Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study.

BACKGROUND: This study investigated the impact of coronary angiography on outcomes of emergency operation in acute type A aortic dissection (ATAAD) patients who were initially misdiagnosed as an acute coronary syndrome. METHODS: From October 2016 to April 2019, 129 patients underwent emergency operation for ATAAD in our institution, including 21 patients (16.3%, coronary angiography group) who received preoperative coronary angiography without knowledge of the ATAAD, and the rest 108 did not (Non-coronary angiography group). Preoperative clinical characteristics, 30-day mortality and postoperative complications were compared. Multivariable logistic regression was performed to confirm the independent prognostic factors for short-term and long-term outcomes. RESULTS: Patients undergoing coronary angiography had higher prevalence of preoperative hypotension or shock (61.9% vs 35.2%, P = 0.022), ischemic changes on electrocardiogram (66.7% vs 37.0%, P = 0.012), platelet inhibition (ADP-induced inhibition 92.0% vs 46.0%, P = 0.001), and coronary involvement (66.7% vs 30.6%, P = 0.002). 30-day mortality was 4.8% versus 9.3% (P = 0.84). Coronary angiography group had more intraoperative bleeding (1900 ml vs 1500 ml, P = 0.013) and chest-tube drainage on the first postoperative day (1040 ml vs 595 ml, P = 0.028). However, preoperative coronary angiography was not independent risk factors for 30-day mortality (OR 0.171, 95%CI 0.013-2.174, P = 0.173) and overall survival (HR 0.407; 95%CI 0.080-2.057; P = 0.277). CONCLUSION: Patients undergoing coronary angiography carried a higher risk of preoperative hemodynamic instability, myocardial ischemia, and perioperative bleeding. However, unintentional coronary angiography did not have a significant impact on short-term and long-term outcomes of emergency surgery in ATAAD.

High plasma D-dimer level is associated with decreased survival in patients with lung cancer: a meta-analysis.

An elevated plasma D-dimer level indicates the activation of coagulation and fibrinolysis. Several studies suggested that high level of plasma D-dimer was associated with the prognosis of lung cancer. In the present study, we performed a meta-analysis to evaluate the relationship between plasma D-dimer level and the prognosis of lung cancer based on larger sample size. We retrieved the literature, assessed and selected the data, and performed the statistical analysis according to the RevMan 5.0 guidelines. Literature-based searching was guided to gather data, and fixed-effects model was used to pool the hazard ratio according to the test of heterogeneity. A total of seven eligible studies including 1,377 lung cancer patients were analyzed. Survival time was significantly better in patients in the low D-dimer group than those in the high D-dimer group (hazard ratio for high D-dimer group = 1.12; 95% confidence interval 1.02 to 1.23). Patients with high levels of D-dimer have a poorer overall survival compared with those patients with low levels of D-dimer.

[Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute kidney injury following cardiac surgery].

OBJECTIVE: To evaluate the independent risk factors for failure of continuous veno-venous hemodialysis (CVVHD) in the treatment of acute kidney injury (AKI) following cardiac surgery. METHODS: Adult patients without any prior pre-operative history of chronic renal disease suffering AKI following cardiac surgery and undergoing CVVHD at our center from January 2005 to December 2012 were recruited and divided into either a success group or a failure group. All pre-, intra- and post-operative data were collected and retrospectively analyzed. RESULTS: Ninety-three adult patients were enrolled. Among them, sixty-three patients survived with a failure rate of 32.2% and a mortality rate of 19.4%. Through univariate analysis and multivariate Logistic regression, independent risk factors for failure of CVVHD in the treatment of post-operative AKI included pre-operative LVEF (OR = 0.61, 95%CI 0.42-0.85) and duration of oliguria until dialysis (OR = 2.76, 95%CI 1.51-5.83). CONCLUSION: Pre-operative impaired left ventricular function is an important risk factor for failure of CVVHD in the treatment of AKI after cardiac surgery. The sooner the implementation of CVVHD, the better prognosis.

[Experiences of establishing an abdominal heart transplantation model in rats].

OBJECTIVE: To review the experiences and key factors of establishing an abdominal cardiac transplantation model in rats at National Institutes of Health Clinical Center. METHODS: Dark Agouti rats served as donor while Brown Norway rats as recipient. Cardiac transplantations were performed with a modified version of heterotopic cardiac transplantation. Proficiency was defined as 20 consecutive operations with < 15% mortality and no significant major co-morbidities. RESULTS: We performed 10 donor harvest-alone operations and 70 transplantations to reach the proficiency level. The survival rate of the last 20 consecutive surgeries was 95%. The mean total operative duration was 55 min and mean ischemic time of donor hearts 35 min. CONCLUSION: To ensure a consistently high operative success rate, a surgeon must not only be proficient in micro-surgical skills, but also closely follow the standardized training procedures and strictly observe the animal care and use guidelines.

Short- (30-90 days) and mid-term (1-3 years) outcomes and prognostic factors of patients with esophageal cancer undergoing surgical treatments.

BACKGROUND: The factors influencing the prognosis of patients with esophageal cancer vary among studies and are still poorly known. AIM: To determine the factors associated with survival in patients with esophageal cancer. METHODS: This retrospective study included patients with esophageal cancer admitted between January 2017 and March 2020 at Heping Hospital Affiliated to Changzhi Medical College. All patients were treated according to the available guidelines. Follow-up was censored in October 2020. Univariable and multivariable Cox regression analyses were used to determine the independent risk factors for overall survival (OS). RESULTS: In total, 307 patients were included. Their median age was 64 (range, 44-79) years, 63.5% were male, and the median disease course was 2 (0.1-36) months. The median tumor size was 3 (0-10) cm. Most patients were T3 (29.6%), N0 (70.0%). Most tumors were grade 2 (48.2%), and 87.3% were squamous cell carcinoma. The in-hospital mortality was 16.9%, the 30-day mortality was 19.9%, and the 90-day mortality was 25.4%. The cumulative OS rates at the last follow-up were 82.1% (95%CI: 67.7%-96.5%) for stage 0/I/II and 47.4% (95%CI: 16.5-78.6%) for stage III/IVA (P < 0.001). The multivariable analysis showed that creatinine levels (HR = 1.02, 95%CI: 1.00-1.03, P = 0.050), pTNM III/IVA (HR = 4.19, 95%CI: 2.19-8.01, P < 0.001), adjuvant radiotherapy and/or chemotherapy (HR = 0.23, 95%CI: 0.11-0.49), and the Comprehensive Complication Index (CCI) (HR = 1.02, 95%CI: 1.004-1.03, P = 0.011) were independently associated with OS. CONCLUSION: The survival of patients with esophageal cancer is poor, especially those with pTNM III/IVA. pTNM stage III/IVA, CCI, and adjuvant therapy (radiotherapy and/or chemotherapy) are independently associated with OS.

Results of radiofrequency ablation for permanent atrial fibrillation in patients undergoing mitral valve surgery.

OBJECTIVES: The study aim was to evaluate the safety and feasibility of radiofrequency ablation for the surgical treatment of permanent atrial fibrillation in patients with degenerative mitral valve disease. DESIGN: From August 2000 to August 2003, 40 consecutive patients (mean age 69.0 +/- 9.3 years) with permanent atrial fibrillation and degenerative mitral valve disease underwent surgical radiofrequency ablation in conjunction with 22 mitral valve repairs and 18 mitral valve replacements. The mean duration of chronic AF was 5.1 +/- 3.4 years. The completeness of follow-up was 100%. The mean follow-up time was 4.6 +/- 2.0 years (range 0 to 7.8 years). RESULTS: Thirty-day mortality was 2.5% (1 patient), the cause of death was cardiac failure. Cardiac failure and temporary A-V block were the most common postoperative complications. Both occurred in 10% (4 patients). No complication was related to the ablation procedure. At discharge, 65% (26/40) of the patients were in sinus rhythm. Overall incidence of sinus rhythm at the end of the follow-up was 56.4% (22/39).The 1-, 3- and 5-year survival was 97.5%, 91.8% and 85.9%, respectively. CONCLUSION: Mitral valve surgery combined with radiofrequency ablation is a safe and effective procedure in patients with permanent atrial fibrillation and degenerative mitral valve disease. The result is encouraging in restoring sinus rhythm, and an excellent postoperative survival rate can be achieved.

[Coronary flow obstruction in percutaneous aortic valve replacement using self-expandable valved stent: an in vitro study].

OBJECTIVE: To study the effects of self-expandable and orthotopically implanted percutaneous aortic valved stent on coronary artery flow in vitro. METHODS: Self-expandable valved stent was developed with nitinol stent and bovine pericardium. The ascending aorta of Chinese mini swine hearts was cut proximal to the brachiocephalic trunk. The right and left main coronary arteries were dissected. In vitro coronary flow tests were performed. Firstly, baseline coronary flow with the native aortic valve was measured (n = 12). Secondly, the valved stent was deployed orthotopically. The commissures of prosthesis were positioned randomly. Through an endoscope, the effects of valved stent and native valve on coronary ostium were obtained and coronary flow measurements repeated (valve preservation group, n = 12). Then the distance from coronary ostium to native leaflet free edge was measured. Native leaflets were removed before similar valved stent deployment. Coronary flow measurements and endoscopic inspections were repeated post-implantation (valve removal group, n = 12). RESULTS: In valve preservation group, valved stent implantation resulted in a significant decrease in left coronary flow (29.46%, P < 0.05). The obstruction was due to native leaflets sandwiched between the stent and aortic wall. The left ostia were obstructed totally in 3 and partially in 4. The flow of right coronary decreased 7.34% (P > 0.05). The right ostia were obstructed partially in 3. In valve removal group, 6.82% and 5.37% decrement in left and right coronary flow were observed after valved stent placement (P > 0.05). The distances from right coronary ostia to annulus were farther than from left coronary ostia. In two groups, the commissures of prosthesis obstructed partially left coronary ostia in 4 and right coronary ostia in 1. CONCLUSION: Orthotopic implantation of a percutaneous self-expandable aortic valved stent would obstruct the left coronary ostium with the native valve. Coronary ostium may be obstructed partly by the commissures of prosthesis.

[Effect of atorvastatin on postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting].

OBJECTIVE: To evaluate the effect of atorvastatin on postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG). METHODS: A cohort of 140 consecutive patients without a history of documented AF or previous statin use, who were scheduled to undergo selective CABG, were enrolled. Included patients were randomly assigned to atorvastatin group (n = 71) who were administered atorvastatin 20 mg/d or to control group (n = 69). After CABG, subjects were monitored continuously by electrocardiographic monitors at least 7 days. During the initial postoperative 7 d, the incidence and duration of AF were recorded. And the levels of high-sensitivity C-reactive protein (hs-CRP) were measured before and 24 hours, 72 hours, 7 days after operation, respectively. The statistical software package SPSS (version 13.0) were used to analyze the data. The differences between groups were evaluated by chi(2)-test for discrete variables and student t-test for continuous variables. Multivariate logistic regression analysis was performed to determine the independent predictors of early postoperative AF. RESULTS: During initial postoperative 7 d, AF occurred at least once in 10 cases in atorvastatin group, with a prevalence of roughly 14%, and in 23 cases in control group, with a prevalence of approximately 34% (P = 0.009). The mean duration of single AF was 3.6 +/- 0.4 hours in atorvastatin group and 5.7 +/- 0.5 hours in control group (P < 0.01), respectively. The multivariate logistic analysis showed that perioperative atorvastatin administration was an independently risk factor for early postoperative AF (OR = 0.219, 0.076-0.633, P = 0.005). There was also statistical difference in hs-CRP after CABG between the two groups. CONCLUSIONS: Perioperative atorvastatin administration may inhibit inflammatory reaction, reduce the incidence and duration of postoperative AF, hence may prevent and treat postoperative AF.

[Effect of the valved stent on closure of patent ductus arteriosus in a miniswine model].

OBJECTIVE: To evaluate the feasibility of a valved stent on closure patent ductus arteriosus in a Chinese miniswine model. METHODS: Self-expandable nitinol stents were made of Ni-Ti shape memory alloy (9 mm in diameter). Bovine pericardium was shaped and sutured onto the stents. Fluid passing test, pre-releasing test and static test of pressure in tube were performed in all devices before use. In eight Chinese miniswine, vascular grafts (PTFE vascular prosthesis) were surgically inserted between the descending thoracic aorta and pulmonary artery for establishment of patent ductus arteriosus model. Valved stents were deployed to occlude the patent ductus arteriosus. Echocardiography was performed two hours post operation. Aortic angiography was made 30 days post operation in survived animals. Animals were then sacrificed for autopsy and electron microscopy examinations. RESULTS: In vitro testing showed that the closure of the valved stent leaflets was satisfactory and fluid flows were not restricted in the opposite direction. The valved stents could be released through catheter, expanded completely, rapidly fixed in the tube. Closure of patent ductus arteriosus was succeeded in 6 out of 8 animals. One animal died of respiratory failure 2 hours post operation, another one died of pulmonary embolism due to valved stent displacement. Resident shunt was not evidenced by echocardiography, aortic angiography and dissection examinations in the remaining 6 animals. The new endothelial tissue fully covered the pulmonary and aortic sides of patent ductus arteriosus in 4 and 3 animals respectively. The electron microscopic observation revealed endothelial coverage of dives. CONCLUSION: The valved stent could effectively close artificial patent ductus arteriosus in vivo with satisfactory new intima covering on both sides of patent ductus arteriosus.

High shear stress suppresses proliferation and migration but promotes apoptosis of endothelial cells co-cultured with vascular smooth muscle cells via down-regulating MAPK pathway.

BACKGROUND: Early neointimal hyperplasia of vein graft may be ameliorated via enhancing intravenous surface shear stress. Cellular processes including proliferation, apoptosis and migration of endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) may play very important roles in the process of neointimal hyperplasia of vein graft; and mitogen-activated protein kinase (MAPK) pathways including extracellular signal-regulated kinase (ERK1/2) and p38 pathways play vital roles in regulating a large variety of cellular processes. This study evaluated the impacts of shear stress and MAPK pathways on cellular processes of ECs in a co-culture system with VSMCs, and aimed to test the hypothesis that high shear stress suppresses proliferation and migration but promotes apoptosis of ECs co-cultured with VSMCs via down-regulating MAPK pathway. METHODS: Primary ECs and VSMCs derived from porcine great saphenous vein were collected, respectively. 4-7 generation of cells were used as work cells. ECs and VSMCs were co-cultured and synchronized under high and low shear stress using Parallel-Plate Flow Chamber system. And then, ECs co-cultured with VSMCs were incubated with U0126 (ERK1/2 inhibitor) or PD98059 (p38 inhibitor) under different shear stress. Proliferation, apoptosis and migration of ECs in a co-culture system with VSMCs were detected by 4,5-dimethyl-2-thiazolyl (MTT) assay and bromodeoxyuridine (BrdU) assay, fluorescent-activated cell sorting (FACS) technique, and Transwell assay separately. Each test repeated 3 times. Additionally, protein expressions of ERK1/2 and p38 MAPK were detected by using Western blot, respectively. RESULTS: Under higher level of shear stress condition, proliferation and migration of ECs co-cultured with VSMCs were suppressed, while cell apoptosis was promoted. And blocking ERK1/2 pathway by U0126 or blocking p38 pathway by PD98059, proliferation and migration of ECs co-cultured with VSMCs were further suppressed, while cell apoptosis was further promoted. Additionally, protein expressions of phosphorylation of ERK1/2 and p38MAPK were decreased under higher level of shear stress condition, and were further reduced by blocking ERK1/2 or p38 pathway under shear stress condition. CONCLUSIONS: High shear stress may suppress proliferation and apoptosis of ECs in a co-culture system with VSMCs but promote cell migration via down-regulating ERK1/2 and p38 MAPK pathways.

[Influence of pravastatin on blood lipids and serum high sensitive C-reactive protein in patients undergoing conventional coronary artery bypass grafting under on-pump: a clinical study of 81 cases].

OBJECTIVE: To investigate the effect of pravastatin on blood lipids and serum high sensitive C-reactive protein (HsCRP) in patients undergoing conventional coronary artery bypass grafting under on-pump bypass (CCABG). METHODS: Eighty-one patients underwent CCABG. Among which 40 took orally pravastatin 20 mg once daily to at least 28 days after operation, and 41 were used as control group. The serum levels of total cholesterol (TC), triglyceride (TG), HDL-C cholesterol (HDL-C), LDL-C cholesterol (LDL-C), and HsCRP were monitored before and 24 h, 72 h, 7 days, 10 days, 14 days, and 28 days postoperatively. RESULTS: In the control group the levels of different blood lipids after operation remarkably decreased after operation compared with those before operation (all P < 0.05), reached the lowest levels 24 h after operation, then gradually increased, however, still lower than those before operation (all P < 0.05), and recovered to the baseline level 28 hours after operation; and the HsCRP level increased 24 h after operation and peaked 72 h after, then gradually decreased, and recovered to the baseline level 28 days after operation. In the pravastatin group the TC level reached its lowest level 24 h after operation, then gradually increased, however, still lower than that before operation, and recovered to the baseline level 28 days after operation; and the TG level reached the lowest level 24 h after operation (P < 0.05), and then gradually increased 3 d after operation (P > 0.05). The TC, TG, and LDL-C levels 7, 10, 14, and 28 d after operation of the pravastatin group were all significantly lower than those of the control group (all P < 0.05). The HsCRP levels at different time points of the pravastatin group were all significantly lower than those of the control group (all P < 0.05). CONCLUSION: The use of pravastatin in the early stage of CCABG is safe and can decrease systemic inflammatory reaction.

[Opportunity for treatment of acute renal failure after cardiac vascular operation using continuous blood purification].

OBJECTIVE: To evaluate the effect and timing of continuous blood purification (CBP) in treatment of acute renal failure (ARF) following cardiac-vascular surgery. METHODS: Twenty-five patients with ARF following cardiac-vascular surgery were divided into systematic inflammatory response syndrome (SIRS) Group (n = 13) and multiple organ dysfunction syndrome (MODS) Group (n = 12) according to the illness state prior to CBP and were divided into Group A (n = 5, with the APACHEIII score prior to CBP 90). All of the 25 patients underwent continuous veno-venous hemofiltration (CVVH). Before and 24h after the CVVH APACHEIII score was calculated and [peripheral; blood samples were collected to detect the levels of blood urea nitrogen (BUN) and serum creatinine (Scr) and the plasma levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha). RESULTS: The APACHEIII score, BUN, Scr, IL6, IL8, and TNFalpha 24 h after the CBP of the 25 patients were 61 +/- 15 mmol/L, (19 +/- 5) mmol/L, (312 +/- 87) micromol/L, (544 +/- 154) ng/L, (18 +/- 7) ng/L, and (43 +/- 15) ng/L respectively, all significantly lower than those before CBP (81 +/- 20, 26 +/- 5 mmol/L, 458 +/- 107 micromol/L, (842 +/- 132) ng/L, (25 +/- 8) ng/L, and (59 +/- 17) ng/L respectively, all P = 0.000). The survival rate of SIRS Group was 84.62%, significantly higher than that of MODS Group (41.67%, P < 0.05). The APACHEIII score, and the levels of BUN, Scr, IL6, IL8, and TNF-alpha of Group MODS were significantly higher than those of Group SIRS. The higher the level of Scr, IL6, IL8, and TNF-alpha and the APACHEIII score the lower the survival rate. CONCLUSION: CBP has a positive effect on ARF following cardiac-vascular surgery. The APACHEIII score 60 to 90 reflects an opportunity to treat the ARF following cardiac-vascular surgery using CBP.

[Depression before and after operation in patients undergoing coronary artery bypass grafting and the effect thereof on quality of life].

OBJECTIVE: To investigate the presence and severity of depression before and after operation in patients undergoing coronary artery bypass grafting (CABG) and the effect thereof on the quality of life. METHODS: A validated Chinese version of Beck Depression Inventory (BDI) was used in 138 CABG patients that were divided into 2 groups according the fact if depression was present. 1 week before and 1, 3, and 6 months after operation, and SF-36 scale was used to evaluate the quality of life (QOL) one week before operation and 1 and 6 months after operation. RESULTS: Depressive disorders occurred in 42.7% of the patients preoperatively and in 23.1% of the patients 6 months after the operation. There were no significant differences in all the dimensions of the SF-36 scale before operation between the depression and non-depression groups. All the scores of the 36-F dimensions were improved 1 and 6 months after the operation. However, the SF-36 social functioning (SF), mental health (MH), role emotional (RE), and bodily pain (BP) subscale scores 6 months after operation of the depression group were all lower than those in the non-depressive groups (all P < 0.05). CONCLUSION: Depression symptoms at different degrees exist before CABG and can be improved post-operatively. The improvement of QOL of the depressive patients after operation is not so marked compared to the non-depressive patients, especially in SF, MH, RE, and BP dimensions.

[Comparative studies of the blood lipids and apolipoproteins A1 and B in patients underwent coronary artery bypass grafting under on-pump and off-pump bypass].

OBJECTIVE: To compare the influences of coronary artery bypass grafting under on-pump (CCABG) and off-pump bypass (OPCAB) on blood lipids and Apolipoproteins A(1) and B. METHODS: 41 patients underwent CCABG and 38 patients OPCAB. The serum levels of total cholesterol (TC), triglycerides (TG), HDL-C cholesterol (HDL-C), LDL-C cholesterol (LDL-C) and Apolipoproteins A(1) and B were monitored before and 24 h, 72 h, 7 d, 10 d, 14 d, 28 d after operation in all patients. None of them received lipid-lowering drug during the test. RESULTS: (1) There were no difference between two groups. The serum levels of TC, LDL-C decreased significantly in 24 h, 72 h, 7d, 10 d, 14 d after operation (P < 0.001). The level in 24 h was the lowest, then began increasing; until 28 days after operation the serum levels of TC, LDL-C exceeded preoperative baseline level (P < 0.05). (2) the level of TG and HDL-C in 24 h was the lowest (P < 0.001), then began increasing (P > 0.05). Until 28 days after operation the serum levels of TG exceeded preoperative baseline level (P < 0.05). (3) the serum levels of ApoA(1) decreased significantly in 24 h, 72 h, 7 day, 10 day, 14 day after operation (P < 0.001). The level in 24 h was the lowest, and lasted until 28 days after operation (P > 0.05); the serum levels of ApoB in 24 h was the lowest, then began increasing (P > 0.05). CONCLUSIONS: There presents significant influence on blood lipids and Apolipoproteins A(1) and B after CABG, and initiate lipid (s)-lowering therapy as soon as possible.

[Depression before and after operation in coronary artery bypass grafting patients].

OBJECTIVE: To investigate the presence of depression in coronary artery bypass grafting (CABG) patients before and after the operation. METHODS: A questionnaire survey was conducted among 72 CABG patients, 21 of which, aged 65.30 +/- 1.15, underwent on-pump coronary artery bypass grafting (ONCAB) and 51 of which, aged 63.70 +/- 0.22, underwent off-pump CAB (OPCAB), using Beck Depression Inventory (BDI) one day before, and 3 and 6 months after the operation. RESULTS: Depressive disorders occurred in 49.2% of the patients preoperatively and 26.7% of the patients 6 months after the operation. The mean pre-operative BDI score was 5.77, and the post-operative BDI scores 3 and 6 months after operation were 4.12 and 3.06 respectively. At different post-operative time points the BDI scores of the depressive group were all lower than those of the non-depressive group, however, there was still a trend of lowering of BDI scores in the latter group. There were more patients who failed to resume their original work and more patients with angina and hypertension in the depression group. The proportion of females after operation was higher in the depression group. There was no significant difference in BDI score between the ONCAB and OPCAB groups both pre- and post-operatively. CONCLUSION: Depression at different degrees exists before CABG and can be improved post-operatively. Pre-operative BDI score is predictor of post-operative psychological outcome.

Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation.

OBJECTIVE: Postoperative atrial fibrillation is the most frequent complication arising after cardiac surgery, occurring in 40% of cases. The treatment of postoperative atrial fibrillation with epicardial amiodarone/corticosteroid hydrogel delivery can increase efficacy and reduce side effects. To further evaluate whether amiodarone hydrogel is superior to corticosteroid hydrogel or placebo, we performed a randomized prospective study in 150 patients with coronary artery bypass grafting to compare the effectiveness with different epicardial drug approaches in the postoperative period. METHODS: After institutional review board approval, 150 patients, from January 2012 to July 2014, who had undergone cardiac surgery were randomized to 3 equal groups. Group I received poly-based hydrogel with amiodarone, and group II received poly-based hydrogel with triamcinolone. Both hydrogels were sprayed diffusely over the biatrial epicardium. The control group underwent the procedure with only hydrogel spray. Continuous telemetry monitored for postoperative atrial fibrillation, and amiodarone or triamcinolone levels in the atria, plasma, and tissue were measured postoperatively. Daily electrocardiographic parameters were measured until postoperative day 14. RESULTS: The incidence of postoperative atrial fibrillation was significantly less in group I, with 4 of 50 patients (8%) incurring atrial fibrillation compared with 11 of 50 patients (22%) in group II and 13 of 50 patients (26%) in the control group (P < .01). The mean amiodarone and triamcinolone concentrations in the atria (12.06 ± 3.1/1.5 ± 0.7) were significantly greater than those in the extracardiac tissues (1.32 ± 0.9/0.2 ± 0.4; P < .01). The plasma amiodarone and triamcinolone levels remained below the detection limit (<8 µg/mL and <0.2 µg/mL) during the 14 days of follow-up. Bradycardia was observed less in the control group (93 ± 18) than in study group I (76 ± 29; P < .01). CONCLUSIONS: Epicardial application of amiodarone-releasing adhesive hydrogel is a less-invasive, well-tolerated, quick, and effective therapeutic option for preventing postoperative atrial fibrillation with minimal risk of extracardiac adverse side effects. However, there was no clinical evidence that epicardial corticosteroid prevented postoperative atrial fibrillation.

Besides an ITIM/SHP-1-dependent pathway, CD22 collaborates with Grb2 and plasma membrane calcium-ATPase in an ITIM/SHP-1-independent pathway of attenuation of Ca2+i signal in B cells.

CD22 is a surface immunoglobulin implicated in negative regulation of B cell receptor (BCR) signaling; particularly inhibiting intracellular Ca2+ (Ca2+i)signals. Its cytoplasmic tail contains six tyrosine residues (Y773/Y783/Y817/Y828/Y843/Y863, designated Y1~Y6 respectively), including three (Y2/5/6) lying within immunoreceptor tyrosine-based inhibitory motifs (ITIMs) that serve to recruit the protein tyrosine phosphatase SHP-1 after BCR activation-induced phosphorylation. The mechanism of inhibiting Ca2+i by CD22 has been poorly understood. Previous study demonstrated that CD22 associated with plasma membrane calcium-ATPase (PMCA) and enhanced its activity (Chen, J. et al. Nat Immunol 2004;5:651-7). The association is dependent on BCR activation-induced cytoplasmic tyrosine phosphorylation, because CD22 with either all six tyrosines mutated to phenylalanines or cytoplasmic tail truncated loses its ability to associate with PMCA. However, which individual or a group of tyrosine residues determine the association and how CD22 and PMCA interacts, are still unclear. In this study, by using a series of CD22 tyrosine mutants, we found that ITIM Y2/5/6 accounts for 34.3~37.1% Ca2+i inhibition but is irrelevant for CD22/PMCA association. Non-ITIM Y4 and its YEND motif contribute to the remaining 69.4~71.7% Ca2+i inhibition and is the binding site for PMCA-associated Grb2. Grb2, independently of BCR cross-linking, is constitutively associated with and directly binds to PMCA in both chicken and human B cells. Knockout of Grb2 by CRISPR/Cas9 completely disrupted the CD22/PMCA association. Thus, our results demonstrate for the first time that in addition to previously-identified ITIM/SHP-1-dependent pathway, CD22 holds a major pathway of negative regulation of Ca2+i signal, which is ITIM/SHP-1-independent, but Y4/Grb2/PMCA-dependent.

[The characteristics during exercise test in long QT syndrome patients and the effects of left cardiac sympathetic denervation].

OBJECTIVE: To explore the mechanism of the left cardiac sympathetic denervation (LCSD) surgery to reduce the incidence of cardiac events for long QT syndrome (LQTS) patients. METHODS: 12 LQTS patients were selected to do exercise test (ET) to mimic sympathetic activation. The dynamic alterations on ECG during exercise and recovery phases (Rec) were observed and the exercise test characteristics for LQTS patients before and after surgery were summarized and compared. RESULTS: The QTc at resting was shortened from 0.54 s +/- 0.04 s to 0.50 s +/- 0.04 s, P = 0.026, while the maximum heart rate during exercise decreased from 141 beat/min +/- 18 beat/min to 124 beat/min +/- 14 beat/min, P = 0.003. QTc was shortened during exercise, however, it was prolonged during the early recovery phase (before ET 0.54 s +/- 0.02 s, ET 10 min 0.46 s +/- 0.02 s, Rec 4 min 0.55 s +/- 0.03 s); LCSD could reduce such abrupt alteration of QTc during early recovery phase (after surgery: before ET 0.53 s +/- 0.03 s, ET 10 min 0.48 s +/- 0.03 s, Rec 4 min 0.53 s +/- 0.05 s). QT/RR interval slope, representing the adaptation response of QT interval to heart rate, became steeper after exercise (from 0.61 +/- 0.06 to 0.71 +/- 0.07 after exercise, P < 0.01). LCSD made the slopes become less steep both before exercise (from 0.61 +/- 0.06 before surgery to 0.55 +/- 0.07 after surgery, P = 0.013) and after exercise (from 0.71 +/- 0.07 before surgery to 0.66 +/- 0.06 after surgery, P = 0.018). Notched T wave alterations occurred in 7 patients at the end of exercise and/or during early recovery phase before surgery, and LCSD diminished such alteration in 4 patients. CONCLUSION: The slope between QT and RR both the pre-exercise and post-exercise slopes, interval becomes less steep after LCSD, which suggests that exaggerated delay in repolarization with decreasing heart rate for LQTS patients is improved by LCSD. This may be one of the mechanisms of LCSD efficacy for treating LQTS patients. Exercise test is one of tools to evaluate the effect of LCSD on LQTS patients.

[Changes of interleukin-1beta and tumor necrosis factor-alpha of right atrial appendages in patients with rheumatic valvular disease complicated with chronic atrial fibrillation].

OBJECTIVE: To investigate whether atrial expression of interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) of right atrial appendages are altered in patients with rheumatic valvular disease during chronic atrial fibrillation. METHODS: A total of 48 patients with rheumatic heart disease were included. 27 patients had no history of atrial fibrillation, 21 patients had atrial fibrillation. Atrial tissue was obtained from the right atrial appendage during open heart surgery. The protein expression of IL-1beta and TNF-alpha was detected by immunohistochemistry method. The fibrosis of right atrial appendage was detected by Masson staining. RESULTS: The fibrosis of right atrial appendage was significantly increased in patients with chronic atrial fibrillation. The protein expression of IL-1beta and TNF-alpha were significantly increased in patients with chronic atrial fibrillation. CONCLUSIONS: The protein expression of IL-1beta and TNF-alpha were significantly increased in patients with rheumatic valvular disease during chronic atrial fibrillation. Inflammation may be one of the mechanisms for the development and persistence of atrial fibrillation.

Study on the relationship of APACHE III and levels of cytokines in patients with systemic inflammatory response syndrome after coronary artery bypass grafting.

The aim of this study was to explore the relationship and interpret the clinical importance of acute physiology and chronic health evaluation III (APACHE III) and levels of cytokines in patients with systemic inflammatory response syndrome (SIRS) after coronary artery bypass grafting (CABG) with or without cardio-pulmonary bypass (CPB) to see if they are beneficial for evaluating the seriousness of SIRS. The data suggested that the APACHE III score and levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1beta), and soluble interleukin-2 receptor (sIL-2R) were significantly higher after conventional CABG (CCABG) than after off-pump coronary artery bypass grafting (OPCAB) (p<0.05). With an increase in the APACHE III score, the levels of IL6, IL8, TNF-alpha, IL-1beta, and sIL-2R and the morbidity of multiple organ dysfunction syndrome (MODS) increased gradually (p<0.01), while the level of IL2 decreased (p<0.01). Stepwise regression analysis showed that IL-1beta, IL6, IL8, and sIL-2R levels had significant influences on the APACHE III score (p<0.05). The APACHE III score and levels of IL6, IL8, TNF-alpha, IL-1beta, and sIL-2R were significantly higher in the MODS group than in the non-MODS group (p<0.05), but the level of IL2 was significantly lower in the MODS group (p = 0.04). In conclusion, despite comparable surgical trauma, we believe that CPB is one of the most important factors responsible for stimulating an inflammatory response. SIRS after OPCAB was clearly mitigated compared with CCABG. Determination of the APACHE III score and plasma IL-1beta, IL6, IL8 and sIL-2R concentrations might be helpful for evaluating the severity of SIRS following CABG and making a prognosis.