group), pulmonary artery perfusion with cold oxygenated blood after aortic cross clamping; group LSIV (means intravenous injection of LS group), intravenous injection of LS (65 µg/kg) before thoracotomy, and the rest of the procedure was identical to the control group; group LPS (means pulmonary perfusion with LS group), pulmonary perfusion with cold oxygenated blood combined with LS (65 µg/kg) after aortic cross clamping. Lung tissues were removed and subjected to evaluation of pathological alterations, W/D ratio and MDA and SOD concentrations. RESULTS: In group C, the W/D ratio and MDA concentration were higher, while the SOD concentrations were lower (p<0.05). Compared with groups P and LSIV, the MDA concentration was lower in group LPS, while that of SOD was higher (p<0.05); Light and electron microscopy indicated that LS intervention reduced impairment of lung tissues. CONCLUSION: Our findings suggest that LS plays an important role in protecting lung tissues.

Value of neutiophil gelatinase-associated lipocalin in early diagnosis of acute kidney injury following adult valvular heart surgery / 安徽医科大学学报

Objective To explore the value of neutiophil gelatinase-associated lipocalin ( NGAL) taken from blood and urine samples in early diagnosis of acute kidney injury ( AKI) after heart valves replacement surgeries. Meth-ods A total of 56 patients received heart valves replacement surgeries were selected prospectively in this study. NGAL from blood and urine samples and serum creatinine ( Scr) were tested among them at different moments. AKI and non-AKI groups were divided based on Scr levels and the value of NGAL taken from blood and urine sam-ples was estimated in early diagnosis of AKI with receiver operating characteristic curve ( ROC) . Results 16 AKIs were observed among all of them. The peak value of Scr in AKI group was shown between 12 and 24 hours after surgeries, while blood-NGAL was seen high significantly (P<0.05) since 2 hours after surgeries, peak value at 4 hours, for urine-NGAL, peak value was seen at 2 hours. The area of ROC of blood-NGAL 4 hours and urine-NGAL 2 hours after surgeries for AKI diagnosis were 0.891 and 0.934, respectively. The better sensitivity and specificity were shown in both threshold set as 50 μg/L and 110 μg/L. Conclusion Blood-NGAL and urine-NGAL can be used as early diagnostic markers of AKI after heart valves replacement surgeries, whose change is significantly earli-er than that of Scr.

Pathophysiologic changes of local ischemic coronary artery and cardiac muscle after ligating canine LAD / 中国病理生理杂志

AIM: To evaluate the reliability of making a research model of coronary artery stenosis and local myocardial infarction reproduced in dog by ligating canine LAD. METHODS: We disparted 30 aged healthy cross-breed dogs [(18.5?6.7) kg] into three groups. The near part of the LAD through left minimal thoracic incision was ligated to interdict 25% (group A), 50% (group B), 75% (group C) of the flux, respectively. The changes of plasma endothelium-derived factors NO, ET-1, sP-selectin and CTnT were measured before ligation and at different time points after ligation. The expression of P-selectin gene in cardiac muscle was detected by Western blotting. The segments of distal parts of the ligated LAD were cut and pathological changes of the patches of topical cardiac muscle were observed by electronic microscope. RESULTS: After ligation, NO/ET-1, P-selectin and CTnT had significant changes in group B (P