Risk factors for venoarterial-extracorporeal membrane oxygenation related nosocomial infection in children after cardiac surgery / 中南大学学报(医学版)

OBJECTIVES@#Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support strategy for the treatment of critically ill children with reversible heart and lung failure, increasingly being used in patients with low cardiac output after cardiac surgery. However, the mortality of patients is closely related to the complications of ECMO, especially bleeding, thrombosis, and infection, ECMO-related nosocomial infection has become a challenge to the success of ECMO. This study aims to analyze the incidence and risk factors for venoarterial-ECMO (VA-ECMO)-related nosocomial infections in children after cardiac surgery.@*METHODS@#We retrospectively collected the data of patients who underwent VA-ECMO treatment after pediatric cardiac surgery in the Second Xiangya Hospital of Central South University from July 2015 to March 2021, and divided them into an infected group and a non-infected group. The clinical characteristics of the 2 groups of patients, VA-ECMO-related nosocomial infection factors, pathogenic microorganisms, and patient mortality were compared. Logistic regression was used to analyze the risk factors for nosocomial infection related to VA-ECMO after cardiac surgery.@*RESULTS@#Of the 38 pediatric patients, 18 patients (47.37%) had VA-ECMO related nosocomial infection, served as the infected group, including 7 patients with blood infections and 11 respiratory tract infections. Gram-negative pathogens (16 strains, 88.9%) were the main bacteria, such as Acinetobacter baumannii (6 strains), Klebsiella pneumoniae (3 strains), and Stenotrophomonas maltophilia (3 strains). Compared with the non-infected group (n=20), the infection group had longer time of cardiopulmonary bypass, time of myocardial block, and time of VA-ECMO assistance (All P<0.05). Multivariate logistic regression analysis showed that time of cardiopulmonary bypass (OR=1.012, 95% CI 1.002 to 1.022; P=0.021) was an independent risk factor for ECMO-related nosocomial infection. The number of surviving discharges in the infected group was less than that in the non-infected group (1 vs 11, P<0.05).@*CONCLUSIONS@#Cardiopulmonary bypass time is an independent risk factor for VA-ECMO-related nosocomial infection in children after cardiac surgery. Shortening the duration of extracorporeal circulation may reduce the incidence of VA-EMCO-related nosocomial infections in children after cardic surgery. The occurrence of VA-ECMO-related nosocomial infections affects the number of patient's discharge alive.

Application of the index system for clinical evaluation of implementation effect: An example of vaginal delivery / 中南大学学报(医学版)

Objective:In order to apply the index system for clinical evaluation of implementation effect in hospitals.Methods:A total of 862 patients with vaginal delivery from 9 hospitals were randomly divided into an clinical pathway group (n=496) and a control group (n=366).The patients in the control group received traditional treatment procedure while the patients in the clinical pathway group experienced procedure of the clinical treatment.The index system was used for clinical evaluation of implementation effect.Results:There were obvious advantages in 15 indicators in the clinical pathway group than those in the control group (P＜0.05).The comprehensive score of the clinical pathway group was higher than the control group of the corresponding grade and nature of the hospital.The comprehensive score for secondary hospitals (Ci=0.7967) were higher than that for the tertiary hospitals (Ci=0.2033).The comprehensive score for the general hospitals (Ci=0.8948) were higher than that for the specialized hospitals (Ci=0.1052).As for clinical implementation effect,the secondary hospitals were better than the tertiary hospital,and the general hospitals were better than the specialized hospitals.Conclusion:The index system for clinical evaluation could quantify the implementation effect,and compare the implementation effect in different hospitals,which provides reference for the management of clinical pathway.

Clinical analysis of surgical treatment for aortic coarctation / 中国医师杂志

Objective To summarize the methods and experiences of one-stage repair of aortic coarctation.Methods During January 2009 and September 2016,31 patients underwent surgery for coarctation of aorta (COA) in our department.Of them,fifteen patients were accompanied by patent ductus arteriosus (PDA),five associated with ventricular septal defect (VSD),five with VSD and PDA,and six patients were single COA.All patients accepted one-stage repair and follow-up.The surgical strategies and follow-up results were retrospectively reviewed.Results Excision of coarctation and anastomoses was performed in 24 patients,a bypass with artificial graft was performed in 3 patients,longitudinally section transverse suture was performed in 2 patients,and aortoplasty with patch graft was used in 2 patients.Accompanied intracardiac malformations were repaired simutaneously.One patient died of low cardiac output syndrome 1 d after operation.Other patients recovered smoothly.Thirty patients were followed up from 6 months to 7 years.The anastomotic systolic pressure difference disappeared in 21 patients.Eight patients still suffered from systolic pressure difference (5-20 mmHg),but had no need of reoperation.One patient suffered from anastomotic recoarctation 2 years and 3 months after operation and the pressure difference was 48 mmHg.After exerting balloon dilatation,the pressure difference reduced to 17 mmHg.Conclusions Surgery is an effective method of COA treatment.The surgical strategies should be selected according to the characters of coarctation lesions,intracardiac malformations,and the age of patient.

Clinical analysis of surgical treatment for aortic coarctation / 中国医师杂志

Objective To summarize the methods and experiences of one-stage repair of aortic coarctation.Methods During January 2009 and September 2016,31 patients underwent surgery for coarctation of aorta (COA) in our department.Of them,fifteen patients were accompanied by patent ductus arteriosus (PDA),five associated with ventricular septal defect (VSD),five with VSD and PDA,and six patients were single COA.All patients accepted one-stage repair and follow-up.The surgical strategies and follow-up results were retrospectively reviewed.Results Excision of coarctation and anastomoses was performed in 24 patients,a bypass with artificial graft was performed in 3 patients,longitudinally section transverse suture was performed in 2 patients,and aortoplasty with patch graft was used in 2 patients.Accompanied intracardiac malformations were repaired simutaneously.One patient died of low cardiac output syndrome 1 d after operation.Other patients recovered smoothly.Thirty patients were followed up from 6 months to 7 years.The anastomotic systolic pressure difference disappeared in 21 patients.Eight patients still suffered from systolic pressure difference (5-20 mmHg),but had no need of reoperation.One patient suffered from anastomotic recoarctation 2 years and 3 months after operation and the pressure difference was 48 mmHg.After exerting balloon dilatation,the pressure difference reduced to 17 mmHg.Conclusions Surgery is an effective method of COA treatment.The surgical strategies should be selected according to the characters of coarctation lesions,intracardiac malformations,and the age of patient.

Hybrid procedure for infants/children treatment with pulmonary stenosis under transesophageal echocardiographic guidance / 中南大学学报(医学版)

OBJECTIVE@#To investigate the outcomes of hybrid procedure in treating 10 infants/children with pulmonary stenosis under transesophageal echocardiographic guidance.
@*METHODS@#Between September, 2009 and December, 2015, 10 infants/children underwent hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis in the Second Xiangya Hospital, Central South University. The age, height and weight at the time of admission were 0.7-42 (14.8±15.8) months, 53-97 (74.8±16.3) cm, and 4-15.5 (9.3±4.1) kg, respectively. Atrial septal defect, patent foramen ovale, patent ductus arteriosus, muscular ventricular septal defect, persistent left superior vena cava and tricuspid regurgitation were found in 2, 6, 1, 2, 1 and 5 cases, respectively.
@*RESULTS@#After the operation, all patients were sent into ICU. The mean duration mechanical ventilation, ICU stay and hospitalization were 0.5-41(6.8±12.3) h, 2-85 (31.1±22.8) h, and 6-20 (11.4±5.1) d, respectively. Postoperative transvalvular pressure gradient reduced to 16-45 (31.1±9.8) mmHg, which was decreased significantly compared with that in preoperative (P<0.001). There was no death during hospitalization and follow-up.
@*CONCLUSION@#Hybrid procedure of transthoracic balloon pulmonary valvuloplasty for pulmonary stenosis under transesophageal echocardiographic guidance is a safe and effective treatment.

Surgical repair of complete atrioventricular septal defect in 86 patients / 中国医师杂志

Objective To investigate the early surgical outcomes of 86 patients with complete atrioventricular septal defect.Methods Between January 2007 and December 2014,consecutive 86 cases received surgical repair in our department.There were 44 male patients,and 42 female patients.Two-patch repair was performed in 69 cases,and modified single-patch repair in 17 cases.The mean age,height,and weight at the time of operation were (32.3 ± 46.5)months with a range from 1 month to 17 years,(82.1 ±27.6) cm with a range from 53 to 165 cm,and (10.8 ± 8.7) kg with a range from 4.1 to 43 kg,respectively.Rastelli A type was found in 67 cases,B type in 15 cases,and C type in 4 cases.Down's syndrome was complicated in 6 cases.Preoperative mild regurgitation of common atrioventricular valve was shown in 32 cases,moderate regurgitation in 38 cases,and moderate to severe regurgitation in 16 cases.Mild pulmonary hypertension was observed in 15 cases,moderate in 54 cases,and severe in 17 cases.Results After operation,all patients were sent into intensive care units (ICU).The mean duration mechanical ventilation,ICU stay,and hospitalization were (30.9 ± 47.7) h with a range from 2.5 to 244 h,(87.7 ± 76.8) h with a range from 14 to 306 h,and (16.4 ±9.2)d with a a range from 6 to 50 d,respectively.We encountered 4 operatively mortalities (4.7％),including 3 in two-patch repair group,and 1 in modified single-patch repair group.The cause of death was mitral regurgitation.Conclusions Modified single-patch and two-patch technique have a satisfied early outcomes.

Effect of social support and coping styles on the stress and mental health in relatives of patients with traumatic brain injury / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of social support and coping style on the stress and mental health in relatives of patients with traumatic brain injury.@*METHODS@#The stress, mental health, social support and coping style were investigated in 300 relatives of patients with traumatic brain injury by Relative Stress Scale, Symptom Checklist-90, Social Support Rating Scale and Simplified Coping Style Questionnaire in Changsha City.@*RESULTS@#The mental health problems in relatives of patients with traumatic brain injury were closely related to the levels of stress, the ways of coping and the social support. In addition to the direct eff ect of stress on mental health in relatives of patients, the ways of coping and social support functioned as a mediator in this regard. The value of mesomeric eff ect for coping styles and social support ranged from 23.6% to 43.0%, and social support had an advantage over the coping styles.@*CONCLUSION@#Social support and coping styles should be considered in psychological nursing program to prevent and adjust the mental distress in relatives of patients with traumatic brain injury, which is beneficial to the treatment and recovery for patients.

Study on the survival and differentiation situation of SHH gene-transfected mesenchymal stem cells in myocardial transplanta-tion / 中国医师杂志

Objective To investigate the survival and differentiated situation of transplanted mesenchymal stem cells ( MSCs) transfected with Sonic hedgehog (SHH) gene after chronic myocardial infarction (MI).Methods MSCs were obtained from bone marrow of limb bones by density gradient centrifugation combined with attachment culture method .SHH gene was cloned and eukaryotic expression plasmid pcDNA 3.1-SHH was constructed .Then nucleofector TM was used to transfer SHH gene into MSCs and the expres-sions of mRNA and protein of SHH gene were detected in vitro .Myocardial infarction model was established by ligating the left anterior descending branch .A total of 150μl (3 ×106 ) of MSCs transferred with SHH gene was injected into ischemic area at the fourth week after MI model was set up .Brdu immunohistochemical staining and electron microscope examination were used to detect the survival and differentiation of MSCs with SHH in vivo at the 1st, 2nd, 4th, and 8th week after MSCs SHH transplantation.Results It was con-firmed that SHH gene clone and the recombinant eukaryotic expression vector pcDNA 3.1-SHH construction were successful by gene se-quence analysis and double digestions with EcoR I and Bamh I .Reverse transcriptase polymerase chain reaction ( RT-PCR) and West-ern-blot demonstrated that the expression of SHH mRNA was significantly increased in transfected MSCs compared with untransfected MSCs.Brdu immunohistochemical staining confirmed MSCs with SHH were survived from one to eight weeks in MI area after transplan -tation.Electron microscope examination showed that MSCs had the trend to be differentiated into myocardiac -like cells in MI area at the 4th and 8th week after transplantation .Conclusions The expression of SHH mRNA was significantly increased while MSCs were transfected with SHH gene , and MSCs SHH could survive and differentiate in good condition in the transplanted recipients .Those data provide the experimental basis for further transgenic cell therapy research of ischemic heart disease .

Clinical analysis for the surgical treatment of 76 cases with complete atrioventricular septal defect / 中国医师杂志

Objective To achieve the best chance and optimize the method of operation,the clinical outcomes of 76 cases with complete atrioventricular septal defect (CAVSD) were summarized.Methods According to the Rastelli classification,there were 57 cases of type A,6 type B,and 13 type C.The repaired procedures included the two-patch technique for atrioventricular septal defect (65 cases),direct closure of ventricular septal defect (7 cases),and the Glenn bidirection shunt (4 cases).Results Two patients died.Of them,one was concomitant with double outlet right ventricle (DORV) and total anomalous pulmonary venous connection (TAPVC),died of low cardiac output syndrome; another was complicated with severe pulmonary hypertension,and the death reason was hypoxaemia and respiratory function failure.The survived patients were followed up,and the follow-up period was varied from one to ten years,mitral valve regurgitation was found in 12 cases,3 were middle and 9 were mild.Conclusions In order to prevent deteriorated condition of these patients and improve the survival rate,CAVSD should be operated as soon as the diagnosis is certain,and the co-exist malformation also should be corrected.

Asymmetric occluder in minimal-invasive surgical device closure of ventricular septal defects / 中南大学学报(医学版)

OBJECTIVE@#To discuss the suitable types of ventricular septal defects for asymmetric occluders, and elucidate the critical role of echocardiography in choosing occluders, guiding successful occlusion and avoiding injury during operation.@*METHODS@#We retrospectively studied 179 patients with ventricular septal defects who received minimal-invasive surgical device closure with asymmetric occluder. We analyzed the types, size and morphology of ventricular septal defects suitable for asymmetric occluders. The therapeutic efficiency was evaluated by follow-ups.@*RESULTS@#Out of the 179 successful cases treated with asymmetric occluders, 86.59% had perimembranous ventricular septal defects, and double-committed sub-arterial ventricular septal defects accounted for 13.41%. In general, the size of occluders to be selected was the maximum diameter of the defects plus 2-3 mm. Follow-ups showed that occluders were placed and fixed properly. No severe residual shunt, valve regurgitation or heart block were discovered.@*CONCLUSION@#Application of asymmetric occluders expands the range of indications for occlusion via small chest incision. Accurate echocardiography helps to improve the safety and successful rate of the surgery.

Echocardiography in mini-invasive surgical device closure of secundum atrial septal defects / 中南大学学报(医学版)

OBJECTIVE@#To discuss the preoperative, intraoperative, and postoperative application of echocardiography in mini-invasive surgical device closure of secundum atrial septal defects, including those special and difficulty-occluded defects.@*METHODS@#We performed mini-invasive surgical device closure of secundum atrial septal defects on 287 patients. Before the surgery, transthoracic echocardiography was applied for screening; during the surgery we reassessed the sizes of the defects and their remaining margins, designated the suitable occluders, and guided the placement of the occluders by multiplane transesophageal echocardiography. The patients were postoperatively followed up at regular intervals by multiplane transesophageal echocardiography (MTEE) which was employed to assess the therapeutic efficacy.@*RESULTS@#Out of the 287 atrial septal defects, 276 (96.17%) were successfully closed. There were 37 porous defects and 23 cases with short posterior-inferior margin of defects. Follow-ups at intervals showed the occluders stayed firmly and echoed clearly. No notable residual shunt or valve regurgitation was observed.@*CONCLUSION@#Echocardiography plays a vital and reliable role in mini-invasive surgical device closure of secundum atrial septal defects, especially those special and difficulty-occluded defects.

Reparation of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the effect of mitral annuloplasty of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring.@*METHODS@#From March 2009 to December 2011, 32 patients having anterior mitral valve prolapse received mitral annuloplasty with artificial chord and mitral annuloplasty ring in our department, among which 27 simple anterior mitral valve plasty and 5 combine anterior-posterior mitral valve plasty were completed.@*RESULTS@#All patients survived. Postoperative echocardiography showed no or trivial mitral regurgitation in 28 patients and mild mitral regurgitation in the other 4 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) obviously decreased after the operation. During the follow up of 3 months to 3 years, the cardiac function of the patients improved at different degrees.@*CONCLUSION@#Reparation of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring is simple, reliable and effective, and its early to midterm result after the operation proves good.

A new triple-branched aortic arch covered stent graft in DeBakey Type I aortic dissection / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of a new triple-branched aortic arch covered stent graft on DeBakey Type I aortic dissection, and to assess its efficacy in comparison with traditional surgery.@*METHODS@#From January 2010 to November 2010, 38 patients of DeBakey Type I aortic dissection were treated surgically in the Second Xiangya Hospital of Central South University, in which 16 operations used triple-branched aortic arch covered stent grafts (stent graft group, SG group), 22 operations used traditional 4 sides branches aortic arch grafts (arch graft group, AG group).@*RESULTS@#Compared with AG group, the cardiopulmonary bypass time[(138.1± 56.42) vs (179.21± 67.64) min], the clamp time [(98.56±28.08) vs (134.36±46.46) min] and the selective cerebral perfusion time[(27.3±14.76) vs (48.74±18.22) min] in SG group were obviously shortened(P<0.05). The volume of drainage 24 hours after operation in SG group also reduced[(608.93±308.15) vs (899.04±437.79) mL](P<0.05). The SG group had a lower rate of recurrent laryngeal nerve injury (6.25% vs 27.3%) and duration of hospitalization[(16.15±6.68) vs (21.18±12.69) d](P<0.05). During a following-up period of 14 to 24 months,reexamination of aortic CT angiography showed that the triple-branched aortic arch covered stent graft expanded well, and attached to the wall satisfactorily, while the corresponding false lumen of the aortic artery disappeared and the distal false lumen was filled with thrombus. The life quality of patients were good.@*CONCLUSION@#The new triple-branched aortic arch covered stent graft is appropriated for most patients with DeBakey Type I aortic dissection. Its use can simplify the aortic arch procedure,decrease the operation risk and has satisfactory results in early and middle stage after operation.

The use of pulmonary valve biorifice to reconstruct right ventricular outflow tract in tetralogy of Fallot / 中国医师杂志

ObjectiveTo introduce a new technique to create a pulmonary valve biorifice for reconstruction of right ventricular outflow tract in tetralogy of Fallot (TOF),and to summarize its initial clinical experience and therapeutic effect.MethodsThe new technique regarding reconstruction of right ventricular outflow tract with a pulmonary valve biorifice was used in a total of 53 TOF cases (the observation group).The conventional technique regarding reconstruction of right ventricular outflow tract was used in other 50 TOF cases (the control group).The clinical dates of all cases were reviewed retrospectively.ResultsThe ages,weights,cardiopulmonary bypass time,cardiac arrest time,as well as the post operation ventilation support time were not different significantly between two groups.Compared with the contrul group,patients from the observation group had shorter duration of ICU stay.After operation,in the observation group,only 2 cases had large amount of pleural effusion,1 case meddle,and 8 cases little amount of pleural effusion; whereas,in the control group,the corresponding numbers were 1,5 and 17,respectively.At the time point of 1 week after operation,all patients were rechecked by echocardiography,no pulmonary valve stenosis was found.Moderate pulmonary valve regurgitation was found in 8 cases,mild regurgitation in 15 cases from the observation group; and severe regurgitation in 3 cases,moderate regurgitation in 17 cases,and mild regurgitation in 16 cases from the control group.A total of 33 cases from the observation group were rechecked at the time point of half year after operation,and moderate - mild pulmonary regurgitation were found in 3 cases.A total of 18 cases of them were rechecked 1 - year latter,no pulmonary regurgitation was found.ConclusionsThe new technique to create pulmonary valve biorifice can reduce the pulmonary valve regurgitation and postoperative pleural effusion,and improve the early outcomc.

The feasibility of transfection of Sonic hedgehog gene into bone marrow mesenchymal stem cells / 中国医师杂志

Objective To evaluate the feasibility of transfection of Sonic hedgehog gene (SHH)into bone marrow mesenchymal stem cells(BMMSC).Methods After the SHH gene was transfected into BMMSC by electroporation apparatus,the transfection rate was evaluated by fluorescence inverted microscope.The growth curves of untransfected and transfected BMMSC were drawn,respectively,to observe the influence of transfection on cells.The expression of SHH gene in the BMMSC was detected by PCR,RT-PCR,Western-blot analyses.Results Through fluorescence inverted microscope,the observed transfection rate was appropriately 30％,PCR showed a obvious increase of SHH expression in transfected cells than that in untransfected cells,and it is quantified by qPCR for appropriately 7 times.Western-blot further demonstrated that the SHH protein expression in transfected cells had a distinct increase.However,it was observed that the exponential phase of BMMSCSHH growth curve delayed.The growth curves of both overlap 12 days after transfection.Conclusions This electroporation method can transfect exogenous SHH gene into BMMSC sufficiently with the effective protein expression in BMMSCSHH.It is the foundation of further research of genetic therapy for ischemic heart disease.

Unidirectional valved patch for congenital heart disease with severe pulmonary hypertension / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of unidirectional valved patch (UVP) for congenital heart disease (CHD) with severe pulmonary hypertension (PH).@*METHODS@#We retrospectively analyzed the treatment of 37 CHD patients with severe PH by UVP in the operation, and summarized its short-term to mid-term effect to find an optimum therapeutic regimen.@*RESULTS@#Before the operation, the ECG showed that the mean pulmonary artery pressure (MPAP) ranged 65-72 mmHg, and the cardiac catheterization showed the pulmonary artery pressure ranged 80-120 mmHg, P(P)/P(A) ranged 0.8-1.05,PVR ranged 8.5-19.2 (under oxygen inhalation 6.8-14.6) wood unit.After the operation, P(P)/P(A) ranged 0.4-0.72 on weaning-off CPB. Postoperative ECG showed the MPAP ranged 32-48 mmHg. No pulmonary hypertension crisis occurred and no patient died. Mechanical ventilation time ranged from 32 h to 8 d and the SaO₂ ranged 93%-96% at rest after the extubation.The right-to-left shunt situations by ECG were as follows:22 cases had shunt 5 d after the operation, 11 cases had shunt 1 month after the operation,4 cases 3 months after the operation, and none 1 year after the operation but one patient lost follow-up.However,there were no long-term follow-up data: 12 patients had a 1-year follow-up, 5 patients had a 3-year follow-up, and most patients had just 3-month follow-up.@*CONCLUSION@#UVP can decrease the operative risk in CHD with severe PH at perioperative period. The short-term to mid-term effect is satisfactory, while long-term effect remains uncertain.

High fat diet influence on vitamin D receptor expression and endothelial nitric oxide synthase in apolipoprotein E-deficient mice / 中国医师杂志

Objective This study investigated high fat diet influence on the changes of vitamin D receptor (VDR) expression and endothelial nitric oxide synthase (eNOS) in apolipoprotein E-deficient(apoE-/-) mice.MethodsApoE-/- mice and C57BLP6J mice were divide into two groups (normal control and high fat diet),high fat diet group were feed high fat feedstuff.Plasma 25-(OH)D levels were determined by competitive protein binding radioimmunity,VDR expression were determined by immunofluorescence and reverse transcription-polymerase chain reaction.The levels of NO and eNOS were determined by nitrate reductase.ResultsCompared with normal control group,high fat diet caused more severe dam-age of atherosclerosis in wild type mice and apoE-/- mice.In apoE-/- mice,the levels of plasma 25-(OH)D were significantly decreased [(26.44±1.28) ng/mL,(22.68±2.07)ng/mL,(17.46±2.22)ng/mL,(15.88±0.97)ng/mL,P＜0.01],the expression of VDR protein and mRNA were significantly increased[VDR :0.244±0.088,0.346±0.132,0.547±0.128,0.768±0.162;VDRmRNA:0.228±0.083,0.375±0.103,0.451±0.117,0.597±0.131,P＜0.01],and the levels of NO and eNOS were significantly increased[NO:(39.74±4.81)μmol/L,(48.1±5.24 )μmol/L,(67.34±6.14 )μmol/L,(86.74±8.05)μmol/L;eNOS:(8.6±0.77 )U/L,(12.28±1.42)U/L,(15.96±0.92)U/L,(18.68±1.15)U/L,P＜0.01].These changes were more significantly in high fat diet group(P＜0.01).ConclusionsThere were abnormalities of plasma 25-(OH)D level,VDR expression and the level of NO and eNOS in apoE-/- mice.These changes were more significantly in high fat diet group.

Surgical repair for anomalous drainage of left superior vena cava to left atrium / 中南大学学报(医学版)

OBJECTIVE@#To investigate the characters and surgical treatment methods of anomalous drainage of left superior vena cava to left atrium.@*METHODS@#Clinical data of 8 cases were analyzed retrospectively.The patients aged from 6 months to 168 months with weight between 6 and 29 kg.@*RESULTS@#The associated cardic lesions existed in all patients: 4 had partial atrioventricular septal defect (PAVSD),including 1 coronary sinus orifice atresia (CSOA), 1 ventricle septal defect (VSD), 1 ventricle septal defect associated with right ventricular outlet tract stenosis (VSD/RVOTS), and 1 atrial septal defect (ASD) and complete atrioventricular septal defect (CAVSD), respectively.No patient died. Preoperation diagnosis was in 1 case, intraoperation diagnosis in 5 cases,and postoperation diagnosis in 2 cases due to reoperation for hypoxemia.Three patients were repaired by intratrium tunnel, and the other 5 were managed by extracardic shunt.@*CONCLUSION@#This lesion is easily missed in preoperation diagnosis,which can be avoided by awareness and careful inspection.The methods for management of anomalous drainage of left superior vena cava to left atrium depend on time of diagnosis and experience of surgeons.

Effect of vascular smooth muscle alpha-actin on cardiac allograft vasculopathy and fibrosis / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of vascular smooth muscle alpha-actin(VSMA-alpha) on cardiac allograft vasculopathy and fibrosis.@*METHODS@#After heterotopic cardiac transplantation model was established, the rats were divided into an acute rejection group, a chronic rejection group, an isograft group, and a normal group. Van Gieson staining and Massonos trichrome staining were used to observe the cardiac allograft vasculopathy and fibrosis respectively, and immunohistochemical stainings were used to examine VSM-alpha expression.@*RESULTS@#The fibrosis score of the normal group, the isograft group, the acute rejection group and the chronic rejection group were 0.00+/-0.00, 0.63+/-0.52, 1.75+/-0.71, and 2.75+/-0.46, respectively. The fibrosis score of the chronic rejection group increased significantly as compared with that of the normal group and the isograft group (both P<0.01), the indexes of coronary arteries stenosis were 0.08+/-0.02, 0.09+/-0.04, 0.12+/-0.05, and 62.86+/-17.18, respectively. The stenosis index in the chronic rejection group increased significantly as compared with that of all the other groups (P<0.01).VSMA-alpha was abundant in the allograft myocardium in the chronic rejection group.@*CONCLUSION@#Reactivation of fetal structural genes of vascular smooth muscle alpha-actin and its ectopic expression is associated with the cardiac allograft vasculopathy and fibrosis.

Effect of blood glucose control on level of lactic acid in patients with cardic-valve replacement / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the effect of different control levels of glucose on the serum lactic acid during operation, and to investigate the relation between glucose and lactic acid to find a new way of myocardial protection.@*METHODS@#Volunteers were divided into an experiment group(n=38) and a control group(n=33) by random sampling and double blind method. The experiment group received intensive insulin therapy and the control group received traditional therapy. The arterial blood gas samples of all the patients at different time points after the operation were harvested in the intensive care unit for blood gas analysis. The related data were collected and analyzed.@*RESULTS@#The serum glucose level in the 2 groups decreased firstly, then increased, and recovered finally. The serum lactic acid level in the 2 groups increased firstly, decreased later, then reincreased, and recovered finally. The highest level of the serum lactic acid was found 2 hours after the operation. There were significant differences in serum glucose and lactic acid levels at 2, 12, and 24 h after the operation in the two groups (P0.05).@*CONCLUSION@#The variation of serum glucose and lactic acid level at 2, 12, 24 h after the valve replacement is consistent and significant. The serum lactic acid in the serum may be decreased by controlling the blood glucose, which provides experiment basis for myocardial protection.