Choledochoscope-guided treatment of pulmonary embolism caused by ventricular myxoma.

A 33-year male patient presented with a 6-month history of cough and shortness of breath upon physical activity. Echocardiography demonstrated right ventricular space-occupying lesions. Contrast-enhanced computed tomography of the chest showed multiple emboli in the pulmonary artery and its branches. Right ventricle tumor (myxoma) resection, tricuspid valve replacement, and clearance of the pulmonary artery thrombus were performed under cardiopulmonary bypass. Minimally invasive forceps and balloon urinary catheters were used to clear the thrombus. Clearance was confirmed by direct visualization using a choledochoscope. The patient recovered well and was discharged. The patient was prescribed oral warfarin 3 mg/day, and the international normalized ratio for prothrombin time was maintained between 2.0 and 3.0. Pre-discharge echocardiogram showed no lesion in the right ventricle or pulmonary arteries. The 6-month follow-up echocardiography indicated that the tricuspid valve was functioning well and showed no thrombus in the pulmonary artery.

Case report: Surgical repair of congenitally corrected transposition of the great arteries with the guidance of three-dimensional printing.

A 10-year-old girl presented with obvious cyanosis, and the saturation of arterial blood oxygen (SpO2) was decreased to 60.5% in the outpatient examination. Computed tomography angiography (CTA) and echocardiography suggested congenitally corrected transposition of the great arteries (ccTGAs), membranous ventricular septal aneurysm (MVSA), atrial septal defect (ASD), severe pulmonary stenosis (PS), and severe tricuspid regurgitation (TR). Due to the complex pathological anatomical structures, the three-dimensional printed model was used for preoperative assessment. After a comprehensive evaluation was completed, the operation was performed by physiological correction under cardiopulmonary bypass, including the resection of MVSA, repair using the bovine pericardial patch for ASD, and linear valvuloplasty of the tricuspid valve. Due to the special anatomical structures of ccTGA, PS was treated by extracardiac pipe technique. After the operation, the patient recovered well, cyanosis disappeared, SpO2 was up to 96%, and the extracardiac pipe was well-functioning without regurgitation or obstruction.

Resting-State Functional Magnetic Resonance Imaging Reveals Overactivation of the Habitual Control Brain System in Tobacco Dependence.

INTRODUCTION: We studied the regulatory mechanism of the habitual brain network in tobacco dependence to provide a theoretical basis for the regulation and cessation of tobacco dependence. METHODS: We used resting-state functional magnetic resonance imaging (rs-fMRI) to explore the Fractional amplitude of low-frequency fluctuations (fALFF) and functional connectivity (FC) of the habitual brain network in tobacco-dependent subjects and to evaluate the relationship between the FC level and tobacco selection preference behavior. In total, 29 male tobacco-dependent participants and 28 male nonsmoking participants were recruited. rs-fMRI was used to collect blood oxygen level-dependent signals of the participants in the resting and awake states. After rs-fMRI, all subjects completed cigarette/coin selection tasks (task 1 and task 2). RESULTS: Compared with the control group, the tobacco dependence group showed increased fractional amplitude values of fALFF in the left posterior cingulate cortex and right parahippocampus. FC in the tobacco-dependent group was increased in the right inferior temporal gyrus, left middle frontal gyrus, left cingulated gyrus, and bilateral superior frontal gyrus, compared with that in the control group. Moreover, the preference selection behavior was associated with the enhancement of FC about parts of the brain regions in the habitual brain network of the tobacco-dependent participants. Thus, habitual network activity was significantly enhanced in tobacco-dependent participants in the resting state. Moreover, a positive correlation was found between the cigarette selection preference of the smokers and certain brain regions related to the habitual network. DISCUSSION: This suggests that increased activity of the habitual brain network may be essential in the development of tobacco-dependent behavior.

MicroRNA-663 participates in myocardial fibrosis through interaction with TGF-ß1.

MicroRNA-663 (miRNA-663) regulates the expression of transforming growth factor ß1 (TGF-ß1), which participates in the pathogenesis of myocardial fibrosis. Therefore, microRNA-663 may also serve a role in myocardial fibrosis. The present study aimed to determine whether miRNA-663 participates in myocardial fibrosis via interaction with TGF-ß1. In the present study, the expression of miRNA-663 was significantly downregulated, whereas that of TGF-ß1 was significantly upregulated in the endomyocardial biopsies of patients with myocardial fibrosis compared with those in control necropsies. Pearson's correlation analysis revealed that the expression levels of miRNA-663 were negatively correlated with those of TGF-ß1 in patients with myocardial fibrosis, but not in the controls. Receiver operating characteristic curve analysis demonstrated that the downregulation of miRNA-663 distinguished patients with myocardial fibrosis from controls. In the AC16 human cardiomyocyte cell line, miRNA-663 overexpression resulted in downregulated TGF-ß1 expression, whereas exogenous TGF-ß1 treatment exhibited no significant effects on miRNA-663 expression. These results indicate that miRNA-663 may participate in myocardial fibrosis, possibly through interaction with TGF-ß1.

CCN3 and DLL1 co-regulate osteogenic differentiation of mouse embryonic fibroblasts in a Hey1-dependent manner.

Notch signaling pathway is one of the most important pathways to regulate intercellular signal transduction and is crucial in the regulation of bone regeneration. Nephroblastoma overexpressed (NOV or CCN3) serves as a non-canonical secreted ligand of Notch signaling pathway and its role in the process of osteogenic differentiation of mesenchymal stem cells (MSCs) was undefined. Here we conducted a comprehensive study on this issue. In vivo and in vitro studies have shown that CCN3 significantly inhibited the early and late osteogenic differentiation of mouse embryonic fibroblasts (MEFs), the expression of osteogenesis-related factors, and the subcutaneous ectopic osteogenesis of MEFs in nude mice. In mechanism studies, we found that CCN3 significantly inhibited the expression of BMP9 and the activation of BMP/Smad and BMP/MAPK signaling pathways. There was also a mutual inhibition between CCN3 and DLL1, one of the classic membrane protein ligands of Notch signaling pathway. Additionally, we further found that Hey1, the target gene shared by BMP and Notch signaling pathways, partially reversed the inhibitory effect of CCN3 on osteoblastic differentiation of MEFs. In summary, our findings suggested that CCN3 significantly inhibited the osteogenic differentiation of MEFs. The inhibitory effect of CCN3 was mainly through the inhibition of BMP signaling and the mutual inhibition with DLL1, so as to inhibit the expression of Hey1, the target gene shared by BMP and Notch signaling pathways.

Notch signaling pathway promotes osteogenic differentiation of mesenchymal stem cells by enhancing BMP9/Smad signaling.

Notch is an important pathway in that it regulates cell-to-cell signal transduction, which plays an essential role in skeletal remodeling. Bone morphogenetic protein (BMP)9 has been regarded as one of the most efficient BMPs by which to induce osteogenic differentiation in mesenchymal stem cells (MSCs). Understanding the interaction between Notch and BMP9 signaling is a critical issue for optimizing the application of MSCs and BMPs in bone tissue engineering. In the present study, we investigated the role of Notch signaling in the BMP9­induced osteogenic differentiation of MSCs. Our data demonstrated that Notch signaling obviously enhanced BMP9­induced osteogenic differentiation in MSCs in vitro and in vivo. Notch signaling augmented the activity of BMP9­induced BMP/Smad signaling and increased the gene expression of essential osteogenic factors induced by BMP9 in MSCs, such as runt­related transcription factor 2 (Runx2), type I collagen (Colla1) and inhibitor of differentiation (Id)1. We also found that Notch signaling promoted the expression of activin­like kinase 2 (ALK2) induced by BMP9, and the inhibitory effect of dnALK2 on BMP9­induced osteogenic differentiation was rescued by constitutive overexpression of Delta­like 1 (DLL1). Notch signaling also exhibited an apparent effect on the proliferation of mouse embryo fibroblasts (MEFs) during BMP9­induced osteogenic differentiation. These results indicate that Notch plays a significant role in mediating BMP9­induced osteogenic differentiation in MSCs, which may be partly regulated by upregulation of the expression of ALK2.

In vitro degradation kinetics of pure PLA and Mg/PLA composite: Effects of immersion temperature and compression stress.

The effects of the immersion temperature and compression stress on the in vitro degradation behavior of pure poly-lactic acid (pure-PLA) and PLA-based composite unidirectionally reinforced with micro-arc oxidized magnesium alloy wires (Mg/PLA or MAO-MAWs/PLA) are investigated. The degradation kinetics of pure-PLA and the PLA matrix in MAO-MAWs/PLA exhibit an Arrhenius-type behavior. For the composite, the synergic degradation of MAO-MAWs maintains a steady pH and mitigates the degradation of PLA matrix during immersion. However, the external compression stress decreases the activation energy (Ea) and pre-exponential factor (k0) consequently increasing the degradation rate of PLA. Under a compression stress of 1MPa, Ea and k0 of pure PLA are 57.54kJ/mol and 9.74×107day-1, respectively, but 65.5kJ/mol and 9.81×108day-1 for the PLA matrix in the composite. Accelerated tests are conducted in rising immersion temperature in order to shorten the experimental time. Our analysis indicates there are well-defined relationships between the bending strength of the specimens and the PLA molecular weight during immersion, which are independent of the degradation temperature and external compression stress. Finally, a numerical model is established to elucidate the relationship of bending strength, the PLA molecular weight, activation energy, immersion time and temperature. STATEMENT OF SIGNIFICANCE: We systematically evaluate the effects of compression stress and temperature on the degradation properties of two materials: (pure-PLA) and MAO-MAWs/PLA (or Mg/PLA). The initial in vitro degradation kinetics of the unstressed or stressed pure-PLA and MAO-MAWs/PLA composite is confirmed to be Arrhenius-like. MAO-MAWs and external compression stress would influence the degradation activation energy (Ea) and pre-exponential factor (k0) of PLA, and we noticed there is a linear relationship between Ea and ln k0. Thereafter, we noticed that Mg2+, not H+, plays a significant role on the mitigation of the PLA degradation and external compression stress brings the molecular structure change of PLA. Finally, we proposed a model to predict the bending strength of the specimens versus immersion time at different immersion temperatures. This fundamental study could provide some scientific basis in our understanding for the evaluations and biomedical applications of these biodegradable materials.

Alignment of Red Poly[dodecadyin-1,12-diol-bis(4-butoxycarbonyl-methyl-urethane)] in Couette Flow.

The flow-induced alignment of red poly[dodecadyin-1,12-diol-bis(4-butoxycarbonyl-methyl-urethane)] (poly-4BCMU) in chloroform/toluene solution is reported. Absorption spectra have been measured over a range of shear rates in an optically transparent quartz Couette cell. The measured spectra show that the poly-4BCMU structure stays the same in flow, while the measured absorbance anisotropy is attributed to the flow-induced particle alignment in the red form poly-4BCMU solutions. A limiting orientation at shear rates >50 s(-1) is observed. Numerical simulations show that the spectral changes are consistent with the rodlike poly-4BCMU particle having an aspect ratio of 2.9. The dichroic ratio of 1.9 interpreted from the data indicates that the individual poly-4BCMU chains do not aggregate amorphously in the rodlike conformation, rather they show a preferred orientation along the long axis of the prolate aggregates.

[Correlation between endogenous sulfur dioxide and homocysteine in children with pulmonary arterial hypertension associated with congenital heart disease].

OBJECTIVE: To determine the relationship between the serum sulfur dioxide, homocysteine and the pulmonary arterial pressure in children with congenital heart defects who generated a pulmonary arterial hypertension syndrome (PAH-CHD), and analyze their role in the pathological process of the disease. METHOD: This was a prospective cohort study, children with systemic pulmonary shunt CHD were selected. The patients were divided into three groups: the CHD with no PAH group:n = 20, 10 males, 10 females, 5 with ventricular septal defect (VSD), 8 with atrial septal defect (ASD) and 7 with patent ductus arteriosus (PDA), mean age (1.9 ± 1.8) years; the CHD with mild PAH group:n = 20, 10 males, 10 females, 12 with VSD, 6 with ASD, and 2 with PDA, mean age (1.0 ± 0.8) year; the CHD with moderate or severe PAH group:n = 20, 8 males, 12 females, 12 with VSD, 6 with ASD, and 1 with PDA, 1 with ASD+VSD, mean age (1.8 ± 1.6) year. Twenty healthy children were enrolled from outpatient department as the control group [included 8 males, 12 females, mean age (1.9 ± 1.5) years]. The homocysteine and SO2 concentrations in the serum samples were detected by a modified high performance liquid chromatographic method with fluorescence detection (HPLC-FD), then, multiple comparisons among the groups were performed with analysis of variance, and the pearson correlation. RESULT: The serum homocysteine concentrations were respectively (11.0 ± 2.7) , (11.7 ± 2.5), (12.0 ± 2.1), (14.3 ± 3.2) µmol/L in the control group, CHD with no PAH group, CHD with mild PAH group, and CHD with moderate or severe PAH group. According to the multiple comparisons, the CHD with moderate or severe PAH group had the highest level (P all < 0.05) .While the comparison within the control group, CHD with none PAH group, and CHD with mild PAH group, the differences were not significant (P all > 0.05). The serum sulfur dioxide strength (concentrated as SO3(2-)) were respectively (10.6 ± 2.4), (8.9 ± 2.3), (7.3 ± 2.9), (4.3 ± 2.1) µmol/L in the control group, CHD with none PAH group, CHD with mild PAH group, and CHD with moderate or severe PAH group. CHD with moderate or severe PAH group had the highest level of serum sulfur dioxide (P < 0.05) . The pearson correlation analysis indicated that in the CHD children, the serum homocysteine were positively correlated with the pulmonary arterial pressure (r = 0.481, P < 0.01), while, the sulfur dioxide were negatively correlated with pulmonary arterial pressure (r = -0.553, P < 0.01).In all children, the serum homocysteine levels were negatively correlated with the sulfur dioxide (r = -0.231, P = 0.039). CONCLUSION: The PAH-CHD children had higher homocysteine levels and lower sulfur dioxide levelsl, which demonstrated the disturbance of homocysteine-sulfur dioxide pathway in the sulfur containing amino acids metabolish in the disease. The homocysteine may become a biological marker which reflecting the severities of the PAH-CHD, while the sulfur dioxide can be a new target for the therapy of PAH-CHD.

[Relationship between the prevalence study of smoking and metabolic syndrome among the males of Uygur and Kazakh in Xinjiang].

OBJECTIVE: To investigate the prevalence and risk factors of smoking and metabolic syndrome (MS) among male Uygur and Kazakh adults residing in Xinjiang. METHODS: Four-stage selected random sampling was used to analyze the prevalence and the relationship between the risk factors of smoking and metabolic syndrome. The sampled adult populations over 35 years old were collected 6 localities (Urumqi, Kelamayi, Fukang, Turfan Basin locality, Hetian locality & Yili Kazakh Autonomous Prefecture) in Xinjiang, China. The subjects were 4019 males of Uygur and Kazakh. Each individual answered a questionnaire, received physical examinations and a biochemical indicator survey. The smoking patients were divided into two groups: one complicated with metabolic syndrome and the other not. A logistic regression analysis was also made to identify the possible risk factors and their powers on the prevalence of metabolic syndrome with smoking. RESULTS: With regards to the habit of smoking, the smokers of Uygur and Kazakh were 869 and 1114 respectively. The prevalence of MS was 24.74% and 29.62% for Uygur and Kazakh smokers respectively. And 16.75% and 24.72% for Uygur and Kazakh non-smokers respectively. The comparison of baseline information showed that, in Uygur males, the mean values of diastolic blood pressure, waist circumference and triglyceride were higher in smoker group than those in non-smoker group (P < 0.05); in Kazakh males, the mean values of systolic blood pressure, diastolic blood pressure and waist circumference were higher than nonsmoker group (P < 0.05). Logistic regression analysis showed that the OR value of smoking was 1.698 (95%CI 1.129 - 2.553) in Uygur and 1.845 (95%CI 1.544 - 2.206) in Kazakh of MS patients. CONCLUSION: The prevalence of MS is higher in male smokers than that in non-smokers in Uygur and Kazakh. Perhaps smoking is one of the risk factors for MS.