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Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.
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@#Objective To investigate the multidisciplinary management of patients with acute type A aortic dissection in late pregnancy. Methods The clinical data of 3 patients admitted to the Second Affiliated Hospital of Army Medical University from 2018 to 2019 were analyzed. Their age ranged from 27 to 32 years, while gestational age was 34-37 weeks. Sudden chest pain was the main clinical symptom before operation. All 3 patients underwent Bentall surgery after cesarean section under general anesthesia, of whom 2 patients received total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and 1 received coronary artery bypass grafting (CABG) additionally. Results No patient died during the perioperative period, and all the newborns were delivered successfully and survived healthily. The ICU stay was 3-5 d. The postoperative hospital stay was 15-18 d. The follow-up was 250-751 d. There was no recurrence or death. One patient who developed spontaneous pneumothorax and hydropneumothorax was cured in our center. Conclusion The multidisciplinary diagnosis and treatment strategy plays a crucial role in saving the life of pregnant patients with acute type A aortic dissection.
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PURPOSE: Previous studies have confirmed that microRNAs play important roles in the pathogenesis of acute aortic dissection (AAD). Here, we aimed to explore the role of miR-145 and its regulatory mechanism in the pathogenesis of AAD. MATERIALS AND METHODS: AAD tissue samples were harvested from patients with aortic dissection and normal donors. Rat aortic vascular smooth muscle cells (VSMCs) were transfected with miR-145 mimic/inhibitor or negative control mimic/inhibitor. Gene and protein expression was measured in human aortic dissection tissue specimens and VSMCs by qRT-PCR and Western blot. Luciferase reporter assay was applied to verify whether connective tissue growth factor (CTGF) was a direct target of miR-145 in VSMCs. Methyl thiazolyl tetrazolium assay was used to detect VSMC viability. RESULTS: miR-145 expression was downregulated in aortic dissection tissues and was associated with the survival of patients with AAD. Overexpression of miR-145 promoted VSMC proliferation and inhibited cell apoptosis. Moreover, CTGF, which was increased in aortic dissection tissues, was decreased by miR-145 mimic and increased by miR-145 inhibitor. Furthermore, CTGF was confirmed as a target of miR-145 and could reverse the promotion effect of miR-145 on the progression of AAD. CONCLUSION: miR-145 suppressed the progression of AAD by targeting CTGF, suggesting that a miR-145/CTGF axis may provide a potential therapeutic target for AAD.
Subject(s)
Animals , Humans , Rats , Apoptosis , Blotting, Western , Connective Tissue Growth Factor , Luciferases , MicroRNAs , Muscle, Smooth, Vascular , Tissue Donors摘要
Objective To investigate the effects of cardiopulmonary bypass (CPB) on the differentiation of T lymphocyte subsets and the expression of specific transcription regulator T-bet/GATA binding protein 3 (GATA3). Methods A prospective double-blind study was conducted. Patients with CPB pulmonary repair of ventricular septal defect (observation group) or off-pump ligation of ductus arteriosus (control group) with 20 cases each in the 150th Military Hospital from February 2015 to February 2016 were enrolled. The blood sampled was collected on the time of before operation, at the end of CPB or operation, 4 hours after operation, and 24 hours after operation. T lymphocytes were isolated, the helper T cell 1 (Th1) specific transcription factor T-bet mRNA, helper T cell 2 (Th2) specific transcription factor GATA3 mRNA expression and cytokine γ-interferon (IFN-γ) mRNA, interleukin-4 (IL-4) mRNA expression were measured by Northern Blot. Results Compared with before operation, expression levels of T-bet mRNA [integral gray values: (1.39±0.52)×105vs. (2.92±0.88)×105], IFN-γ mRNA [integral gray values: (3.68±0.65)×105vs. (6.10±0.93)×105] were decreased transiently at the end of CPB in the observation group (both P < 0.05), returned to preoperative levels at 24 hours after operation [integral gray values: (2.77±0.74)×105, (6.22±1.25)×105, respectively, both P > 0.05]; expression levels of GATA3 mRNA [integral gray values:(4.96±0.88)×105vs. (3.21±0.68)×105], IL-4 mRNA [integral gray values: (3.52±1.13)×105vs. (1.85±0.63)×105] were increased (both P < 0.05), recovered to the preoperative levels at 24 hours after operation [integral gray values: (3.11±0.51)×105, (1.93±0.84)×105, respectively, both P > 0.05]. There were no significant differences in the expressions of T-bet, GATA3, IFN-γ and IL-4 mRNA in the control group at each time points (all P >0.05). Conclusions CPB causes the imbalance of Th1, Tc1/Th2, Tc2 and pro-inflammatory and anti-inflammatory reactions specially, which participate the complication occurrence after CPB. The changing of T-bet/GATA3 may be the internal mechanism for these changes.
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Objective To study the effect of lithium chloride on the gap junction in the myocardium under chronic hypoxia.Methods Twenty-five C57BL/6J mice were randomly divided into normoxia group,hypoxia group,normoxic control group,hypoxia + saline group and hypoxia + lithium chloride group.Hypoxia group was treated with 10％ oxygen concentration for 4 weeks.Hypoxia + saline group and hypoxia + lithium chloride group were intraperitoneal injection of saline and lithium chloride.Electrophysiology and cardiac catheterization were used to assess arrhythmias,heart rate and ejection fraction.The expression of Cx43,phosphorylated glycogen synthase kinase 3β(p-GSK-3β) and glycogen synthase kinase 3β (GSK-3β) were detected by Western blot.Results Compared with the normoxia group,the hypoxia group had a faster heart rate [(448 ± 18) bpm vs.(401 ± 13) bpm,P＜0.05),and the ejection fraction was decreased [(56±5)％ vs.73±4)％,P＜0.05],arrhythmia score increased [(3.4±0.5)％ vs.(0.6±0.5)％,P＜0.05],Cx43 expression was decreased.Compared to hypoxia + normal saline group,the heart rate decreased[(412±11)bpm vs.(454±18)bpm,P＜0.05],ejection fraction increased[(69±3)％ vs.(55±4)％,P＜0.05],the score of arrhythmia decreased [(1.8±0.4) ％ vs.(3.0±0.7)％,P＜0.05] in hypoxia + lithium chloride group,the expression of Cx43 and the rate of p-GSK-3β to GSK-3β were increased.Conclusion During the chronic hypoxia,lithium chloride can sustain the gap junction through inhibition of GSK-3β signaling way,which can also reduce the rate of arrhythmia.
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Objective To summarise the clinical characteristics and surgical treatment experience of primary cardiac tumours treated by tumorectomy under extracorporeal circulation .Methods The clinical data of 352 patients with primary cardiac tumors in our hospital from January 1980 to December 2015,who received surgical treatment of tumorectomy under extracorporeal circulation were retrospectively ana -lyzed.Results Among the 352 cases in all, there were 338 cases (96%) of benign tumor, including 309 cases (87.8%) of myxoma and 14 cases (4.0%) of malignant tumor.There were 4 cases of perioperative death, and all the 4 cases were malignant tumor.Conclusion Myxoma is the most common primary cardiac tumor ,and the best solution for the cardiac benign tumor is surgery .However , the effect of sur-gical operation on malignant cardiac tumors was poor .
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Objective To explore the protective effects of pretreatment with alanyl-glutamine dipeptide on intestinal barrier function in rats after cardiopulmonary bypass.Methods CPB model in rats was established.60 SD rats were randomly divided into group G(pretreatment with alanyl-glutamine before CPB for 3 days and primed with it during CPB,n =20),group CPB(n =20) and sham-operation(SH) group(n =20).The diamine oxidase(DAO) activity of plasma and tissue homogenate of intestinal mucosa were measured by spectrophotometry,and the concentration of plasma D-lactate was also detected by spectrophotometry.The levels of plasma lipopolysaccharide(LPS) was measured by tachypleus amebocyte lysate development process.And software SPSS 16.0 was used for statistics analysis.Results The plasma DAO activity in group G was significantly lower than that in group CPB(P ＜0.05),even though compared with group SH,the DAO activity in group G and CPB were significantly increased (P ＜ 0.05).The activity of DAO in tissue homogenate in group G and CPB were decreased more significantly than that in group SH(P ＜ 0.05),but there was no difference between group G and CPB (P =0.065).The plasma concentrations of D-lactate and LPS in group G were significantly lower than that in group CPB (P ＜ 0.05),and the plasma concentration of D-lactate and LPS in both group G and CPB were markedly enhanced compared with group SH(P ＜ 0.05).Conclusion Precondition with alanyl-gluamine dipeptide can decrease the permeability of gut mucosa,and might be a new way to protect the intestinal barrier function during cardiopulmonary bypass.
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Objective To investigate the metabolism change of intestinal flora due to chronic hypoxia in infants. Methods Ten infants with tetralogy of fallot were considered as the chronic hypoxia group,10 healthy infants were regarded as the control group. The urine concen-tration of hippurate in the morning with fasting was detected by 1 H nuclear magnetic resonance. Results The concentration of hippurate was decreased in hypoxia group compared with the control group,(47. 15 ± 32. 88) mg/L vs (346. 698 ± 13. 555) mg/L,with significant differ-ence,P=0. 002. Conclusion Chronic hypoxia alters metabolism of intestinal flora in infants.
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Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) combined with ultrafiltration in treatment of kidney injury induced by serious hemorrhagic shock in rabbits.Methods Models of pressure-controlled hemorrhagic shock was developed in 24 New Zealand white rabbits which were divided into unresuscitation group (n =8),ECMO combined with ultrafiltration group (combined resuscitation group,n =8),and fluid resuscitation group (n =8) according to the random number table.Heart rate was monitored via electrocardiograph and arterial pressure via fermoral artery catheter.Blood samples were collected pre-and post-shock and after resuscitation to measure levels of lactic acid,serum creatinine,IL-6,and TNF-α.Kidney samples were collected for measurement of histopathological changes via HE staining,expression of heat shock protein 70 (HSP70) via immunohistochemical staining.Results Arterial pressure was (53.1 ± 11.4) mmHg in combined resuscitation group,higher than (41.3 ± 11.1) mmHg in fluid resuscitation group and (25.9 ± 10.5) mmHg in unresuscitation group (F =41.425,P ＜ 0.05).Hemorrhagic shock induced significant up-regulation of lactic acid,serum creatinine,IL-6,and TNF-α(P ＜ 0.05),but all were lowered after resuscitation,especially in combined resuscitation group (P ＜ 0.05).HE staining showed the degree of kidney tissue necrosis and inflammatory cytokine infiltration in combined resuscitation group alleviated notably compared with fluid resuscitation group.Median and interquartile values of HSP70 were 17 828.960 0 (15 779.865 0-21 751.980 0) in unresuscitation group,2 714.270 0 (1 339.215 0-7 616.950 0) in fluid resuscitation group,and 262.930 0 (198.820 0-538.195 0) in combine resuscitation group,with statistical differences among groups(P ＜ 0.05).Conclusion ECMO combined with ultrafiltration is superior to conventional fluid resuscitation in improving hypoxia tissue injury and inflammatory reaction after hemorrhagic shock and is beneficial to attenuating kidney injury.
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Objective To summarize the clinical experiences of coronary artery bypass grafting ( CABG) in the treatment of coronary artery disease. Methods CABG were performed on 395 consecutive cases from January 2002 to December 2012,including 299 male and 96 female with a mean age of 62. 3 years old. All the operation were performed under cardiopulmonary bypass (CPB ) with moderate hypothermi-a. Left ventricular aneurysm plasty operation were performed in 18 patients. Results The mean number of grafts was 3. 2,the mean CPB time was 88 min( 62~170 min) ,aortic cross-clamping time was 68 min( 25~102 min) ,mean ventilation time was 18 h( 12~72 h) . There were 8 deaths with a mortality of 2. 0%. Six patients died of multiple organ failure,1 patients died of ventricular fibrillation after operation,1 patients died of acute myocardial infarction. Postoperative follow up was carried out on 280 cases,follow-up time was from 8 months to 11 years. Five of them died of unknow causes. The heart function of the rest was significantly improved. 195 patients were free of angina. 85 pa-tients’ s symptom got better. Conclusion CABG performed under cardiopulmonary bypass ( CPB ) with moderate hypothermia is safe and effective for the treatment of coronary artery disease.
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Objective To summarize the effect of venous anastomisis from left atrium-common venous anastomisis ( supracardiac anasto-mosis) at the top of left atrium,and to find the best method to treat total anomalous pulmonary venous connection ( TAPVC) . Methods 52 cases,of which 35 male and 17 female with the age of 1 month to 41 years old and the weight of 3. 1~77 kg,hospitalized in West China hos-pital from January 2000 to April 2008,were treated by supracardiac anastomosis. Results One was dead and the other 51 cases were fully recovered and left hospital. After the operation,no anastomotic stenosis or arrhythmia was observed except the dead one. During follow-up peri-od which lasted from 3 months to 12 years,the heart function of 45 cases were normal. Conclusion supracardiac anastomosis can reduce the risk of anastomotic stenosis and arrhythmia,it is a promising method to treat supracardiac type TAPVC .
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BACKGROUND: Peroxisome proliferator-activated receptor-gamma(PPAR-γ) can restrain the inflammatory reaction of hypertrophic myocardium through restraining the expression of interleukin-6, cyclooxygenase, endothelin-1, nitricoxide synthase, matrix metalIoproteinase-9, gelatinase and adhesion molecule, etc.OBJECTIVE: To observe the influence of rosiglitazone sodium(the ligand for PPAR-γ) on inflammatory factors in rats with myocardial hypertrophy in the course of myocardial hypertrophy resulting from pressure load.DESIGN: Randomized controlled trial based on animals.SETTING: Department of Cardiovascular Surgery, Xinqiao Affiliated Hospital, the Third Military Medical University of Chinese PLA.MATERIALS: Fifty purebred male SD rats of S.P.F. Grade, whose body mass was (220±22) g.METHODS: The experiment was completed in the Institute of Battle Surgical Research, the Third Military Medical University of Chinese PLA from August 2004 to October 2005. Fifty rats were randomly divided into 5groups: control group, sham operation-normal saline group, sham operationrosiglitazone group, myocardial hypertrophy-normal saline group and myocardial hypertrophy-rosiglitazone group, 10 rats per group. The rat model of myocardial hypertrophy induced by pressure overload was established with the method of coarctation of abdominal aorta. Rosiglitazone group: At the postoperative 4th week, the rats were injected intraperitoneally with the Normal saline group: At the postoperative 4th week, the rats were injected intraperitoneally with normal saline[1 mL/(kg.d)] for 1 week. At the postoperative 5th week, the indexes of myocardial hypertrophy and hemodynamics were determined. The contents of tumor necrosis factor-α, platelet activating factor and myeloperoxidase in the left ventricle muscle were determined with radioimmunosorbent technique. The expression of PPAR-γ mRNA was detected with RT-polymerase chain reaction. The activity of nuclear factor-κB was detected with EMSA.MAIN OUTCOME MEASURES: The indexes of hemodynamics, cardiac ventricle reconstitution and cardiac muscle in the rat models.RESULTS: Except 1 rat in the control group died of the external injury induced by biting after 3 weeks, 49 of 50 rats entered the result analysis.①After the coarctation of aorta, the contents of tumor necrosis factor-α, platelet activating factor and myeloperoxidase of hypertrophic myocardium in the myocardial hypertrophy-rosiglitazone group were lower significantly than those in the myocardial hypertrophy-normal saline group(P ＜ 0.01-0.05), but they were still higher than those in the control group(P＜0.01).②The expressions of PPAR-γ mRNA of myocardial tissue in both the myocardial hypertrophy-rosiglitazone and myocardial hypertrophy-normal saline groups were higher obviously than those in the control group(P＜0.01), and those in the myocardial hypertrophy-rosiglitazone group were higher than those in the myocardial hypertrophy-normal saline group(P＜0.01).③The activity of nuclear factor-κB combined with DNA in cardiac muscle cell in both the myocardial hypertrophy-normal saline and myocardial hypertrophy-rosiglitazone groups were higher obviously than those in the control group (P＜0.01), and those in the myocardial hypertrophy-rosiglitazone group were lower obviously than those in the myocardial hypertrophy-normal saline group(P＜0.01).CONCLUSION: The increasing of pressure load induces myocardial hy pertrophy. The activation of nuclear factor-κB in the tissue of hypertrophic myocardium is strengthened obviously. The expressions of tumor necrosis factor-α, platelet activating factor and myeloperoxidase in hypertrophic myocardium increase. This inflammatory reaction, which is strengthened obviously, can be restrained by rosiglitazone sodium that is the synthetical lig and for PPAR-γ.
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By analyzing the status of Cardiovascular Surgery advanced students,we discussed the characteristics and problems of clinical teaching for advanced students of Cardiovascular Surgery.Strategies of clinical teaching for advanced students of cardiovascular surgery are explored to improve the quality of clinical teaching.
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This paper introduces the structure,technological process and design of the elrctrocardiomonitor system with whole course.It accomplishes the real-time collection,analysis,storage,inquiry and quotation of whole course ECG information.
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Objective To observe the effect of retrograde sinus coronary perfusion on the function of myocardial cell membrane following retrograde sinus coronary perfusion Methods Thirty two isolated rabbit hearts were randomized into 4 groups: Group A, hearts were kept beating by retrograde perfusion with normothermic oxygenated blood; Group B, hearts received retrograde coronary sinus perfusion with warm blood cardioplegia; Group C, hearts received retrograde coronary sinus perfusion with cold blood cardioplegia; Group D, hearts received retrograde coronary sinus perfusion with cold crystalloid cardioplegia After 60 min retrograde perfusion, the hearts were switched on Langendorff Neely antegrade perfused working heart model for other 60 min Free calcium in myocardial cell, myocardial membrane MDA, ATPase and myocardial cell membrane fluidity were measured Results After retrograde coronary sinus perfusion, activity of ATPase and fluidity of the myocardial cell membrane in group A were higher than those in groups B, C and D The contents of myocardial cell membrane MDA and calcium in myocardial cell following retrograde perfusion were much lower in group A than those in groups B and C There was no remarkable difference between group C and group D Conclusion Retrograde perfusion of beating heart is superior to those perfused with warm blood cardioplegia in reducing free radical production, ameliorating paradoxical calcium accumulation in myocardial cell and maintaining activity of ATPase and fluidity of the myocardial cell membrane Warm blood cardioplegia is superior to cold blood cardioplegia
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Objective To investigate the changes of plasma levels of homocysteine (Hcy) and monocyte chemoattract protein 1 (MCP 1) in coronary artery disease (CAD) patients and to analyze the effect of Hcy on the expression of MCP 1. Methods The CAD diagnosis of all the studied subjects was confirmed by coronary angiography. A total of 70 patients with CAD and 50 control subjects were recruited in the study. Plasma Hcy concentration, plasma malondialdehyde (MDA) and plasma MCP 1 were determined by high performance liquid chromatography (HPLC), standard protocols and ELISA, respectively. Results Plasma levels of Hcy, MDA and MCP 1 in patients with CAD were significantly higher than those in the control subjects ( P
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Objective To review retrospectively the clinical experience in surgical treatment of congenital subaortic stenosis in 21 cases. Methods A total of 21 cases of congenital subaortic stenosis, including 12 cases of diaphragmatic type of stenosis and 9 cases of cast constriction, underwent intracardiac surgery from January 1999 to June 2003. Simple resection of stenosis membrane was performed in 12 cases, simple resection of stenosis membrane plus resection of myocardium of left ventricle outflow tract in 9 cases, simple resection of stenosis membrane plus resection of myocardium of left ventricle outflow tract plus treatment of united cardiac monstrosity in 16 case. Results No operative death and complications were found in all patients. Disappearance of cardiac murmur was found in 15 cases and diminishment of cardiac murmur in the rest of the patients after operation. A follow up time for 6 months to 2 years revealed that there were no obvious clinical symptoms, and the surgical outcomes were satisfactory. The cardiac ultrasound suggested that the left ventricular outflow tract was fluent without recurrent constriction. Conclusion Early treatment of congenital subaortic stenosis should be conducted when the disease was diagnosed. Better knowledge of pathological anatomy, proper operation, and prevention of complications are essential.
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Objective: To investigate the role of thrombus precursor protein (TPP) in the monitoring of anticoagulation after mechanical heart valve replacement. Methods: TPP and INR were compared between the coagulant group and control group. In the coagulant group, TPP and INR were also compared between the patients with atrial fibrillation and the patients without atrial fibrillation. The relationship between TPP levels and INR levels in 60 cases of anticoagulated patients was analyzed by linear regression. Results: It was found that the anticoagulant therapy could effectively decrease the level of TPP and increase the level of INR. In the anticoagulant group, the patients with atrial fibrillation had higher TPP level than other patients. No significant relationship was found between TPP levels and INR levels. TPP level in the patients with bleeding complications was far lower than 6 ?g/ml. Conclusion: TPP is a very valuable monitoring marker assisting INR. Patients with atrial fibrillation may require higher anticongulant intensity. INR and TPP should be tested at the same time in the patients receiving oral anticoagulation after mechanical heart valve replacement.
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Objective To investigate the effect of chronic atrial fibrillation on free calcium concentration and expression of Ca 2+ /calmodulin dependent protein kinase Ⅱ (CaMKⅡ) in human atrial myocytes. Methods The intracellular free calcium concentration in rapidly isolated atrial myocytes and the expression of CaMKⅡ in atrial tissue of rheumatic heart disease patients with atrial fibrillation (AF) or with normal sinus rhythm were measured by laser scanning confocal microscopy and Western blotting respectively. Results The intracellular Ca 2+ concentration of patients with atrial fibrillation was significantly higher than that of patients with normal sinus rhythm [(276.38?38.12) vs (122.28?45.63) nmol/L, (P
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Objective To design and construct the vector of protein-rich tyrosine kinase 2 small RNA interference and investigate the effect of the recombinant plasmid on the proliferation of adult rat cardiac fibroblasts. Methods The pAVU6+27-PYK_2 siRNA expression vector was constructed by gene recombination, then transfected into the cultured adult rat cardiac fibroblasts by DOTAP method. PYK_2 mRNA and protein in cardiac fibroblasts were determined by RT-PCR and Western blotting respectively. Cell proliferation was tested by MTT and ~3H-TdR incorporation. Results The pAVU6+27-PYK_2 siRNA expression vector was successfully constructed. The recombinant plasmid can inhibit the proliferation of adult rat cardiac fibroblasts, as compared with control. Conclusion pAVU6+27-PYK_2 siRNA expression vector is efficient to suppress DNA synthesis of cardiac fibroblasts, which will be beneficial to further study of myocardial fibrosis.