Advances in mesenchymal stem cell-derived extracellular vesicles therapy for Sjogren's syndrome-related dry eye disease.

Sjogren's syndrome (SS) is a chronic autoimmune disorder that affects exocrine glands, particularly lacrimal glands, leading to dry eye disease (DED). DED is a common ocular surface disease that affects millions of people worldwide, causing discomfort, visual impairment, and even blindness in severe cases. However, there is no definitive cure for DED, and existing treatments primarily relieve symptoms. Consequently, there is an urgent need for innovative therapeutic strategies based on the pathophysiology of DED. Mesenchymal stem cells (MSCs) have emerged as a promising therapeutic tool for various autoimmune disorders, including SS-related DED (SS-DED). A particularly intriguing facet of MSCs is their ability to produce extracellular vesicles (EVs), which contain various bioactive components such as proteins, lipids, and nucleic acids. These molecules play a key role in facilitating communication between cells and modulating a wide range of biological processes. Importantly, MSC-derived EVs (MSC-EVs) have therapeutic properties similar to those of their parent cells, including immunomodulatory, anti-inflammatory, and regenerative properties. In addition, MSC-EVs offer several notable advantages over intact MSCs, including lower immunogenicity, reduced risk of tumorigenicity, and greater convenience in terms of storage and transport. In this review, we elucidate the underlying mechanisms of SS-DED and discuss the relevant mechanisms and targets of MSC-EVs in treating SS-DED. In addition, we comprehensively review the broader landscape of EV application in autoimmune and corneal diseases. This review focuses on the efficacy of MSC-EVs in treating SS-DED, a field of study that holds considerable appeal due to its multifaceted regulation of immune responses and regenerative functions.

A Review of Advances in the Surgical Treatment of Coronary Heart Disease and Lung Cancer.

Lung cancer is currently the most prevalent and fatal malignant tumor in China. Additionally, the incidence of coronary heart disease is steadily increasing. Both diseases exhibit a higher risk of mortality with age, particularly among elderly patients. Moreover, these diseases are interconnected and share common risk factors. However, the treatment options for patients suffering from both lung cancer and coronary heart disease lack clarity and standardized criteria. This article critically examines the literature on surgical interventions for patients with lung cancer complicated by coronary artery disease during the period from January 2021 to December 2022. It summarizes the safety and effectiveness of these interventions and highlights the various surgical options available for different patient profiles.

Mesenchymal Stem Cell-Derived Exosomes in Cardioprotection: A Novel Application to Prevent Myocardial Injury.

Perioperative myocardial injury is a common complication caused by major surgery. Many pharmacological and nonpharmacological studies have investigated perioperative cardioprotection. However, the methods are insufficient to meet the increasing clinical needs for cardioprotection. The application of Mesenchymal Stem Cell-Derived Exosomes (MSC-Exos) is a novel cell-free therapeutic strategy and has significantly benefitted patients suffering from various diseases. In this review, we comprehensively analyzed the application of MSC-Exos to prevent myocardial infarction/injury by regulating inflammatory reactions, inhibiting cardiomyocyte apoptosis and autophagy, promoting angiogenesis, and mediating cardiac remodeling. Finally, we assessed the therapeutic effects and the challenges associated with the application of MSC-Exos from a clinical perspective.

Bioinformatic-based Identification of Genes Associated with Aortic Valve Stenosis.

BACKGROUND: Aortic valve stenosis (AS) disease is the most common valvular disease in developed countries. The pathology of AS is complex, and its main processes include calcification of the valve stroma and involve genetic factors, lipoprotein deposition and oxidation, chronic inflammation, osteogenic transition of cardiac valve interstitial cells, and active valve calcification. The aim of this study was to identify potential genes associated with AS. METHODS: Three original gene expression profiles (GSE153555, GSE12644, and GSE51472) were downloaded from the Gene Expression Omnibus (GEO) database and analyzed by GEO2R tool or 'limma' in R to identify differentially expressed genes (DEGs). Functional enrichment was analyzed using the ClusterProfiler package in R Bioconductor. STRING was utilized for the Protein-Protein Interaction (PPI) Network construct, and tissue-specific gene expression were identified using BioGPS database. The hub genes were screened out using the Cytoscape software. Related miRNAs were predicted in Targetscan, miWalk, miRDB, Hoctar, and TarBase. RESULTS: A total of 58 upregulated genes and 20 downregulated genes were screened out, which were mostly enriched in matrix remodeling and the immune system process. A module was thus clustered into by PPI network analysis, which mainly involved in Fc gamma R-mediated phagocytosis, Osteoclast differentiation. Ten genes (IBSP, NCAM1, MMP9, FCGR3B, COL4A3, FCGR1A, THY1, RUNX2, ITGA4, and COL10A1) with the highest degree scores were subsequently identified as the hub genes for AS by applying the CytoHubba plugin. And hsa-miR-1276 was finally identified as potential miRNA and miRNA-gene regulatory network was constructed using NetworkAnalyst. CONCLUSIONS: Our analysis suggested that IBSP, NCAM1, MMP9, FCGR3B, COL4A3, FCGR1A, THY1, RUNX2, ITGA4, and COL10A1 might be hub genes associated with AS, and hsa-miR-1276 was potential miRNA. This result could provide novel insight into pathology and therapy of AS in the future.

Learning Curve of Aortic Arch Replacement Surgery in Chinese Mainland with Stanford Type A Aortic Dissection.

BACKGROUND: Stanford type A aortic dissection (TAAD) is the most common cause of death caused by aortic disease in the Chinese mainland. Patients suffering TAAD need immediate surgical treatment [Pompilio 2001; Di Eusanio 2003; Ueda 2003; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Emergency aortic arch replacement is difficult and risky. The prognosis following surgery varies depending on the different surgical approaches [Pompilio 2001; Kazui 2002; Di Eusanio 2003; Ueda 2003; Moon 2009; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Aortic arch replacement includes total-arch replacement (Sun's operation) and hemi-arch replacement. The comparative analysis of learning curves between the two procedures has not been systematically studied. In this study, we studied and analyzed the learning curves of total-arch replacement and hemi-arch replacement using cumulative sum (CUSUM) analysis. METHODS: From January 2013 to December 2019, a total of 139 Stanford TAAD operations were performed by the same surgeon and two assistants, including 61 cases of hemi-arch replacement and 78 cases of total-arch replacement. Baseline information, including preoperative conditions, intraoperative related data and postoperative prognosis, were collected. Descriptive statistics and CUSUM were used to analyze the total operation time, cardiopulmonary bypass (CPB) time, aortic clamping (AC) time, operative mortality, incidence of postoperative complications, postoperative intensive care unit (ICU) time, hospital stay, and postoperative drainage volume. RESULTS: A total of 139 patients with TAAD (age 48.8 ± 12.3, male, 107, female, 32) underwent emergency aortic arch replacement. A total of 61 patients (43.9%) underwent hemi-arch replacement, and 78 patients (56.1%) underwent total-arch replacement. The total time, cardiopulmonary bypass (CPB) time, and aortic clamping (AC) time of hemi-arch operation were 434.2 ± 137.0 minutes, 243.3 ± 87.2 minutes, and 157.0 ± 60.2 minutes. The total, CPB, and AC times of total-arch operation were 747.8 ± 164.3 minutes, 476.4 ± 121.6 minutes, and 238.5 ± 67.6 minutes. The mortality of hemi-arch operation was 3.3%, and that of total-arch operation was 6.4%. The incidence of complications after hemi-arch operation was 11.3%, and that after total-arch operation was 46.2%. The ICU time and hospital stay after hemi-arch surgery were 7.3 ± 4.4 days and 27.2 ± 16.2 days, respectively, and the ICU time and total hospital stay after total-arch surgery were 7.2 ± 5.9 days and 24.0 ± 10.3 days, respectively. The total drainage volume after hemi-arch operation was 2182.4 ± 1236.4 ml, and that after total-arch operation was 2467.3 ± 1385.7 ml. According to CUSUM analysis, the same cardiovascular surgery team seems to have different learning curves in the time of two operations. CUSUM analysis of intraoperative and postoperative indicators shows that after a certain period of professional and systematic cardiovascular surgery training, aortic hemi-arch replacement has the characteristics of short learning cycle and easy to master for surgeons, while total-arch replacement requires a longer learning cycle. CONCLUSIONS: Although the emergency operation of TAAD is difficult and risky, according to results the of CUSUM analysis, cardiovascular surgeons can achieve better learning results in hemi-arch replacement than total-arch replacement.

Thoracoscopic Lung Cancer Resection with Simultaneous Heart Valve Procedure.

Comorbidity of primary lung cancer and heart valve disease, both requiring surgical therapy, characterizes a high-risk group of patients necessitating prompt diagnosis and treatment. Recently, the rate of minimal invasive approach for patients who were not indicated for conventional thoracotomy surgery due to their high-risk status with the procedure has increased as treatment for heart valve disease. We herein report four patients of lung cancer resection with simultaneous valve procedure though thoracoscopic technique [Bablekos 2016].

Inferior Vena Cava Filter Migrated to Left Ventricle.

Inferior vena cava (IVC) filters have been widely used to prevent pulmonary emboli in patients with venous thromboembolism. Here we report a rare case of complete pericardial tamponade with severe mitral and tricuspid valve regurgitation due to a fractured IVC filter. A 38-year-old male came to our emergency department with a 19-day history of progressive chest tightness. Chest x-ray revealed a tethering catheter fractured at the level of the junction of the superior vena cava and the right atrium. We performed open surgery and discovered that a steel wire had punctured the atrioventricular septum, the mitral valve, and finally the posterior wall of the left ventricle. The patient recovered quite well and was discharged after 1 week.

Left atrial appendage exclusion is effective in reducing postoperative stroke after mitral valve replacement.

OBJECTIVE: This study aimed to evaluate the role of surgical left atrial appendage (LAA) exclusion in the prevention of stroke after mitral valve replacement (MVR). METHODS: We retrospectively reviewed clinical data of 860 patients who received MVR in our center from January 2008 to January 2013. The patients were randomly assigned to two surgical groups, namely LAA exclusion group (n = 521) and LAA nonexclusion group (n = 339) according to whether concurrent surgical exclusion of the LAA was to be undertaken or not before surgery in a blind fashion. MVR was performed by two experienced surgeons. The LAA was explored during the operation and mural thrombus removed in all cases. The LAA was left intact in nonocclusion group whereas the neck of the LAA was closed with a two-layer continued suture in exclusion group. The incidence of early postoperative ischemic stroke between the two groups was compared. RESULTS: The patients' age was 53 ± 12 years, with 48.1% male and 67.9% with rheumatic disease. Mural thrombosis was seen in 18.8% of the patients and atrial fibrillation (AF) coexisted in 62.4%. All operations were successfully performed and no difference was noted in in-hospital mortality, re-exploration for bleeding, and other major complications between the two groups. The incidence of ischemic stroke in LAA exclusion group was significantly lower than in nonexclusion group (0.6% vs. 2.7%, p = .011). The subgroup multivariate analysis showed that LAA exclusion significantly reduced the risk of postoperative stroke in patients with AF (odds ratio [OR] = 0.070, 95% confidence interval [CI]: 0.006-0.705, p = .025) but not in non-AF patients (OR = 1.902, 95% CI: 0.171-21.191, p = .601). CONCLUSIONS: Concurrent LAA exclusion during MVR is a safe and effective way to reduce postoperative ischemic stroke, particularly in patients with AF.

Study of the migration behaviours of imidazoline corrosion inhibitor in concrete using UV-vis spectrophotometry.

In this study, UV-visible light spectrophotometry was used for the first time to examine the migration behaviours of cationic and nonionic imidazoline corrosion inhibitors in concrete. Imidazoline can react with bromocresol purple resulting in a reduction in absorbance, which can be used to calculate quantitatively imidazoline concentration. The results showed that the migration rate of nonionic imidazoline was faster than that of cationic imidazoline with or without the presence of an electric field, possibly because of the better water solubility of nonionic imidazoline. The electric field could significantly accelerate the migration rate of the cationic and nonionic imidazoline. However, the penetration performance of nonionic imidazoline was much improved compared with that of cationic imidazoline in concrete. From X-ray photoelectron spectroscopy analysis, the N element could be detected on steel, verifying the migration behaviour of the nonionic imidazoline. This nonionic imidazoline could markedly retard steel corrosion according to potentiodynamic polarization.

The Pacopexy procedure for left ventricular aneurysm: a 10-year clinical experience.

PURPOSE: To evaluate our 10-year clinical experience of performing the Pacopexy procedure for left ventricular aneurysm (LVA). METHODS: Between January, 1998 and November, 2015, a cohort of 92 patients with LVA underwent surgery to reshape the left ventricle. Fifty-seven patients underwent the Dor procedure and 35 underwent the Pacopexy procedure to emphasize the conical shape, whereby patch placement followed an oblique trajectory between the left ventricular apex and the septum below the aortic valve. RESULTS: The early-mortality rate was 4.34% (4/92; n = 2 in each group). The 10-year survival rate was 70.4 ± 7.9% in the Pacopexy group vs 41.7 ± 7.2% in the Dor group (p < 0.05), and the rate of freedom from hospital re-admission for heart failure (HF) or cardiac death was 60.0 ± 8.6% vs 28.8 ± 6.8%, respectively (p < 0.05). The Dor procedure and left ventricular end systolic volume index (LVESVI) ≥ 60 ml/m2 were strongly and significantly associated with long-term mortality and hospital re-admission for HF. CONCLUSIONS: The Pacopexy procedure is a reproducible surgical option for the treatment of LVA. The improved configuration achieved by the Pacopexy procedure has resulted in good long-term survival and a high degree of freedom from re-admission for HF in patients with advanced LVA.

Nursing Management of Severe COVID-19 Patients Undergoing Extracorporeal Membrane Oxygenation Combined with Prone Position Ventilation.

Acute respiratory distress syndrome (ARDS) is a serious lung injury in patients with severe coronavirus disease 2019 (COVID-19). This process often is difficult to reverse, eventually leading to the death of patients. Extracorporeal membrane oxygenation (ECMO) treatment can provide patients with cardiopulmonary function support and buy time for clinicians' treatment. However, some patients still suffer from poor oxygenation after ECMO treatment. At this time, nurses can change the patient's position to prone position to improve oxygenation level and promote sputum excretion. It is a great challenge for COVID-19 patients to change their postures while receiving ECMO treatment. This article provides suggestions for this process by reviewing our hospital's experience in treating severe COVID-19 patients.

Severe Left Main Coronary Stenosis Due to Aortic Bioprosthesis Implantation: A Case Report.

Coronary artery ostial stenosis is a common but life-threatening complication that usually presents right after valve implantation, especially in transcatheter aortic valve implantation (TAVI) procedure. However, as reported in our case, it may also have a late delayed presentation in valve replacement through median sternotomy. Here, we present a rare case of one patient who underwent percutaneous coronary intervention (PCI) for severe stenosis of the left main (LM) coronary artery six months after Mosaic aortic bioprosthesis implantation.

Progress in Treatment of Myocardial Injury in Patients with 2019-nCoV: A Chinese Experience.

Since December 2019, the 2019 novel coronavirus (2019-nCoV) infection began to appear in Hubei Province of China and gradually spread to other provinces and other countries. The virus has the characteristics of strong transmission capacity, diverse clinical manifestations, long incubation period, and latent infection, thus posing a serious threat to human life safety and health. With the increasing number of cases and the continuous enrichment of clinical data, 2019-nCoV-infected patients have received more and more attention regarding myocardial injury related to virus infection besides typical respiratory system manifestations. According to the published data, we summarize the myocardial injury manifestations, characteristics, effects on disease condition, and prognosis of 2019-nCoV-infected patients and discuss the possible injury mechanism, treatment methods, and future research directions.

Minimally Invasive Isolated Tricuspid Valve Redo Surgery Has Better Clinical Outcome: A Single-Center Experience.

BACKGROUND: Reoperation for isolated tricuspid valve (TV) surgery is considered a high-risk procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either through thoracoscopic approach (thoracoscopic group), right thoracotomy (thoracotomy group), or median sternotomy (sternotomy group). METHODS: We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-TV procedure through thoracoscopic approach (n = 33), right lateral thoracotomy approach (n = 14), or sternotomy (n = 72). RESULTS: All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. 69% and 31% of patients received valve replacement and valvuloplasty, respectively. After operation, one patient in the sternotomy group received reoperation for bleeding, while another patient received valve replacement surgery 2 weeks after operation due to heart failure caused by valvuloplasty failure. No obvious complications occurred in the minimally invasive groups. The overall success rate of valve repair during 1-year follow-up was 99.2%. CONCLUSION: Minimally invasive, isolated TV surgery as reoperation can be safe and may improve clinical outcome.

Red Blood Cell Distribution Width Predicts Postoperative Death of Infective Endocarditis.

Infectious endocarditis (IE) is a rare disease with high mortality rate. Recently, red cell distribution width (RDW) has drawn special attention for predicting cardiovascular disease. This study aims to explore the relationship between RDW value and postoperative death of IE patients.Clinical records of patients with definite IE from Chinese People's Liberation Army General Hospital department of cardiovascular surgery were collected and analyzed. Clinical, echocardiographic, and biochemical variables were evaluated along with RDW.Results: A total of 158 consecutive IE patients (mean age 47.0 ± 16.3 years, male 61.4%) were enrolled in this study. According to receiver operating characteristic (ROC) curve analysis, the optimal RDW cutoff value for predicting mortality was 15.45% (area under the curve 0.913, P < 0.001). A total of 28 patients (17.8%) died postoperatively; of these, 89.3% had RDW value >15.45%. Binary regression analysis showed that aging, multiple valvular involved, valvular vegetation formation, pulmonary hypertension, and high RDW are strong predictors of postoperative death. Multiple regression analysis revealed that high RDW value was independent predictors of postoperative mortality in patients with IE (ß: 3.704, 95% confidence interval (95%CI): 2.729-604.692, P < 0.05).IE has a high inhospital mortality rate, and increased RDW is an independent predictor of postoperative death in these patients.

Identify the critical protein-coding genes and long noncoding RNAs in cardiac myxoma.

Cardiac myxoma (CM) is the most common benign cardiac tumor which is mostly sporadic. Increasing evidence show that protein-coding genes (PCGs) and long noncoding RNAs (lncRNAs) play important roles in the pathology processes of multiple cancers. However, the functional roles and regulatory mechanisms of RNAs interaction in CM are still unclear. In this study, we investigated three pairs of surgically excised CM by high throughput sequencing and screened a set of PCGs and lncRNAs which were differentially expressed and could serve as expression markers in CM. By constructing protein-protein interactions (PPI) and lncRNA-mRNA coexpressing network, we screened out a CM-related hub lncRNA-mRNA modules, which were enriched in different pathways such as MAPK and TGF-beta whose imbalance were validated by q-PCR. In addition, we identified a specific dysregulated competing endogenous RNA (ceRNA) network in CM by integrating lncRNA-miRNA-mRNA interactions. These results will help us to understand the interaction mechanisms of RNAs in CM and provide novel PCGs and lncRNAs as potential therapeutic targets for CM.

Surgery for Patients with Radiation-Induced Constrictive Pericarditis.

Radiation-induced heart disease (RIHD) is a major side effect of chest radiation therapy (RT). Most changes of pericardium will occur within a few weeks after receiving chest RT, while most of them will take decades or more to become constrictive pericarditis. Pericardiectomy is an effective treatment method. Here, we report 2 cases of radiation pericarditis after chest RT at our center.