Mechanism of gut-microbiota-liver axis in the pathogenesis of intestinal failure-associated liver disease / 中华胃肠外科杂志

Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.

TGF-β1-regulated miR-3691-3p targets / 亚洲男科学杂志(英文版)

Transforming growth factor-β1 (TGF-β1) acts as a tumor promoter in advanced prostate cancer (PCa). We speculated that microRNAs (miRNAs) that are inhibited by TGF-β1 might exert anti-tumor effects. To assess this, we identified several miRNAs downregulated by TGF-β1 in PCa cell lines and selected miR-3691-3p for detailed analysis as a candidate anti-oncogene miRNA. miR-3691-3p was expressed at significantly lower levels in human PCa tissue compared with paired benign prostatic hyperplasia tissue, and its expression level correlated inversely with aggressive clinical pathological features. Overexpression of miR-3691-3p in PCa cell lines inhibited proliferation, migration, and invasion, and promoted apoptosis. The miR-3691-3p target genes E2F transcription factor 3 (E2F3) and PR domain containing 1, with ZNF domain (PRDM1) were upregulated in miR-3691-3p-overexpressing PCa cells, and silencing of E2F3 or PRDM1 suppressed PCa cell proliferation, migration, and invasion. Treatment of mice bearing PCa xenografts with a miR-3691-3p agomir inhibited tumor growth and promoted tumor cell apoptosis. Consistent with the negative regulation of E2F3 and PRDM1 by miR-3691-3p, both proteins were overexpressed in clinical PCa specimens compared with noncancerous prostate tissue. Our results indicate that TGF-β1-regulated miR-3691-3p acts as an anti-oncogene in PCa by downregulating E2F3 and PRDM1. These results provide novel insights into the mechanisms by which TGF-β1 contributes to the progression of PCa.

Strategy of acetabular anteversion in total hip arthroplasty with lumbar degenerative kyphosis / 中国骨伤

OBJECTIVE@#To investigate how to place the anteversion of acetabular prosthesis more reasonably in patients with lumbar degenerative kyphosis.@*METHODS@#A total of 122 patients with degenerative kyphosis of lumbar spine who underwent total hip arthroplasty from December 2017 to October 2019 were included and divided into experimental group and control group, 61 cases in each group. In experimental group, there were 25 males and 36 females, with a median age of 67.0 years;the median course of disease was 46.0 months;the functional pelvic plane with acetabular anteversion was set according to different types of pelvic anterior plane bracket. In control group, there were 27 males and 34 females, with a median age of 67.0 years;the median course was 42.0 months;in control group, the anteversion was set by the traditional method. The patients were followed up for 3 months. The operation time and blood loss were recorded. The incidence of infection and dislocation within 3 months was counted. Harris score before and 3 months after operation was recorded. Functional anteversion angle of standing position was measured 3 months after operation.@*RESULTS@#Compared with control group, there was no difference in operation time and blood loss between the two groups (P=0.918, 0.381);there was no infection between two groups within 3 months after operation;there was 1 case of hip joint dislocation in the control group and no dislocation in experimental group. There was no significant difference in Harris score before and after operation. Three months later, reexamination of pelvic standing radiographs showed that the number of patients with functional anteversion of acetabular prosthesis outside the safe area was less in experimental group thanin control group (@*CONCLUSION@#According to the preoperative evaluation and classification of patients, better functional anteversion of acetabular prosthesis can be obtained with the help of pelvic anterior plane reference bracket in hip arthroplasty with lumbar degenerative kyphosis.

Short and medium term follow-up study on the changes of spine pelvic parameters in patients with hip-spine syndrome after total hip arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the influence of total hip arthroplasty on the changes of spine pelvic parameters in patients with hip spine syndrome.@*METHODS@#From January 2013 to October 2014, 22 patients (26 hips) with hip spine syndrome accompanied by necrosis of femoral head, hip osteoarthritis and congenital dysplasia of hip were treated with total hip arthroplasty. There were 12 males and 10 females with an average age of 58.4 years (range, 45 to 76 years). The course of disease was 1.5 to 25 years with an average of 12.8 years. Before and after the operation, the anteroposterior, full length radiographs of both lower limbs, thoracolumbar spine and pelvis in standing position were routinely taken. The balance parameters of spine pelvis coronal plane and sagittal plane before and after the replacement were measured. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Harris score were performed before and after the operation.@*RESULTS@#All cases were followed up for 21 to 52 (32±8) months. No infection, prosthesis subsidence, loosening, prosthesis dislocation were found in the last follow up. After total hip arthroplasty, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic tilt (PT) were significantly reduced(@*CONCLUSION@#After total hip arthroplasty, the coronal and historical balance parameters of spine and pelvis are significantly improved, and the short term and medium-term effects are satisfactory.

Escalation surgical therapy approaches for complicated intra-abdominal infection / 中国实用外科杂志

Complicated intra-abdominal infections(cIAIs)is always associated with high mortality,invasive open surgery cannot improve patients' prognosis.With the spread of the concept of minimally invasive surgery(MIS)and damage control surgery(DCS),the authors propose the escalation surgical therapy approaches to better manage cIAIs with less operative damange.These approaches include minimally invasive drainage(percutaneous drainage,endoscopic drainage),MIS(minimally invasive operative drainage,enterostomy)and open surgery(relaparotomy on demand,planned relaparotomy,open abdomen).These treatments cause increasing trauma stress,longer recovery period and higher morbidity rates to patients successively.Due to the increased use of planned relaparotomy in treating cIAIs,abdominal packing and open abdomen were applied more frequently.However,the prevention of open abdomen-associated morbidies,including enterocutaneous fistula and abdominal wall defect,should be paid attention to.In clinical practice,use of escalation surgical therapy approaches to treat cIAIs is not fixed,doctors should choose appropriate management according to patients' conditions.Meanwhile,good resuscitation,appropriate choice of antibiotics and nutritional support are essential to improve the outcome of patients with cIAIs.

Advance in the perioperative management:Enhanced recovery after surgery,perioperative surgical home and perioperative medicine / 中国实用外科杂志

Surgery plays a pivotal role in the treatment of certain diseases,which in turn promotes the development of enhanced recovery after surgery (ERAS). However,with the renewal of concept and technology,it is gradually realized that the key to a successful treatment is not only surgery itself but also preoperative and postoperative management. Patientbased perioperative management is closely related to the prognosis of the disease. Therefore,“perioperative medicine”and“perioperative surgical home (PSH)”are gaining more and more attention from all over the world. These novel concepts aim to cover the whole disease treatment process and improve the prognosis.

Genotyping and gene nucleotide polymorphism of epidemic strain of Echino-coccus granulosus metacestode from humans and sheep in Tianjun region, Qinghai Province / 中国血吸虫病防治杂志

Objective To understand the genotypes and nucleotide polymorphisms of Echinococcus granulosus metacestode from humans and sheep in Tianjun region,Qinghai Province. Methods The specific primers were designed according to the cox1 and nad1 genes of E.granulosus mitochondrial genome sequences accessed by GenBank.The primers were used to detect the cyst samples from 16 sheep and 2 humans infected with E.granulosus in Tianjun region of Qinghai Province by PCR,then the PCR amplification products were sequenced,the genotypes and nucleotide polymorphisms of the cox1 and nad1 genes were analyzed.Results The 18 isolated samples all belonged to E.granulosus G1 genotype.Among all the isolates,9 haplotypes ex-isted in the cox1 gene with 16 nucleotide mutation sites,and there were 0 to 5 nucleotide differences with the highest variation rate of 0.31%,whereas 7 haplotypes occurred with 15 nucleotide mutation sites,and there were 1 to 8 nucleotide differences with the highest variation rate of 0.89% for the nad1 gene.Conclusions The epidemic genotype of E.granulosus is G1 in hu-mans and sheep in Tianjun region of Qinghai Province,and the nucleotide polymorphisms of the cox1 gene were more abundant than those of the nad1 gene,and the resolution of the nucleotide polymorphisms of cox1 gene is higher than that of the nad1 gene used in E.granulosus isolates.

Current Status of Antithrombotic Strategy for Elderly Patients With Atrial Fibrillation and Acute Coronary Syndrome After Stent Implantation in Beijing Area / 中国循环杂志

Objective: To investigate the current status of antithrombotic strategy for elderly patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) after stent implantation in Beijing area and to study the safety and efficacy of different therapeutic strategy. Methods: A total of 467 relevant patients were enrolled by re-travelling electronic medical records from 12 hospitals in Beijing area. The patients' mean age was (78.70±3.32) years and they were divided into 2 groups by antithrombotic therapy condition: Triple therapy group, n=17 (3.64％), Double therapy group, n=450 (96.36％). The incidence of major adverse cardiac and cerebral events (MACCE) including all-caused death, non-fatal myocardial infarction, stent thrombosis, target vessel revascularization (TVR), stoke and bleeding was compared between Triple therapy group and Double therapy group.Results: The medication in Double therapy group included aspirin+ticagrelor, aspirin+clopidogrel, clopidogrel+warfarin and cilostazol+clopidogrel; in Triple therapy group was aspirin+clopidogrel+warfarin. Patient with HAS-BLED score≥3 was defined as high risk of bleeding and they were all treated by double therapy; HAS-BLED<3 was defined as low risk of bleeding, only 5.03％ patients were treated by triple therapy. 3 patients in Triple therapy group and 33 in Double therapy group suffered from gastrointestinal bleeding, P=0.338; 6 patients in Triple therapy group and 128 in Double therapy group had MACCE, P=0.589; 3 and 80 patients died in Triple therapy group and Double therapy group, P=0.766. Conclusion: Triple therapy was rarely used in elderly AF and ACS patients after stent implantation, double therapy was the main strategy; the incidence of MACCE and mortality were similar between triple and double therapies; patients with triple therapy had the higher incidence of gastrointestinal bleeding.

Elimination of latent HIV genome and its infected cells by CRISPR/Cas9 system / 中国人兽共患病学报

The incidence and mortality of AIDS have been decreasing after the adoption of combined antiretroviral therapy strategy in the world,then AIDS has become a manageable chronic infectious disease.But HIV/AIDS continues to be a major global public health problem since it is restricted by a variety of factors.The major reason for the persistence of HIV/AIDS is the inability of existing treatments to clear or eradicate the multiple HIV reservoirs that exist in the human body.To suppress the virus replication and rebound,HIV/AIDS patients must take life-long antiviral medications.A few years ago,the clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated nuclease 9 (Cas9)system has been developed as a simple,fast and easy to operate gene-editing technique.Several studies in HIV infected cells and/or in animal models have shown that the system has the potential to eliminate or disrupt HIV-integrated genome or HIV-infected cells from multiple HIV reservoirs,which may result in the complete cure of HIV/AIDS.This paper analyzes the results of CRISPR/CAS9 in the elimination of latent HIV,and discusses the possible problems and trends.

Research progress of HIV-1 drug resistance mutations / 中国人兽共患病学报

By the end of 2015,all over the world there were around 17 million HIV/AIDS cases received antiretroviral therapy,the HIV-1 morbidity and mortality decreased rapidly.With antiretroviral treatment to all HIV infected persons,HIV resistance mutation is also a threat to the long-term treatment and also,had a negative impact on the important public health strategy of the global elimination in 2030.This review attempts to proceed from different economic and geographical environment,describing genetic barrier of commonly used antiretroviral drugs,the degree of their cross-reactions,and the epidemiology and management of drug-resistant mutations from the individual and group levels.The paper also summarizes the prevalent modes of transmitted drug resistance (TDR) and acquired drug resistance (ADR) in both high-income and low-and middle-income countries (LMICs),and analyze the two kind problems of public health significance to HIV resistant mutations,i.e.pretreatment resistance (PDR) and preexposure prophylaxis (PREP).In addition,in view of effectivel HIV cases of treatment and management in different countries,this paper also analyzes the genotypic resistance testing and treatment practices related to AIDS prevention and control.The content has a certain reference function to our country.

Treatment of Chronic Radiation Intestinal Injury by Ileostomy Combined with Perioperative Nutrition Support Therapy / 肠外与肠内营养

Objective: To review the application of ileostomy combined with perioperative nutrition support therapy in the treatment of chronic radiation intestinal injury. Methods: The clinical data of patients with chronic radiation intestinal injury who received ileostomy combined with perioperative nutrition support therapy in the department of general surgery, Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2016 were retrospectively analyzed. The short-term complications and perioperative nutrition process were recorded, and the long-term prognoses were followed up. Results: Forty-six patients were included in the study. The overall postoperative complication rate was 36. 96％. All the patients restored total enteral nutrition at the time of discharge (18±15) days. There was no post-operative mortality. Thirty-six patients were followed up (follow-up rate of 78. 26％), and the follow-up time was (25 ± 17) months. Tumor recurrence was occurred in 7 patients (19. 44％) during follow-up and 6 deaths (16. 67％). All of the 30 (83. 33％) survived patients maintained total enteral feeding, 27 of whom (75％) returned to normal diet. Twenty-one patients (58. 33％) underwent a second staging ostomy surgery in our hospital and recovered well. Conclusion: For selected patients with chronic radiation intestinal injury, ileostomy combined with perioperative nutrition support therapy could effectively restore intestinal patency and total enteral nutrition, and reduce the mortality.

16S rDNA-based molecular profiles of circulating bacteria in patients with severe acute pancreatitis / 肠外与肠内营养

Objective:This study aims to characterize the bacterial profile presenting in peripheral blood of severe acute pancreatitis (SAP) patients and investigate the potential role of circulating microorganisms in the development of systemic infection.Methods:A total of 30 patients with SAP were recruited in this study and divided into three groups:infected,sepsis and Septic shock (n =10 for each group).The peripheral blood was collected sterilely for extraction of DNA,which was subsequently amplified using the universe primers targeted the V6-V8 region of 16S ribosomal RNA genes.The amplicons were separated by denaturing gradient gel electrophoresis (DGGE),and then the gels were stained and photographed.The bands were cut out and sequenced to determine the closest bacterial relatives.Results:As shown in DGGE profile,multiple DNA bands (3 to 8 bands) were detected in peripheral blood from all (100％) of SAP patients complicated with septic shock.The microorganisms most frequently presenting in the blood of these cases included Escherichia coli,Bacillus coagulans,Pseudomonas putida,Pseudomonas aeruginosa,and Klebsiella pneumonia,with an incidence of 40 ％ or higher.In patients with sepsis,bacterial DNA consisting of 2 to 4 bands was observed in 90％ of the blood samples.The most common bacterial species was Pseudomonas putida (60％),followed by Shigella flexneri (40％),Staphylococcus aureus (30％) and Enterococcusfaecium (20％).By contrast,the positive rate of blood bacterial DNA was relatively lower in infected patients (70 ％).Of them,single bacterial species was commonly found in the blood samples.Conclusions:Our data showed that the bacterial profiles presenting in peripheral blood are distinct among SAP patients with different manifestations.Polymicrobial translocation could contribute to the development of systemic infection,offering novel insights into the pathogenesis of sepsis in SAE The findings are helpful for the prevention and treatment for bacterial infection and complications of SAP.

Patients Administered Neoadjuvant Chemotherapy Could be Enrolled into an Enhanced Recovery after Surgery Program for Locally Advanced Gastric Cancer / 中华医学杂志(英文版)

<p><b>Background</b>Most studies on enhanced recovery after surgery (ERAS) for gastric cancer exclude patients who received neoadjuvant chemotherapy. Here, we aimed to evaluate whether patients who received neoadjuvant chemotherapy can be enrolled into the ERAS program for locally advanced gastric cancer.</p><p><b>Methods</b>From April 2015 to July 2017, 114 patients who received neoadjuvant chemotherapy for locally advanced gastric cancer were randomized into ERAS and standard care (SC) groups. Postoperative length of stay, complications, bowel function, and nutritional status were recorded.</p><p><b>Results:</b>The postoperative length of stay of the ERAS group was shorter compared with that of the SC group (5.9 ± 5.6 vs. 8.1 ± 5.3 days, P = 0.037). The postoperative complication rate was 9.3% in the ERAS group and 11.5% in the SC group (P = 0.700). The time to first flatus (2.7 ± 2.0 vs. 4.5 ± 4.6 days, P = 0.010) and time to a semi-liquid diet (3.2 ± 2.1 vs. 6.3 ± 4.9 days, P < 0.001) in the ERAS group were shorter compared with those in the SC group. On the 10day after surgery, the values of weight, total protein, albumin, and prealbumin of the ERAS group were lower compared with those of the SC group.</p><p><b>Conclusions:</b>Patients who received neoadjuvant chemotherapy could be enrolled into ERAS programs for locally advanced gastric cancer. The nutritional status of these patients was not adversely affected.</p>

Impaired Coagulation Status in the Crohn's Disease Patients Complicated with Intestinal Fistula / 中华医学杂志(英文版)

<p><b>Background</b>Intestinal fistula is one of the common complications of Crohn's disease (CD) that might require surgical treatment. The clinical characteristics and outcomes of CD with intestinal fistula are much different from CD alone. This study was to investigate whether the coagulation status of CD is changed by intestinal fistula.</p><p><b>Methods</b>Data were retrospectively analyzed for 190 patients with a definitive diagnosis of CD who were registered at the Jinling Hospital between January 2014 and September 2015. Baseline clinical characteristics and laboratory indices of initial admission and 7 days after intestinal fistula resections were collected. Student's t-test and the Wilcoxon rank-sum test were used to compare differences between the two groups.</p><p><b>Results</b>Compared with CD patients without intestinal fistula, prothrombin time (PT) in patients with intestinal fistula was significantly longer (12.13 ± 1.27 s vs. 13.18 ± 1.51 s, P < 0.001 in overall cohort; 11.56 ± 1.21 s vs. 12.61 ± 0.73 s, P = 0.001 in females; and 12.51 ± 1.17 s vs. 13.37 ± 1.66 s, P = 0.003 in males). Platelet (PLT) count was much lower in intestinal fistula group than in nonintestinal fistula group (262.53 ± 94.36 × 10/L vs. 310.36 ± 131.91 × 10/L, P = 0.009). Multivariate logistic regression showed that intestinal fistula was significantly associated with a prolonged PT (odds ratio [OR] = 1.900, P < 0.001), a reduced amount of PLT (OR = 0.996, P = 0.024), and an increased operation history (OR = 5.408, P < 0.001). Among 65 CD patients receiving intestinal fistula resections, PT was obviously shorter after operation than baseline (12.28 ± 1.16 s vs. 13.02 ± 1.64 s, P = 0.006).</p><p><b>Conclusions</b>Intestinal fistula was significantly associated with impaired coagulation status in patients complicated with CD. Coagulation status could be improved after intestinal fistula resections.</p>

Safety and efficacy of the second generation biodegradable polymer Cobalt-Chromium sirolimus-eluting stent (EXCEL 2) stent in diabetic patients:A Subgroup analysis of the CREDIT Ⅱ and CREDIT Ⅲ trials / 中国介入心脏病学杂志

Objective To invesgate the safety and efficacy of the second generation biodegradable polymer Cobalt-Chromium sirolimus-eluting stent (EXCEL2) stent in diabetic patients by a subgroup analysis of of the CREDITⅡand CREDIT Ⅲ trials. Methods All patients who were implanted with the EXCEL2 stent were enrolled in the CREDITⅡand CREDIT Ⅲ trials. The primary endpoint was target lesion failure at 24-month, defi ned as a composite of cardiac death, target vessel myocardial infarction (TV-MI) and target lesion revascularization(TLR). The secondary endpoint was endpoints including all-cause death, all myocardial infarction (MI) or any revascularization.Results A total of 828 patients were included from the patients who were implanted with the EXCEL2 stent in the CREDIT II and CREDIT Ⅲ trials. 24-month follow-up rate was 99.5%. There was no significant difference in the primary endpoint (P>0.05) and event rates of the secondary endpoints(P>0.05) between the diabetic and non-diabetic group, which included all-cause death[diabetics (2.5%)vs.non-diabetics(1.4%),P>0.05],myocardial infarction(MI)(7.5% vs.5.0%,P>0.05),all from of revascularization(5.0% vs.3.9%,P>0.05),and stent thrombosis(0.6% vs.0.4%,P>0.05).Conclusions EXCEL 2 stent met the objective performance goal on effcacy and safety, which can reduce make stent restenosis, target vessel revascularization ,with 160 diabetic cases among them, and stent thrombosis in diabetic patients.

Role of miR-126 in effect of biological behaviour and epithelial to mesenchymal transition (EMT) in human colon cancer cells / 中国免疫学杂志

Objective:To investigate the expression of miR-126 in human colon cancer cell lines with different metastatic potential and its effect on the proliferation, invasion and metastasis of colon cancer cells, and to explore the possible mechanism.Methods:The expression of miR-126 in human colon cancer cell lines(SW480,SW620 and HCT116) was determined by Real-time fluorescence quantitative PCR.miR-126 mimics were transiently overexpressed in SW620 cells throuIgh liposome transfection and the negative control group was set up.The proliferation ability of cells was detected by CCK8 method and the mobility of cells was detected by wound healing assay and Transwell migration and invasion assay.The expression of E-cadherin,Vimentin was determined by Western blot.Results:The expression of miR-126 was decreased in SW620 and HCT116 cells with high metastatic potential compared SW480 cells with low metastatic potential.The overexpression of miR-126 significantly inhibited the proliferation,migration and invasion ability of SW620 cells and Western blot indicated that miR-126 overexpression increased the expression of E-cadherin and decreased the expression of Vimentin in SW620 cells,which was significantly different from that of negative control(P<0.05).Conclusion:Low expression of miR-126 is closely related to metastasis of colon cancer and the effect of miR-126 on the biological behavior of colon cancer cells may be mediated by the regulation of the EMT process.

Study of PAK4 induces epithelial-mesenchymal transition of breast cancer cells / 中国免疫学杂志

[Abstartc] Objetcive: To analyze the effect of p21 protein activated kinase 4( PAK4) on epithelial-mesenchymal transition of breast cancer cells.Met hods: The mRNA and protein expression of PAK4,E-Cadherin,N-Cadherin and Vimentin were detected by qRTP-CR and Western blot in breast cancer cells transfected with pcDNA -PAK4 or siRNA PAK4;The biology behaviors of MCF-7 cells and MDA-MB-231 cells transfected with pcDNA-PAK4 or siRNA PAK4 were analysed by cell migration assay ,invasion assay.Results:Overexpressing PAK4 could significant increase in the migration and invasion compared with vector-infected cells, decrease the expression of epithelial marker E-cadherin and upregulate the expression of mesenchymal markers N-cadherin and Vimentin in detached MCF7 cells.Silenced PAK4 gene in detached MDA-MB-231 cells could suppress the migration and invasion ,decrease the levels of the mesenchymal markers and increased the levels of the epithelial markers at both mRNA and protein levels .Conclusion:PAK4 plays a key role in EMT of breast cancer cells ,and its promoting EMT effect associated with upregulating the expression of Slug .

One-stage Repair and Surgical Management in Patients With Interrupted Aortic Arch Combining Aortopulmonary Window / 中国循环杂志

Objective: To retrospectively summarize the clinical experience of one-stage repair and surgical management in patients with interrupted aortic arch (IAA) combining aortopulmonary window (APW). Methods: A total of 8 patients with IAA combining APW received surgical repair in our hospital from 2009-01 to 2016-08 were enrolled including 4 male, the age at operation was between 3 months to 4.5 years. There were 6 patients<1 year at the mean age of (5.2±2.7) months with the mean body weight at (5.7±1.6) kg; 2 patients>1 year at the mean age of (4.1±0.6) years with the mean body weight at (14.6±0.9) kg. All patients had the history of repeated respiratory infection before the operation. The IAA morphology included type A in 6 patients and type B in 2; APW morphology included type II in 6 patients and type III in 2. All patients received median sternotomy with deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. The malformation of IAA combining APW was corrected by one-stage operation. Results: The mean pre-operative pulmonary artery systolic pressure (PASP) was (83.1±8.3) mmHg, mean cardiopulmonary bypass time was (127.0±18.5) min, aortic cross-clamp time was (78.0±14.1) min; the mean post-operative PASP was (43.6±8.5) mmHg, no operative death occurred. The patients were followed-up for (19.8±13.9) months and the mean aortic arch pressure gradient was (11.2±4.7) mmHg, all patients were well recovered. Conclusion: Primary anatomical IAA combining APW can be thoroughly corrected by one-stage operation; median sternotomy was simple method with good effect.

Surgical Treatment in Patients With Anomalous Left Coronary Artery From Pulmonary Artery Combining Severe Left Ventricular Dysfunction / 中国循环杂志

Objective:To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery (ALCAPA) combining severe left ventricular dysfunction.Methods:A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied.The patients' mean age was 7.0 (5.0,17.8)months including 13 male;mean left ventricular ejection fraction (LVEF)＜30％ and the median pre-operative LVEF was 21.0％ (17.3％,26.5％).Results:There were 2/24 (8.3％) in-hospital death,The median cardiopulmonary bypass time was 109 (95,128) min,aorta cross-clamp time 65 (48,87) min,mechanical ventilation time 94.5 (48.3,165.5) h and ICU stay time 176.5 (101.0,305.3) h;2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation.In 22 survival patients,the median discharge LVEF was 26.0％ (20％,35％) which was similar to pre-operative condition,P＞0.05.The mean follow-up time was (15.3±14.9) months at the longest of 63 months,no re-admission,reoperation and death occurred.The patients had NYHA I and the last follow-up LVEF was 60％ (50％,69％) which was increased than discharge level,P＜0.05,4 patients had LVEF＜50％.Conclusion:Surgical treatment had satisfactory short-and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction;comprehensive effort should be emphasized in surgery,anesthesia,cardiopulmonary bypass and ICU management at peri-operative period.

Surgical Treatment in Patients With Anomalous Left Coronary Artery From Pulmonary Artery Combining Severe Left Ventricular Dysfunction / 中国循环杂志

Objective:To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery (ALCAPA) combining severe left ventricular dysfunction.Methods:A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied.The patients' mean age was 7.0 (5.0,17.8)months including 13 male;mean left ventricular ejection fraction (LVEF)＜30％ and the median pre-operative LVEF was 21.0％ (17.3％,26.5％).Results:There were 2/24 (8.3％) in-hospital death,The median cardiopulmonary bypass time was 109 (95,128) min,aorta cross-clamp time 65 (48,87) min,mechanical ventilation time 94.5 (48.3,165.5) h and ICU stay time 176.5 (101.0,305.3) h;2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation.In 22 survival patients,the median discharge LVEF was 26.0％ (20％,35％) which was similar to pre-operative condition,P＞0.05.The mean follow-up time was (15.3±14.9) months at the longest of 63 months,no re-admission,reoperation and death occurred.The patients had NYHA I and the last follow-up LVEF was 60％ (50％,69％) which was increased than discharge level,P＜0.05,4 patients had LVEF＜50％.Conclusion:Surgical treatment had satisfactory short-and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction;comprehensive effort should be emphasized in surgery,anesthesia,cardiopulmonary bypass and ICU management at peri-operative period.