Surgical Treatment of Primary Cardiac Paragangliomas: A Single-Center Experience.

BACKGROUND: Cardiac paragangliomas are rare neuroendocrine tumors that will cause significant morbidity if left undiagnosed. Because of the paucity of cohort data, their rapid diagnosis and appropriate management still pose unique challenges to cardiac surgeons. We aimed to investigate the clinical features and surgical management of primary cardiac paragangliomas in our single center. METHODS: From May 2014 to October 2020, patients diagnosed with primary cardiac paragangliomas retrospectively were reviewed. Demographic data, clinical presentation, preoperative imaging methods, surgical resection, perioperative management, histological analysis, and outcomes were recorded. Postoperative follow up also was reviewed. RESULTS: With multiple imaging methods, including echocardiography, computed tomography, positron-emission tomographic-computed tomography, and biochemical tests, there were five cases of primary cardiac paraganglioma verified by postoperative immunohistochemical staining, two of which were hormonally active. There were no metastatic cardiac paragangliomas, according to positron-emission tomographic-computed tomography, and all patients accepted surgical treatment. Preoperative adrenoceptor blockade was given to hormonally active patients, accordingly. Complete resection of the tumor was accomplished under cardiopulmonary bypass in each case. Tumor distribution included two masses on the roof of the left atrium, two masses in the right atrioventricular groove, and one between the ascending aorta and main pulmonary artery. Immunohistochemical staining for chromogranin, neuron-specific enolase, synaptophysin, and S-100 were positive, which were typical of cardiac paraganglioma. There were no operative deaths. All the patients had an uneventful recovery except one patient who underwent low cardiac output syndrome. During follow up (mean 4.2 years, range 0.6-7.0 years), all patients were well with New York Heart Association class I or II. Only one patient developed thyroid carcinoma three years after surgery but with no paraganglioma recurrence during periodic computed tomography, and this patient recovered well after thyroidectomy. CONCLUSION: Although cardiac paragangliomas are rare and may present surgical challenges for clinicians, surgical resection remains the choice of treatment with favorable outcomes through a multidisciplinary heart team. Moreover, lifelong surveillance still is recommended to detect possible recurrence or associated nonchromaffin tumors in time.

Association of biomarkers related to preoperative inflammatory and coagulation with postoperative in-hospital deaths in patients with type A acute aortic dissection.

The aim of this study was to analyze the role of blood biomarkers regarding preoperative inflammation and coagulation in predicting the postoperative in-hospital mortality of patients with type A acute aortic dissection (AAD). A total of 206 patients with type A AAD who had received surgical treatment were enrolled in this study. Patients were divided into two groups: the death group (28 patients who died during hospitalization) and the survival group (178 patients). Peripheral blood samples were collected before anesthesia induction. Preoperative levels of D-dimer, fibrinogen (FIB), platelet (PLT), white blood cells (WBC) and neutrophil (NEU) were compared between the two groups. Univariable and multivariable logistic regression analysis were utilized to identify the independent risk factors for postoperative in-hospital deaths of patients with type A AAD. Receiver operating characteristic (ROC) curve were used to analyze the predictive value of these indices in the postoperative in-hospital mortality of the patients. Univariable logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Further multivariable logistic regression analysis indicated that higher preoperative D-dimer and WBC levels were independent risk factors for postoperative in-hospital mortality of patients with type A AAD. ROC curve analysis indicated that application of combining FIB and PLT could improve accuracy in prediction of postoperative in-hospital mortality in patients with type A AAD. Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the postoperative in-hospital mortality of such patients. The combination of FIB and PLT may improve the accuracy of clinical prognostic assessment.

MicroRNA-30e protects the heart against ischemia and reperfusion injury through autophagy and the Notch1/Hes1/Akt signaling pathway.

The aim of the present study was to determine the cardioprotective mechanisms by which micro (mi)RNA-30e protects the heart from myocardial ischemia/reperfusion injury (MI/R) and to explore the signaling pathways that may confer protection for the heart and be potential therapeutic targets. It was demonstrated that miRNA­30e expression was decreased in patients with MI/R. In H9C2 cells, silencing (si)miRNA­30e significantly inhibited cellular apoptosis, the expression of apoptosis regulator BAX (Bax) and caspase­3 activity. It also significantly increased the expression of microtubule­associated proteins 1A/1B light chain 3B, p62, Beclin­1, neurogenic locus notch homolog protein­1 (Notch1), Hes1 and phosphorylated­protein kinase B (p­Akt), and decreased the expression of inducible NO synthase (iNOS) and proteins associated with oxidative stress. The inhibition of autophagy following treatment with 3­methyladenine significantly reversed the effect of si­miRNA­30e on apoptosis, Bax, caspase­3, iNOS and oxidative stress in H9C2 cells. The promotion of Notch1 expression increased the effect of si­miRNA­30e on apoptosis, Bax, caspase­3, iNOS, Notch1, Hes1 and p­Akt protein expression and oxidative stress in H9C2 cells. Taken together, these results indicate that miRNA­30e protects the heart from MI/R via autophagy and the Notch1/Hes1/Akt signaling pathway.

Tetrandrine suppresses metastatic phenotype of prostate cancer cells by regulating Akt/mTOR/MMP-9 signaling pathway.

Tetrandrine (TET), a bisbenzylisoquinoline alkaloid found in traditional Chinese medicines, exerts anticancer activity in vitro and in vivo. However, its potential role in the prostate cancer metastatic process has not yet been elucidated. Thus, we investigated the inhibition effect of tetrandrine on prostate cancer migration and invasion and the corresponding molecular basis underlying its anticancer activity. Cell migration and invasion were determined using the Transwell chamber model. The protein expression of Akt, phosphorylated Akt, the mammalian target of rapamycin (mTOR), phosphorylated mTOR and matrix metalloproteinases 9 (MMP-9) was detected by western blot in the presence or absence of tetrandrine or in the group tetrandrine combination with LY294002 (inhibitor of Akt) and rapamycin (inhibitor of mTOR). Our studies showed that excluding the effect of tetrandrine on cell proliferation, tetrandrine significantly inhibited cell migration and invasion in prostate cancer DU145 and PC3 cells. Furthermore, tetrandrine decreased the protein levels of p-Akt, p-mTOR, and MMP-9. While the inhibition of Akt or mTOR by the respective inhibitors could potentiate this effect of tetrandrine on prostate cancer cells, the studies indicate that tetrandrine inhibits the metastasis process by negatively regulating the Akt/mTOR/MMP-9 signaling pathway. These results suggest that tetrandrine might serve as a potential metastasis suppressor to treat cancer cells that have escaped surgical removal or that have disseminated widely.

Clinical and histopathological analysis of 66 cases with cardiac myxoma.

BACKGROUND AND PURPOSE: Cardiac myxoma is a major primary heart tumor which often causes unexpected symptoms or sudden death. This present study was designed to investigate its clinical pathological features and biological behavior. METHODS: A retrospective analysis of the clinical pathologic and immunohistochemical features of 66 cases with cardiac myxoma was conducted. RESULTS: In 66 patients with cardiac myxoma, 61 cases had involvement of the left atrium, one case in both the right ventricular and left atria. The female: male ratio was 2.7:1. Patients had symptoms of blood flow obstruction and systemic alterations with performance of arterial embolization. Tumors were spherical, lobulated or irregular in shape, and soft and brittle. Immunohistochemical markers of vimentin and CD34 in tumor cells were positive. CONCLUSION: Cardiac myxoma always exists in the left atrium and is more common in women, with diverse clinical manifestations and pathomorphism. Although proliferative activity and the recurrence rate are low, in addition to thorough surgical resection, strengthened review is important for young patients.

[Expression of MMP-9 and TIMP-1 in nasopharyngeal carcinoma and its signification at Xi'an and Shenzhen].

OBJECTIVE: To compare the expression of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 of nasopharyngeal carcinoma at Xi'an and Shenzhen area. METHOD: The protein expression of MMP 9 and TIMP 1 were studied by immunohistochemistry staining in 21 cases nasopharyngeal carcinoma of Xi'an and 22 cases of Shenzhen. RESULT: The expression positive rates of MMP-9 in nasopharyngeal carcinoma tissues at Xi'an and Shenzhen were 61.90% and 68.18%. The positive rates of TIMP-1 in nasopharyngeal carcinoma tissues at two regions were 28.57% and 31.82%. The expression between MMP-9 and TIMP-1 were negative relationship either Xi'an or Shenzhen. The expression of MMP-9 was positively correlated to lymph node metastasis, and TIMP-1 was no relationship with lymph node metastasis. The expression of MMP-9 and TIMP-1 was no difference between Xi'an and Shenzhen. CONCLUSION: The expression of MMP-9 and TIMP-1 in nasopharyngeal carcinoma 2 tissues was no difference between Xi'an and Shenzhen. Increase of MMP-9 play an important role in progression and metastasis of nasopharyngeal carcinoma.

[Clinicopathologic features of cardiac myxoma--a report of 47 cases].

BACKGROUND & OBJECTIVE: Myxoma is the most common neoplasm of the heart, and has various morphologic structures, but its biological behaviors and histogenesis are still controversial. This study was to summarize the clinical, histomorphologic, and immunophenotypic features of cardiac myxoma. METHODS: The clinical data and HE sections of 47 cases of cardiac myxoma were reviewed. Special staining and immunohistochemical staining for 10 kinds of antibodies were carried on some cases to observe the morphologic features. RESULTS: Of the 47 patients with cardiac myxoma, 32 were women, the youngest was 3 years old. The volume of tumors ranged from 0.7 cm x 0.7 cm x 0.4 cm to 12 cm x 8 cm x 7 cm. Of the 47 tumors, 42 were pedunculated, the rest had broad fundus without pedicel; 43 located in the left atrium, 3 in the right atrium, and 1 in the left ventricle where near to the apex of heart. Tumor cells were stellate, spindle, round, or irregular, and arranged as masses or stripes, with abundant mucus around them. Tumor cells surrounded arterioles in 4 cases. Pseudo-capsule was formed by hyperplastic fibrous tissue in 4 cases. The mesenchyma presented angiomatous fashion in 2 cases. Sheets of old hemorrhage, hemosiderin and iron salt deposition, and fibrosis were observed in 7 cases. One case had foci adenoid structure, 1 lipoid metaplasia and ossification, 1 was rich of cells. Vimentin and CD34 were found in lining cells and parenchymal cells in 12 cases. Cytokine kinase (CK) and epithelial membrane antigen (EMA) were positive in the region of adenoid differentiation. Proliferating cell nuclear antigen (PCNA) and Ki67 were positive in the cell-rich tumor. None of the 21 patients had tumor recurred after follow-up. CONCLUSIONS: Cardiac myxoma has various secondary morphologic changes, including adenoid metaplasia, old hemorrhage, fibrosis, ossification, and lipoid metaplasia. Whether the cell-rich tumors tend to be malignant needs further study. Cardiac myxoma may come from multipotential mesenchymal cells.