Rapid Detection of Serratia fonticola by TaqMan Quantitative Real-Time PCR Using Primers Targeting the gyrB Gene.

A gyrB gene is present in the majority of bacterial species, and encodes the ATPase domain of DNA gyraseB-subunit protein, which is essential for transcription and replication of bacteria. The gyrB gene exhibits higher nucleotide sequence variability than the 16S rDNA gene and thus could be more reliable in differentiating Serratia fonticola. A species-specific primer pair and probe were designed for quantitative real-time PCR detection of S. fonticola using gyrB as the target gene. Nine members of the Serratia family (representing nine Serratia species) were chosen to verify the specificity of the primers. Additionally, two species each of Salmonella and Klebsiella, and five other species belonging to five other genera of Enterobacteriaceae, were tested for primer cross-reaction. All the tested strains gave negative results. The limit of detection for S. fonticola using the gyrB gene was 100 copies per PCR reaction. This TaqMan PCR assay provided a specific, rapid, and sensitive method to detect S. fonticola based on its gyrB gene.

Serum salusin-α levels are inversely correlated with the presence and severity of coronary artery disease.

We sought to measure serum salusin-α levels in patients with coronary artery disease (CAD) and to assess their correlation with the severity of the disease. We enrolled 172 patients with CAD and 91 controls. We assessed the angiographic severity of CAD by coronary atherosclerosis index (CAI) and detected serum salusin-α levels by enzyme-linked immunosorbent assay (ELISA). We demonstrated that CAD patients had significantly lower serum salusin-α levels compared to controls. Moreover, serum salusin-α levels were independently and negatively correlated with the presence and severity of CAD. These findings indicated that salusin-α might serve as a potential biomarker for predicting the development and progression of CAD.

[Effect of inhaling specific phosphodiesterase inhibitor on lung injury induced by cardiopulmonary bypass].

OBJECTIVE: To evaluate the effect of pretreatment by inhaling specific phosphodiesterase inhibitor on lung injury induced by cardiopulmonary bypass (CPB). METHODS: From April 2010 to November 2010, 30 patients were divided randomly into two groups: control group (n = 15) and milrinone group (n = 15). In milrinone group, 5 mg milrinone diluted by 5ml normal saline was inhaled per 8 h two days pre-operation. In control group, only 10 ml normal saline was inhaled. Blood samples were drawn from ulnar vein and radial artery pre-operation (T(0)), 30 min post-aortic unclamping (T(1)), at the end of operation (T(2)), 24 h, 72 h and 7 d post-operation (T(3)-T(5)). The following parameters were determined: TNF-α (tumor necrosis factor-alpha), IL-6 (interleukin-6), HSCRP (high-sensitivity C-reactive protein), MDA (malondialdehyde), MPO (myeloperoxidase) level and leucocyte count ratio of venous and arterial blood. And the values of pulmonary vascular resistance (PVR) and oxygenation index (OI) were measured through a Swan-Ganz catheter at the first 5 time points. RESULTS: PVR rose while OI declined at post-operation. But the range of above-mentioned indices in milrinone group was significantly smaller than that in control group. And the indices recovered much earlier in milrinone group. The levels of TNF-α, IL-6, HSCRP, MDA, MPO and leucocyte count ratio were not significantly different at T(0) between two groups and increased significantly after CPB in both groups. But the level of TNF-α (ng/L) was significantly lower at T(2), T(4), T(5) in milrinone group than that in control group (60 ± 5 vs 79 ± 7, 29 ± 6 vs 40 ± 8, 18 ± 5 vs 28 ± 7, all P < 0.05). The levels of IL-6 and MDA were significantly lower at T(1)-T(4) in milrinone group. The level of HSCRP became elevated post-operatively in both groups and reached its peak at 24 h post-operation, especially in control group. The level of MPO (µg/L) was significantly lower at T(2), T(3) and T(5) (134 ± 20 vs 190 ± 23, 142 ± 28 vs 178 ± 20, 65 ± 9 vs 75 ± 11, all P < 0.05). And the V/A ratio was significantly lower at T(1)-T(3) in milrinone group than in control group (1.12 ± 0.11 vs 1.37 ± 0.09, 1.07 ± 0.07 vs 1.25 ± 0.07, both P < 0.01). CONCLUSION: Inhaled milrinone may protect the lungs from acute injury induced by CPB. Inhaling milrinone is safe and feasible for the prevention of acute CPB-induced injury.

Roundabout homolog 1 inhibits proliferation via the YY1-ROBO1-CCNA2-CDK2 axis in human pancreatic cancer.

Pancreatic cancer (PC) is highly malignant and has a high mortality with a 5-year survival rate of less than 8%. As a member of the roundabout immunoglobulin superfamily of proteins, ROBO1 plays an important role in embryogenesis and organogenesis and also inhibits metastasis in PC. Our study was designed to explore whether ROBO1 has effects on the proliferation of PC and its specific mechanism. The expression of ROBO1 was higher in cancer tissues than in matched adjacent tissues by immunohistochemistry (IHC) and qRT-PCR. Low ROBO1 expression is associated with PC progression and poor prognosis. Overexpression of ROBO1 can inhibit the proliferation of PC cells in vitro, and the S phase fraction can also be induced. Further subcutaneous tumor formation in nude mice showed that ROBO1 overexpression can significantly inhibit tumor growth. YY1 was found to directly bind to the promoter region of ROBO1 to promote transcription by a luciferase reporter gene assay, a chromatin immunoprecipitation (ChIP) and an electrophoretic mobility shift assay (EMSA). Mechanistic studies showed that YY1 can inhibit the development of PC by directly regulating ROBO1 via the CCNA2/CDK2 axis. Taken together, our results suggest that ROBO1 may be involved in the development and progression of PC by regulating cell proliferation and shows that ROBO1 may be a novel and promising therapeutic target for PC.

Effect of the transcription factor YY1 on the development of pancreatic endocrine and exocrine tumors: a narrative review.

Pancreatic tumors are classified into endocrine and exocrine types, and the clinical manifestations in patients are nonspecific. Most patients, especially those with pancreatic ductal adenocarcinoma (PDAC), have lost the opportunity to receive for the best treatment at the time of diagnosis. Although chemotherapy and radiotherapy have shown good therapeutic results in other tumors, their therapeutic effects on pancreatic tumors are minimal. A multifunctional transcription factor, Yin-Yang 1 (YY1) regulates the transcription of a variety of important genes and plays a significant role in diverse tumors. Studies have shown that targeting YY1 can improve the survival time of patients with tumors. In this review, we focused on the mechanism by which YY1 affects the occurrence and development of pancreatic tumors. We found that a YY1 mutation is specific for insulinomas and has a role in driving the degree of malignancy. In addition, changes in the circadian network are a key causative factor of PDAC. YY1 promotes pancreatic clock progression and induces malignant changes, but YY1 seems to act as a tumor suppressor in PDAC and affects many biological behaviors, such as proliferation, migration, apoptosis and metastasis. Our review summarizes the progress in understanding the role of YY1 in pancreatic endocrine and exocrine tumors and provides a reasonable assessment of the potential for therapeutic targeting of YY1 in pancreatic tumors.

[Surgical treatment of giant thymoma in a patient with myasthenia gravis].

We report a case report of giant thymoma (17 cm×14 cm×4 cm) in a 32-year-old male patient with myasthenia gravis. Examinations revealed that the tumor invaded the mediastinum, blood vessels and pericardium, and was histologically classified as WHO type B1 and Masaoka stage III. The patient developed myasthenia gravis crisis after radical resection of the thymoma and appropriate treatments with tracheotomy were administered. The patient recovered and was discharged after a hospital stay for 252 days with a mechanical ventilation time of 102 days.

[Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for Stanford type A aortic dissection: analysis of 23 cases].

OBJECTIVE: To assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection. METHODS: Twenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection. RESULTS: There was no perioperative death in these cases. The mean extracorporeal circulation time was 209∓52 min, the aortic cross clamp time was 85∓21 min, and the mean chest tube output within the first 24 h after the operation was 570∓263 mL; none of the patients required chest reopening for management of bleeding. Postoperative acute renal failure requiring hemodialysis occurred in 3 cases, transient neurologic dysfunction in 2 cases, paraplegia in case and hematosepsis in 1 case. No such complications as permanent neurologic deficit or postoperative visceral malperfusion occurred in these cases. All the patients survived and were discharged from hospital without experiencing severe complications in the follow-up for 6-18 months. CONCLUSION: Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique is a safe and simple procedure with controllable bleeding and can serve as an optional procedure for aortic arch replacement.

[Establishment of a rabbit model of small diameter vascular graft replacement].

OBJECTIVE: To establish an rabbit model that mimics the hemodynamics of the bypass graft after coronary artery bypass surgery. METHODS: Sixteen New Zealand rabbits were randomly divided into two groups for abdominal aortic artery replacement using a 3-cm-long ePTFE graft with an inner diameter 4 mm through an incision at 1/3 from the middle to the lower part of the abdomen (group A) or in the lower abdomen (group B). The general conditions of the rabbits, operative time, number of collateral vessels that needed to be ligated, rate of massive intraoperative bleeding, fluctuation of vascular anastomosis after surgery, patency rate of the graft on day 7 after the operation were compared between the two groups. RESULTS: The two groups of rabbits had similar body weight, diameter of the abdominal aortic artery, intraoperative bleeding rate and occlusion rate of the vascular graft at 7 days after the procedure. The operative time was longer in group A, but the difference was not statistically significant. In group A, the number of the vascular branches that needed to be ligated was smaller and the rate normal femoral artery pulsation was higher than those in group B. CONCLUSION: It is feasible to establish models of small diameter vascular graft replacement in rabbits, and the patency rate of the graft can be monitored by observation of the general condition and ultrasound examination of the rabbits.

[The protective effects to the function of kidney and long by clearing of cytokines in patients with open-heart surgery].

OBJECTIVE: To observe the effect of cytokines absorption on renal and respiratory function in patients with open-heart surgery. METHODS: 30 patients undergoing valve replacement with cardiopulmonary bypass (CPB) were randomly divided into two groups. A sulfonated polyacrylonitrile hemofilter (AN69) that has been used to absorb cytokines was connected into the efferent limb of CPB in Group A (n = 15), and a cellulose triacetate hemofilter (CT 190G) instead of AN69 was used as controls (Group B, n = 15). The levels of plasma pro-inflammatory (TNF-alpha, IL-6, IL-8) anti-inflammatory cytokines (IL-10, IL-1ra), C-reactive protein (CRP) levels, and post-operation renal and respiratory function were compared between the two groups. Blood samples were analysed for TNF-alpha and IL-6 and IL-8 and C-reactive protein (CRP). The changes in renal, respiratory function were also observed. RESULTS: (1) At the end of CPB, TNF-alpha 10 ng/L +/- 3 ng/L and IL-6 115 ng/L +/- 22 ng/L levels in Group A were significantly lower than that in Group B 13 ng/L +/- 3 ng/L, 134 ng/L +/- 29 ng/L) respectively (P < 0.05 in all). There is no statistical differences in plasma IL-10 and IL-1ra levels between the two groups. (2) After 24 hours of CPB, the magnitude of increased body temperature, heart rate, white blood cell and plasma CRP in Group A [1.6 degrees C +/- 0.2 degrees C, 15/min +/- 4/min, (17 +/- 3) x 10(9)/L, 56 mg/L +/- 13 mg/L], were significantly lower than that in Group B [2.1 degrees C +/- 0.2 degrees C, 23/min +/- 6/min, (22 +/- 3) x 10(9)/L, 69 mg/L +/- 15 mg/L] respectively (P < 0.05 in all). (3) After 24 hours of CPB, the levels of 24h urinary protein excretion and urinary N-acetyl-beta-D-glucosaminidase (NAG) were significantly lower in Group A when compared to that in Controls (0.20 g/d +/- 0.08 g/d vs 0.30 g/d +/- 0.14 g/d, 28 U/L +/- 11 U/L vs 38 U/L +/- 13 U/L respectively), P < 0.05 in all. The level of creatinine clearance (Ccr) in Group A (68 +/- 7) ml.min(-1).1.73 m(-2) was significantly elevated than that in Group B (57 +/- 11) ml.min(-1).1.73 m(-2) (P < 0.05). (4) One hour after the end of CPB, the magnitude of increased plateau airway pressure (P(Plateau)) and peak airway pressure (P(Peak)) in Group A were significantly lower than that in Controls (P < 0.01 in all). The duration that need mechanical ventilation after operation in Group A (4.9 h +/- 0.6 h) was much shorter than that in Group B (5.8 h +/- 0.8 h, P < 0.05). CONCLUSIONS: Lowering the plasma levels of cytokines by extracorporeal absorption may attenuate systemic inflammatory response and protect lung and kidney function in patients with open-heart surgery.

[Development study on model WY multi-functional thoracic cavity closed drainage system].

Based on the improved design of the existing thoracic cavity closed drainage system, a new multi-functional device is developed and is described here in detail. The device is more convenient and more efficient than the existing system. Besides, it has a function of autotransfusion. Animal experimental results show that it has attained the goal of the improved design.

Combined valve operations with transection of ascending aorta.

To facilitate combined aortic and mitral valve operations, a new approach was developed. It was employed in 50 patients with both aortic and mitral valve disease. The ascending aorta was transected 1.5 cm above the aortic annulus, and the roof of the left atrium was incised. The damaged valves were replaced or repaired. Both aortic and mitral valves could be exposed satisfactorily by this approach. All patients recovered smoothly after the operation. Complications comprised intraoperative bleeding from the distal end of the ascending aorta in 1 patient and hoarseness in 3 postoperatively. The approach was considered quick and easy for combined valve operations.

[Considerations in coronary artery bypass grafting: problems for discussion].

Based on the experience in coronary artery bypass grafting (CABG), the author addresses some problems emerging from the practice of this surgery. The author proposes that (1) Coronary artery diseases with extensive myocardial infarction and chronic congestive heart failure may not be the absolute contraindications to CABG, and the decision for the operation should be derived from the presence of extensive stunned myocardium and a careful evaluation if the artery in the infarcted area can afford CABG. (2) To decide on the presence of stunned myocardium in the infarcted area, examination with positive electron tomography (PET) should be performed. (3) In recent years, CABG has been successfully performed in some cases of serious heart failure (with left ventricular eject fraction<30%) with the support of intraaortic balloon pump during and after operation. Intraaortic balloon pump has made off-pump CABG possible for patients that used to be denied this chance. (4) Similar to standard CABG procedures, off-pump CABG is by no means faultless and its indications at the time being have not yet been well defined. (5) Sequential anastomosis also has its disadvantages. When not a few large target arteries need anastomosis while graft vessels are not sufficient and serious atherosclerosis of the ascending aorta is present, this technique should been adequately applied. (6) Endarterectomy may give rise to thrombosis but in some cases it seems to be compulsory. The author suggests 3 indications for considering endarterectomy.

[Protective effect of ecdysterone against sodium arsenite-induced endothelial cell apoptosis].

OBJECTIVE: To study whether ecdysterone (EDS) inhibits apoptosis of endothelial cells. METHODS: In the model of sodium arsenite (Ars)-induced endothelial cell apoptosis, the effect of EDS at varied dosages (50, 200, 800 mg/L) on cell apoptosis was observed by measuring the number of apoptotic endothelial cells, intracellular adhesion molecule-1 (ICAM-1) and the oxidative state (OS). RESULTS: Ars at the dosages of 40, 80, 160 mmol/L was capable of causing an increase in the number of apoptotic endothelial cells in vitro, and 160 mmol/L Ars exhibited the strongest effect. EDS was shown to exert influence on the apoptosis-inducing effect of Ars, which decreased the apoptotic cell number at the dosage of 50 and 200 mg/L, but a contrary effect occurred while at the dosage of 800 mg/L. Meanwhile EDS (50, 200 mg/L) inhibited the increase of ICAM-1 expression in the endothelial cells in response to Ars, but failed to significantly elevate the low OS induced by Ars (P>0.05). CONCLUSION: Ars induces endothelial cell apoptosis dose-dependently, and in a similar manner, EDS produces influence on the apoptosis-inducing action of Ars. EDS (50, 200 mg/L) may decrease the apoptotic endothelial cell number and lower the Ars-induced increase of ICAM-1 expression, demonstrating its protective effect on the endothelial cells against apoptosis.

[Thymectomy for late-onset myasthenia gravis in the elderly (with report of 23 cases)].

OBJECTIVE: To evaluate the effect of thymectomy in the treatment of late-onset myasthenia gravis (MG) in the elderly. METHODS: Twenty-three such cases receiving thymectomy were followed up. RESULTS: MG was more frequent in male patients in the elderly, with generalized MG more prevalent that was often complicated by thymoma and myasthenia crisis. The total effective rate of the surgical intervention was 43.5 %. CONCLUSION: Thymectomy is applicable in late-onset MG in the elderly in spite of the fact that its effect is not as good as that in younger patients.

[Coronary artery bypass grafting without cardiopulmonary bypass: report of 6 cases].

OBJECTIVE: To explore the approach for coronary artery bypass grafting without cardiopulmonary bypass and assess the feasibility and safety of this procedure. METHODS: The clinical data of 6 patients receiving coronary artery bypass grafting without cardiopulmonary bypass were reviewed. RESULTS: No death occurred in these patients during the operation and the follow-up visit for 3 to 12 months found no incidence of angina pectoris, and the life quality of the patient was obviously improved. CONCLUSION: Coronary artery bypass grafting without cardiopulmonary bypass is applicable in patients with multiple coronary artery disease, especially those at high risk for cardiopulmonary bypass procedures.

Hydrodyamical assessment of valve prosthesis made of expanded ultra-microporous Teflon in vitro.

OBJECTIVE: To assess the hydrodynamical performance of the valve prosthesis made of expanded ultra-microporous Teflon in vitro. METHOD: Sheets of the expanded ultra-microporous Teflon were sewn onto flexible bracket to prepare artificial valve prosthesis. The leakage and steady flow of the valve prosthesis was tested in vitro with Baxter valve prosthesis as control. RESULTS: The rate of leakage of this new valve prosthesis was similar to that of Baxter valve prosthesis (P>0.05), and the systolic pressure gradient of the former was much lower than control(P<0.05). CONCLUSION: This new artificial valve prosthesis has good in vitro hydrodynamical properties, which are superior to Baxter valve.

Coronary artery bypass grafting with simultaneous mitral valve replacement: report of one case.

Coronary artery bypass grafting and mitral valve replacement was performed simultaneously under cardiopulmonary bypass in a patient suffering from both coronary artery disease and severe mitral incompetence. The operation was completed smoothly with uneventful postoperative recovery of the patient. The author called for due attention to the importance of precise preoperative diagnosis and addressed the issues of the operation procedure and protection of myocardium.

[Echocardiographical features during the rejection free period after heart transplantation: report of one case].

OBJECTIVE: To study the echocardiographic features during the period free of acute allograft rejection after heart transplantation by monitoring one patient within one year after heart transplantation. METHODS: The dimension of atrial and ventricular, interventricular septal and ventricular wall thickness, blood flow pattern through the mitral and tricuspid valves, left ventricular muscle weight (LVMW) and LVMW index during different periods were measured by echocardiography, and all these data were compared with those of the donor before operation. RESULTS: The patient recovered well without any signs of acute rejection. Echocardiography revealed that the dimension of right atrial, left and right ventriculars decreased significantly while left atrial showed significant increase, with obvious increase in the interventricular septal and ventricular wall thickness. LVMW and LVMW index were also significantly increased. The peaks E-and A.wave velocifies of the mitral and tricuspid E peak flow velocity decreased significantly, while the A peak flow velocity of the tricuspid did not undergo any significant changes. Mitral back flow occurred 4 months after the operation and tricuspid back flow persisted after operation. CONCLUSIONS: The changes of morphology, structure and function of the transplanted heart during periods without rejection are to some extent specific to this special phase, when some of these changes are similar to those during early acute rejection, and correct diagnosis relies on endo-myocardial biopsy.

[Diagnosis and treatment of traumatic tracheobronchial ruptures: report of 17 cases].

OBJECTIVE: To evaluate the diagnosis and treatment of tracheobronchial ruptures due to thoracic trauma. METHODS: The clinical data of 17 cases of bronchial rupture caused by chest trauma was analyzed retrospectively. The surgical approaches and post-trauma complications were described. RESULTS: End-to-end anastomosis was performed in 14 cases. Among the other 3 patients, one received lobectomy after bronchial repair, another had tracheal repair, and resection of the stenosed segment along with end-to-end anastomosis during thoracotomy was necessitated in the last case. Anastomotic stricture occurred early after the operation in 2 of all these cases, while 2 months postoperatively, all the patients were free from such strictures. CONCLUSION: Early diagnosis and operation in such cases can be life-saving, and may warrant early recovery of the pulmonary function. Accurate diagnoses of bronchial rupture can be obtained by bronchoscopy, with which the surgeons can easily locate the rupture during surgery.

[Surgical treatment of ascending aortic aneurysm by Bentall's procedure: report of 14 cases].

OBJECTIVE: To review our experience in surgical treatment of ascending aortic aneurysm (AAA) with aortic insufficiency in 14 cases of by Bentall's procedure. METHODS AND RESULTS: All the patients underwent replacement of the ascending aorta and aortic valve with composite valved vascular prosthesis and received direct implantation of the aortic graft of the coronary orifices (Bentall's procedure) with satisfactory results. Five patients had ascending aortic dissection and 4 had typical Marfan's syndrome. All the patients suffered severe aortic insufficiency while 2 had mitral insufficiency. Coronary orifices were implanted in situ in 13 cases while in 1 case, Cabrol's method was adopted. No death occurred during the surgery and in the subsequent follow-up, and all the patients had good recovery. CONCLUSION: Bentall's procedure can be effective in the treatment of AAA with aortic insufficiency.