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Objective:To explore the clinical outcomes of recipients with refractory heart failure requiring an insertion of mechanical circulation support(MCS)device prior to heart transplantation(HT).Methods:From March 2017 to December 2021, retrospective review is performed for clinical data of 7 recipients with refractory heart failure requiring a bridging placement of MCS.There are 2 males and 5 females with an average age of(39.0±16.3)years(7~56 years)and an average weight of(57.6±19.9)kg(7~56 kg).The primary diseases of recipients are dilated cardiomyopathy(4 cases)severe viral myocarditis(2 cases)and ischemic cardiomyopathy(1 case).All of them develope acute decompensation of congestive heart failure.Before implanting MCS, two or more inotropic drugs are offered at maximal doses ages or IABP device, 6 cases required cardio-pulmonary resuscitation treatment and another patient for Heartcon assistance.All the patients bridge to heart transplatation.Results:Adjuvant therapy of MCS was offered for(20.0±11.5)d(7~34 d).Emergency HT is performed.Two post-HT deaths occurr due to multiple organ failure(1 case)and severe infection(1 case).The remainders recover smoothly during a follow-up period of(6~24 months).Conclusions:MCS device is recommended as a bridging too for HT recipients with refractory heart failure.It is imperative to improve clinical outcomes with MCS support before an onset of multiple organ dysfunction.Despite a perioperative mortality, long-term prognosis is generally satisfactory.
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Objective To evaluate the effect of preoperative pulmonary artery pressure on perioperative prognosis of the recipients with end-stage heart failure undergoing heart transplantation. Methods Clinical data of 105 recipients receiving heart transplantation were retrospectively analyzed. The mean pulmonary artery pressure (mPAP) was used as the diagnostic criterion. The optimal cut-off value of mPAP for predicting perioperative prognosis of heart transplant recipients was determined. According to the optimal cut-off value of mPAP, all recipients were divided into the low mPAP group (n=66) and high mPAP group (n=39). Intraoperative indexes (cardiopulmonary bypass time, aortic occlusion time, assisted circulation time and cold ischemia time of donor heart) and postoperative indexes [intra-aortic balloon pump (IABP) support rate, IABP support time, extracorporeal membrane oxygenation (ECMO) support rate, ECMO support time, mechanical ventilation time, length of ICU stay, incidence of moderate and severe tricuspid regurgitation and perioperative mortality rate] were compared between the low and high mPAP groups. The prognosis of the two groups was compared. Results The optimal cut-off value of mPAP in predicting clinical prognosis of heart transplant recipients was 30.5 mmHg. In the high mPAP group, the ECMO support rate and perioperative mortality rate were higher than those in the low mPAP group (both P < 0.05). No significant differences were observed in the cardiopulmonary bypass time, aortic occlusion time, assisted circulation time, cold ischemia time of donor heart, IABP support rate, IABP support time, ECMO support time, mechanical ventilation time, length of ICU stay and incidence of moderate and severe tricuspid regurgitation between two groups (all P > 0.05). No significant differences were noted in the 1-, 2-, 3- and 4- survival rates between two groups (all P > 0.05). Conclusions Preoperative mPAP in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off value of mPAP in predicting perioperative prognosis of heart transplant recipients is 30.5 mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation.
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Objective:To summarize the results and methods of surgical treatment for type A aortic dissection with small true lumen of the descending aorta.Methods:9 patients underwent surgical treatment for type A aortic dissection with small true lumen of the descending aorta between January 2017 and December 2019 were analyzed retrospectively. There were 7 males and 2 females, mean age of (41.6±9.2) years. Acute dissection were 2 cases, and chronic dissection were 7 cases. Preoerative computed tomography was used to diagnose the dissection and evaluate the true lumen of the descending aorta. This procedure was done in all patients via a median sternotomy under hypothermic CPB with SCP. 4-branched prosthetic graft was used to replace the ascending aorta and aortic arch. The procedures involving the descending aorta: Hybrid surgery using TEVAR. Distal intimal flap fenestration. Implanting the intraoperative stent-graft or prosthetic graft at false lumen for second-step operation.Results:There was no in-hospital mortality. Stroke, Spinal cord, visceral ischemia and lower limbs malfunction were not observed. Reintervention was not found in case with acute dissection during follow-up. One patient who reveived fenestration underwent TEVAR, others with chronic dissection underwent thoracoabdominal aortic replacement 3 months after surgery.Conclusion:Hybrid or staged procedures was a suitable alternative to patients with type A aortic dissection with small true lumen of the descending aorta.
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Objective@#To examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR).@*Methods@#Clinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases. Abdominal aorta below the level of the diaphragm was not involved in all patients. Two patients received "chimney technology" for left subclavian artery procedures. Time to infection was 5(3) months (M(QR)) (range: 1 to 24 months). Aortic endograft infection was diagnosed with a combination of microbiology (positive blood cultures, except one with mycotic), radiological evidence and clinical evidence of sepsis. Two patients suffered from aorto-esophageal fistula received emergency surgery, others were treated with elective surgery. Extra-anatomic prosthetic graft bypass was used for reconstruction of aorta, infected endogarft and aorta was removed, sac drainage was performed. Aorto-esophageal fistula was procedured according to the degree of lesions. All patients received antibiotics with specialist advice for 6 to 8 weeks.@*Results@#One patient died due to septic shock. In the follow-time (range: 6 to 24 months), 1 patient suffered from thoracic infection in 3 months after surgery, an other patient got iliac abscess after a month.@*Conclusions@#Endograft infection after TEAVR is high risk but may be curative. Appropriate selection of patients for infected endograft explantation could get a satisfied results.
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Cultivating students' creative spirit was an important aim of higher education,and improving scientific research ability was an effective way to realize this aim.Using Journal of Zhejiang Medical College as the carrier,Journal editorial department tried to improve students' scientific research ability.For instance,served fund projects,found competition's added value,offered course about research design and paper writing.The students' scientific research ability was improved.
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Objective To determine mitochondria-associated signaling pathway on cell apoptosis in Leptospira interrogans infected murine mononuclear-macrophages. Methods A cell apoptotic model of L. interrogan serogroup Icterohaemorrhagiae strain Lai inducing apoptosis of murine mononuclear-macrophage line (J774A. 1) was established. Pathological changes of mitochondria in the infected cells were observed under transmission electron microscope. Mitochondrial potential and reactive oxygen species(ROS) levels in the infected cells were detected using JC-1 staining method and DCFH-DA fluorescent probe, respectively,and caspase-8/-9 activities in the infected cells were measured using commercial kits. and the apoptosis block effects of caspase inhibitors were determined by flow cytometry. Apoptosis in the infected cells and ap-optosis-blocking effect by caspase inhibitors were detected by flow cytometry. Western blot assay was adopted to examine the levels of cytochrome C (CytC) , AIF, EndoG and Smae in the mitochondria and cytoplasm.The transposition of either AIF or EndoG from the cytoplasm into cell nucleus was determined by immunoflu-orescence staining test. Results L. interrogans strain Lai could induce J774A. 1 cell apoptoais. In the in-fected cells, visible mitochondrial injury, declined mitochondrial membrane potential and elevated ROS level were presented. The activity of caspase-8 but not of caspase-9 was significantly increased. The caspase in-hihitors could not completely block the cell apoptosis. Both the AIF and EndoG was released from the mito-chondria and subsequently transferred from the cytoplasm into the nucleus in the infected cells. However,elevation of CytC level and Smac release in cytoplasm of the infected cells could not be found. Conclusion L.interrogans can induce apoptosis in the infected mononuclear-macrophage via AIF and EndoG belonging to caspase-independent pathway.
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Using recombinant TpNs proteins of Treponema pallidum as antigens, ELISAs are proved to be of higher sensitivity and specificity. However, they can be further increased by using multiple TpNs antigens. According to the epitope analysis, we firstly used linking primers PCRs to obtain an artificial fusion gene segment tpE17-47 containing epitopes of both TpN17 and TpN47. Subsequently, we conducted the prokaryotic expression systems of entire tpN17 and tpN47 genes and tpE17-47 fusion gene. SDS-PAGE analysis and BioRad Gel Image Analysis System showed that the recombinant proteins rTpN17, rTpN47 and rTpE17-47 expressed stably, with 36%, 20% and 28% yields of total bacterial protein, respectively. After purified by Ni-NTA affinity chromatography, all the three recombinant proteins could be recognized by T. pallidum antibody positive sera from syphilis patients. The positive rate of rTpE17-47-ELISA for detecting serum specimens in clinically 630 cases with syphilis was 98.6%. This rate was slightly higher than that by Treponema pallidum particle agglutination (TPPA) (97.9%) (P > 0.05), but significantly higher than those by rTpN17-ELISA (83.8%), rTpN47-ELISA (83.3%) and rapid plasma reagin (RPR) (72.1%) (P < 0.01). Furthermore, both ELISAs and TPPA for detecting the serum specimens in 25 cases with SLE, 36 cases with RA and 250 healthy cases were all negative. RPR showed positive in 1 case with SLE, 2 cases with RA and 2 healthy cases. This could be a novel serological screening or diagnostic method of syphilis with advantages of quickness, convenience, safety, sensitivity and specificity.