Detection and staging of chronic obstructive pulmonary disease using a computed tomography-based weakly supervised deep learning approach.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is underdiagnosed globally. The present study aimed to develop weakly supervised deep learning (DL) models that utilize computed tomography (CT) image data for the automated detection and staging of spirometry-defined COPD. METHODS: A large, highly heterogeneous dataset was established, consisting of 1393 participants retrospectively recruited from outpatient, inpatient, and physical examination center settings of four large public hospitals in China. All participants underwent both inspiratory chest CT scans and pulmonary function tests. CT images, spirometry data, demographic information, and clinical information of each participant were collected. An attention-based multi-instance learning (MIL) model for COPD detection was trained using CT scans from 837 participants. External validation of the COPD detection was performed with 620 low-dose CT (LDCT) scans acquired from the National Lung Screening Trial (NLST) cohort. A multi-channel 3D residual network was further developed to categorize GOLD stages among confirmed COPD patients. RESULTS: The attention-based MIL model used for COPD detection achieved an area under the receiver operating characteristic curve (AUC) of 0.934 (95% CI: 0.903, 0.961) on the internal test set and 0.866 (95% CI: 0.805, 0.928) on the LDCT subset acquired from the NLST. The multi-channel 3D residual network was able to correctly grade 76.4% of COPD patients in the test set (423/553) using the GOLD scale. CONCLUSIONS: The proposed chest CT-DL approach can automatically identify spirometry-defined COPD and categorize patients according to the GOLD scale. As such, this approach may be an effective case-finding tool for COPD diagnosis and staging. KEY POINTS: • Chronic obstructive pulmonary disease is underdiagnosed globally, particularly in developing countries. • The proposed chest computed tomography (CT)-based deep learning (DL) approaches could accurately identify spirometry-defined COPD and categorize patients according to the GOLD scale. • The chest CT-DL approach may be an alternative case-finding tool for COPD identification and evaluation.

A Holistically-Nested U-Net: Surgical Instrument Segmentation Based on Convolutional Neural Network.

Surgical instrument segmentation is an essential task in the domain of computer-assisted surgical system. It is critical to increase the context-awareness of surgeons during the operation. We propose a new model based on the U-Net architecture for surgical instrument segmentation, which aggregates multi-scale feature maps and has cascaded dilated convolution layers. The model adopts dense upsampling convolution instead of deconvolution for upsampling. We set the side loss function on each side-output layer. The loss function includes an output loss function and all side loss functions to supervise the training of each layer. To validate our model, we compare our proposed model with advanced architecture U-Net in the dataset consisting of laparoscopy images from multiple surgical operations. Experiment results demonstrate that our model achieves good performance.

Long noncoding RNA HAND2-AS1 inhibits cancer cell proliferation, migration, and invasion in esophagus squamous cell carcinoma by regulating microRNA-21.

Long noncoding RNA (lncRNA) HAND2-AS1 is a well-characterized tumor suppressor in several types of malignancies, while its role in esophagus squamous cell carcinoma (ESCC) is unknown. In this study, we found that lncRNA HAND2-AS1 was downregulated, while microRNA-21 ( miRNA-21) was upregulated in tumor tissues than in adjacent healthy tissues of ESCC patients. Expression levels of lncRNA HAND2-AS1 and miRNA-21 were significantly and inversely correlated in tumor tissues but not in healthy tissues. Plasma levels of lncRNA HAND2-AS1 were lower in ESCC patients than in healthy controls, and downregulation of plasma lncRNA HAND2-AS1 distinguished early stage ESCC patients from healthy controls. lncRNA HAND2-AS1 overexpression resulted in downregulation of miRNA-21 in cells of ESCC cell lines and inhibited cell proliferation, migration, and invasion. miRNA-21 overexpression failed to affect lncRNA HAND2-AS1 expression but significantly attenuated the inhibitory effect of lncRNA HAND2-AS1 overexpression on cancer cell proliferation, migration, and invasion. Therefore, lncRNA HAND2-AS1 may inhibit cancer cell proliferation, migration, and invasion in ESCC by regulating miRNA-21.

[Influential factors for mechanical ventilation offline in patients with severe pneumonia].

OBJECTIVE: To determine the risk factors for mechanical ventilation offline in patients with severe pneumonia. METHODS: Th e data of 59 patients, who were admitted to the First Hospital of Changsha because of severe pneumonia and required mechanical ventilation between June 2011 and December 2013, were reviewed retrospectively. The patients were divided into two groups: a successful weaned group (n=31) and a failure group (n=28). Th e patients' background, laboratory and bacteriological examinations at the beginning of mechanical ventilation were recorded. All the indexes were analyzed by univariate analysis and logistic regression analysis. RESULTS: Univariate analysis showed that there was no significant difference in gender and age in the 2 groups (P>0.05). Smoker, APECHE II score, D-dimer and brain natriuretic peptide (BNP) concentration in the success weaned group were lower than those in the failure group. The difference between the 2 groups was significant (P<0.05). The serum albumin level in patients of the success weaned group at the time of entering respiratory intensive care unit was higher than that in the failure group, with significant difference (P<0.05). The logistic regression analysis showed that the high concentration of D-dimer, lung diseases based on thoracic CT and low serum albumin were independent risk factors for mechanical ventilation offline in severe pneumonia patients. CONCLUSION: The severe pneumonia patients with low albumin, high concentration of D-dimer and lung diseases should be comprehensive evaluated and receive treatment, which is beneficial to the mechanical ventilation offline.

A Six-gene Prognostic Model Based on Neutrophil Extracellular Traps (NETs)-related Gene Signature for Lung Adenocarcinoma.

BACKGROUND: Lung adenocarcinoma (LUAD) is one of the most common malignant cancers. Neutrophil extracellular traps (NETs) have been discovered to play a crucial role in the pathogenesis of LUAD. We aimed to establish an innovative prognostic model for LUAD based on the distinct expression patterns of NETs-related genes. METHODS: The TCGA LUAD dataset was utilized as the training set, while GSE31210, GSE37745, and GSE50081 were undertaken as the verification sets. The patients were grouped into clusters based on the expression signature of NETs-related genes. Differentially expressed genes between clusters were identified through the utilization of the random forest and LASSO algorithms. The NETs score model for LUAD prognosis was developed by multiplying the expression levels of specific genes with their corresponding LASSO coefficients and then summing them. The validity of the model was confirmed by analysis of the survival curves and ROC curves. Additionally, immune infiltration, GSEA, mutation analysis, and drug analysis were conducted. Silencing ABCC2 in A549 cells was achieved to investigate its effect. RESULTS: We identified six novel NETs-related genes, namely UPK1B, SFTA3, GGTLC1, SCGB3A1, ABCC2, and NTS, and developed a NETs score signature, which exhibited a significant correlation with the clinicopathological and immune traits of the LUAD patients. High-risk patients showed inhibition of immune-related processes. Mutation patterns exhibited variability among the different groups. AZD3759, lapatinib, and dasatinib have been identified as potential candidates for LUAD treatment. Moreover, the downregulation of ABCC2 resulted in the induction of apoptosis and suppression of migration and invasion in A549 cells. CONCLUSION: Altogether, this study has identified a novel NET-score signature based on six novel NET-related genes to predict the prognosis of LUAD and ABCC2 and has also explored a new method for personalized chemo-/immuno-therapy of LUAD.

A Clinically Applicable Nomogram for Predicting the Risk of Invasive Mechanical Ventilation in Pneumocystis jirovecii Pneumonia.

Objective: Pneumocystis jirovecii pneumonia (PCP) is a life-threatening disease associated with a high mortality rate among immunocompromised patient populations. Invasive mechanical ventilation (IMV) is a crucial component of treatment for PCP patients with progressive hypoxemia. This study explored the risk factors for IMV and established a model for early predicting the risk of IMV among patients with PCP. Methods: A multicenter, observational cohort study was conducted in 10 hospitals in China. Patients diagnosed with PCP were included, and their baseline clinical characteristics were collected. A Boruta analysis was performed to identify potentially important clinical features associated with the use of IMV during hospitalization. Selected variables were further analyzed using univariate and multivariable logistic regression. A logistic regression model was established based on independent risk factors for IMV and visualized using a nomogram. Results: In total, 103 patients comprised the training cohort for model development, and 45 comprised the validation cohort to confirm the model's performance. No significant differences were observed in baseline clinical characteristics between the training and validation cohorts. Boruta analysis identified eight clinical features associated with IMV, three of which were further confirmed to be independent risk factors for IMV, including age (odds ratio [OR] 2.615 [95% confidence interval (CI) 1.110-6.159]; p = 0.028), oxygenation index (OR 0.217 [95% CI 0.078-0.604]; p = 0.003), and serum lactate dehydrogenase level (OR 1.864 [95% CI 1.040-3.341]; p = 0.037). Incorporating these three variables, the nomogram achieved good concordance indices of 0.829 (95% CI 0.752-0.906) and 0.818 (95% CI 0.686-0.950) in predicting IMV in the training and validation cohorts, respectively, and had well-fitted calibration curves. Conclusions: The nomogram demonstrated accurate prediction of IMV in patients with PCP. Clinical application of this model enables early identification of patients with PCP who require IMV, which, in turn, may lead to rational therapeutic choices and improved clinical outcomes.

MASSD: Multi-scale attention single shot detector for surgical instruments.

Surgical instrument detection is a significant task in computer-aided minimal invasive surgery for providing real-time feedback to physicians, evaluating surgical skills, and developing a training plan for surgeons. In this study, a multi-scale attention single detector is designed for surgical instruments. In the field of object detection, accurate detection of small objects is always a challenging task. We propose an innovative feature fusion technique aimed at small surgical instrument detection. First, the attention map is created from high-level features to act on the low-level features and enrich the semantic information of the low-level features. The original and processed features are then fused by skip connection. Finally, multi-scale feature maps are created to predict fusion features. The experiments on the ATLAS Dione dataset yielded results with a detection time of 0.066 s per frame and a mean average precision of 90.08%. Our proposed feature fusion module can obtain more semantic information for low-level features and significantly enhance the performance of small surgical instrument detection.

Circ_0000003 promotes the proliferation and metastasis of non-small cell lung cancer cells via miR-338-3p/insulin receptor substrate 2.

Background: Circular RNAs (circRNAs) play a pivotal regulatory role in a variety of tumors.Nevertheless, the detailed function of circ_0000003 in non-small cell lung cancer (NSCLC) and its regulatory mechanism remain elusive.Methods: RT-PCR was carried out to detect the expressions of circ_0000003, miR-338-3p and insulin receptor substrate 2 (IRS2)in NSCLC tissues. Besides, western blot was done to monitor IRS2 expression in NSCLC cells. The correlation between circ_0000003 and clinicopathologic characteristics of NSCLC patients was analyzed as well.CCK8 and BrdUassays were used to monitor cell proliferation; flow cytometry was used to detect apoptosis; and transwell assay was conducted to detect its migration and invasion.Moreover, dual luciferase reporter gene assay was done to verify the targeting relationship between circ_0000003 and miR-338-3p.Additionally, the effect of circ_0000003 on the growth of NSCLC cells in vivo was evaluated by tumorigenesis assay in nude mice.Results: The expression of circ_0000003 was significantly high in NSCLC tissues and cell lines, and its high expression level was notably correlated with lymph node metastasis andTNM staging.In vitro experiments showed that overexpression of circ_0000003 facilitated the proliferation, migration, invasion and inhibited the apoptosis of NSCLC cells, while the knockdown of circ_0000003 had the opposite effect.In vivo experiments revealed that knockdown of circ_0000003 impeded tumor growth and metastasis. Further, the underlying mechanism showed that circ_0000003 functioned as endogenous competitive RNA and directly targeted miR-338-3p to positively regulated IRS2 expression.Conclusion: Circ_0000003 promotes the proliferation and metastasis of NSCLC cells via modulating miR-338-3p/IRS2 axis.

Small molecule inhibitor agerafenib effectively suppresses neuroblastoma tumor growth in mouse models via inhibiting ERK MAPK signaling.

Neuroblastoma (NB) is the most common extracranial solid tumor in early childhood. Despite intensive multimodal therapy, nearly half of children with high-risk disease will relapse with therapy-resistant tumors. Dysregulation of MAPK pathway has been implicated in the pathogenesis of relapsed and refractory NB patients, which underscores the possibility of targeting MAPK signaling cascade as a novel therapeutic strategy. In this study, we found that high expressions of RAF family kinases correlated with advanced tumor stage, high-risk disease, tumor progression, and poor overall survival. Targeted inhibition of RAF family kinases with the novel small molecule inhibitor agerafenib abrogated the activation of ERK MAPK pathway in NB cells. Agerafenib significantly inhibited the cell proliferation and colony formation ability of NB cells in vitro, and its combination with traditional chemotherapy showed a synergistic pro-apoptotic effect. More importantly, agerafenib exhibited a favorable toxicity profile, potently suppressed tumor growth, and prolonged survival in NB mouse models. In conclusion, our preclinical data suggest that agerafenib might be an effective therapeutic agent for NB treatment, both as a single-agent and in combination with chemotherapy.

[Effects of minimally invasive versus open esophagectomy on circulating tumor cells in patients with esophageal cancer].

OBJECTIVE: To investigate the effects of minimally invasive esophagectomy (MIE) and open esophagectomy (OE) on the level of circulating tumor cells (CTCs) in patients with esophageal cancer (EC). METHODS: A total of 73 patients with EC undergoing MIE (n=38) or OE (n=35) in our department between October, 2015 and October, 2017 were enrolled, with 10 patients with benign esophagus disease and 10 healthy volunteers as controls. The levels of CTCs in the peripheral blood of the participants were detected using CanPatrolTM technique and analyzed for their association with the operation methods and perioperative complications. RESULTS: CTCs were detected in 60.3% (44/73) of the EC patients but in none of the control subjects. CTC level after the surgery was significantly higher than that during the surgery, and CTC level during the surgery was significantly higher than that before surgery (P<0.001). The preoperative and intra-operative CTC levels were not significantly different between MIE and OE groups (P>0.05), but the postoperative CTC level was significantly lower in MIE group than in OE group, and postoperative increment of CTC level (from the preoperative level) was significantly lower in MIE group than in OE group (P<0.001). The total incidence of postoperative complications was significantly lower in MIE group than in OE group (28.9% vs 54.3%, P=0.023), and in both groups, CTC levels in patients with complications were significantly higher than those in patients without complications (P=0.001 and P=0.005 in MIE and OE groups, respectively). CONCLUSION: MIE may help to reduce the number of peripheral blood CTCs early after the operation, and dynamic monitoring CTCs level assists in evaluation of the prognosis of EC patients. CTC level may serve as an indicator for monitoring the prognosis of EC.

ω-3 Polyunsaturated Fatty Acid Postconditioning Protects the Isolated Perfused Rat Heart from Ischemia-Reperfusion Injury.

AIMS: This study aimed to evaluate the cardioprotective effects of ω-3 polyunsaturated fatty acids (PUFAs) postconditioning against ischemia-reperfusion (I/R) injury. METHODS: Sixty Sprague-Dawley rats were randomly divided into 4 groups (n = 15 for each) and used to generate the Langendorff isolated perfused rat heart model. The sham group received a continuous perfusion of 150 min. The remaining three I/R-treated groups sequentially received a 30-min perfusion, a 30-min cardioplegia, and a 90-min reperfusion. The I/R-ischemic preconditioning (IP) group additionally received three cycles of 20-s reperfusion and 20-s coronary reocclusion preceded the 90 min of reperfusion. The I/R-ω group were perfused with ω-3 PUFAs for 15 min before the 90 min of reperfusion. The myocardial infarct size, the degree of mitochondrial damage, the antioxidant capacity of the myocardium, and the cardiac functions during reperfusion were compared among groups. RESULTS: Compared with the I/R group, the I/R-ω group had significantly reduced myocardial infarct size, reduced levels of lactate dehydrogenase and malondialdehyde, elevated superoxide dismutase level, and elevated rising (+dp/dtmax) and descending (-dp/dtmax) rate of left ventricular pressure. The I/R-ω group had a significantly lower rate of mitochondrial damage in myocardial tissue compared with the I/R and I/R-IP groups. CONCLUSION: ω-3 PUFA postconditioning possesses good cardioprotective effects and may be developed into a therapeutic strategy for myocardial I/R injury.

H3K27me3 induces multidrug resistance in small cell lung cancer by affecting HOXA1 DNA methylation via regulation of the lncRNA HOTAIR.

BACKGROUND: The long non-coding RNA (lncRNA) HOX transcript antisense RNA (HOTAIR) serves as a powerful predictor of tumor progression and overall survival in patients. Our previous studies showed that HOTAIR modulated HOXA1 DNA methylation by reducing DNMT1 and DNMT3b expression in drug-resistant small cell lung cancer (SCLC). Moreover, H3 lysine 27 trimethylation (H3K27me3) is catalyzed by enhancer of zeste homolog 2 (EZH2) and plays a critical role in SCLC chemoresistance. However, it is not completely clear whether H3K27me3 affects HOXA1 DNA methylation or whether this effect is mediated by HOTAIR. METHODS: The levels of EZH2 and H3K27me3 were identified in SCLC tissues by immunohistochemical (IHC) staining and in SCLC multidrug-resistant cells by Western blotting. Cell counting kit-8 (CCK-8) and flow cytometry were used to detect and analyze the biological function of H3K27me3. Then, we assessed the role of HOTAIR in the regulation of EZH2 and H3K27me3 by using lentivirus and small interfering RNA. Further, bisulfite sequencing PCR was conducted to detect the methylation levels of HOXA1 DNA. Finally, Western blotting was performed to examine the regulatory role of H3K27me3 in controlling HOTAIR expression in SCLC. RESULTS: In this study, we found that EZH2 and H3K27me3 levels were markedly higher in SCLC tissues and multidrug-resistant SCLC cells. The results indicated that H3K27me3 was related to multidrug resistance. HOTAIR overexpression and knockdown showed that EZH2 and H3K27me3 were regulated by HOTAIR. Moreover, H3K27me3 affected HOXA1 DNA methylation levels. Strikingly, we found that H3K27me3 acted as a negative feedback regulator of HOTAIR. CONCLUSIONS: Our study showed that H3K27me3 affects HOXA1 DNA methylation via HOTAIR regulation, indicating that H3K27me3 may be a potential therapy target for SCLC chemoresistance.

The Impact of the Predictive Nursing Education Process on Degree of Comfort and Quality of Life for Patients in the Oncology Department.

BACKGROUND: We investigated the application of a predictive nursing education process on the degree of comfort and quality of life for cancer patients. METHODS: A total of 168-cancer patient in Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China between June 2014 and June 2016 were enrolled and admitted for surgery or radiotherapy/chemotherapy treatment. Patients were randomly divided into control and observation groups, each containing 84 cases. Patients in the control group received routine cancer care, whereas the observation group received care incorporating a predictive nursing education process. Patients were assessed after admission and prior to discharge via the Kolcaba's comfort status scale (through a General Comfort Questionnaire (GCQ)), quality of life scale (QOL), and Barthel Index (BI) for activities of daily living (ADL). Patient mental state was also evaluated using the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD). RESULTS: GCQ, QOL, and BI scores of the observation group were all significantly higher than those of the control group (P <0.05). HAMA and HAMD scores were significantly lower in the observation group compared to the control group (P < 0.05). CONCLUSION: The predictive nursing education process could significantly improve degree of comfort and activities of daily living for cancer patients, and thus improve mental states and quality of life.

In vivo biocompatibility and hemocompatibility of a polytetrafluoroethylene small diameter vascular graft modified with sulfonated silk fibroin.

OBJECTIVE: To evaluate the biocompatibility and hemocompatibility of an enhanced polytetrafluoroethylene (ePTFE) graft modified with sulfonated silk fibroin (SF) and to compare the patency rate of the modified graft to that of the commercially available unmodified ePTFE graft in a rabbit model. METHODS: Twelve SF-modified grafts were used to replace a section of the lower abdominal aortic artery in rabbits, and 10 unmodified ePTFE grafts were used as controls. The patency rates of these grafts were examined according to physical findings, ultrasonic examination, and scanning electron microscopy (SEM). RESULTS: The patency rates of SF-modified ePTFE grafts on day 3, from day 4 to 3 months, and at 3 months were 100%, 91.7%, and 91.7%, respectively, and these values were higher than those for the unmodified grafts (60.0%, 33.3%, and 20.0%, respectively, with P = 0.029, 0.022, and 0.002, respectively). SEM images of grafts harvested 3 months postoperatively showed that approximately 84% of the inner surface of the SF-modified grafts was covered with endothelial cells growing longitudinally with extensive cell-cell connections. In comparison, endothelial cells covered only approximately 11% of the inner lumen of the unmodified grafts, and the inner surface of these grafts was covered with activated platelets, erythrocytes, and newly formed extracellular matrix. We also have developed a rabbit model to evaluate the patency rate of small diameter vessel graft by replacing the lower abdominal aortic artery with graft. CONCLUSION: The SF-modified ePTFE graft had a higher patency rate than the unmodified PTFE graft in vivo. In addition, replacement of the rabbit abdominal aortic artery represents a feasible and convenient model for evaluating the patency of small diameter vascular grafts.

[Establishment of a rabbit model of small diameter vascular graft replacement].

OBJECTIVE: To establish an rabbit model that mimics the hemodynamics of the bypass graft after coronary artery bypass surgery. METHODS: Sixteen New Zealand rabbits were randomly divided into two groups for abdominal aortic artery replacement using a 3-cm-long ePTFE graft with an inner diameter 4 mm through an incision at 1/3 from the middle to the lower part of the abdomen (group A) or in the lower abdomen (group B). The general conditions of the rabbits, operative time, number of collateral vessels that needed to be ligated, rate of massive intraoperative bleeding, fluctuation of vascular anastomosis after surgery, patency rate of the graft on day 7 after the operation were compared between the two groups. RESULTS: The two groups of rabbits had similar body weight, diameter of the abdominal aortic artery, intraoperative bleeding rate and occlusion rate of the vascular graft at 7 days after the procedure. The operative time was longer in group A, but the difference was not statistically significant. In group A, the number of the vascular branches that needed to be ligated was smaller and the rate normal femoral artery pulsation was higher than those in group B. CONCLUSION: It is feasible to establish models of small diameter vascular graft replacement in rabbits, and the patency rate of the graft can be monitored by observation of the general condition and ultrasound examination of the rabbits.

Application of jejunum with vascular pedicle in reconstruction of the digestive tract.

OBJECTIVE: To reconstruct the digestive tract using the jejunum with vascular pedicle after esophagectomy or gastrectomy, and observe the therapeutic effects and the patients' quality of life after the operation. METHODS: This study included a total of 25 patients, 10 of whom received proximal subtotal gastrectomy followed by reconstruction of the digestive tract with P-shaped jejunum for anastomosis of the esophagus and the residual stomach, 15 had total gastrectomy and anastomosis of the P-shaped jejunum with the esophagus inferior to the arch of aorta, with another 2 having total gastrectomy and the anastomosis superior to the arch of aorta. The pH value of the esophagus was tested, barium meal and gastroscopy were carried out 3 months after the operations, and the patients' quality of life assessed. RESULTS: Anastomotic leakage or infections in the thoracic or abdominal cavity occurred in none of the patients. All the patients had no postoperative difficulty in eating cooked rice, and were free of reflux esophagitis and burning sensation in the chest. The pH value of the esophagus was 5.5-6.6. Eight patients survived for more than 5 years. CONCLUSIONS: The effects of digestive tract reconstruction using the jejunum with vascular pedicle after esophagectomy or gastrectomy are satisfactory, especially in patients with esophageal cancer in the lower section or cardia cancer. This operation gives rise to low rate of operative complications, and insures good quality of life of the patients.

[Minimally invasive closure of atrial septal defect without extracorporeal circulation: report of 5 cases].

OBJECTIVE: To review our experience with a new surgical approach for closure of atrial septal defect (ASD) through a minimally invasive method without extracorporeal circulation. METHODS: Five female patients (age range, 7-38 years) with secondary atrial septal defect ranging from 1.8 to 3.4 cm, underwent minimally invasive closure under ultrasonic cardiography guidance. RESULTS: The ASD was closed successfully in all of the 5 cases without residual shunt or displacement of occluder. The mean hospital stay was 7 days. CONCLUSION: This minimally invasive surgical approach is an easy and safe voay for clinical application.

[Experience with coronary artery bypass grafting and concomitant procedures in 21 cases].

OBJECTIVE: To review our experience with coronary artery bypass grafting (CABG) and its concomitant procedures. METHODS: From December, 1998 to December, 2002, 21 patients underwent CABG and their clinical data were analyzed. RESULTS: Nineteen patients were discharged uneventfully after the procedure. Early death occurred in 2 patients who received emergency operation after acute myocardial infarction. Among the 18 patients followed up, angina was eliminated in all but one patient. CONCLUSION: Although the concomitant procedures such as valve replacement may prolong the operation time for CABG, good clinical outcome of the patients can still be expected by implementation of intensive perioperative management and complete myocardial revascularization.

[Effects of adenosine a1 receptors on l-name induced the second window of cardioprotection in isolated/perfused rat hearts]. / Effets des recepteurs a l' adenosine a1 sur la seconde fenêtre de cardioprotection induite par l-name chez le coeur de rat isole/perfuse.

AIMS: The aim of this study is to demonstrate whether adenosine A1 receptors may be a mediator of L-NAME induced the second window of cardioprotection. MATERIALS AND METHODS: Three groups of Sprague-Dawley rats (control group = 10, L-NAME group = 10 and DPCPX group = 10) were studied in an isolated/perfused heart model. After excision of the hearts, the hearts have been stabilized in the KH solution for 15 minutes (S15), followed by cardiac ischemic for 60 minutes and the reperfusion during 120 minutes but subdivided into three periods: R1, R60 and R120. Heart rate, left ventricular developed pressure, coronary flow and cardiac troponin I were recorded and analyzed. The injury of cardiac tissue was observed under the electronic microscopy. RESULTS: During the 120 minutes of reperfusion, the hemodynamic parameters were lower in the DPCPX group than that in the L-NAME group (P< 0.05); but, the cardiac troponin I was higher in the DPCPX group than that in the L-NAME group (P< 0.05). End, the injury of myocardial cell in the DPCPX was more serious than that in the L-NAME group. CONCLUSION: These results indicate that adenosine A1 receptors are involved in L-NAME-induced the second window of cardioprotection. Adenosine A1 receptors may be a mediator of L-NAME-induced myocardial the second window of cardioprotection.

BUT: Le but de ce travail est de démontrer si les récepteurs à l'adénosine A1 peuvent être ou non un médiateur de la seconde fenêtre de cardioprotection induite par L-NAME (L-nitro-L-arginine méthyl ester). MATÉRIELS ET MÉTHODES: Trois groupes de rats Sprague dawley (SD) (groupe témoin = 10, groupe L-NAME = 10 et groupe DPCPX (8-cyclo pentyl-1,3- dipropylxanthine) = 10) ont été étudiés selon le modèle de coeur isolé-perfusé.Les coeurs ont été stabilisés dans la solution de KH pendant 15 minutes (S15) après leurs excisions,puis soumis à une ischémie globale de 60 minutes ,ensuite reperfusés pendant 120 minutes mais subdivisées en R1,R60 et R120 . La fréquence cardiaque, la pression développée par le ventricule gauche, le débit coronaire et la troponine inhibitrice cardiaque ont été enregistrés et analysés. Les coupes fines du tissu cardiaque ont été observées au microscope électronique. RÉSULTATS: Les paramètres hémodynamiques étaient très diminués dans le groupe DPCPX par rapport à ceux dans le groupe L-NAME(P< 0.05); par contre, les taux de troponine inhibitrice cardiaque étaient très élévés dans le groupe DPCPX par rapport à ceux dans le groupe L-NAME(P< 0.05) pendant la période de reperfusion post- ischémique.Les lésions des cellules du myocarde étaient aussi très graves dans le groupe DPCPX par rapport à celles dans le groupe L-NAME. CONCLUSION: Ves résultats indiquent que les récepteurs à l'adénosine A1 sont impliqués dans la seconde fenêtre de cardioprotection induite par L-NAME, par conséquent peuvent être médiateurs de la seconde fenêtre de cardioprotection induite par L-NAME.