Changing of haemostatic system in a pig model during different types of hypothermic circulatory arrest.

BACKGROUND: Hypothermic circulatory arrest is usually used in aortic surgery, congenital heart defect repairs and other complex surgeries. It is frequently associated with excessive postoperative bleeding and the transfusion of allogeneic blood products. The physiopathology of hypothermic circulatory arrest-induced coagulopathy has never been systematically studied. The aim of the study was to investigate this phenomenon in a pig model. METHODS: Ten pigs were randomly assigned to 30 min of hypothermic circulatory arrest at either 15 °C (n = 5) or 25 °C (n = 5). Detection of apoptosis and haemostatic system assays were performed in this experiment. Enzyme-linked immunosorbent assays were performed at ten time points in each group to study the changes in the coagulation system in hypothermic circulatory arrest. All of the statistical analyses were performed in SPSS software, version 18.0, and as bilateral tests, and p < 0.05 was considered statistically significant. RESULTS: There was no significant difference in the effect of different types of hypothermic circulatory arrest on routine laboratory tests and tissue sample analysis (p > 0.05, for all). Our results demonstrated that more severe systemic activation of the coagulation system (TAT and F1+2) was applied in the deep hypothermic circulatory arrest group but not in the moderate hypothermic circulatory arrest group (TAT/p = 0.01, F1+2/p = 0.03). However, this activation of the coagulation system (AT III and PC) was not associated with changes in the anticoagulation pathway (AT III/p = 0.24, PC/p = 0.33). In addition, analysis of biomarkers of the haemostatic system revealed that the consumption of coagulation is more concentrated on extrinsic coagulation factors (FVII/p = 0.01). CONCLUSIONS: Moderate hypothermic circulatory arrest is more suitable for patients with coagulation dysfunction. We believe the application of deep hypothermic circulatory arrest should pay more attention to changes in coagulation rather than the anticoagulation pathway. Extrinsic coagulation factor supplementation is more effective after deep hypothermic circulatory arrest.

Effects of the linoleic acid/docosahexaenoic acid ratio and concentration inducing autophagy in Raw264.7 cells against Staphylococcus aureus.

Our study was to understand the autophagy induce by different ratios and concentrations of LA/DHA on Raw264.7 cell, and then to investigate the effect of Raw264.7 autophagy on the clearance of Staphylococcus aureus. Raw264.7 cells was treated by LA/DHA in different concentrations (50/100 µmol/L) and ratios (4:1, 6:1, 8:1, 1:4, 1:6 and 1:8) for 6/12/24 h, cell viability assay was assessed by Cell Counting Kit-8, LC3B, p62, P-mTOR, P-Akt, P-PI3K and BECN 1 were detected by the Western blot. LA/DHA could induce autophagy of Raw264.7 cells through the PI3K-Akt-mTOR signaling pathway, the strong effect on autophagy by the concentration is 100 µmol/L, the ratio is 6:1 of LA/DHA, and the treatment time is 24 h. Compared with the images in the control group obtained by merging red and green fluorescence channels, the treatment of LA, DHA in a ratio of 6:1 at a concentration of 100 µmol/L for 24 h significantly lead to a substantial number of autophagosomes (yellow) as well as autolysosomes (red), enhancing autophagy flux. Autophagy induce by LA/DHA can devour and damage intracellular and extracellular Staphylococcus aureus. These results indicate that LA/DHA cloud induce autophagy and enhance the phagocytosis and killing ability of macrophages to intracellular parasitic bacteria.

Case report of achalasia secondary to a lung carcinoma of the mediastinal type.

Pseudo- or secondary achalasia may mimic primary achalasia upon radiological examination and may be difficult to diagnose. It is usually due to a cancer or metastases involving the gastroesophageal junction. We present the case of a 53-year-old woman with recent onset of dysphagia, and with typical findings suggesting primary achalasia. We found a 4-cm mediastinal tumor invading the lower esophagus, which was proven to be a metastasis from a lung carcinoma. The patient was treated with surgery, chemotherapy and radiotherapy. In patients with a new onset of achalasia symptoms, keeping in mind the possibility of an underlying cancer is important.

The prognostic value of admission D-dimer level in patients with cardiogenic shock after acute myocardial infarction.

Background: Shock is associated with the activation of the coagulation and fibrinolytic system, and D-dimer is the degradation product of cross-linked fibrin. However, the prognostic value of D-dimer in patients with cardiogenic shock (CS) after acute myocardial infarction (AMI) remains unclear. Methods: We retrospectively analyzed the data of consecutive patients with CS complicating AMI. The primary endpoint was 30-day mortality and the secondary endpoint was the major adverse cardiovascular events (MACEs) including 30-day all-cause mortality, ventricular tachycardia/ventricular fibrillation, atrioventricular block, gastrointestinal hemorrhage, and non-fatal stroke. Restricted cubic spline (RCS) analyses were performed to assess the association between admission D-dimer and outcomes. A multivariable Cox regression model was performed to identify independent risk factors. The risk predictive potency with D-dimer added to the traditional risk scores was evaluated by C-statistics and the net reclassification index. Results: Among 218 patients with CS complicating AMI, those who died during the 30-day follow-up presented with worse baseline characteristics and laboratory test results, including a higher level of D-dimer. According to the X-tile program result, the continuous plasma D-dimer level was divided into three gradients. The 30-day all-cause mortality in patients with low, medium, and high levels of D-dimer were 22.4, 53.3, and 86.2%, respectively (p < 0.001 for all). The 30-day incidence of MACEs was 46.3, 77.0, and 89.7%, respectively (p < 0.001). In the multivariable Cox regression model, the trilogy of D-dimer level was an independent risk predictor for 30-day mortality (median D-dimer cohort: HR 1.768, 95% CI 0.982-3.183, p = 0.057; high D-dimer cohort: HR 2.602, 95% CI 1.310-5.168, p = 0.006), a similar result was observed in secondary endpoint events (median D-dimer cohort: HR 2.012, 95% CI 1.329-3.044, p = 0.001; high D-dimer cohort: HR 2.543, 95% CI 1.452-4.453, p = 0.001). The RCS analyses suggested non-linear associations of D-dimer with 30-day mortality. The enrollment of D-dimer improved risk discrimination for all-cause death when combined with the traditional CardShock score (C-index: 0.741 vs. 0.756, p difference = 0.004) and the IABP-SHOCK II score (C-index: 0.732 vs. 0.754, p difference = 0.006), and the GRACE score (C-index: 0.679 vs. 0.715, p difference < 0.001). Similar results were acquired after logarithmic transformed D-dimer was included in the risk score. The improvements in reclassification which were calculated as additional net reclassification index were 7.5, 8.6, and 12.8%, respectively. Conclusion: Admission D-dimer level was independently associated with the short-term outcome in patients with CS complicating AMI and addition of D-dimer brought incremental risk prediction value to traditional risk prediction scores.

Total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse.

OBJECTIVE: To evaluate clinical effectiveness of total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse. METHODS: We retrospectively analyzed the clinical data of 21 patients with severe pelvic organ prolapse. The anatomical outcomes were evaluated by Pelvic Organ Prolapse Quantitation, functional effectiveness by Prolapse Quality of Life method, and sexual function and operation-related complications were also analyzed. RESULTS: All surgical operations were accomplished successfully by the same surgeon. No impairment of bladder, urethra, rectum, or great vessels was noted, and no patient required blood transfusion. The mean operation duration was (63±19) minutes, and the mean intra-operative blood loss was (143±72) ml. One patients experienced post-operative urinary retention for 7 days, and the remaining 20 patients were able to micturate spontaneously 1-2 day after surgery. The post-operative morbidity rate was 14.3%. Three patients (14.3%) experienced mesh erosion. Of 12 patients who were sexually active, two patients suffered from algopareunia from dyspareunia, one from de novo overactive bladder, and one from stress urinary incontinence Questionnaire scores showed that the overall post operative quality of life was improved significantly (P=0.000), while quality of sexual life significantly degraded (P=0.044) The anatomic cure rate was 95.2% (20/21), and the patient subjective satisfaction rate was 85.7% (18/21) CONCLUSIONS: The total pelvic floor reconstruction is a safe and effective approach for the repair of severe pelvic organ prolapse, although its functional effectiveness is not as notable as anatomical outcomes However, the complications such as mesh erosion, low urinary tract symptoms, algopareunia, and dyspareunia should be carefully managed.

[Study on association of PPP1R3 gene 5 bp deletion/insertion within 3'-untranslated region polymorphism with type 2 diabetes].

OBJECTIVE: To determine whether the muscle-specific glycogen-targeting regulatory subunit of the glucogen bound protein phosphatase 1 (PPP1R3) gene 5 bp deletion/insertion(D/I) within 3'-untranslated region ( 3'-UTR) polymorphism is associated with type 2 diabetes in Chinese Han population in Hefei region of Anhui province. METHODS: The PPP1R3 gene 3'-UTR 5 bp D/I polymorphism was detected by polymerase chain reaction in 268 patients with type 2 diabetes and 106 normal controls. RESULTS: (1) The distributions of the frequency of three genotypes and two alleles of the PPP1R3 gene 5 bp D/I polymorphism showed no significant difference between the type 2 diabetic cases and the normal controls. (2) In both the cases and controls, there was no significant difference in age at onset, duration of disease, blood glucose, blood lipid profile, blood pressure, insulin sensitive index, body mass index, and waist hip ratio between the three genotypic groups(P 0.05). (3) The PPP1R3 gene 3'-UTR polymorphism in Chinese Han population in Hefei region of Anhui province was found to be similar to that in both Japanese population and Canadian population, and to be different from that in Piman Indians and the Caucasians in Sweden. CONCLUSION: The PPP1R3 gene 5 bp D/I within 3'-UTR polymorphism taking on genetic variation among the different races of mankind may not play a critical role in the development of type 2 diabetes mellitus in Chinese Hans of Hefei region in Anhui province.

[A preliminary experience of treatment of severe aplastic anemia with murine anti-human CD3 T lymphocyte monoclonal antibody].

OBJECTIVE: To investigate the efficacy of the specific murine anti-human CD(3) T lymphocyte monoclonal antibody (CD(3) MoAb) for severe aplastic anemia (SAA). METHODS: 13 SAA patients were chosen with a medium age of 22 years, including 4 untreated patients and 9 nonresponding to previous management. They were treated with 5 mg of CD(3) MoAb per day for a total 10 days. RESULTS: The response rate was 11/13, including 2 cured and 2 remission cases during a follow up of 3 to 15 months. As compared with the pretreatment condition the proliferation of bone marrow in 8 cases become better; the leukocytes, granulocytes, hemoglobin and platelets of peripheral blood increased 1.59 x 10(9)/L, 0.72 x 10(9)/L, 40 g/L and 47 x 10(9)/L respectively (P < 0.01, respectively); the ratio of CD(4)/CD(8) of T cell subsets increased from 1.12 to 1.42 while the expression of HLA-DR antigen decreased from 29.2 to 15.2 (P < 0.01, respectively); TNF alpha, IFN gamma and IL-2 secreted by peripheral blood mononuclear cells (PBMNCs) decreased obviously from 267, 784 and 92 to 152, 570 and 51 U/ml on the average respectively (P < 0.01, respectively). The main side effects were fever in all the patients and shortness of breath in 4 cases, but none died during the therapy. CONCLUSIONS: In contrast to other kinds of common immune suppressor, CD(3) MoAb showed better response and probably higher efficacy and safety for SAA. It is necessary to have more cases and to follow up longer to estimate its long term effect and side effects.

Effect of intensive blood glucose control on quality of life in elderly patients with type 2 diabetes in Anhui Province.

BACKGROUND: Intensive blood glucose control is proven to be associated with the diabetic microvascular and macrovascular complications, which could affect quality of life (QOL). This study was performed to determine the effects of intensive glucose control therapy on QOL of elderly patients with type 2 diabetes in Anhui Province. METHODS: Ninety-seven elderly patients with type 2 diabetes in Anhui were randomly assigned to standard treatment group and intensive therapy group. All patients were followed up for five years on average. Correlated information has been collected during the regular follow-up. RESULTS: Patients with microvascular complications reported significantly lower European Quality of Life-5 Dimensions (EQ-5D) scores and had more problems with usual activities, pain and anxiety than those without complications (P < 0.05). Patients having experienced hypoglycemic episodes had significantly more problems with anxiety than those without hypoglycemic episodes (P < 0.05). No significant difference was detected in all dimensions in quality of life, as well as in Visual Analog Scale score between two groups (P > 0.05). There was no significant difference in quality of life at the fifth year compared with that of the first year in both groups. Women had more feelings of pain and anxiety than men (P < 0.05) and longer disease course was associated with increased levels of pain and anxiety (P < 0.05), as well as with lower QOL. In addition, patients with higher body mass index (BMI) had more problems with daily activities than patients with lower BMI (P < 0.05). CONCLUSIONS: Anxiety is common in elderly diabetic patients and they experienced frequent hypoglycemic episodes. Diabetic vascular complications significantly affect QOL of the patients. Intensive glucose control has no significant effect on QOL of the diabetic patients. Female, older age, long disease course, less education and high BMI are all factors caused reduced QOL and patients with these factors should be given more psychological support. Frequent mild hypoglycemic episodes do not cause impaired function of the central nervous system.

[Study on the association of PPP1R3 gene polymorphism with type 2 diabetes in Han population of Anhui province].

OBJECTIVE: To study the association of muscle-specific glycogen-targeting regulatory subunit of the glucogen-bound protein phosphatase 1 (PPP1R3) gene codon 905 Asp/Tyr polymorphism with type 2 diabetes in Chinese Han population in Hefei region of Anhui province. METHODS: PPP1R3 gene Asp905Tyr polymorphism was detected by polymerase chain reaction and appropriate restriction enzyme (PCR-RFLP) in 262 type 2 diabetic cases and 104 normal controls. Case and control groups were divided into subgroups by body mass index (BMI) 25 kg/m2. RESULTS: When PPP1R3 gene Asp905Tyr polymorphism was not associated with type 2 diabetes mellitus. When subjects with BMI < 25 kg/m2 and Tyr/Tyr genotypes were used as reference. Subjects with Asp905 and BMI > or = 25 kg/m2 had a 3.69-fold increase of risk suffering from type 2 diabetes (OR = 3.69, 95% CI: 1.38-8.89, P=0.006). CONCLUSIONS: PPP1R3 gene Asp905Tyr polymorphism did not seem to play a critical role in the development of type 2 diabetes mellitus in Han population of Chinese in Anhui province but interaction between the Asp905 and BMI cause the increase of risk of type 2 diabetes.